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Palliative Care

Welcome to the palliative care category for physicians and pharmacists. This clinical category features links to resources on palliative care guidelines, syringe driver, prescribing in palliative medicine and symptom management e.g. pain, constipation, nausea and vomiting, dry mouth and respiratory secretions.

The International Association for Hospice and Palliative Care Manual of Palliative Care 3rd Edition

The IAHPC Manual of Palliative Care is not intended to be a substitute for any textbook or reference book. Nor do its authors claim that it is exhaustive and comprehensive. It does however contain much of what is necessary for the day-to-day practice of palliative care.

Source: hospicecare.com
Clinical Resource: Manual
Register to Access Content: No

Last Checked: 24/04/14 Link Error: Report It

 

European Association for Palliative Care Recommendations and White Papers in Progress

Source: eapcnet.eu
Clinical Resource: Recommendations and White Papers
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Last Checked: 24/04/14 Link Error: Report It

 

Fast Facts and Concepts

Fast Facts provide concise, practical, peer-reviewed and evidence-based summaries on key palliative care topics important to clinicians and trainees caring for patients facing serious illness.

Source: mypcnow.org
Clinical Resource: Summaries
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Last Checked: 02/03/16 Link Error: Report It

 

Palliative Care Tips

"How to" Practical Suggestions for Common Problems in the Terminally Ill

Source: palliative.org
Clinical Resource: Tips
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Last Checked: 24/04/14 Link Error: Report It

 

The Cochrane Collaboration
Cochrane Reviews - Palliative and Supportive Care

Cochrane is an international, non-profit, independent organisation, established to ensure that up-to-date, accurate information about the effects of healthcare interventions is readily available worldwide. It produces and disseminates systematic reviews of healthcare interventions, and promotes the search for evidence in the form of clinical trials and other studies of the effects of interventions.

Source: cochrane.org
Clinical Resource: Systematic Reviews
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Last Checked: 13/07/15 Link Error: Report It

 

Bandolier Knowledge
Palliative and supportive care

The aim is to try and gather together information of interest in palliative care.

Source: bandolier.org.uk
Clinical Resource: Evidence Based Abstracts
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Last Checked: 13/06/17 Link Error: Report It

 

Pallipedia - The Free Online Palliative Care Dictionary

Source: pallipedia.org
Clinical Resource: Dictionary
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Last Checked: 24/04/14 Link Error: Report It

 

 

palliativedrugs.com

Palliativedrugs.com provides essential independent information for health professionals about drugs used in palliative and hospice care. It includes unlicensed (unlabeled) indications and routes, and details about the administration of multiple drugs by continuous subcutaneous infusion.

Source: palliativedrugs.com
Clinical Resource: Various
Register to Access Content: Yes - registration is FREE

Last Checked: 24/04/14 Link Error: Report It

 

Palliative Care Guidelines Plus

The site aims to offer up-to-date, evidence based information and guidance on professional aspects of palliative care.

Source: pallcare.info
Clinical Resource: Various
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Last Checked: 24/04/14 Link Error: Report It

 

Palliative Care Tools - Promoting Excellence in End-of-Life Care

These palliative care tools were developed or adapted by Promoting Excellence in End-of-Life Care demonstration projects and national workgroups. Click on any of the categories below to run a current search.

Clinical Care Tools
Evaluation Tools
Educational Tools
Organizational Tools

Source: promotingexcellence.org
Clinical Resource: Tools
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Last Checked: 24/04/14 Link Error: Report It

 

National Palliative Care Research Center Measurement and Evaluation Tools

Under each of the sections below is a selection of measurement and evaluation tools for conducting palliative care research. Many of these tools are copyrighted and professionals should site sources and register, if applicable, when using the material.

