Using medication in children’s palliative care

2021 ◽  
pp. 145-152
Author(s):  
Andy Gray ◽  
Jane Riddin ◽  
Richard Hain
Keyword(s):  
Palliative Care ◽  
Symptom Control ◽  
Evidence Base ◽  
Oral Route ◽  
Essential Medicines ◽  
Insufficient Evidence ◽  
Rights Of The Child ◽  
Child Friendly ◽  
The Individual ◽  
Alternative Routes

Using medication in children’s palliative care (CPC) is fraught with difficulties as a result of an insufficient evidence-base and a lack of child friendly formulations, however this cannot be a reason not to intervene and allow unnecessary suffering. A lack of access in some countries to even essential medicines such as opioids is an infringement of the rights of the child to pain relief and needs urgent redress. Often, the only reasonable option is to extrapolate from adult data and to proceed rationally on the basis of what the prescriber knows about the available drug, the individual child, and the likely effects of their disease. Alternative routes for administration of medicines in children who are no longer able to use the oral route, such as the trans- and sub-cutaneous and buccal route mean symptom control can be provided at home and until end of life.

Breathlessness and other respiratory symptoms in palliative care

2021 ◽  
pp. 589-603
Author(s):  
Miriam J. Johnson ◽  
David C. Currow
Keyword(s):  
Palliative Care ◽  
Perceptual Experience ◽  
Coping Style ◽  
Help Seeking ◽  
Evidence Base ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Help Seeking Behaviour ◽  
The Individual ◽  
Underlying Pathophysiology

Breathlessness is prevalent among palliative care patients with intensity likely to increase as death approaches for many people. There are two main patterns of breathlessness—episodic breathlessness and constant breathlessness—and three separate qualities of breathlessness—air hunger, work or effort, and tightness. Chronic breathlessness is defined as disabling breathlessness despite optimal treatment of the underlying pathophysiology. The measurement of breathlessness includes three domains: sensory-perceptual experience, affective distress, and symptom impact. The management of breathlessness includes specific disease management, non-pharmacological interventions, pharmacological therapies, and, in a very small proportion of people, palliative non-invasive ventilation. A full assessment of the widespread effects of chronic breathlessness on the individual including coping style and help-seeking behaviour is important to tailor interventions. Interventions focused on the breathlessness can be based on a ‘Breathing, Thinking, Functioning’ clinical framework. Oral, low-dose morphine in steady state remains the pharmacological treatment with the strongest evidence base.

Informatics and Literature Search

2015 ◽  
Author(s):  
Jennifer J. Tieman ◽  
David C. Currow
Keyword(s):  
Palliative Care ◽  
Health Professionals ◽  
Domain Knowledge ◽  
Literature Search ◽  
Evidence Base ◽  
Practice Research ◽  
Clinical Knowledge ◽  
Research And Education ◽  
The Individual

Health information technology is changing how health professionals engage with and use knowledge and how health systems organize care. Tools and resources can facilitate access to evidence and enable its application in practice improving outcomes for the individual patient and for the health-care system. However, the quality of these applications relies on the quality and currency of the domain knowledge that is embedded within them and distributed through them. Therefore being able to identify and retrieve palliative care’s evidence base is more critical than ever. Given the complexity of timely, efficient, and effective retrieval of needed knowledge, new approaches are needed to manage the expanding and diffuse knowledge base for palliative care. Such strategies include developing online repositories of clinical knowledge to ensure immediate access and creating search solutions that shortcut access to literature and evidence to support practice, research, and education.

Principles of palliative care

2018 ◽  
Vol 11 (12) ◽  
pp. 676-679
Author(s):  
Joshua Getty
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Symptom Control ◽  
Management Options ◽  
Initial Management ◽  
Factors Affecting ◽  
Dying Patients ◽  
Life Threatening ◽  
The Individual

Palliative care traditionally focused on symptom-control in dying patients, but has recently evolved to include care of life-threatening or limiting conditions by optimising the benefits of treatment and considering other ways to improve the quality of life for patients. This is achieved through holistic consideration of physical, psychosocial and spiritual factors affecting the individual patient. The aim of this article is to explore these factors and initial management options.

