1/12. Balancing the focus: art and music therapy for pain control and symptom management in hospice care.Pain and symptom management are a major part of hospice care. literature and direct experience suggest that pain can be resistant if psychological, emotional, or spiritual issues are not addressed. This article explains how art and music therapies can work in conjunction with traditional medical treatment of pain control in the hospice setting. The process of pain modulation through the use of art and music interventions is diagrammed and described. Brief clinical examples demonstrate the use of art and music therapies for pain reduction with a variety of hospice patients. Information regarding appropriate education and training necessary for art and music therapists to practice in their field is presented.- - - - - - - - - - ranking = 1keywords = hospice (Clic here for more details about this article) |
2/12. Stenting the sigmoid colon in a terminally ill patient with prostate cancer.Large bowel obstruction in the terminally ill patient can be difficult to manage. We describe a patient with sigmoid colon obstruction caused by metastatic prostate cancer in the pelvis who required hospitalization because of severe pain and obstructive symptoms. Treatment with an endoscopically placed self-expandable metal stent allowed the patient to have immediate resolution of symptoms and to receive hospice care at home.- - - - - - - - - - ranking = 0.14285714285714keywords = hospice (Clic here for more details about this article) |
3/12. The concept of total pain: a focused patient care study.This article considers the care of a patient admitted into a hospice environment for pain management and respite care. The concept of 'total' pain is discussed together with the need for a multidimensional assessment of pain to enable effective management to be accomplished. A multiprofessional approach to care along with inclusion of both the patient and her husband in decision making achieved the best possible quality of life for them both. A palliative care approach requires healthcare professionals to focus on the achievement of quality of life for all patients whose disease is not responsive to curative treatment. This is achieved by providing relief from pain and other distressing symptoms, including psychological, spiritual and social aspects of care, together with the acknowledgement of patient and relative autonomy. Hence, the study also exemplifies contemporary palliative care in action.- - - - - - - - - - ranking = 0.14285714285714keywords = hospice (Clic here for more details about this article) |
4/12. Multidimensional continuous pain assessment chart (MCPAC) for terminal cancer patients: a preliminary report.Current use of pain measures is limited in clinical practice. The common pain measures neither target nor monitor the changes that occur with time with regard to the effect of other parameters associated with pain control. Changes in parameters, such as pain type, various pharmacological and nonpharmacological interventions, dosage of medications, and use of rescue doses, usually complicate pain control in terminal cancer patients. The authors propose use of a multidimensional, continuous pain chart that permits better assessment and control of pain. The chart integrates visual analogue pain assessment, special treatment techniques, regular medications and rescue doses, co-analgesics, pain categories, parameters relating to quality of life, sleep, and mobility. A total of 1,178 assessments were performed in 100 consecutive patients with full compliance. The chart permitted a continuous monitoring of patients 'most important needs concerned with pain control and was easily integrated into the hospice daily routines. We conclude that the chart represents an effective and friendly graphic tool to monitor pain and associated parameters that relate to the quality of the broad spectrum of pain control. The hope is that this tool may improve pain control by hospice professionals and facilitate communication between patients and the interdisciplinary team members.- - - - - - - - - - ranking = 0.28571428571429keywords = hospice (Clic here for more details about this article) |
5/12. Bilateral acrometastasis secondary to breast cancer.BACKGROUND: One out of every 8 women will be diagnosed with breast cancer and 1 in 28 will succumb to the disease. Skeletal metastasis occurs in 16% to 73% of breast cancer patients. OBJECTIVE: To present a comprehensive look at the pathophysiology, clinical presentation, and treatment options for skeletal metastasis secondary to breast carcinoma by discussing the case of an 80-year-old female patient with bilateral distal lower extremity metastasis following a previous diagnosis of breast cancer. CLINICAL FEATURES: The patient had severe pain in both lower extremities, which caused her to have difficulty when ambulating. She also complained of fatigue and anorexia, with an 8-lb weight loss. Chest examination revealed widespread rales without change. Her left calcaneus was tender to palpation and both feet and ankles were hot and swollen. Laboratory CA 27.29 values were 1131 on October 16, 2001, which was elevated compared with the 454 value obtained previously. Plain films of the lower extremities revealed destructive lesions of the distal left and right tibia and fibula with involvement of the left calcaneus. These findings were most consistent with metastasis. INTERVENTION AND OUTCOME: The patient refused further care and sought a hospice referral. CONCLUSION: There is no cure for acrometastasis and prognosis is poor. Treatment focuses on symptomatic relief, extended survival, and maintaining quality of life. Clinicians should consider metastasis in a patient with distal lower extremity osteolytic lesions with a previous history of breast malignancy.- - - - - - - - - - ranking = 0.14285714285714keywords = hospice (Clic here for more details about this article) |