Pain and Symptom Management
Functional Status
Psychosocial Care
Caregiver Assessment
Quality of Life

Source: npcrc.org
Clinical Resource: Tools
Register to Access Content: Yes - some of these tools require registration

Last Checked: 24/04/14 Link Error: Report It

 

 

Palliative Care Service
Christchurch Hospital Palliative Care Service

  • Palliative Care Guidelines
    • Management of Persistent Pain in the Palliative Setting
    • Nausea and Vomiting
    • Constipation
    • Intestinal Obstruction
    • Dyspnoea
    • Cough
    • Retained Secretions
    • Hiccoughs
    • Dry Mouth
    • Sweating
    • Itch/ Pruritis
    • Agitation
    • Delirium
    • Care of the Imminently Dying

  • Health Professional Resources
    • Prescribing of Opioids
    • Subcutaneous Administration of Medications
    • Drug Information Sheets
    • Guidelines and Factsheets
    • Making Resuscitation Decisions
    • Niki T34 Syringe Pump
    • Intraspinal Analgesia
Source: cdhb.govt.nz
Clinical Resource: Guidelines
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Last Checked: 24/04/14 Link Error: Report It

 

Scottish Palliative Care Guidelines

The Scottish Palliative Care Guidelines reflect a consensus of opinion about good practice in the management of adult patients with life limiting illness. They are designed for healthcare professionals from any care setting who are involved in supporting people with a palliative life-limiting condition.

Pain
Symptom Control
Palliative Emergencies
End of Life Care
Medicine Information
Patient Information

Source: palliativecareguidelines.scot.nhs.uk
Clinical Resource: Guidelines
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Last Checked: 21/08/15 Link Error: Report It

 

99 Common Questions (and more) About Hospice Palliative Care
A nurse’s handbook

The handbook was published in 2013 by the Edmonton Zone Palliative Care Program, Alberta Health Services, following a review by hospice palliative care (HPC) professionals from across Canada. The handbook was written to enhance the professional caregiver’s capacity and confidence in offering Hospice Palliative Care.

Source: palliative.org
Clinical Resource: Handbook
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Last Checked: 19/05/14 Link Error: Report It

 

Evidence-Based Management Tools, Protocols and Guidelines

The following evidence-based care management tools have been developed by health care professionals with expertise in palliative care. Disciplines such as nursing, pharmacy, and medicine were represented. These tools are intended for use by palliative care consultants, as well as other health care professionals who are involved in the care of palliative patients.

Source: palliative.org
Clinical Resource: Tools, Protocols and Guidelines
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Last Checked: 24/04/14 Link Error: Report It

 

The Palliative Care Handbook
Advice on clinical management

This handbook contains guidance to help GPs, community nurses and hospital staff as well as specialist palliative care teams. It aims to provide a checklist for the management of common problems in palliative care, with some information on drug treatment.

Source: ruh.nhs.uk
Clinical Resource: Handbook
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Last Checked: 24/04/14 Link Error: Report It

 

The Palliative Care Handbook
Guidelines for Clinical Management and Symptom Control

Written by:

  • Prof Rod MacLeod, Department of General Practice and Primary Health Care, University of Auckland and Hospice North Shore, Auckland
  • Jane Vella-Brincat, Clinical Pharmacist, Christchurch Hospital
  • Assoc. Prof. A.D. (Sandy) Macleod, Health Science Department, University of Canterbury and Palliative Medicine Specialist, Christchurch Hospital, Christchurch
Source: fmhs.auckland.ac.nz
Clinical Resource: Handbook
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Last Checked: 24/04/14 Link Error: Report It

 

Adult Palliative Care General Guidelines

This leaflet contains general guidelines on prescribing in Palliative Care.

Contents:

  1. Pain
  2. Constipation
  3. Nausea & Vomiting
  4. Mouth Care
  5. Dyspnoea
  6. Terminal Care
Source: wales.nhs.uk
Clinical Resource: Leaflet
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Last Checked: 24/04/14 Link Error: Report It

 

ABC of palliative care

Principles of palliative care and pain control

The World Health Organisation defines palliative care as “the active total care of patients whose disease is not responsive to curative treatment. Control of pain, of other symptoms, and of psychological, social and spiritual problems, is paramount.

Difficult pain problems

Roughly 80-90% of pain due to cancer can be relieved relatively simply with oral analgesics and adjuvant drugs in accordance with the World Health Organisation's guidelines. The remaining 10-20% can be difficult to treat.

