bluuebunny/crossref_metadata_2025_split huggingface dataset:
Establishing the safety and efficacy of an opioid titration protocol
Authors: Wells Nancy , Murphy Barbara , Douglas Stacey , Yelton Nancy 
Published: May 2006

The primary goal of this single-group study was to determine the safety of a standard opioid titration order sheet to manage pain in ambulatory cancer patients. Secondary goals were to examine opioid toxicity and efficacy of this pain protocol. Twenty-seven patients who required fixed-dose opioids and who had uncontrolled pain were enrolled. All patients had their initial opioid dose titrated by the study physician using the opioid titration order sheet. Data were obtained by the study nurse during a weekly telephone interview and used to determine if pain was controlled. After initial titration, a trained study nurse titrated opioid doses based upon the standing order sheet. At each contact, patients were assessed for adverse effects, pain intensity, and analgesics used. Patients who completed the four-week trial (n = 17) did not differ from patients who did not complete the trial. No adverse effects were observed in 39 opioid titrations completed by the study nurse. Opioid toxicities, worst pain, usual pain, and pain-related distress declined from baseline to week four. Patients who were adherent to their prescribed medications reported significantly lower pain intensity and distress (psα .06). The opioid titration order sheet, used by a trained nurse, is safe to use in ambulatory cancer patients who have moderate to severe pain. Common opioid toxicities were reduced. The protocol also demonstrated initial efficacy in improving worst and usual pain and pain-related distress. Further research to establish efficacy of the protocol is recommended.
Medical house officers’ attitudes toward vigorous analgesia, terminal sedation, and physician-assisted suicide
Authors: Kaldjian Lauris C. , Wu Barry J. , Kirkpatrick James N. , Thomas-Geevarghese Asha , Vaughan-Sarrazin Mary 
Published: May 2006

In 2000, the authors surveyed 236 medical house officers in three internal medicine residency programs in Connecticut to assess attitudes toward vigorous analgesia, terminal sedation, and physician-assisted suicide. The goal was to identify associations between these attitudes and training, demographic, and religious factors. The results of the study indicated that most medical house officers supported vigorous analgesia, the majority supported terminal sedation, but only a minority supported physician-assisted suicide. Some house officers’ attitudes toward terminal sedation and assisted suicide may have been influenced by their religious commitments and the pressures of training.
Pacemaker and defibrillator deactivation in competent hospice patients: An ethical consideration
Authors: Ballentine Jennifer M. 
Published: May 2006

The Denver Community Bioethics Committee (DCBC) is an independent, community-based group that undertakes ethics consultations for any individual or organization. Its members include adult protection professionals, physicians, elder-law attorneys, chaplains, nurses, social workers, and lay persons. In its 11-year history, the Committee has heard numerous cases concerning end-of-life care, futile treatment, and patients’ rights. In 2003, a Colorado hospice provider asked the DCBC for assistance in developing a policy on deactivation of pacemakers and defibrillators in competent hospice patients. The hospice had encountered concerns from some physicians and cardiac care clinicians that deactivating such devices treads the fine line between legitimate withdrawal of burdensome treatment and assisted death. Although the specific deliberations of the DCBC are confidential, this article summarizes contributions from the committee’s discussion, as well as independent research undertaken by the author.
Cardiopulmonary resuscitation is not addressed in the admitting medical records for the majority of patients who undergo CPR in the hospital
Authors: Mirza Ayoub , Kad Rishi , Ellison Neil M. 
Published: May 2006