6/12. High-dose fentanyl patch for cancer pain.OBJECTIVE: To describe a successful experience with a high dose (1000 microg/hr) of transdermal fentanyl for cancer pain relief. CASE REPORT: A 62-year-old man suffering from rectal carcinoma was treated by our home care hospice unit during his last 3.5 months of life. At admission to our home care unit, he suffered mostly from severe anal pain (verbal pain scale of 10/10) due to advanced disease. He was then on 150 microg/hr transdermal fentanyl. Adjuvant therapy with amitriptyline 50 mg/day and dexamethasone 4 mg/day was added, but it did not relieve his pain. The dose of transdermal fentanyl was increased gradually to 1000 microg/hr with good pain control (verbal pain scale of 1 to 4/10 most of the time). Before his death, he was mentally alert with good pain control. CONCLUSIONS: High doses of transdermal fentanyl (1000 microg/hr; 10 patches) should be considered for pain relief in cancer patients.- - - - - - - - - - ranking = 0.14285714285714keywords = hospice (Clic here for more details about this article) |
7/12. palliative care management of a child with juvenile onset Huntington's disease.This is a case report of the palliative care management of a 13-year-old girl who died of juvenile onset Huntington's disease in a children's hospice in the southeast of england. It outlines her disease progression and describes the care that she received. In particular, the medications and other measures used to control her symptoms during her last 10 days are discussed. The article also explores some of the ethical difficulties of caring for children dying from degenerative disorders. Although juvenile onset Huntington's disease is an extremely rare condition, the issues around terminal care management are very similar to those for any neuro-degenerative disorder, whether in an adult or child. A number of children's hospices have opened in the last 10-15 years in the UK. They accept children with a wide range of life-limiting conditions and have become experts in offering respite care and symptom control to these children and their families. They are chosen increasingly as the place of death for such children.- - - - - - - - - - ranking = 0.28571428571429keywords = hospice (Clic here for more details about this article) |
8/12. End-of-life care for homeless patients: "she says she is there to help me in any situation".Homelessness annually affects an estimated 2.3 million to 3.5 million individuals living in the united states. Homeless people face difficulties in meeting their basic needs. Many have substance abuse problems and mental illness, lack social support, and have no medical insurance. These challenges complicate the homeless patient's ability to engage in end-of-life advanced planning, adhere to medications, and find an adequate site to receive terminal care. Employing a multidisciplinary team to care for homeless patients can help address their needs and improve care. For patients who continue to use illicit substances while receiving end-of-life care, experts recommend scheduling frequent clinic visits, using long-acting pain medications, dispensing small quantities of medications at a time, and using a written pain agreement. Homeless people are less likely to have a surrogate decision maker. Clinicians should have frequent, well-documented conversations with these patients about end-of-life wishes. Homeless people can rarely use hospice services because they lack the financial resources for inpatient hospice and have neither the home nor the social support required for home hospice. Developing inpatient palliative care services at hospitals that serve many homeless people could improve the end-of-life care homeless people receive.- - - - - - - - - - ranking = 0.42857142857143keywords = hospice (Clic here for more details about this article) |
9/12. Stereotaxic placement of a ventricular catheter and reservoir for the administration of morphine sulfate.patients with intractable pain due to cancer present a unique challenge to both medical and nursing personnel. This case study illustrates a unique home hospice managed pain control regime that has been implemented for a terminal cancer patient with intractable pain. A ventricular catheter attached to a reservoir was stereotaxically implanted for the administration of preservative-free morphine sulfate. The presentation will include the history of intraspinal morphine, the surgical placement of the ventricular access devise, and the procedure for intraventricular morphine administration. Also, the preoperative nursing assessment and patient family education will be discussed. education of hospice nurses in the technique of injection, postoperative pain assessment, monitoring of side effects and discharge planning will conclude the presentation.- - - - - - - - - - ranking = 0.28571428571429keywords = hospice (Clic here for more details about this article) |
10/12. Continuity of care for the cancer patient with chronic pain.The care of patients with cancer and chronic pain, often complicated and demanding, strains the resources of a single physician. Continuity of care programs, such as that developed by the Pain Service of Memorial Sloan-Kettering Cancer Center (new york), with good communication and liaison work between hospital and community, add a much needed dimension to the pain management of these patients in the home. Although continuity of care programs resemble hospice programs in philosophy, there are major differences in admission criteria: the program is not restricted to dying individuals; patients may live alone; they may receive active therapy with a focus on cure or remission; and they continue to receive their care, including pain management, within a standard medical system under the supervision of their primary physician and nurse.- - - - - - - - - - ranking = 0.14285714285714keywords = hospice (Clic here for more details about this article) |
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