Breathlessness, cough, and other respiratory problems

Respiratory problems are common in patients with advanced incurable disease. This article describes palliation of adult patients with malignant disease, but the principles can be applied to many types of non-malignant disease.

Mouth care, skin care, and lymphoedema

Patients' oral problems can be kept to a minimum by good hydration, brushing the teeth with a fluoride toothpaste twice daily, and daily observation of the oral mucosa.

Nausea, vomiting, and intestinal obstruction

Nausea, vomiting, and retching are common and distressing complaints: surveys have found that 50-60% of patients with advanced cancer suffer from one or more of these.

Anorexia, cachexia, and nutrition

This article covers approaches to cachexia other than treatment of the underlying disease.

Constipation and diarrhoea

Constipation is more common in patients with advanced cancer than in those with other terminal diseases, and many of the associated symptoms may mimic features of the underlying disease.

Depression, anxiety, and confusion

A common mistake is to assume that depression and anxiety represent nothing more than natural and understandable reactions to incurable illness.

HIV infection and AIDS

Currently, the clinical picture is changing through the use of new combinations of antiretroviral drugs, which improve patients' wellbeing and delay disease progression.

Emergencies

Some acute events in malignancy have to be treated as an emergency if a favourable outcome is to be achieved. As in any emergency, the assessment must be as prompt and complete as possible.

The last 48 hours

During the final 48 hours of life, patients experience increasing weakness and immobility, loss of interest in food and drink, difficulty swallowing, and drowsiness.

Source: europepmc.org
Clinical Resource: Journal Articles
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Last Checked: 07/04/14 Link Error: Report It

 

Guidelines for the Management of Common Symptoms in the Last Few Days of Life
LOROS Hospice

Source: loros.co.uk
Clinical Resource: Guideline
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Last Checked: 19/05/14 Link Error: Report It

 

Current Learning in Palliative Care

Our free CLiP programme gives professionals, carers and teams from a variety of health and social care settings the knowledge and skills needed in their daily work. You can work through a CLiP worksheet in the time it takes to have a coffee break; around 15 minutes.

The tutorials and worksheets can be used by individuals or by small groups to help with developing shared dialogue and learning.

The content has been designed, and is regularly updated, by doctors, nurses and other professionals involved in clinical palliative care practice.

Source: hospiceuk.org
Clinical Resource: CE / CPD / Learning
Register to Access Content: Yes - Registration is FREE

Last Checked: 21/08/15 Link Error: Report It

 

A Guide to Prescribing for Patients with Advanced Malignancy
Dr Nicky Rudd & Dr Caroline Cooke

This booklet is a guide to common problems encountered in patients with advanced cancer

Source: loros.co.uk
Clinical Resource: Booklet
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Last Checked: 19/05/14 Link Error: Report It

 

Subcutaneous Drug Infusion Compatibility Guidelines
Gippsland Region Palliative Care Consortium Clinical Practice Group

In palliative care clinical practice, the oral route of administration is the preferred option. However, when the parenteral route is required, the subcutaneous route should be the first option. Drugs may be given as infusions over 24 hours or as bolus doses.

The combination of drugs for subcutaneous infusions must be checked for compatibility prior to prescription and administration of injectable medication.

Source: grpcc.com.au
Clinical Resource: Guideline
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Last Checked: 29/11/16 Link Error: Report It

 

Syringe Driver Drug Compatibilities - Guide to Palliative Care Practice 2016
Eastern Metropolitan Region Palliative Care Consortium

Source: emrpcc.org.au
Clinical Resource: Guideline
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Last Checked: 29/11/16 Link Error: Report It

 

Drug Compatibility in Subcutaneous Infusions Chart in Standard Forms

Printable colour pictorial chart with indicators of drug compatibility

Source: grpcc.com.au
Clinical Resource: Chart
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Last Checked: 29/11/16 Link Error: Report It

 

Scottish Intercollegiate Guidelines Network (SIGN) Guideline > Control of Pain in Adults With Cancer

Source: sign.ac.uk
Clinical Resource: Guideline
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Last Checked: 18/05/15 Link Error: Report It

 

 

Cancer Pain Management

A perspective from the British Pain Society, supported by the Association for Palliative Medicine and the Royal College of General Practitioners

Source: britishpainsociety.org
Clinical Resource: Discussion Document
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Last Checked: 17/07/15 Link Error: Report It

 

Opioid Analgesics

Opioid analgesics are prescribed for moderate to severe pain, particularly of visceral origin, and are used in step two and step three of the analgesic ladder. Dependence and tolerance are well known features with regular use although this should not inhibit prescribing in palliative care.

