Abstract:
:This study looked at the efficacy of drug treatment in managing death rattle in a 30-bedded specialist palliative care unit. The study was conducted in two phases. In the first, patients received hyoscine hydrobromide as the antimuscarinic; glycopyrrolate was used in the second phase. The patients in the two phases were well matched for diagnosis, age, sex and duration of death rattle. A noise score scale of 0-3 was used, which was separately validated using a verbal rating scale and noise-meter readings. Noise scores were taken at the start; 30 min after an antimuscarinic drug was administered; an hour after the initial injection if a repeat dose was given at 30 min; and 4-hourly thereafter. Drug charts of all patients with death rattle were analysed to ascertain the amount of each drug given and the cost. The incidence of death rattle was 44% in phase I, and 36% in phase II. The percentage of patients with reduced noise scores 30 min after one injection of hyoscine was significantly greater than after one dose of glycopyrrolate (56% vs 27%, P = 0.002). The need for a second injection after 30 min was less using hyoscine (33% vs 50%, P = 0.03). There was no statistically significant difference in improvement at 1 h, or at the last recorded score before death. A comparison of the cost of drug treatment using hyoscine or glycopyrrolate was made, and the potential reduction in cost per patient in the glycopyrrolate group was largely offset by increased expenditure on other drugs, especially diamorphine, midazolam and levomepromazine. The results of this study suggest that: (1) glycopyrrolate 0.2 mg is less effective at reducing death rattle than hyoscine hydrobromide 0.4 mg when assessed at 30 min, (2) the use of glycopyrrolate may lead to an increased need for other sedative or anti-emetic medication such as diamorphine, midazolam or levomepromazine, and (3) the cost benefit of using glycopyrrolate over hyoscine hydrobromide is a small part of the total drug budget, and may be less than anticipated due to the increased need of these other drugs.
journal_name
Palliat Medjournal_title
Palliative medicineauthors
Back IN,Jenkins K,Blower A,Beckhelling Jdoi
10.1191/026921601678320313subject
Has Abstractpub_date
2001-07-01 00:00:00pages
329-36issue
4eissn
0269-2163issn
1477-030Xjournal_volume
15pub_type
临床试验,杂志文章abstract:BACKGROUND:Population ageing will lead to more deaths with an uncertain trajectory. Identifying patients at risk of dying could facilitate more effective care planning. AIM:To determine whether screening for likely death within 12 months is more effective using screening tools or intuition. DESIGN:Randomised controll...
journal_title:Palliative medicine
pub_type: 杂志文章,随机对照试验
doi:10.1177/0269216317698621
更新日期:2018-02-01 00:00:00
abstract:BACKGROUND:Death anxiety is important but understudied in palliative care. New self-report measurements have been developed, but their interpretation and clinical utility may not be evident. AIM:To inform our understanding of death anxiety in patients with advanced cancer by exploring the relationship between this sel...
journal_title:Palliative medicine
pub_type: 杂志文章
doi:10.1177/0269216316628780
更新日期:2016-09-01 00:00:00
abstract:BACKGROUND:The complexity of end-of-life care, represented by a large number of units caring for dying patients, different types of organizations and difficulties in identification and prognostication, signifies the importance of finding ways to measure the quality of end-of-life care. AIM:To establish, test and manag...
journal_title:Palliative medicine
pub_type: 杂志文章
doi:10.1177/0269216311414758
更新日期:2012-06-01 00:00:00
abstract::The purpose of this study is to analyze French general practitioners' attitudes toward prescribing opiate painkillers for dying patients and compare them with their attitudes toward making frequent home visits. One hundred and fifteen general practitioners indicated the acceptability of prescribing opiates in 48 scena...
journal_title:Palliative medicine
pub_type: 杂志文章
doi:10.1177/0269216309107012
更新日期:2010-01-01 00:00:00
abstract:BACKGROUND:The Gold Standards Framework (GSF) was developed to improve the delivery of palliative care in general practice. AIM:The aim of the study was to evaluate the first phase of GSF in terms of its acceptability to primary care teams, effectiveness in changing practice and professionals' views on the consequence...
journal_title:Palliative medicine
pub_type: 杂志文章
doi:10.1177/0269216306072501
更新日期:2007-01-01 00:00:00
abstract::This study reports the process and results of a psychometric evaluation of a clinical audit tool, the Support Team Assessment Schedule (STAS), used to measure outcomes of palliative care. The STAS was developed in London, UK to audit community palliative care services provided by a support team. The purpose of this st...
journal_title:Palliative medicine
pub_type: 杂志文章
doi:10.1191/026921600677786382
更新日期:2000-01-01 00:00:00
abstract::A system of 12-hour nursing shifts was adopted at a newly-opened independent hospice. This paper presents the results from an exploratory, descriptive study in which nursing staff reported perceived advantages, disadvantages and satisfaction with the 12-hour shift system. A small sample (n = 11) of both qualified and ...
