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Journal articles on the topic 'Medicina palliativa'

Author: Grafiati

Published: 10 March 2023

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1

Toraldo, Domenico Maurizio. "Il trattamento del cancro polmonare: evidenze scientifiche e valori bioetici in conflitto nelle scelte terapeutiche." Medicina e Morale 50, no. 4 (August 31, 2001): 741–78. http://dx.doi.org/10.4081/mem.2001.732.

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Il cancro del polmone costituisce una delle principali cause di morte dei paesi europei. La malattia se inoperabile ha una prognosi generalmente infausta e circa l’80% dei pazienti muore entro un anno dalla diagnosi. Stabilire un efficace piano di trattamento costituisce una priorità di salute pubblica e oggetto di continuo dibattito scientifico. La diagnosi precoce offre la possibilità al malato di usufruire del trattamento chirurgico che può guarire la malattia. La polichemioterapia e la radioterapia si rivelano spesso fallimentari e nel migliore dei casi possono allungare di qualche mese la vita del malato al costo di sofferenze importanti. Nella pratica clinica in molti ospedali italiani pur non esistendo un protocollo diagnostico-terapeutico di riferimento, e il trattamento medico viene proposto, nella maggior parte dei casi, senza un adeguato consenso informato che spieghi al paziente le difficoltà e la complessità terapeutiche ed il paziente nella maggior parte dei casi non partecipa alle decisioni che lo riguardano. L’Autore attraverso una revisione della letteratura scientifica recente mette a punto il problema dal punto di vista tecnico e affronta contestualmente i numerosi problemi bioetici e deontologici sollevati dall’assenza sia di un’etica della comunicazione nelle problematiche della diagnosi e della terapia sia della relazione di cura cioè nella conduzione della terapia nel tempo, mettendo in evidenza le inesauribili possibilità curative che il medico dovrebbe evidenziare con la su presenza e con il suo attaccamento al malato. Viene analizzato il ruolo decisivo del medico nelle ultime fasi della vita del paziente e l’utilità della medicina palliativa nella sedazione del dolore e nel controllo dei sintomi come forma di rispetto della dignità della persona. Infine l’Autore auspica la necessità di una formazione etica e deontologica attraverso corsi di aggiornamento obbligatorio del medico ospedaliero per poter acquisire una consapevolezza dei valori in gioco.

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2

Prönneke, Rainer. "Die palliative Sedierung." Der Klinikarzt 47, no. 08 (August 2018): 366–71. http://dx.doi.org/10.1055/a-0657-9120.

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ZusammenfassungEine gewerbemäßige, d. h. auf Wiederholung angelegte Suizidbeihilfe wurde per Gesetz unter Strafe gestellt, danach gehört die Suizidbeihilfe explizit nicht zur ärztlichen Aufgabe. Öffentlich kaum bekannt, ist die sogenannte palliative Sedierung gegen unerträgliches Leid als palliativmedizinische Behandlungsmethode eingeführt worden. Es beinhaltet ein Behandlungskonzept, welches bei fortgeschrittenen und fortschreitend Erkrankten zur Linderung unerträglichen Leids eine gezielte medikamentöse Bewusstseinsminderung bis zum Eintritt des Todes vorsieht. Die palliative Sedierung ist optionaler Bestandteil einer Palliativgesamtbehandlung und unterliegt damit dem palliativ-ethischen Grundgedanken, das Leben nicht gezielt verkürzen und die Sterbezeit nicht verlängern zu wollen. Basis der palliativen Sedierung bleibt neben der fachlichen Kompetenz und professionellen Reflektion der Behandler die menschliche Zuwendung und hospizliche Begleitung des Betroffenen und seiner häufig seelisch sehr bewegten Bezugspersonen.

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3

Inderbitzi, Rolf, and A. Rolle. "Surgical palliation in thoracic malignant diseases." Therapeutische Umschau 58, no. 7 (July 1, 2001): 435–41. http://dx.doi.org/10.1024/0040-5930.58.7.435.

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Palliative thoraxchirurgische Eingriffe zielen auf die Sicherung oder Wiederherstellung einer möglichst umfassenden Lebensqualität des betroffenen Patienten. Die chirurgischen Grundlagen dazu basieren einesteils auf gesicherten, statistischen Ergebnissen, andererseits setzen sie profunde, klinische Erfahrung in onkologischer Chirurgie voraus. Um so mehr, als Palliation nicht Heilung als Ziel fordern kann, setzen derartige Operationen eine präzise Information und den partnerschaftlichen Einbezug des betroffenen Patienten voraus. Die Operabilität hängt vom Allgemeinzustand des Kranken und von der Invasivität des geplanten Eingriffes ab. Wird Tumorgewebe reseziert, ist auch in der palliativen Situation die lokale Radikalität grundsätzliches Ziel; multimodale Therapiestrategien gestatten chirurgisch-anatomisch bedingte Modifikationen. Zu den zentralen Indikationen der pallativen Thoraxchirurgie gehören die Lungenmetastasenresektionen. Dank neuen, lasertechnischen Verfahren lässt sich der Parenchymverlust minimieren und die Lobektomierate von 25% auf 4% senken. Bei Mortalitäts- und Morbiditätsraten unter 1% beträgt die 5-Jahres-Überlebensrate nach kompletter Metastasenentfernung über 30%. Brustwandtumoren verursachen Schmerzen und neigen zur Exulzeration; zudem bewirken sie durch ihre stete Präsenz Angst. Ihre Entfernung, kombiniert mit der plastischen Defektdeckung, ist deshalb auch in fortgeschrittenem Stadium sinnvoll. Bei mediastinalen Tumoren stellt die Chirurgie kurativ und palliativ – nebst der Aufgabe zur Histologiesicherung – einen der plurimodalen Behandlungspfeiler dar. Die thorakoskopische Talkpleurodese weist bei malignen Pleuraergüssen eine Erfolgsrate von über 90% aus, wenn die Lunge nach Ergussdrainage noch entfaltbar ist.