Source: patient.co.uk
Clinical Resource: Article
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Last Checked: 24/04/14 Link Error: Report It

 

Chronic Pain Management
An Appropriate Use of Opioid Analgesics

An accepted definition of pain is “an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.”

Source: acpinternist.org
Clinical Resource: Supplement
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Last Checked: 24/04/14 Link Error: Report It

 

Breakthrough pain in cancer – information for medical professionals

Breakthrough pain is a common problem in cancer patients, and is associated with significant morbidity in this group of patients. However, the condition is not well understood by many healthcare professionals, and, as a result, the condition is not well managed in many cancer patients.

The main objective of this website is to provide a definitive source of information about breakthrough cancer pain for healthcare professionals. The website will be updated on a regular basis, with particular emphasis on highlighting new research findings. The website will have an interactive element, and healthcare professionals are encouraged to submit comments about the current content, suggestions about future content, and questions for the editorial board.

Source: breakthroughcancerpain.org
Clinical Resource: Various
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Last Checked: 24/04/14 Link Error: Report It

 

Opioid Conversion Guidelines
Gippsland Region Palliative Care Consortium Clinical Practice Group

Opioid analgesics vary in potency, side effect and pharmacokinetic profile. Therefore the Opioid Conversion Guidelines has been developed to assist when changing opioid drug therapy.

Source: grpcc.com
Clinical Resource: Guideline
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Last Checked: 28/11/16 Link Error: Report It

 

Opioid Conversion Ratios - Guide to Palliative Care Practice 2016
Eastern Metropolitan Region Palliative Care Consortium

Source: emrpcc.org.au
Clinical Resource: Guideline
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Last Checked: 28/11/16 Link Error: Report It

 

A Guide to Equivalent Doses for Opioid Drugs

Source: southwest.devonformularyguidance.nhs.uk
Clinical Resource: Guide
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Last Checked: 28/11/16 Link Error: Report It

 

Approximate Equivalent Opioid Doses

Source: nhstaysideadtc.scot.nhs.uk
Clinical Resource: Table
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Last Checked: 28/11/16 Link Error: Report It

 

Opioid Conversion Chart

The dosage of a new opioid is based on several factors including the available equi-analgesic dose data, the clinical condition of the patient, concurrent medications and patient safety. It is recommended that the new dose should be reduced by 30-50% to allow for incomplete cross-tolerance. The patient should be monitored closely until stable when switching opioid medications.

Source: olh.ie
Clinical Resource: Chart
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Last Checked: 28/11/16 Link Error: Report It

 

Opiate Conversion Doses

Note: these conversions are provided only as an approximate guide to equivalences and individual patient variability needs to be considered when switching from one opioid to another.

Source: wales.nhs.uk
Clinical Resource: Table
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Last Checked: 28/11/16 Link Error: Report It

 

Opioid dose conversion chart, syringe driver doses, rescue/PRN doses and opioid patches

Use the conversion chart to work out the equivalent doses of different opioid drugs by different routes

Source: yorkhospitals.nhs.uk
Clinical Resource: Chart
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Last Checked: 28/11/16 Link Error: Report It

 

What are the equivalent doses of oral morphine to other oral opioids when used as analgesics in adult palliative care?
Prepared by UK Medicines Information (UKMi) pharmacists for NHS healthcare professionals

Morphine is generally the strong opioid of choice and a common question is how to convert a dose of another opioid to morphine or vice versa.

