Association between hospice care and psychological outcomes in Alzheimer's spousal caregivers.

Context: Dementia care giving can lead to increased stress, physical and psychosocial morbidity, and mortality. Anecdotal evidence suggests that hospice care provided to people with dementia and their caregivers may buffer caregivers from some of the adverse outcomes associated with family caregiving in Alzheimer's Disease (AD).

Objectives: This pilot study examined psychological and physical outcomes among 32 spousal caregivers of patients with AD.

Hospice staff perspectives on Dignity Therapy.

Background: Dignity Therapy is a brief psychotherapy performed with patients at the end of life. Previous research has examined the effects of Dignity Therapy with patients and family, but none has examined hospice staff perceptions of the treatment.

Objective: The study objective was to investigate hospice staff perspectives regarding the impact and value of Dignity Therapy when provided as a clinical service.

Clarifying delirium management: practical, evidenced-based, expert recommendations for clinical practice.

Delirium is highly prevalent in those with serious or advanced medical illnesses. It is associated with many adverse consequences, including significant patient, family, and health care provider distress. This article suggests a novel approach to delirium assessment and management and provides useful, practical guidance for clinicians based on a complete review of the existing literature and the expert clinical opinion of the authors and their colleagues, derived from over a decade of collective bedside experience.

Comparison of international medical graduates with US medical students and residents after a four-week course in palliative medicine: a pilot study.

Background: The need for doctors who have skills in pain management and palliative medicine is greatest in low and moderate resource countries where patients most frequently present to their health care system with advanced illness and greater than 80% of the global deaths occur. While medical students trained in the United States are required to have training in palliative medicine, international medical graduates (IMGs), who have completed medical school outside North America, may not have the same exposure to palliative medicine training as U.S.

The effect of education in hospice and palliative care on emergency medicine residents' knowledge and referral patterns.

Objectives: To determine: (1) residents' knowledge base in key concepts in hospice and palliative care, (2) residents' comfort level in discussing end-of-life (EOL) care and managing EOL symptoms, and (3) if a brief educational intervention improves residents' knowledge of and comfort in dealing with EOL issues both immediately following and six months after the intervention.

Methods: This prospective cohort study was performed at a level-1 community trauma center. A survey was developed regarding knowledge of palliative care and its emergency department (ED) utilization and administered to emergency medicine (EM) residents.

The hospice caregiver support project: providing support to reduce caregiver stress.

Introduction: The vast majority (80%) of care provided to hospice patients is given by informal and unpaid caregivers, who are often family members. They may be responsible for everything from management of the household and finances to medical and personal care. Providing this kind of care to a loved one at the end of life can contribute to increased stress, health problems, and decreased quality of life.

Methylnaltrexone for opioid-induced constipation in advanced illness.

Background: Constipation is a distressing side effect of opioid treatment. As a quaternary amine, methylnaltrexone, a mu-opioid-receptor antagonist, has restricted ability to cross the blood-brain barrier. We investigated the safety and efficacy of subcutaneous methylnaltrexone for treating opioid-induced constipation in patients with advanced illness.