Cardiopulmonary resuscitation (CPR) is routinely performed on patients who develop cardiopulmonary arrest in the hospital. In some situations, it is performed on terminally or critically ill patients where death is predicted to be inevitable despite CPR. Since prior consent is not required for this procedure, CPR may be performed without patient consent or foreknowledge. Many of these patients may not want CPR if the anticipated outcome is reviewed with them. This study investigated the frequency of occurrence of a CPR discussion at the time of hospital admission for patients who undergo CPR during hospitalization. Results showed that CPR is infrequently addressed in the hospital orders or medical records in patients who undergo CPR during their hospital stay. In addition, the severity of illness at the time of admission does not appear to influence whether physicians discuss CPR with patients and their families.
Palliative care volunteerism among college students in Canada
Authors: Claxton-Oldfield Stephen , Tomes Jennifer , Brennan Michelle , Fawcett Catherine , Claxton-Oldfield Jane 
Published: May 2006

The goal of Study 1 was to investigate whether young Canadian adults were interested in becoming involved in palliative care volunteer work. After reading a brief description of what volunteering in a palliative care environment typically involves, participants (undergraduate students) were asked to indicate whether they would be interested in this kind of volunteer experience and to provide a written explanation of their answer. Of the 105 participating students, only 39 (37.1 percent) expressed an interest in volunteering, while 66 (62.9 percent) were not interested. Not surprisingly, the results revealed that significantly more females than males were interested in palliative care volunteer work (45.9 percent and 25.0 percent, respectively). The most common reason students gave for wanting to become a palliative care volunteer was to help others; the reason given most often for not wanting to volunteer was that it would be too emotionally demanding. It is important to note that prior to taking part in this study the majority of the participating students (75.9 percent) did not know what palliative care was. The goal of Study 2 was to investigate undergraduate students’ interest in volunteering in a nursing home, in a classroom, and at a food bank. Of the 111 participating students, 74 (66.7 percent) expressed an interest in volunteering at a food bank and in a nursing home, and 89 (80.2 percent) were interested in becoming a classroom volunteer. Together, the results of Studies 1 and 2 support the view that young people in Canada (especially males) are not interested in becoming involved in the care of dying persons. However, the results also indicate that they are very interested in volunteering with other populations (e.g., the elderly, school children) and in other settings (e.g., food bank).
Exploratory study on end-of-life issues: Barriers to palliative care and advance directives
Authors: Feeg Veronica D. , Elebiary Hoda 
Published: May 2006

Background. In the United States, as in most developed countries, death is rarely unexpected. It usually occurs in older persons with chronic progressive illnesses that often are complicated by infections or exacerbations. Many patients with terminal illnesses choose palliative care to relieve symptoms, improve the quality of their lives, and strive for a peaceful death. Professionals who serve dying patients need to recognize the importance of advance directives as part of a patient’s decision to forgo curative treatment for palliative care. Objectives. SOLACE™ (Supporters of Life-Affirming Care at End of Life) is a coalition of interdisciplinary professionals in the northern Virginia community dedicated to improving end-of-life care. The objectives of the SOLACE survey were to identify and describe: 1) professionals’ perceptions about barriers related to hospice and palliative care, 2) professionals’ opinions about barriers related to dying at home, 3) professionals’ perceptions about barriers related to advance directives, and 4) relationships between professionals and their perceived barriers to advance directives and hospice and palliative care. Methods. From several consultations with hospice experts, a survey questionnaire was developed to solicit responses from professionals on palliative care, dying at home, and advance directives. Measures that assessed obstacles to palliative care were modified from previous studies to yield composite barrier scores. From a sample of a variety of participants at a national conference on palliative care (n = 200), 101 subjects returned questionnaires (51 percent) yielding 100 usable completed forms from attendees who demonstrated an interest in palliative care and, in some cases, a high level of personal or professional experience. Survey results were analyzed on respondents’ perceptions concerning barriers related to advance directives and the delivery of palliative care. Results. Of the 13 obstacle statements, results show that respondents rated the top three barriers as 1) physician reluctance to make referrals (mean = 4.23), 2) physician lack of familiarity with availability and suitability of hospice (mean = 3.93), and 3) association of hospice with death (mean = 3.93). There was a statistically significant difference in scores for respondents from hospitals and respondents from hospices on their assessment of barriers for the association of hospice with death (t = -2.09, p < .05) and the lack of information about the severity of or irreversibility of the patient’s illness (t = -2.78, p < .01).
The use of metal or plastic needles in continuous subcutaneous infusion in a hospice setting
Authors: Abbas Syed Qamar , Yeldham Margaret , Bell Suzanne 
Published: May 2006