Source: sps.nhs.uk
Clinical Resource: Medicines Question and Answer
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Last Checked: 22/09/16 Link Error: Report It

 

Palliative Care Opioid Conversion Guide

Source: saferx.co.nz
Clinical Resource: Guide
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Last Checked: 19/05/14 Link Error: Report It

 

Changing Routes of Administration of Opioids

Source: endoflife.northwestern.edu
Clinical Resource: Table
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Last Checked: 28/11/16 Link Error: Report It

 

Palliative Care Morphine Initiation and Dose Titration Guide

Source: saferx.co.nz
Clinical Resource: Guide
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Last Checked: 24/04/14 Link Error: Report It

 

Guidelines for the Use of Transdermal Opioids - Fentanyl and Buprenorphine ‘Patches'

Source: arthurrankhouse.nhs.uk
Clinical Resource: Factsheet
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Last Checked: 21/08/15 Link Error: Report It

 

How should conversion from oral morphine to fentanyl patches be carried out?
Prepared by UK Medicines Information (UKMi) pharmacists for NHS healthcare professionals

Fentanyl patches are an effective alternative to oral morphine and a common question is how to change a patient from oral morphine to a fentanyl patch.

Source: sps.nhs.uk
Clinical Resource: Medicines Question and Answer
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Last Checked: 22/09/16 Link Error: Report It

 

Transdermal opioids for cancer pain

Patients with moderate to severe malignancy-related pain frequently require the use of opioid pharmacotherapy. Unfortunately, many cancer patients continue to be prescribed subtherapeutic doses of pain medications resulting in undo suffering and diminished quality of life. The choice of analgesic pharmacotherapy should be individualized and based on the intensity and etiology of pain reported by the patient.

Source: europepmc.org
Clinical Resource: Journal Article
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Last Checked: 07/04/14 Link Error: Report It

 

Fentanyl Transdermal Patches

In this article Lynn Winter (MAU Pharmacist) describes some of these misadventures to highlight potential risks, and then goes onto to discuss the guidance available on the prescribing of fentanyl patches. Such guidance aims to reduce the risk associated with the use of fentanyl patches, to hopefully prevent further prescription-induced admissions to hospital.

Source: elmmb.nhs.uk
Clinical Resource: Medicines and Prescribing Bulletin
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Last Checked: 24/04/14 Link Error: Report It

 

Question: How many transdermal fentanyl patches can be applied at one time?

There are two brands of matrix transdermal fentanyl patches currently available in Ireland, Durogesic DTrans® transdermal patches and Matrifen® transdermal patches.

Source: olh.ie
Clinical Resource: Question and Summary
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Last Checked: 29/11/16 Link Error: Report It

 

Question: Can transdermal fentanyl patches be changed every 48 hours instead of every 72 hours?

In the majority of patients, analgesia is maintained for the duration of the recommended 72 hours that the patch is in situ.

Source: olh.ie
Clinical Resource: Question and Summary
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Last Checked: 29/11/16 Link Error: Report It

 

Opioid Drug-Drug Interactions

Source: paineducation.vcu.edu
Clinical Resource: Table
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Last Checked: 24/04/14 Link Error: Report It

 

Management of Adverse Opioid Reactions

Source: paineducation.vcu.edu
Clinical Resource: Table
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Last Checked: 24/04/14 Link Error: Report It

 

Use of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) in palliative care patients

Source: hospiceintheweald.org.uk
Clinical Resource: Guideline
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Last Checked: 24/04/14 Link Error: Report It

 

Identification and Treatment of Neuropathic Pain in Patients with Cancer

Several forms of chronic pain can be distinguished. Somatic nociceptive pain results from tissue damage and activation of nociceptors that innervate the skin, the ligaments, small joints, muscles, and tendons and is usually characterized by a well-localized pain. Visceral nociceptive pain, often characterized by colic, occurs in the hollow organs, mesenterium, capsules, and some parenchyma (e.g., the pancreas).

In addition to these nociceptive types of pain, chronic pain can also occur if the nervous system itself is damaged, which in the case of cancer may occur by tumor infiltration of nerves, tumor-associated toxins, therapy-related toxins, or surgical damage. This type of cancer pain is called neuropathic cancer pain.

