Hypodermoclysis (HDC) for Symptom Control Vs. the Edmonton Injector (EI)

1991 ◽  
Vol 7 (4) ◽  
pp. 5-8 ◽  
Author(s):  
Robin L. Fainsinger ◽  
Eduardo Bruera
Keyword(s):  
Palliative Care ◽  
Symptom Control ◽  
Terminally Ill ◽  
Palliative Care Unit ◽  
New Method ◽  
Time Saving ◽  
Treatment Methods ◽  
Terminally Ill Patients

Hypodermoclysis (HDC) is a well-known method of providing symptom control in terminally ill patients. In this article we make reference to two previous reports describing our use of HDC and a new method of subcutaneous narcotic delivery called the Edmonton Injector (El). The rationale for using HDC mainly for rehydration and the El when subcutaneous narcotics are needed is explored. The controversy surrounding the treatment of dehydration in the terminally ill is examined. Finally, the advantages on our palliative care unit of the convenience, increased flexibility, and cost and time saving of these two treatment methods are discussed.

Availability of Frozen Foods and an In-Room Freezer for Terminally Ill Patients with Malignancies in a Palliative Care Unit

2020 ◽  
Vol 23 (11) ◽  
pp. 1419-1420
Author(s):  
Hideaki Kawabata ◽  
Kazumi Kitamura ◽  
Yoshiki Yamamoto ◽  
Yohei Okamoto ◽  
Kaori Aoki ◽  
...  
Keyword(s):  
Palliative Care ◽  
Terminally Ill ◽  
Palliative Care Unit ◽  
Frozen Foods ◽  
Terminally Ill Patients

Sedation for Delirium and Other Symptoms in Terminally Ill Patients in Edmonton

2000 ◽  
Vol 16 (2) ◽  
pp. 5-10 ◽  
Author(s):  
Robin L Fainsinger ◽  
Donna De Moissac ◽  
Isabel Mancini ◽  
Doreen Oneschuk
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Acute Care ◽  
Terminally Ill ◽  
Care Program ◽  
Palliative Care Unit ◽  
Pharmacological Management ◽  
Terminally Ill Patients ◽  
Pain Syndromes ◽  
Care Groups

The use of sedation and the management of delirium and other difficult symptoms in terminally ill patients in Edmonton has been reported previously. The focus of this study was to assess the prevalence in the Edmonton region of difficult symptoms requiring sedation at the end of life. Data were collected for 50 consecutive patients at each of (a) the tertiary palliative care unit, (b) the consulting palliative care program at the Royal Alexandra Hospital (acute care), and (c) three hospice inpatient units in the city. Patients on the tertiary palliative care unit were significantly younger. Assessments confirmed the more problematic physical and psychosocial issues of patients in the tertiary palliative care unit. These patients had more difficult pain syndromes and required significantly higher doses of daily opioids. Approximately 80% of patients in all three settings developed delirium prior to death. Pharmacological management of this problem was needed by 40% in the acute care setting, and by 80% in the tertiary palliative care unit. The patients sedated varied from 4% in the hospice setting to 10% in the tertiary palliative care unit. Of the 150 patients, nine were sedated for delirium, one for dyspnea. The prevalence of delirium and other symptoms requiring sedation in our area is relatively low compared to others reported in the literature. Demographic variability between the three Edmonton settings highlights the need for caution in comparing results of different palliative care groups. It is possible that some variability in the use of sedation internationally is due to cultural differences. The infrequent deliberate use of sedation in Edmonton suggests that improved management has resulted in fewer distressing symptoms at the end of life. This is of benefit to patients and to family members who are with them during this time.

Policy, Resources and Practice: A Palliative Care Ward

1989 ◽  
Vol 5 (2) ◽  
pp. 6-9 ◽  
Author(s):  
Paul D. Henteleff
Keyword(s):  
Palliative Care ◽  
Terminally Ill ◽  
Palliative Care Unit ◽  
Terminally Ill Patients ◽  
Direct Admission ◽  
Dying At Home ◽  
Care Ward ◽  
At Home ◽  
Policies And Practices

Palliative Care, like any other service, must operate with policies, practices and resources. The St. Boniface Hospital Program undertook to reduce the insecurities of dying at home by assuring direct admission of terminally ill patients to the Palliative Care Unit. The operation of the unit was simulated with a computer to define rules for controlling bed utilization. The simulated description of the program also enabled projection of bed needs to accommodate changing demand and guided redefinition of policies and practices to adjust to changes. Over a ten year period the program was able to double program size with fixed resources.