scholarly journals PRESCRIBING TRENDS IN ASTHMA IN PEDIATRICS: A LONGITUDINAL, OBSERVATIONAL STUDY

2021 ◽  
pp. 70-74
Author(s):  
AMANPREET KAUR ◽  
ARSHIYA SEHGAL ◽  
VIJAY K SEHGAL ◽  
HARJINDER SINGH
Keyword(s):  
Inhaled Corticosteroids ◽  
Symptom Control ◽  
Oral Route ◽  
Essential Medicines ◽  
World Health ◽  
Treatment Change ◽  
Male Predominance ◽  
Essential Drug List ◽  
Prescribing Trends ◽  
Health Organization

Objectives: In recent years, the prevalence of asthma has globally increased. Despite intensive treatment, many children with asthma are not achieving good symptom control. The present study aims to analyze the prescribing trends in pediatric asthma according to the World Health Organization (WHO) prescribing indicators. Methods: This was an observational, longitudinal study conducted for the duration of 6 months with a sample size of 62. Children with age 1–14 years with asthma, who fulfilled the inclusion criteria, were enrolled after obtaining the written informed consent. Data were collected from outpatient department prescription slips for 2 times, one at 1st enrollment and the next after 1 month and changes in the prescription were noted. Peak expiratory flow rate (PEFR) was measured on both visits and the change in PEFR was noted. Results: Male predominance was seen (67.74%) with age of 5–9 years (40.32%). Average number of drugs per prescription was 1.96. The most commonly prescribed anti-asthmatic drug was inhaled corticosteroids (ICS) (78.22%). Only 1.5% drugs were prescribed by generic names and 22.22% drugs from the essential drug list. Inhalational route (38.71%) was preferred over the oral route (20.97%). After 1 month of treatment, change in PEFR was found to be statistically significant. Conclusion: The study concluded that average number of drugs per prescription and use of antibiotics was conforming to the WHO prescribing standards but prescribing from essential medicines list and by generic name need to be encouraged.

Role of Palliative Care in Adolescent and Young Adult Oncology

2010 ◽  
Vol 28 (32) ◽  
pp. 4819-4824 ◽  
Author(s):  
Simon Wein ◽  
Shlomit Pery ◽  
Alona Zer
Keyword(s):  
Palliative Care ◽  
Symptom Control ◽  
National Level ◽  
Evidence Base ◽  
Young Person ◽  
Good Evidence ◽  
Adolescent And Young Adult ◽  
Professional Organizations ◽  
Key Skills ◽  
Developmental Phases

Adolescents and young adults (AYAs) with cancer are a heterogeneous group. Nevertheless, there are sufficient unifying characteristics to form a distinct clinical entity. Management of this special group requires a broad-based interdisciplinary clinical team, which should include palliative care (PC), psychology, social work, oncology, and nursing representatives. The function of PC is to provide impeccable pain and other symptom control and to coordinate care as the disease progresses. Features unique to AYAs with cancer include the psychosocial developmental phases, a young person facing death, grief, and bereavement. Pharmacologic and medical interventions by PC in AYAs are broadly similar to adults. Developing trust and being flexible are key skills that PC must use with AYAs. There is a paucity of high-quality controlled studies in the PC literature in general and AYA-PC in particular. Therefore, the methodology of this article is largely based on the narrative and clinical experience. The experience is based on clinicians' work with AYAs with cancer in Israel and Australia. Clinical lessons will be drawn by comparing and contrasting the cultures. Nevertheless, most PC clinical interventions, both pharmacologic and psychosocial, are derived from literature where there is a good evidence base. Future development of PC within AYAs should be coordinated at a national level via appropriate palliative and oncology professional organizations.

scholarly journals Hypnosis in a specialist palliative care setting – enhancing personalized care for difficult symptoms and situations

2020 ◽  
Vol 14 ◽  
pp. 263235242095343
Author(s):  
Sara Booth
Keyword(s):  
Palliative Care ◽  
Care Setting ◽  
Symptom Control ◽  
Evidence Base ◽  
Self Management ◽  
Specialist Palliative Care ◽  
Personalized Care ◽  
Improve Symptom ◽  
Palliative Care Setting