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4

Signer, Michaela. "Depression in Palliative Care." Therapeutische Umschau 69, no. 2 (February 1, 2012): 99–106. http://dx.doi.org/10.1024/0040-5930/a000259.

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Depression ist eine häufige komorbide behandlungsbedürftige Störung, diedie Lebensqualität von Patienten und ihren Angehörigen erheblich beeinträchtigt. Phänomenologisch ist in palliativen Situationen ein breites Spektrum an Störungen anzutreffen, die es voneinander abzugrenzen gilt: "normal" zu wertende Reaktionen auf eine unheilbare Erkrankung wie Trauer, Wut und Verzweiflung bis hin zu schweren depressiven Störungen. Durch häufige Symptomüberschneidungen zwischen der somatischen Grunderkrankung und einer Depression sind die gängigen ICD-10-Kriterien zur Diagnosestellung Depression in der Palliative Care nicht anwendbar. Es empfiehlt sich, alle Symptome auszuschließen, die auch Folge der Grunderkrankung sein könnten. Durch eine adäquate palliative Betreuung als eines der wenigen Evidenz-basierten Elemente in der Betreuung palliativer Patienten mit Depression kann eine maximale Prävention erreicht werden. Bei der Therapieauswahl sollte neben dem Therapieziel die zu erwartende verbleibende Lebenszeit richtungweisend sein.

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5

Rosin, Ulrich. "Palliative psychosomatic medicine." Therapeutische Umschau 58, no. 7 (July 1, 2001): 449–52. http://dx.doi.org/10.1024/0040-5930.58.7.449.

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Die Psychotherapeutische Medizin, das fachärztliche Gebiet, das sich mit den Grundlagen der Psychosomatik beschäftigt, hat sich bisher überwiegend der Diagnostik und Therapie akuter Krankheitsbilder gewidmet. Die Verläufe bei Patienten mit bio-psycho-sozialen Störungen sind jedoch meist chronisch; und der Psychoanalytiker Sigmund Freud, der Begründer der wissenschaftlichen Psychotherapie, war selber 26 Jahre lang ein Palliativ-Patient, der wegen eines Gaumen- und Kieferkarzinoms über dreißigmal operiert werden musste. Es werden Ziele und einige psychotherapeutische Interventionsstrategien zum Einsatz in der palliativen Psychosomatik dargestellt. Dieses wichtige Aufgabengebiet hat als solches noch wenig Verbreitung gefunden sowie kaum konzeptuelle Darstellung und empirische Überprüfung erreicht.

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6

Gupta, Deepak, Seema Mishra, and Sushma Bhatnagar. "Interventional Palliation: Hour of Need for Evolution of Palliative Medicine." Journal of Palliative Medicine 11, no. 7 (September 2008): 958. http://dx.doi.org/10.1089/jpm.2008.0079.

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7

Beider, Shay. "An Ethical Argument for Integrated Palliative Care." Evidence-Based Complementary and Alternative Medicine 2, no. 2 (2005): 227–31. http://dx.doi.org/10.1093/ecam/neh089.

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‘In the midst of life, we are in death’from The Book of Common PrayerThe Palliative Care, or comfort care, movement in the USA is on the rise. Currently, palliative services are not integrated in an organized way throughout healthcare. If we accept the argument that palliative care is ethically desirable and that all patients are entitled to palliative services regardless of a terminal diagnosis, it follows that it needs to be integrated across a wide range of healthcare services. Ethical questions regarding palliative care and well-known ethical frameworks are discussed and an argument is made for integrating palliative healthcare services throughout the healthcare system and not simply at the end of life. Complementary and alternative medicine (CAM) therapies are discussed as useful and necessary components of palliative care. If we as a society look beyond separating cures and palliation, we will come closer to incorporating compassionate care throughout the disease process.

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8

Sasaki, Jiichiro. "Palliative medicine: how to standardize palliative medicine." Annals of Oncology 26 (November 2015): vii60. http://dx.doi.org/10.1093/annonc/mdv452.

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9

Horváth, Orsolya, Enikő Földesi, and Katalin Hegedűs. "Mikor és hogyan integráljuk az onkológiai és a palliatív ellátást?" Orvosi Hetilap 162, no. 44 (October 31, 2021): 1769–75. http://dx.doi.org/10.1556/650.2021.32254.

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Összefoglaló. A palliatív ellátások korai bevonása az onkológiai betegek ellátásába előnnyel jár mind a beteg életminősége, mind a kezelés színvonala, mind a költséghatékonyság szempontjából. Szükség van egy olyan modellre, mely alapján a megfelelő időben, a megfelelő beteg a megfelelő minőségű palliatív ellátásban részesül. Ebben a közleményben a palliatív ellátás korai integrációjának előnyei, szintjei és a speciális palliatív ellátás fogalmának ismertetése után a leginkább elterjedt beutalási modellek előnyeit és hátrányait mutatjuk be a nemzetközi szakirodalom alapján. A speciális palliatív ellátást igénylő betegek kiszűrésére szolgáló, prognózisalapú modellek hátránya, hogy nincs elég kapacitás az ilyen módon beutalt nagyszámú beteg ellátására, ezért széles körben nem terjedtek el. A tüneteken alapuló modellek sokszor bonyolultak és a mindennapi klinikai gyakorlatban nem használatosak. Az új kutatások alapján egyszerű, gyakorlatias kérdéssorokat alkalmaznak, melyekkel könnyen kiemelhetők, akik profitálnak a speciális palliatív intervencióból. Ezek közül a Yale egyetemi és a PALLIA -10 modellt ismertetjük részletesen. Amennyiben az aktív onkológiai ellátást végzők a megfelelő palliatív beutalási kritériumokat ismerik és alkalmazzák, a betegek időben jutnak a megfelelő komplex kezeléshez anélkül, hogy a palliatív ellátórendszer túlterhelődne. Orv Hetil. 2021; 162(44): 1769–1775. Summary. Early integration of palliative care into the trajectory of cancer care brings advantages into the patients’ quality of life, the level of care and cost-efficiency, too. On the basis of a predefined model, the right patient may receive the right level of palliative care at the right time. Having defined the advantages, the levels of early integration of palliative care and the concept of special palliative care, we also aim to describe the advantages and disadvantages of the most common referral models on the basis of international literature in this article. The drawback of prognosis-based models to identify patients needing special palliative care is the lack of capacity to provide care for the large number of patients so recognised; therefore they have not become widespread. Needs-based models tend to be complicated and thus rarely applied in everyday clinical practice. On the basis of new researches, simple, pragmatic questionnaires are utilised through which the patients who could benefit from special palliative care interventions are easy to identify. Here we give a detailed report of the Yale University and PALLIA-10 models. On condition that appropriate palliative referral criteria are known and applied by active oncology care providers, patients may receive adequate complex care without the palliative care system being overloaded. Orv Hetil. 2021; 162(44): 1769–1775.