Effect of Nutritional Support on Terminally Ill Patients With Cancer in a Palliative Care Unit

2012 ◽  
Vol 30 (7) ◽  
pp. 730-733 ◽  
Author(s):  
Koji Amano ◽  
Tatsuya Morita ◽  
Mika Baba ◽  
Muneyoshi Kawasaki ◽  
Shinichiro Nakajima ◽  
...  
Keyword(s):  
Palliative Care ◽  
Nutritional Support ◽  
Terminally Ill ◽  
Palliative Care Unit ◽  
Patients With Cancer ◽  
Terminally Ill Patients

scholarly journals Symptom clusters and their influence on prognosis using EORTC QLQ-C15-PAL scores in terminally ill patients with cancer

2021 ◽  
Author(s):  
Nanako Koyama ◽  
Chikako Matsumura ◽  
Yuuna Tahara ◽  
Morito Sako ◽  
Hideo Kurosawa ◽  
...  
Keyword(s):  
Palliative Care ◽  
Terminally Ill ◽  
Symptom Clusters ◽  
Rank Test ◽  
Appetite Loss ◽  
Patients With Cancer ◽  
Terminally Ill Patients ◽  
Log Rank Test ◽  
Eortc Qlq ◽  
Cluster 2

Abstract Purpose The aims of the present study were to investigate the symptom clusters in terminally ill patients with cancer using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative Care (EORTC QLQ-C15-PAL), and to examine whether these symptom clusters influenced prognosis. Methods We analyzed data from 130 cancer patients hospitalized in the palliative care unit from June 2018 to December 2019 in an observational study. Principal component analysis was used to detect symptom clusters using the scored date of 14 items in the QLQ-C15-PAL, except for overall QOL, at the time of hospitalization. The influence of the existence of these symptom clusters and Palliative Performance Scale (PPS) on survival was analyzed by Cox proportional hazards regression analysis, and survival curves were compared between the groups with or without existing corresponding symptom clusters using the log-rank test. Results The following symptom clusters were identified: cluster 1 (pain, insomnia, emotional functioning), cluster 2 (dyspnea, appetite loss, fatigue, and nausea), and cluster 3 (physical functioning). Cronbach’s alpha values for the symptom clusters ranged from 0.72 to 0.82. An increased risk of death was significantly associated with the existence of cluster 2 and poor PPS (log-rank test, p = 0.016 and p < 0.001, respectively). Conclusion In terminally ill patients with cancer, three symptom clusters were detected based on QLQ-C15-PAL scores. Poor PPS and the presence of symptom cluster that includes dyspnea, appetite loss, fatigue, and nausea indicated poor prognosis.

Japanese physicians’ experiences of terminally ill patients voluntarily stopping eating and drinking: a national survey

2017 ◽  
Vol 9 (2) ◽  
pp. 143-145 ◽  
Author(s):  
Takuya Shinjo ◽  
Tatsuya Morita ◽  
Daisuke Kiuchi ◽  
Masayuki Ikenaga ◽  
Hirofumi Abo ◽  
...  
Keyword(s):  
Palliative Care ◽  
National Survey ◽  
Clinical Setting ◽  
Deep Sedation ◽  
Terminally Ill ◽  
Treatment Decision ◽  
Mail Questionnaire ◽  
Terminally Ill Patients ◽  
Continuous Deep Sedation

ObjectivesVoluntarily stopping eating and drinking (VSED) could be regarded as a patients’ own non-treatment decision that hastens death, which involves patients voluntarily forgoing food and liquid until death. The aims of this study were to investigate the experience of home hospice physicians and palliative care specialists who care for patients during VSED in Japan, and their opinions on continuous deep sedation (CDS) as a means to relieve patient symptoms during VSED.Methods219 home hospice physicians and 695 palliative care specialists across Japan were surveyed by mail questionnaire in 2016.ResultsA total of 571 (62%) responses were analysed. A total of 185 (32%) had experience of patients who selected VSED. In response to questions about CDS to provide relief to patients during VSED, the number of physicians who replied that CDS was acceptable was 88 (15%).ConclusionsIn Japan, 32% of physicians surveyed replied that they had experience of caring for patients during VSED in a clinical setting and 15% considered CDS acceptable.

scholarly journals Experience of symptom control, anxiety and associating factors in a palliative care unit evaluated with Support Team Assessment Schedule Japanese version

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Tetsuya Ito ◽  
Emi Tomizawa ◽  
Yuki Yano ◽  
Kiyozumi Takei ◽  
Naoko Takahashi ◽  
...  
Keyword(s):  
Palliative Care ◽  
Symptom Control ◽  
Laboratory Data ◽  
Japanese Version ◽  
Palliative Care Unit ◽  
Current Status ◽  
Physical Factors ◽  
Patient Anxiety ◽  
Team Assessment ◽  
Support Team

AbstractVarious physical and psychosocial difficulties including anxiety affect cancer patients. Patient surroundings also have psychological effects on caregiving. Assessing the current status of palliative care intervention, specifically examining anxiety and its associated factors, is important to improve palliative care unit (PCU) patient quality of life (QOL). This study retrospectively assessed 199 patients admitted to a PCU during August 2018–June 2019. Data for symptom control, anxiety level, disease insight, and communication level obtained using Support Team Assessment Schedule Japanese version (STAS-J) were evaluated on admission and after 2 weeks. Palliative Prognostic Index (PPI) and laboratory data were collected at admission. Patient anxiety was significantly severer and more frequent in groups with severer functional impairment (p = 0.003) and those requiring symptom control (p = 0.006). Nevertheless, no relation was found between dyspnea and anxiety (p = 0.135). Patients with edema more frequently experienced anxiety (p = 0.068). Patient survival was significantly shorter when family anxiety was higher after 2 weeks (p = 0.021). Symptoms, edema, and disabilities in daily living correlate with patient anxiety. Dyspnea is associated with anxiety, but its emergence might be attributable mainly to physical factors in this population. Family members might sensitize changes reflecting worsened general conditions earlier than the patients.

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