This is a personal account of using hypnosis as an adjunct to specialist palliative care (SPC) treatment approaches. After a brief systematic review of the literature, one clinician’s experience is outlined illustrated by short, anonymized case histories. It argues that the approach is underused in SPC. The barriers currently restricting its routine adoption in SPC are discussed including (1) a lack of SPC clinical trials, (2) a misunderstanding of hypnosis leading to stigma, and (3) its absence from clinicians’ training pathways. While the evidence base for the effectiveness of hypnosis in ‘supportive care’, for example, managing chemotherapy-induced vomiting, is appreciable, there is a gap in SPC. There is little data to guide the use of hypnosis in the intractable symptoms of the dying, for example, breathlessness or the distress associated with missed or late diagnosis. There are many people now ‘living with and beyond cancer’ with chronic symptomatic illness, ‘treatable but not curable’. Patients often live with symptoms over a long period, which are only partially responsive to pharmacological and other therapies. Hypnosis may help improve symptom control and quality of life. SPC trials are needed so that this useful tool for self-management of difficult symptoms can be more widely adopted.

scholarly journals Palliative opioid use, palliative sedation and euthanasia: reaffirming the distinction

2019 ◽  
Vol 46 (1) ◽  
pp. 48-50 ◽  
Author(s):  
Guy Schofield ◽  
Idris Baker ◽  
Rachel Bullock ◽  
Hannah Clare ◽  
Paul Clark ◽  
...  
Keyword(s):  
Palliative Care ◽  
Real World ◽  
Symptom Control ◽  
Evidence Base ◽  
Routine Care ◽  
Palliative Sedation ◽  
Routine Practice ◽  
Opioid Use ◽  
Important Distinction ◽  
Opioid Prescribing

We read with interest the extended essay published from Riisfeldt and are encouraged by an empirical ethics article which attempts to ground theory and its claims in the real world. However, such attempts also have real-world consequences. We are concerned to read the paper’s conclusion that clinical evidence weakens the distinction between euthanasia and normal palliative care prescribing. This is important. Globally, the most significant barrier to adequate symptom control in people with life-limiting illness is poor access to opioid analgesia. Opiophobia makes clinicians reluctant to prescribe and their patients reluctant to take opioids that might provide significant improvements in quality of life. We argue that the evidence base for the safety of opioid prescribing is broader than that presented, restricting the search to palliative care literature produces significant bias as safety experience and literature for opioids and sedatives exists in many fields. This is not acknowledged in the synthesis presented. By considering additional evidence, we reject the need for agnosticism and reaffirm that palliative opioid prescribing is safe. Second, palliative sedation in a clinical context is a poorly defined concept covering multiple interventions and treatment intentions. We detail these and show that continuous deep palliative sedation (CDPS) is a specific practice that remains controversial globally and is not considered routine practice. Rejecting agnosticism towards opioids and excluding CDPS from the definition of routine care allows the rejection of Riisfeldt’s headline conclusion. On these grounds, we reaffirm the important distinction between palliative care prescribing and euthanasia in practice.

scholarly journals Conceptions about palliative care: literature review

2008 ◽  
Vol 21 (3) ◽  
pp. 504-508 ◽  
Author(s):  
Ednamare Pereira da Silva ◽  
Dora Sudigursky
Keyword(s):  
Palliative Care ◽  
Literature Review ◽  
Ethical Issues ◽  
Symptom Control ◽  
Family Quality Of Life ◽  
Life And Death ◽  
The Family ◽  
Humanistic Approach ◽  
The Individual

This literature review study aimed to identify the conceptions of palliative care mentioned in Brazilian journals. The databases LILACS, SciELO and BDENF were used. In total, 47 articles were selected, published from 2000 to 2006. The conceptions found refer to the concept of palliative care, understood as integral care for individuals in terminal conditions, emphasizing the physical, psychosocial and spiritual aspects of the individual and the family; quality of life; care based on a humanistic approach and valuation of life; pain and symptom control; ethical issues about life and death; multidisciplinary approach; dying as a natural process; the priority of care over cure; communication, spirituality and mourning support. These conceptions are considered highly important in palliative care; however, there is a lack of services and centers to deliver these types of care.