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10

Inoue, Akira. "Palliative Medicine." Haigan 59, Supplement (November 25, 2019): 1125–27. http://dx.doi.org/10.2482/haigan.59.1125.

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11

Inoue, Akira. "Palliative Medicine." Haigan 60, Supplement (November 12, 2020): 874–76. http://dx.doi.org/10.2482/haigan.60.874.

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12

Campbell, Deborah A., and David C. Currow. "Palliative medicine." Medical Journal of Australia 176, no. 1 (January 2002): 33. http://dx.doi.org/10.5694/j.1326-5377.2002.tb04266.x.

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13

Akram, Yasmin. "Palliative medicine." BMJ 336, no. 7647 (April 5, 2008): s123. http://dx.doi.org/10.1136/bmj.39450.677662.ce.

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14

Murie, Jill. "Palliative medicine." BMJ 333, no. 7571 (October 7, 2006): s136—s137. http://dx.doi.org/10.1136/bmj.333.7571.s136.

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15

Forbes, Karen. "Palliative medicine." Lancet 362, no. 9400 (December 2003): 2027. http://dx.doi.org/10.1016/s0140-6736(03)15040-4.

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16

Kunkler, Ian. "Palliative medicine." Lancet Oncology 6, no. 4 (April 2005): 207. http://dx.doi.org/10.1016/s1470-2045(05)70090-5.

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17

Lloyd-Williams, M. "Palliative medicine." BMJ 319, no. 7204 (July 24, 1999): 2. http://dx.doi.org/10.1136/bmj.319.7204.2.

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18

Enck, Robert E. "Palliative Medicine." Home Health Care Management & Practice 25, no. 3 (May 10, 2013): 95–97. http://dx.doi.org/10.1177/1084822313486149.

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19

George, R. J., and A. L. Jennings. "Palliative medicine." Postgraduate Medical Journal 69, no. 812 (June 1, 1993): 429–49. http://dx.doi.org/10.1136/pgmj.69.812.429.

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20

Hillier, R. "Palliative medicine." BMJ 297, no. 6653 (October 8, 1988): 874–75. http://dx.doi.org/10.1136/bmj.297.6653.874.

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21

Pereira, Bernardo, and Paulo Reis Pina. "A Emergência Médica e a Medicina Paliativa: A Necessidade de uma Agenda Comum." Medicina Interna 27, no. 3 (September 24, 2020): 275–76. http://dx.doi.org/10.24950/ce/126/20/3/2020.

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22

Chernus, N. Yu, S. V. Sidorov, E. V. Babayants, and S. E. Krasilnikov. "Legal support of palliative care for cancer patients." Siberian journal of oncology 18, no. 2 (April 26, 2019): 65–69. http://dx.doi.org/10.21294/1814-4861-2019-18-2-65-69.

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Background. According to the novel approach to the treatment of patients as persons, the phenomenon of palliation distinguishes modern medicine from the traditional medical paternalism. it means that medical science and practice go beyond physical health, when treatment methods aimed to improving the quality of patient’ life are widely used. man as a phenomenon of culture becomes something much more than his physical body.The purpose of the study was to analyze the palliative care legislation.Results. The palliative care was shown not to be a type of medical care, but it refers to the terms used in clinical practice to determine the purposes of specialized treatment aimed at not curing the disease, but rather extending life and controlling symptoms. conclusion. it is necessary to include patients’ relatives and friends to the number of people in need of medical care. The development of the federal state educational standard of higher education in the specialty of a palliative care physician is also of great importance.

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23

Frank, Nóra, and Ágnes Csikós. "Szteroidok gyakorlati alkalmazása a palliatív terápiában." Orvosi Hetilap 163, no. 8 (February 20, 2022): 294–300. http://dx.doi.org/10.1556/650.2022.32374.