journal_title:Palliative medicine
pub_type: 杂志文章
doi:10.1177/026921639500900206
更新日期:1995-04-01 00:00:00
abstract::Philip J Larkin, Fliss Murtagh, Heather Richardson, Myra Bluebond Langner and Sheila Payne (2016) Collaboration: Securing a future for palliative care research. Palliative Medicine, September 2016 30:8 709-710, doi: 10.1177/0269216316661970. ...
journal_title:Palliative medicine
pub_type: 杂志文章,已发布勘误
doi:10.1177/0269216316672799
更新日期:2016-12-01 00:00:00
abstract:BACKGROUND:Early palliative care improves quality of life during life-prolonging treatment for patients with cancer, but the role of nurses in facilitating the early involvement of palliative care is unclear. AIM:To conceptualize the psychosocial processes involved in the introduction and provision of palliative care ...
journal_title:Palliative medicine
pub_type: 杂志文章
doi:10.1177/0269216319883980
更新日期:2020-02-01 00:00:00
abstract::This study reports UK doctors' opinions about legalisation of medically assisted dying (euthanasia and physician-assisted suicide), comparing this with the UK general public. A postal survey of 3733 UK medical practitioners was done. The majority of UK doctors are opposed to legalisation, contrasting with the UK gener...
journal_title:Palliative medicine
pub_type: 杂志文章
doi:10.1177/0269216308102041
更新日期:2009-04-01 00:00:00
abstract::The most commonly encountered clinical conditions presenting with cognitive failure (CF) are delirium, dementia and amnestic disorders. Of these, delirium is probably the most prevalent in palliative care, and it is potentially reversible. Thus, improvement in diagnostics seems warranted. The objectives of this review...
journal_title:Palliative medicine
pub_type: 杂志文章,评审
doi:10.1191/0269216304pm920oa
更新日期:2004-09-01 00:00:00
abstract:BACKGROUND AND AIMS:Palliative medicine is not recognized as a medical specialty in any of the five Nordic countries, but there is a great need for physicians with specialty qualifications to serve on an increasing number of palliative care services. The Associations for Palliative Medicine in the five countries agreed...
journal_title:Palliative medicine
pub_type: 杂志文章,多中心研究
doi:10.1177/0269216307087320
更新日期:2008-04-01 00:00:00
abstract::Cyclizine is an antihistamine, which is frequently used to manage nausea and vomiting in cancer patients. Antihistamines can be drugs of misuse/abuse, and the article describes four cancer patients who developed such problems after receiving parenteral cyclizine within the inpatient unit of a cancer centre. The articl...
journal_title:Palliative medicine
pub_type: 杂志文章,评审
doi:10.1177/0269216308094337
更新日期:2008-10-01 00:00:00
abstract:BACKGROUND:As end-of-life (EoL) care expands across Europe and the world, service developments are increasingly studied. The sociocultural context in which such changes take place, however, is often neglected in research. AIM:To explore sociocultural factors in EoL care in Belgium as represented by the literature. DE...
journal_title:Palliative medicine
pub_type: 杂志文章,meta分析,评审
doi:10.1177/0269216311429619
更新日期:2013-02-01 00:00:00
abstract::This paper reviews a number of studies relating to religion and coping with chronic illness, emphasizing those aspects relevant to palliative care. After pointing out that religious and existential needs are common in chronic illness, a critical examination is made of those studies which purport to demonstrate associa...
journal_title:Palliative medicine
pub_type: 杂志文章,评审
doi:10.1177/026921639701100405
更新日期:1997-07-01 00:00:00
abstract:BACKGROUND:In rural settings, relationships between place and self are often stronger than for urban residents, so one may expect that rural people would view dying at home as a major feature of the 'good death'. AIM:To explore the concept of the 'good death' articulated by rural patients with life-limiting illnesses,...
journal_title:Palliative medicine
pub_type: 杂志文章
doi:10.1177/0269216318800613
更新日期:2018-12-01 00:00:00
abstract:BACKGROUND:Death with dignity has been identified as important both to patients and their surviving family. While research results have been published on what patients themselves believe may affect the dignity of their deaths, little is known about what family caregivers consider to be a dignified death. AIM:(1) To as...
journal_title:Palliative medicine
pub_type: 杂志文章
doi:10.1177/0269216313483185
更新日期:2013-07-01 00:00:00
abstract:BACKGROUND:The evidence supporting pharmacological treatment of death rattle is poor; yet, anticholinergic drugs feature in end-of-life care pathways and guidelines worldwide as a treatment option. AIM:This qualitative arm of a wider study aimed to explore important issues which health-care professionals associated wi...
journal_title:Palliative medicine
pub_type: 杂志文章
doi:10.1177/0269216312464407
更新日期:2013-09-01 00:00:00
abstract:BACKGROUND:Gastroparesis is an under-recognised cause of refractory nausea and vomiting in patients with malignancy. The most common aetiologies are paraneoplastic and postsurgical dysmotility. There are little data on the efficacy of treatment to direct the management of patients with this symptom. We present a case a...