THE ROLE OF PHAGE THERAPY IN THE FORMATION OF THE INTESTINAL MICROECOSYSTEM

2020 ◽  
pp. 183-191
Author(s):  
Gladkov S.F. ◽  
Perevoshchikova N.K. ◽  
Chernykh N.S. ◽  
Pichugina Yu.S. ◽  
Surkova M.A.
Keyword(s):  
Intestinal Microbiota ◽  
Allergic Diseases ◽  
Evidence Base ◽  
Immunological Tolerance ◽  
Convincing Evidence ◽  
Selective Decontamination ◽  
Genetic Characteristics ◽  
Treatment And Prevention ◽  
Intestinal Infections ◽  
The Individual

The current adverse situation associated with the presence of a pandemic of allergic diseases is due to the lack of a scientifically based concept of treatment and prevention. The increased interest of researchers from different countries in the formation of immunological tolerance by modeling the intestinal microbiota is of high importance. Methods of influence on the microbial communities of the child's intestine should be as delicate as possible, taking into account the individual genetic characteristics of the microecosystem and the possibility of anaphylaxis. Until now, probiotic drugs have been widely used to correct dysbiosis, but data is gradually accumulating that there is no convincing evidence base for their use for the treatment and prevention of atopy. The use of bacteriophages is very relevant and one of the promising, actively studied areas of correction of intestinal biocenosis today, which are an alternative to antibiotic and probiotic medications. Selective decontamination of representatives of opportunistic flora, as the main factor in the implementation of the atopic phenotype, makes it possible to preserve and accelerate the formation of a unique and individual composition of the intestinal microbiota of the child, which can form an immunoregulatory balance. More than a century of experience in the use of bacteriophages indicates the safety of their use. Today, bacteriophages are actively used in various fields of practical medicine − obstetrics-gynecology, perinatology, urology, pediatric otorhinolaryngology, in the treatment of purulent-septic and intestinal infections. In some cases, bacteriophages are very effective against antibiotic-resistant pathogens. The active personalized use of bacteriophages in real clinical practice will make it possible to solve a number of serious, long-standing health problems in the Russian Federation and to win a world priority in this direction.

The support needs of parent caregivers of children with a life-limiting illness and approaches used to meet their needs: A scoping review

2020 ◽  
pp. 026921632096759
Author(s):  
Fenella J Gill ◽  
Zahraa Hashem ◽  
Roswitha Stegmann ◽  
Samar M Aoun
Keyword(s):  
Palliative Care ◽  
Scoping Review ◽  
English Language ◽  
Support Needs ◽  
Care Needs ◽  
Caregiver Support ◽  
Paediatric Palliative Care ◽  
Heterogenous Population ◽  
Parent Caregivers ◽  
The Individual

Background: Provision of paediatric palliative care is complex and optimally covers meeting the individual needs of a heterogenous population of children and their parent caregivers throughout a life-limiting illness. It is unclear whether existing approaches comprehensively address parent caregivers’ needs. Aim: To examine support needs of parents caring for children with life limiting illnesses and identify specific approaches used to identify and address needs. Design: A scoping review Data sources: MEDLINE, EMBASE, PsycINFO, CINAHL and ProQuest Central, were searched for peer reviewed English language full text research published from 2008 to 2019. Study quality appraisal was undertaken. Fourteen quantitative, 18 qualitative and 12 mixed methods studies were synthesised and themed using summative content analysis and mapped to the Parent Supportive Care Needs Framework (PSCNF). Results: Themes were communication, choice, information, practical, social, psychological, emotional and physical. Communication and choice were central and additional to domains of the PSCNF. Unmet were needs for supporting siblings, for respite care, out of hours, psychological, home and educational support. Six articles reported using instruments to identify parent carer support needs. Conclusion: Support needs of parent caregivers of children with life limiting illnesses are substantial and heterogenous. While studies report evidence of burden and distress in parent caregivers, this rarely translates into improvements in practice through the development of interventions. A systematic and regular assessment of individual parent caregiver support needs is required by using instruments appropriate to use in clinical practice to move the focus to palliative care interventions and improved services for parents.

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