Objectives. Battery-driven portable syringe drivers are a convenient method for administering many drugs by continuous subcutaneous infusion (CSCI) to patients who cannot swallow medications. At the St. Clare Hospice, nurses usually use plastic needles to minimize needlestick injury but sometimes have patients transferred to metal needles. This study retrospectively examines this practice and its effectiveness. Methods. The duration of audit was four months. During this period, there were 40 patients (23 women, 17 men), who required their medications delivered by CSCI. A total number of 74 sites were used. Metal or plastic needle CSCIs connected with one-hour release Graseby ® Syringe Drivers were used. The syringes were set to deliver 2 mm/hour. The maximum volume syringe used was 50 ml. The data were collected retrospectively. Analysis and results. Sixteen patients (21.6 percent) developed minor complications (13 plastic, three metal). Among them, 16 showed inflammation. Two patients (3.5 percent) showed slight bleeding. Only one patient (1.7 percent) showed local infection (metal). In 14 patients (18.9 percent), the needle was reinserted due to various reasons, including needles pulled out by patients or needles falling out due to unknown reasons. There were no needlestick injuries reported, and the staff members reported that all problems encountered were easy to identify and resolve. Conclusion. Plastic needle CSCI prevents needlestick injury and gives minimum distress to the patients. More research is needed to determine the local side effects of drugs used and the strategies to resolve these problems.
The Florida Clergy End-of-Life Education Enhancement Project: A description and evaluation
Authors: Abrams David , Albury Sonya , Crandall Lee , Doka Kenneth J. , Harris Robert 
Published: May 2006

The Florida Clergy End-of-Life Education Enhancement Project was a model program developed to provide an interdenominational and statewide model of clergy education on loss, grief, dying, and death. The authors describe the project including materials and curriculum as well as present data from the project’s evaluation. Clergy and their partners in ministry responded enthusiastically to the project. As a whole, they reported higher levels of knowledge on end-of-life (EOL) issues at the conclusion of the training. Clergy and their ministerial teams also reported that they were better informed about the technical, procedural, medical, and legal issues that arise at the end of life and expressed the desire for subsequent training. The project indicates that clergy both recognize the need for additional training and are anxious to improve their abilities to minister to the dying and bereaved. The model presented here could easily be applied to local organizations such as hospices or denominational training.
Infection control at home
Authors: Lusby Grace , Martin Jeannee Parker , Schietinger Helen 
Published: May 2006

By early 1986, over 16,000 people had been diagnosed with AIDS in the United States. It has been estimated that between 5percent and 15 percent of these are hospitalized at any given time. Of the 80 to 95percent who are living at home, some are experiencing few symptoms and independent in their activities of daily living. However, approximately 20 to 25 percent of those living at homeexperience chronicor acute symptoms associated with AIDS, requiring intervention by the home team. Home care agencies throughout the country have provided services to people with AIDS in the home utilizing basic, standard precautions for infection control. This article will provide information regarding disease transmission, both to allay the anxieties of homecare personnel concerned aboutworking with AIDS patients, and to enable them to utilize appropriate precautions to prevent the transmission of AIDS and the associated opportunistic infections.
Spirituality and the caregiver
Authors: Millison Martin B. 
Published: May 2006

Spiritual aspects of care with the terminally ill has been rarely discussed in professional literature. To many caregivers, the notion of anything spiritual signals a referral to a chaplain rather than an exploration between caregiver and patient. In order to examine the role that spirituality plays for caregivers, eight professionals working with the terminally ill were interviewed. The common thread found in all the interviews was the heightened spirituality experienced by the caregivers as a result of their work with the terminally ill, and the impact that it has upon the patient. All caregivers felt they received more from their patients than they were able to give.
Acupressure wrist bands to relieve nausea and vomiting in hospice patients: Do they work?
Authors: Brown Sonja , North David , Marvel M. Kim , Fons Roger 
Published: May 2006