journal_title:Palliative medicine
pub_type: 杂志文章
doi:10.1177/0269216314528400
更新日期:2014-07-01 00:00:00
abstract::Place of death is at times suggested as an outcome for palliative care services. This study aimed to describe longitudinal preferences for place of care and place of death over time for patients and their caregivers. Longitudinal paired data of patient/caregiver dyads from a prospective unblinded cluster randomised co...
journal_title:Palliative medicine
pub_type: 杂志文章,随机对照试验
doi:10.1177/0269216308092287
更新日期:2008-10-01 00:00:00
abstract::The amount and quality of information and awareness in cancer patients' is a topic frequently debated, but few studies have focussed on terminal patients. This is the objective of the present study that involved two different palliative home-care units in Italy, which recruited 550 terminal cancer patients. Data from ...
journal_title:Palliative medicine
pub_type: 杂志文章,多中心研究
doi:10.1177/0269216308100772
更新日期:2009-06-01 00:00:00
abstract::Enabling patients to be cared for in their preferred location often involves journeys between care settings. The challenge of ensuring journeys are timely and safe emerged as an important issue in an evaluation of palliative care services, which informed a service redesign programme in three areas of the United Kingdo...
journal_title:Palliative medicine
pub_type: 杂志文章,多中心研究
doi:10.1177/0269216309106893
更新日期:2009-12-01 00:00:00
abstract:OBJECTIVES:To review current understanding of the knowledge and information needs of informal caregivers in palliative settings. DATA SOURCES:Seven electronic databases were searched for the period January 1994--November 2006: Medline, CINAHL, PsychINFO, Embase, Ovid, Zetoc and Pubmed using a meta-search engine (Metal...
journal_title:Palliative medicine
pub_type: 杂志文章,评审
doi:10.1177/0269216307085343
更新日期:2008-03-01 00:00:00
abstract:BACKGROUND:Chronically homeless individuals have high rates of hospitalization and death, and they may benefit from the completion of advance directives. AIM:To determine the rate of advance directive completion using a counselor-guided intervention, identify characteristics associated with advance directive completio...
journal_title:Palliative medicine
pub_type: 杂志文章
doi:10.1177/0269216315575679
更新日期:2015-09-01 00:00:00
abstract:BACKGROUND:Terminal illness not only causes physical suffering but also spiritual distress. Spiritual care has been widely implemented by healthcare professionals to assist patients coping with spiritual distress. However, the effects of spiritual care need to be clear. AIM:To evaluate the effects of spiritual care on...
journal_title:Palliative medicine
pub_type: 杂志文章
doi:10.1177/0269216318772267
更新日期:2018-07-01 00:00:00
abstract::The aim of this study is to synthesize knowledge about the process of shared decision-making (SDM) in palliative care. Medline, EMBASE, CINAHL, PsychInfo, Web of Science were searched with core concepts: shared decisions, patient participation in decision-making, and palliative care. Titles and abstracts were screened...
journal_title:Palliative medicine
pub_type: 杂志文章,评审
doi:10.1177/0269216310389348
更新日期:2011-04-01 00:00:00
abstract:BACKGROUND:The Delirium Observation Screening Scale (DOS) is designed to detect delirium by nurses' observations and has shown good psychometric properties. Its use in palliative care unit patients has not been studied. AIM:To determine diagnostic and concurrent validity, internal consistency, and user-friendliness of...
journal_title:Palliative medicine
pub_type: 杂志文章
doi:10.1177/0269216313492187
更新日期:2014-01-01 00:00:00
abstract:INTRODUCTION:Even though depression has serious and wide-ranging effects on outcomes in palliative care, errors in the identification of depressed patients are common. OBJECTIVES:To examine the clinical validity of widely publicised one- and two-question screening tools for depression in two palliative care settings. ...
journal_title:Palliative medicine
pub_type: 杂志文章
doi:10.1191/0269216305pm1021oa
更新日期:2005-06-01 00:00:00
abstract:BACKGROUND:In clinical practice the major role of opioid drugs is the management of malignant and nonmalignant pain. The primary aim of this study is to evaluate the trend in sales of four opioid analgesic drugs (codeine, tramadol, morphine, fentanyl), from wholesalers to community pharmacies, as an indicator of opioid...
journal_title:Palliative medicine
pub_type: 杂志文章,多中心研究
doi:10.1191/0269216305pm1002oa
更新日期:2005-04-01 00:00:00
abstract:BACKGROUND:People with dementia requiring palliative care have multiple needs, which are amplified in long-term care settings. The European Association for Palliative Care White Paper offers recommendations for optimal palliative care in dementia integral for this population, providing useful guidance to inform interve...
journal_title:Palliative medicine
pub_type: 杂志文章
doi:10.1177/0269216319900141
更新日期:2020-04-01 00:00:00