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Összefoglaló. A palliatív ellátás célja a beteg és családja életminőségének javítása egy életet megrövidítő betegség során. A palliatív betegpopuláció 32–80%-a kap szisztémás szteroidot kínzó tünetek enyhítésére. Az alkalmazási irányelvek, a szteroidhasználat a palliatív betegek körében nagyon változó az egyes országok, de az országon belüli ellátók között is. A palliatív betegellátásban szteroidokat – elsősorban szisztémás glükokortikoidokat (dexametazon, betametazon, prednizolon, metilprednizolon) – főleg antiinflammatorikus és a vascularis permeabilitást csökkentő hatásuk miatt alkalmazunk. A palliatív ellátás során glükokortikoid adása számos specifikus indikáció esetén javasolható, mint idegi kompresszió, neuropathiás fájdalom, csontfájdalom és metastasis, májtokfeszülés okozta fájdalom, malignus bélobstrukció, agynyomás-fokozódás, malignus gerincvelő-kompresszió, vena cava superior szindróma, lymphangitis carcinomatosa, nagy légúti obstrukció. Sokszor párhuzamosan jelentkező, nem specifikus tünetek – mint anorexia-cachexia szindróma, hányinger, hányás, fáradtság, gyengeség, nehézlégzés – szintén szükségessé tehetik szteroid adását. A palliatív betegek prognózisát figyelembe véve a szteroidok késői mellékhatásai nem korlátozzák adásukat, az elsődleges terápiás előny felülmúlja a lehetséges kockázatokat. A nemzetközi gyakorlatban a dexametazon a leggyakrabban alkalmazott glükokortikoid, kifejezett gyulladáscsökkentő hatása és kevesebb mineralokortikoid-mellékhatása miatt. Fontos, elengedhetetlen része a biztonságos szteroidterápiának a mellékhatások gondos monitorozása, erről a beteget és a hozzátartozókat is fel kell világosítani. A megfelelő indikációban, dózisban és megfelelő kezelési terv alapján adagolt szteroid hasznos része a palliatív tünetkontrollnak, a beteg életminőség-javításának. Orv Hetil. 2022; 163(8): 294–300. Summary. Palliative care aims to improve the quality of life of patients and their families during a life-shortening illness. 32–80% of the palliative patient population receive systemic steroids to relieve torturous symptoms during end-of-life care. Guidelines for steroid use among palliative patients vary widely from country to country, but also within providers. In palliative care, steroids – mainly systemic glucocorticoids (dexamethasone, betamethasone, prednisolone, methylprednisolone) – are used especially for their anti-inflammatory and vascular permeability-reducing effects. Glucocorticoid administration during palliative care is recommended for a number of specific indications, such as neural compression, neuropathic pain, bone pain and metastasis, liver capsule pain, malignant intestinal obstruction, increased cerebral pressure, malignant spinal cord compression, superior vena cava syndrome, carcinomatous lymphangitis, and large airway compression. Often concomitant non-specific symptoms such as anorexia-cachexia syndrome, nausea, vomiting, fatigue, weakness, dyspnoea may also necessitate steroid administration. Considering the prognosis of palliative patients, the late side effects of steroids do not limit their administration, the primary therapeutic benefit outweighs the potential risks. Internationally, dexamethasone is the most commonly used glucocorticoid due to its pronounced anti-inflammatory effect and fewer mineralocorticoid side effects. Careful monitoring of side effects is an important and essential part of safe steroid therapy and should be made clear to the patient and their relatives. Steroids administered in the right indication and dose as well as according to an appropriate treatment plan are useful parts of palliative symptom control and improve patients’ quality of life. Orv Hetil. 2022; 163(8): 294–300.

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Klenk, Laurence, Nicoletta M. Iucolano, Christian Tasso Braun, Aristomenis K. Exadaktylos, and Steffen Eychmüller. "Endstation Notfallstation: Perzeption und Rezeption des Begriffs «palliativer Patient» sowie Ansätze zur Verbesserung der interdisziplinären Zusammenarbeit – ein Survey unter notfallmedizinischem Personal auf einer Schweizer Notfallstation." Praxis 104, no. 1 (January 1, 2015): 19–25. http://dx.doi.org/10.1024/1661-8157/a001884.

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Hintergrund: Wegen sich verändernder Strukturen im Spitalbereich sowie im Bereich der Hausarztabdeckung als auch infolge zunehmenden Drucks auf das Gesundheitssystem kommen mehr Patienten auf die Notfallstationen, die aufgrund ihrer Grunderkrankung und des fortgeschrittenen Krankheitsstadiums von einem palliativen Behandlungskonzept profitieren. Eine wesentliche Herausforderung ist hierbei bereits die Definition von «Palliative Care» (PC), sowie die Klärung, was genau die palliative Versorgung beinhaltet. Häufig vermischt wird der Terminus «Palliative Care» mit «End of life care». Die vorliegende Studie ist eine Standortbestimmung im Universitären Notfallzentrum des Inselspitals Bern (UNZ), das jährlich rund 32 400 Patienten versorgt. Ziel ist es, mehr über den Wissensstand und die persönliche Einstellung der Mitarbeiter zu palliativen Fragestellungen und speziell zum Begriff «Palliative Care» zu erhalten. Methodik: Die Mitarbeiter des Universitären Notfallzentrums des Inselspitals Bern (UNZ) wurden mittels einer Online-Umfrage durch eine spitalexterne Fachinstitution interviewt. Diese Befragung basiert auf einem Instrument [1], das in einer vergleichbaren Studie auf einer Notfallstation in den USA entwickelt und validiert wurde. Resultate: Von 154 Mitarbeitenden (Pflege und Ärzte) füllten 60 Mitarbeitende die Befragung vollständig aus, entsprechend einer Antwortrate von 39%. Die Definition von Palliative Care (von n=60) war sehr heterogen und konnte in sechs Themenbereiche eingeteilt werden. Bei den Fragen nach spezifischen Leistungsangeboten äusserten die Mitarbeitenden den Wunsch nach einem erleichterten Zugang zu bestehenden Patientendaten, nach einem 24-Stunden-Palliative-Care-Konsiliardienst und nach mehr Besprechungszeit für Fragestellungen der PC im klinischen Alltag. Schlussfolgerungen: Die heterogene Begriffsdefinition von «Palliative Care» bestätigt sich. Es besteht kein klares Vorgehen, und zudem lässt sich ein Zeitmangel für ausführliche Patientengespräche in palliativen Situationen im UNZ feststellen. Der Patientenwunsch oder Patientenverfügungen mit DNR/DNI-Prozedere stehen nicht im Widerspruch zu den persönlichen Wertvorstellungen der meisten Mitarbeitenden. Die 24-Stunden-Verfügbarkeit eines spezialisierten PC-Teams, das Erarbeiten von Guidelines und vermehrtes Training für PC würde von den UNZ-Mitarbeitenden begrüsst.