This study assessed the effects of acupressure wrist bands on the nausea and vomiting ofterminally ill patients. Using a single subject experimental design, six hospice patients were exposed to three conditions: • An acupressure wrist band; • A placebo wrist band; • A no wrist band condition. Patients and their caregivers rated nausea and vomiting during the treatment. Despitesome difficultyobtaining complete data, the results of this preliminary test indicate that acupressure wrist bandswere not effective in reducing nausea and vomiting in this small sample of hospice patients.
Hospice care in Japan
Authors: Suzuki Shizue , Kirschling Jane Marie , Inoue Iku 
Published: May 2006

Hospice care was introduced in Japan in the 1970s. There are currently an estimated 21 programs, which are primarily hospital-based. This paper provides an overview of the history, current state, and future trends of hospice care in Japan. Four programs are described, including staffing information, length of stay, and prognoses of patients. Hospice care in Japan is compared to hospice care in the United States and major differences are described. Lastly, the concept of “truth telling” is explored within the context of the Japanese culture. The discussion is based on a review of the literature and a mailed survey completed by 16 Japanese hospice programs during July 1992. The paper is in four sections: • An overview of Japan. • The history, current state, and future trends of hospice care in Japan. • The major differences between hospice care in Japan and the United States. • An exploration of “truth telling” within the context of the Japanese culture.
The role of the physical therapist in hospice care
Authors: Ebel Susan , Langer Karla 
Published: May 2006

The role of the physical therapist in hospice care is different from the role the therapist plays when a member of a rehabilitation team. This article will address the need for a fundamental role change and offer suggestions for ways physical therapists can contribute to the care of the hospice patient. In working with hospice patients, therapists must, for the most part, change from a controlling role to one of listener and problem-solver. In this manner; therapists can: • Assist the patient to maintain functional abilities for as long as possible; • Reduce the burden of care for the caregivers; • Assist in pain control. Physical therapists can provide hospice nurses with valuable assistance in caring for hospice patients.
What one small hospice learned from its grieving children’s program
Authors: McGlauflin Helene 
Published: May 2006

Bath-Brunswick Hospice, a small hospice in Brunswick, Maine. began their Grieving Children's Program in 1991. This article discusses the unique learning experience this program has been for this hospice. An overview of the entire organization and the Grieving Children's Program is given, as well as observations about how the program has impacted this hospice. Many aspects of this Grieving Children’s Program that are different from the usual hospice work are discussed, and the topics addressed include: • Serving Children! The Training, Coordination and Support of Volunteers; • The Need for Professional Consultants; • Hospice's Mission.
Antiemetic therapy in adults with terminal disease: A brief review
Authors: Rousseau Paul 
Published: May 2006

Although nausea and vomiting (NV) are common complaints among individuals with terminal illness, there are few studies evaluating the magnitude of this disabling syndrome. Most research has emphasized chemotherapy-induced emesis, however, Reuben and Mor’ analyzed National Hospice Study data 2 and noted NV in 62 percent of patients with advanced malignancy during the last two months of life. In addition, NV was observed more frequently in women, persons younger than 65 years of age, and patients with stomach and breast cancer Lamentably, physicians were less likely to prescribe antiemetics in the elderly and inpatients with an impaired level of awareness. With such a paucity of studies on NV in terminally-ill patients, there is frequent confusion regarding the etiology of emesis and the selection of appropriate antiemetics. This article will review the syndrome of N1 and discuss available drug regimens.
A personal exploration of the German hospice system
Authors: Farnon Christa 
Published: May 2006