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Bierle, Rebecca (Schuetz), Karen M. Vuckovic, and Catherine J. Ryan. "Integrating Palliative Care Into Heart Failure Management." Critical Care Nurse 41, no. 3 (June 1, 2021): e9-e18. http://dx.doi.org/10.4037/ccn2021877.

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Background The World Health Organization defines palliative care as an approach that improves the quality of life of patients and their families through the prevention and relief of suffering by assessment and treatment of physical, psychosocial, and spiritual problems. Any patient with chronic debilitating disease, including heart failure, is a candidate for interdisciplinary palliative care to manage their complex physical and psychosocial needs. Clinical Relevance The philosophy of palliative care has evolved to include a vision of holistic care extended to all individuals with serious illness and their families or caregivers that should be integrated throughout the continuum of care, including the acute phase. The critical care nurse will likely encounter patients with heart failure who are receiving or are eligible to receive palliative care at various time points during their illness. Critical care nurses therefore play a pivotal role in symptom palliation affecting the heart failure patient’s quality of life. Purpose To review the models of palliative care and the role that the critical care nurse plays in symptom palliation and preparation of the patient and their family for transition to other levels and settings of care. Content Covered This review addresses the principles and models of palliative care along with how to integrate these principles into all phases of the heart failure disease continuum. Also included are recommendations for palliation of symptoms specific to heart failure patients as well as a discussion of the role of the critical care nurse and the importance of shared decision-making.

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Pestaner, Joseph P. "End-of-Life Care: Forensic Medicine v. Palliative Medicine." Journal of Law, Medicine & Ethics 31, no. 3 (2003): 365–76. http://dx.doi.org/10.1111/j.1748-720x.2003.tb00100.x.

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The increasing life expectancy of terminally-ill people has raised many public policy concerns about end-of-life care. Due to increased longevity and the lack of cures for illnesses like cancer and heart disease, palliative care, particularly pain management, has become an important mode OF medical therapy. Palliative care providers feel that “[h]ealth care professionals have a moral duty to provide adequate palliative care and pain relief, even if such care shortens the patient’s life.” Practitioners of forensic medicine grapple with determining when to classify the death of a person formerly receiving palliative care as a non-natural death. Such classification may be paramount in the enforcement of new statutes that aim at preventing assisted suicide or monitoring the quality of health care, but it potentially places forensic medicine and palliative medicine in adversarial roles.

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Becker, Christoph, and Sabina Hunziker. "Entscheidungsfindung in Gesprächen zu Reanimationsmassnahmen." Therapeutische Umschau 79, no. 8 (October 2022): 387–92. http://dx.doi.org/10.1024/0040-5930/a001379.

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Zusammenfassung. Die Entscheidungsfindung bezüglich allfälliger Reanimationsmassnahmen ist ein typisches Beispiel einer partizipatorischen Entscheidungsfindung bei der Ärzt_innen und Patient_innen gleichermassen zur Entscheidung beitragen. Um eine informierte Entscheidung zu treffen, bedarf es einer Wissensgrundlage, zum Beispiel über mögliche Konsequenzen mit Vor- und Nachteilen der jeweiligen Entscheidungsmöglichkeiten. Dabei sollte auch erörtert werden, was Reanimationsmassnahmen versus Fokussierung auf ein palliatives Vorgehen bedeuten; welche Präferenzen und Bedürfnissen hat der Patient oder die Patientin? Dies sind wichtige Faktoren, die sehr individuell sein können, und daher in die Entscheidung entsprechend einfliessen müssen. Das Leben zu verlängern und den Tod zu verhindern, hat für viele Menschen prinzipiell den höchsten Stellenwert, in manchen Situationen ist jedoch die Linderung von Leiden ein wichtigeres Ziel. Insbesondere bei polymorbiden Patient_innen mit lebenseinschränkenden, palliativen Erkrankungen zeigen Reanimationsmassnahmen häufig keinen Nutzen, sondern würden vielmehr eine Leidensverlängerung bedeuten. Hier ist es besonders wichtig, die limitierten therapeutischen Optionen und entsprechende palliative Möglichkeiten mit den betroffenen Patient_innen gut zu besprechen.

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Davis, Mellar P. "Palliative Medicine Research." Journal of Cancer Pain & Symptom Palliation 1, no. 3 (January 2005): 33–38. http://dx.doi.org/10.3109/j427v01n03_08.

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Lück, Patricia. "Paediatric palliative medicine." South African Medical Journal 104, no. 7 (May 22, 2014): 505. http://dx.doi.org/10.7196/samj.8428.

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von Gunten, Charles F., and Editor-in-Chief. "Global Palliative Medicine." Journal of Palliative Medicine 20, no. 8 (August 2017): 798. http://dx.doi.org/10.1089/jpm.2017.0281.

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31

MacAdam, Douglas B. "Teaching palliative medicine." Medical Journal of Australia 156, no. 3 (February 1992): 192–96. http://dx.doi.org/10.5694/j.1326-5377.1992.tb139706.x.

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32

Walker, Paul W., and Eduardo D. Bruera. "Palliative care medicine." Hematology/Oncology Clinics of North America 16, no. 3 (June 2002): xiii—xiv. http://dx.doi.org/10.1016/s0889-8588(02)00025-4.

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Collins, John J. "Palliative Medicine Secrets." Journal of Pain and Symptom Management 18, no. 6 (December 1999): 452. http://dx.doi.org/10.1016/s0885-3924(99)00108-6.

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Glazer, John P., Joanne M. Hilden, and Dunya Yaldoo Poltorak. "Pediatric Palliative Medicine." Child and Adolescent Psychiatric Clinics of North America 15, no. 3 (July 2006): xvii—xx. http://dx.doi.org/10.1016/j.chc.2006.03.004.

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35

Barrett, Todd. "Cardiac Palliative Medicine." Current Heart Failure Reports 14, no. 5 (September 6, 2017): 428–33. http://dx.doi.org/10.1007/s11897-017-0357-5.

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36

Anneser, Johanna. "Palliative Sedierung: Anmerkungen zu einem strittigen Thema." Therapeutische Umschau 75, no. 2 (July 2018): 86–90. http://dx.doi.org/10.1024/0040-5930/a000971.

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Zusammenfassung. Die palliative Sedierung ist eine Behandlungsoption für Patienten mit einer lebensverkürzenden, unheilbaren Erkrankung. Durch eine Bewusstseinsminderung wird eine Linderung von Leiden, das als unerträglich empfunden wird, angestrebt. In Abgrenzung zum ärztlich assistierten Suizid und zur Tötung auf Verlangen zielt die palliative Sedierung auf eine Symptomlinderung, ohne jedoch den Eintritt des Todes beschleunigen zu wollen. Neben der intermittierenden palliativen Sedierung kommt die kontinuierliche (tiefe) Sedierung bis zum Tod zum Einsatz. Die Mehrzahl der Kontroversen betreffen die kontinuierliche tiefe Sedierung: 1: Kann (neben physischen Symptomen) auch existenzielles oder psychosoziales Leid als Indikation für eine kontinuierliche, tiefe palliative Sedierung betrachtet werden? 2: Wann darf eine kontinuierliche, tiefe palliative Sedierung bis zum Tod frühestens begonnen werden? 3: Wie verhält es sich mit der Gabe von Flüssigkeit und Ernährung während einer kontinuierlichen, tiefen palliativen Sedierung? Eine kritische Reflexion der genannten ethisch kontroversen Themen innerhalb des Behandlungsteams ist wünschenswert. Das Wohl des Patienten und der Respekt vor den Entscheidungen, die er in dieser allein von ihm durchlebten Phase seines Lebens trifft, müssen jedoch bestimmend für das ärztliche und pflegerische Handeln bleiben.

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Rostami, Sohayla, Seth Ladd, Linda Stewart, and Jackie Battista. "Palliative Modified Radical Mastectomy to Improve Quality of Life by Decreasing Disease Burden: A Case Report." Asploro Journal of Biomedical and Clinical Case Reports 4, no. 2 (July 2, 2021): 119–24. http://dx.doi.org/10.36502/2021/asjbccr.6242.

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In cases of advanced pathology, palliative medicine is able to confer a great deal of relief to the patient. In the same light, surgical intervention is able to provide increased quality of life in cases of extensive disease burden, providing palliation where curative measures cannot be achieved. In the case study therein, a patient presents with metastatic breast cancer with a localized fungating mass contributing to severe local and systemic symptomatology. In this setting, invasive management of her disease allowed for clinical improvement of the patient when medical management alone was not sufficient. The patient quickly demonstrated recovery of her symptoms in the post-operative phase when the local disease was resected. The utilization of invasive measures, as seen in this case, further proves the importance of multidisciplinary palliative care where surgical measures are included in patient care.

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Maisto, Antonella, Maria Gabriella Schettino, Giuseppe Ferrucci, Andrea Lombardi, Armando Genovese, Antonietta Pacifico, Giuseppina Moccia, Francesco De Caro, and Vincenzo De Paola. "Modello di presa in carico del paziente oncologico in Pronto Soccorso." La Sanità Pubblica. Ricerca applicata 2, no. 2 (July 25, 2021): 57–68. http://dx.doi.org/10.48268/cancerpatient/2021/0001.2.

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L’obiettivo del progetto consiste nella messa a punto di un modello operativo di valutazione congiunta (Specialista del Pronto Soccorso, Specialista Oncologo/Ematologo, Specialista in Terapie Palliative) del paziente oncologico/ematologico che giunga in PS. Attraverso tale valutazione polispecialistica precoce ci proponiamo d’individuare il percorso assistenziale più adeguato per il paziente oncologico ed oncoematologico ricoverato in Pronto Soccorso, percorso che potrà contemplare sia il ricovero in ambito specialistico specifico onco-ematologico che quello in ambito specialistico di altro genere (es. Medicina Interna, Cardiologia, Chirurgia, etc.) o indirizzarlo ad un’assistenza di tipo squisitamente palliativo (Hospice/Assistenza Domiciliare Integrata territoriale) o di degenza riabilitativa a media-intensità di cura di medio/lungo periodo presso il PO “G. Da Procida” della AOU San Giovanni di Dio e Ruggi d’Aragona.

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Doyle, Derek. "Palliative Medicine in Britain." OMEGA - Journal of Death and Dying 56, no. 1 (February 2008): 77–88. http://dx.doi.org/10.2190/om.56.1.g.

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In Britain, Palliative Medicine was recognized as a subspecialty of Internal Medicine exactly 20 years after Cicely Saunders founded St Christopher's, at exactly the same time that government was at last recognizing the worth and the needs of general practice. Both had far-reaching effects and implications for patients, doctors, and the future of medicine. For Palliative Medicine it meant units wishing to train specialists going through a rigorous selection process; the development of an equally rigorous training program for the doctors who had already gained a higher qualification before starting Palliative Medicine, demonstrating the need for and benefits of palliative medicine to the sceptics in the profession and, now, continuing to recruit the staff for the steadily increasing number of new services. Today there are more Palliative Medicine consultants/specialists than there are oncologists and neurologists combined, with Hospital Palliative Care Teams in every major hospital and cancer center. With nine Chairs in Palliative Medicine, there is now a drive for research and professional education. The specialty faces major challenges, however, ranging from training to care for patients with non-malignant disease to enabling patients to die in the place of their choice—something that rarely happens today; from defining what is distinctive or unique about palliative medicine to clarifying the respective place of general practice and the specialty. Most would agree that the biggest challenge for the young, thriving specialty is how to share its principles with other doctors wherever they work.