While on vacation in Germany, I explored the German hospice system and its differences from that in the United States.I conducted an informal survey asking 10 individuals who were not associated with hospice work, about end-of-life issues. Knowledge of the hospice movement and of advance directives was found to be quite low.Through contact with German hospice associations, I learned that the modern German hospice movement was inspired by the British example. After a difficult beginning, the German hospice system is growing steadily. Professional providers of end-of-life care are paid according to the traditional fee-for-service system. As suggested by the World Health Organization, pain management is provided according to the three-step analgesic ladder. Physician-assisted suicide is illegal as it is in the United States. A federal self-determination law has not yet been enacted.Overall, the German hospice system has many similarities and a few interesting dissimilarities with that in the United States.
Decisions to utilize hospice—Pilot study results
Authors: Greipp Mary Elizabeth 
Published: May 2006

This research included surveys and interviews with 36 hospice clients to examine their decisions to enter hospice and to identify the factors which seemed to influence these decisions. Some of the issues addressed included the time in the client’s course of illness/treatment when the decision was made to enter hospice; who seemed to make the suggestion for the client to enter hospice; use of hospice by minorities, identification of variables which may indicate higher utilization and that could be used as predictors of use; and overall evaluation of the hospice experience. Ninety-seven percent of the study subjects stated that it was a good decision for them to have entered hospice. The one finding that is in direct contrast to the hospice literature is that 94 percent of the study subjects indicated that the timing of their referrals was appropriate and that they did not think that they should have been referred in sooner.
Debility, unspecified: A terminal diagnosis
Authors: Kinzbrunner Barry M. , Weinreb Neal J. , Merriman Melanie Pratt 
Published: May 2006

Objective: To determine whether the diagnosis “debility, unspecified” (ICD-9 code 799.3) is appropriate for use with terminally ill patients and to define the criteria for assigning the diagnosis. Design: A survey of patient charts to determine the clinical characteristics of a defined cohort. Setting: A comprehensive hospice program with average daily census over 500 patients. Patients: All patients who died in the hospice program during the period from January through October, 1993 and were assigned a diagnosis of “debility, unspecified” (ICD-9, 799.3). Measurements: For each patient, the following information was recorded: demographics, level of function (ability to carry out activities of daily living), presence of major system disease, other illnesses, any other appropriate ICD-9 coded diagnosis. Results: The diagnosis of “debility, unspecified” was confirmed in 50 out of 53 cases. All 50 patients exhibited multiple comorbid conditions. Major organ system impairment included central nervous system (96 percent of patients), cardio-pulmonary (76 percent of patients), skin integrity (42 percent of patients), and sepsis at the time of admission (30 percent of patients). The average survival for these patients was 67 days and the median survival was 20 days. In none of the 50 patients was there a single major system impairment of a degree to warrant a specific terminal diagnosis. Conclusions: The use of the ICD-9 code 799.3 “debility, unspecified” as a terminal diagnosis was confirmed to be appropriate based on survival and hospice length of stay data and on the fact that no patients exhibited a singular major system disease sufficient to support a terminal prognosis. A decision tree for assigning the diagnosis is presented.
The hardiness of hospice nurses
Authors: Hutchings Deanna 
Published: May 2006

Hardiness is a developing concept of particular relevance and interest to nursing. Hardiness is defined as a personality construct that is an amalgam of three main elements: control, challenge and commitment. Kobasa 1 asserts that an investment of committed energy serves to strengthen a person under stress or when faced with challenges. Hospice nurses confront a myriad of challenges associated with the rapidly changing needs of dying people and their friends and families. This author suggests that the very nature of palliative care requires mobilization of the same three constituents of hardiness, i.e., control, challenge, and commitment, blended with the key hospice elements of critical competence and compassionate care. This article considers a possible relationship between hardiness and hospice nurses, suggesting that not only are hospice nurses hardy, but that the very practice and philosophy of palliative care is predicated on a triad of control, challenge, and commitment harnessed in concert for the delivery of skilled, compassionate care to dying persons.