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40

Edwards, Asher, and Samuel Nam. "Palliative Care Exposure in Internal Medicine Residency Education: A Survey of ACGME Internal Medicine Program Directors." American Journal of Hospice and Palliative Medicine® 35, no. 1 (January 5, 2017): 41–44. http://dx.doi.org/10.1177/1049909116687986.

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As the baby boomer generation ages, the need for palliative care services will be paramount and yet training for palliative care physicians is currently inadequate to meet the current palliative care needs. Nonspecialty-trained physicians will need to supplement the gap between supply and demand. Yet, no uniform guidelines exist for the training of internal medicine residents in palliative care. To our knowledge, no systematic study has been performed to evaluate how internal medicine residencies currently integrate palliative care into their training. In this study, we surveyed 338 Accreditation Council for Graduate Medical Education–accredited internal medicine program directors. We queried how palliative care was integrated into their training programs. The vast majority of respondents felt that palliative care training was “very important” (87.5%) and 75.9% of respondents offered some kind of palliative care rotation, often with a multidisciplinary approach. Moving forward, we are hopeful that the data provided from our survey will act as a launching point for more formal investigations into palliative care education for internal medicine residents. Concurrently, policy makers should aid in palliative care instruction by formalizing required palliative care training for internal medicine residents.

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Velasquez-Manrique, Annie, Claudia Benavides-Luyo, Susan Chaupi-Rojas, Sandra Andahua-Inuma, Manuel Andrade-Acuña, Rubén Sánchez-Ruiz, and Alonso Soto. "Identification of palliative care requirement in hospital inpatients in internal medicine services in a peruvian reference hospital." Revista de la Facultad de Medicina Humana 23, no. 1 (January 15, 2023): 52–60. http://dx.doi.org/10.25176/rfmh.v22i3.4621.

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Introduction: Hospitals of greater complexity tend to care for patients with advanced chronic diseases, which is why it is important to recognize the need for palliative care. Objective: To identify the proportion of patients who require palliative care in the medicine department of a Peruvian referral hospital. Methodology: Observational, analytical, cross-sectional study. All hospitalized patients were studied in the Department of Internal Medicine of the Peruvian hospital during the period April-May 2018. To determine the need for palliative care, the NECPAL CCOMS-ICO © instrument was used. The quantitative variables are presented as median and interquartile range (IQR); and numerical variables, such as frequencies and percentages. For the comparison of numerical variables, the Mann Whitney test was used and the chi-square test for categorical variables. Results: They were evaluated in 281, where 102 (37.9%) required palliative care. The median age in patients requiring palliative care was 69.5 (IQR: 58-81) years. The median hospital stay in patients with and without the need for palliative care was 7 days (IQR: 4-11) and 9 days (IQR: 5-19) respectively, the mortality in patients with and without the need for palliative care was 37.25% and 4.19% respectively. Conclusions: There is a high frequency of need for palliative care in patients hospitalized in internal medicine wards, the requirement for palliative care was associated with higher mortality and hospital stay, which evidences the need for comprehensive and personalized care based on medical services specialized.

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Jerram, Katie, and Phil Russell. "Textbook of Palliative MedicineTextbook of Palliative Medicine." Nursing Standard 24, no. 4 (September 30, 2009): 30. http://dx.doi.org/10.7748/ns2009.09.24.4.30.b965.

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Appleton, Michael, and Kerry Corboy. "When palliative medicine is not palliative care." American Journal of Hospice and Palliative Medicine® 22, no. 3 (May 2005): 169–70. http://dx.doi.org/10.1177/104990910502200301.

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44

Chakote, DMD, Karunesh, and James Guggenheimer, DDS. "Implications of use of opioid-containing analgesics for palliation of acute dental pain." Journal of Opioid Management 15, no. 1 (January 1, 2019): 35–41. http://dx.doi.org/10.5055/jom.2019.0484.

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Background: Initial palliation of acute dental pain with an opioid-containing pain reliever (OPR) is inappropriate but more likely to occur among the under- and uninsured who are unable to access the customary resources for dental care. Objective: To assess the implications of palliation with an OPR, the authors determined the prevalence of several health attributes and socioeconomic status (SES) of patients taking prescription or over-the-counter (OTC) palliative medications before they presented to an academically affiliated dental clinic for definitive treatment of acute dental pain.Methods: Prior palliation with any OPR/antibiotic combination was compared with a self-reported mood disorder, use of a psychotherapeutic or street drug, low SES (on Medicaid or self-payer), or high SES (having commercial dental insurance).Results: Palliative medications were being taken by 34 percent of 851 patients including 20 percent who were taking an OPR. Use of any palliative prescription medication was significantly associated with low SES (odds ratio: 1.25; 95%; confidence interval: 1.35-2.88; p = 0.004). By comparison, high SES patients were significantly more likely to have used OTC analgesics or no medication (p 0.001). Significantly more low SES patients self-reported mood disorders and street drug use (p = 0.048 and p = 0.019), respectively. Patients taking OPRs included those with self-reported mood disorders or use of a psychotherapeutic or street drug.Conclusions: Palliation of acute dental pain with OPRs cannot resolve the underlying dental condition and contributes to drug misuse and adverse interactions. Preferable palliation should utilize combinations of non-OPR analgesics. These have fewer risks and may provide an incentive to seek definitive dental treatment.

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Sanft, Tara B., and Jamie H. Von Roenn. "Palliative Care Across the Continuum of Cancer Care." Journal of the National Comprehensive Cancer Network 7, no. 4 (April 2009): 481–87. http://dx.doi.org/10.6004/jnccn.2009.0033.

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Optimal oncology care requires the integration of palliative medicine into oncology care across the disease trajectory. All patients require screening for palliative care services at the initial oncologic visit and reassessment throughout the continuum of care. As a result of the increasing attention focused on palliative care nationally and internationally, the domains of palliative cancer care have been elucidated and have fostered the development of guidelines for quality palliative care. The recent recognition of palliative medicine as a subspecialty in the United States, the growing number of hospital-based palliative care programs, and the accreditation of palliative medicine fellowship programs by the Accreditation Council for Graduate Medical Education highlight the increased visibility of palliative medicine. This provides hope for the future of oncologic care. The palliative approach is subsumed in cancer care—it provides assistance with decision-making, symptom management, and access to financial, emotional, and spiritual services. A fully integrated program of oncology and palliative care provides the greatest opportunity for care and cure.

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Finn, Laura, and Sonia Malhotra. "The Development of Pathways in Palliative Medicine: Definition, Models, Cost and Quality Impact." Healthcare 7, no. 1 (February 1, 2019): 22. http://dx.doi.org/10.3390/healthcare7010022.

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Palliative Care and its medical subspecialty, known as Palliative Medicine, is the care of anyone with a serious illness. This emerging field includes Hospice and comfort care, however, it is not limited to end-of-life care. Examples of the types of serious illness that Palliative Medicine clinicians care for include and are not limited to hematologic and oncologic diseases, such as cancer, advanced heart and lung diseases (e.g., congestive heart failure and chronic obstructive pulmonary disorder), advanced liver and kidney diseases, and advanced neurologic illnesses (e.g., Alzheimer’s and Parkinson’s disease). In the past decade, there has been tremendous growth of Palliative Medicine programs across the country. As the population of patients with serious illnesses increases, there is growing concentration on quality of care, including symptom management, meeting patients’ goals regarding their medical care and providing various types of support, all of which are provided by Palliative Medicine. In this review article we define Palliative Medicine, describe care pathways and their applicability to Palliative Medicine, identify different models for Palliative Care and provide evidence for its impact on cost and quality of care.

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Hirsch, Ariel E. "Palliative Radiation Therapy of Symptomatic Recurrent Bladder Cancer." Pain Physician 2;10, no. 3;2 (March 14, 2007): 285–90. http://dx.doi.org/10.36076/ppj.2007/10/285.

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Background: Palliative radiation therapy (RT) is an established tool in the management of symptoms caused by malignancies. RT is effective at palliating both locally advanced and metastatic cancer, including related symptoms of pain, bleeding, or obstruction. Most data on palliative RT is in regard to its use in the treatment of painful bone metastases. There are also data that support RT palliation for locally advanced or recurrent rectal, prostate, and gynecological cancers. With regard to bladder cancer there is some evidence of the benefit of palliative RT for the control of urinary symptoms and hematuria; however, there is little evidence for the use of palliative RT for pain associated with locally recurrent bladder cancer. We report a case of locally advanced recurrent bladder cancer which was refractory to medical pain management, and was found to be highly responsive to palliative RT. Case Report: An 80-year-old woman with recurrent bladder cancer and intractable pelvic pain refractory to oral and transdermal pain medications, received palliative pelvic RT to a dose of 50 Gy (5000 cGy) in 25 fractions with complete resolution of pain. The patient was originally found to have dysuria, frequency, and hematuria, secondary to an invasive high grade transitional cell carcinoma of the bladder with an adenocarcinoma component, AJCC pT2b N1 M0 Stage IV, for which she underwent a radical cystectomy, total abdominal hysterectomy, bilateral salpingo-oophorectomy, partial vaginectomy, and ileal conduit reconstruction. After undergoing 4 cycles of adjuvant chemotherapy, the patient did well for 5 months with no evidence of symptomatic, clinical, or radiographic recurrence of disease. Repeat staging CT of the abdomen and pelvis confirmed tumor recurrence in the left pelvis. The patient was treated with another course of chemotherapy and pain was managed with relatively low doses of opioid medication (25mcg transdermal fentanyl patch, and oxycodone 5mg bid). However at the fourth month, there was rapid escalation of severe pain with the patient becoming bed bound due to pain with an associated decrease in ambulation and anorexia. Ultimately a pain medication regimen of 200mcg transdermal fentanyl patch q2 days, oxycontin 20mg bid, oxycodone 5 – 10mg q 4 hours, ibuprofen 400mg q 8 hours, and gabapentin 600mg TID was not effective in controlling pain. The patient was then referred to Radiation Oncology 6 months after the pain initially began for evaluation. She received a total of 5000cGy over 25 fractions to a small pelvis field over 5 weeks and reported complete pain resolution. She was able to decrease pain medications, increase overall activity, and gain significant improvement in sleep quality and appetite even early on in the course of her radiation therapy. Conclusions: Palliative radiation therapy has been well studied in the setting of bone metastases and treatment of hematuria for locally advanced bladder cancer. There is little data that we are aware of on the use of RT for pain control with patients that have recurrent, locally advanced bladder cancer. We have presented a case in which an excellent outcome in pain control was seen for a patient with medically unmanageable pain. RT is an excellent option for pain management in recurrent bladder cancer and should be offered to patients whose pain is not otherwise optimally controlled. Palliative RT is an important component in the multimodality approach to cancer pain management and optimization of quality of life. Key words: palliation, bladder cancer, radiation therapy

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Goldstein, Nathan E., and Daniel Fischberg. "Update in Palliative Medicine." Annals of Internal Medicine 148, no. 2 (January 15, 2008): 135. http://dx.doi.org/10.7326/0003-4819-148-2-200801150-00008.

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Maddocks, Ian. "Medicine and palliative care." Medical Journal of Australia 171, no. 2 (July 1999): 63–64. http://dx.doi.org/10.5694/j.1326-5377.1999.tb123519.x.

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Chang, Victor T., Brooke Sorger, Kenneth E. Rosenfeld, Karl A. Lorenz, Amos F. Bailey, Trinh Bui, Lawrence Weinberger, and Marcos Montagnini. "Pain and palliative medicine." Journal of Rehabilitation Research and Development 44, no. 2 (2007): 279. http://dx.doi.org/10.1682/jrrd.2006.06.0067.

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