Source: iasp-pain.org
Clinical Resource: Newsletter
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Last Checked: 07/05/15 Link Error: Report It

 

Hospice Palliative Care Symptom Guideline for Nausea and Vomiting

The guideline provides strategies for the assessment and management of adults (age 19 years and older) living with advanced life threatening illness and experiencing the symptoms of nausea and vomiting. This guideline does not address disease specific approaches in the management of nausea and vomiting.

Source: fraserhealth.ca
Clinical Resource: Guideline
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Last Checked: 24/04/14 Link Error: Report It

 

Palliative Care of Nausea and Vomiting

Nausea and vomiting are common and often require attention in palliative-care settings. Fortunately, current treatments can fully control a patient’s symptoms in as many as 70% of cases.

Source: aging.arizona.edu
Clinical Resource: Factsheet
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Last Checked: 26/10/15 Link Error: Report It

 

Palliative Care - South & West Devon Formulary - Hypercalcaemia of Malignancy

Hypercalcaemia is the commonest life-threatening metabolic disorder associated with advanced cancer. It occurs in approximately 10% of patients with cancer.

Source: southwest.devonformularyguidance.nhs.uk
Clinical Resource: Formulary
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Last Checked: 21/08/15 Link Error: Report It

 

Hospice Palliative Care Symptom Guideline for Hypercalcemia in Malignant Disease (Palliative Management)

This guideline provides recommendations for the assessment and symptom management of adult patients (age 19 years and older) living with advanced life threatening illness and experiencing the symptom of hypercalcemia. This guideline does not address disease specific approaches in the management of hypercalcemia.

Source: fraserhealth.ca
Clinical Resource: Guideline
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Last Checked: 24/04/14 Link Error: Report It

 

Use of Steroids in Palliative Care

The factsheet contains further information on side-effects, routes and doses and discontinuing steroids.

Source: arthurrankhouse.nhs.uk
Clinical Resource: Factsheet
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Last Checked: 21/08/15 Link Error: Report It

 

Guideline: Use of Steroids in Palliative Care

Source: hospiceintheweald.org.uk
Clinical Resource: Guideline
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Last Checked: 24/04/14 Link Error: Report It

 

Management of respiratory secretion in the terminal phase
Eastern Metropolitan Region Palliative Care Consortium

Source: emrpcc.org.au
Clinical Resource: Guideline
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Last Checked: 29/11/16 Link Error: Report It

 

Antisecretories

Source: hospiceintheweald.org.uk
Clinical Resource: Guideline
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Last Checked: 24/04/14 Link Error: Report It

 

Memorial Sloan-Kettering Cancer Center
About Herbs, Botanicals & Other Products

Memorial Sloan Kettering Cancer Center’s About Herbs database, a tool for the public as well as healthcare professionals, can help you figure out the value of using common herbs and other dietary supplements.

Source: mskcc.org
Clinical Resource: Database
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Last Checked: 19/10/15 Link Error: Report It

 

Drug Interactions in Palliative Care

Advanced cancer patients are at risk of potential drug interactions because they are often on many medications. Drug-drug interactions can be kinetic, dynamic and pharmaceutical. Pharmacokinetic interactions mainly involved Cytochrome P450 enzymes system.

Source: fmshk.org
Clinical Resource: Newsletter
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Last Checked: 24/04/14 Link Error: Report It

 

Association of British Clinical Diabetologists position statement on diabetes and end of life care

Source: diabetologists-abcd.org.uk
Clinical Resource: Position Paper
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Last Checked: 24/04/14 Link Error: Report It

 

Caring for Diabetics in a Palliative Care setting; The challenges.

Source: rbch.nhs.uk
Clinical Resource: Presentation
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Last Checked: 24/04/14 Link Error: Report It

 

Diabetes Mellitus at the End of Life

Source: hospiceintheweald.org.uk
Clinical Resource: Guideline
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Last Checked: 24/04/14 Link Error: Report It

 

Renal Drug Dosage Chart

Source: hospiceintheweald.org.uk
Clinical Resource: Chart
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Last Checked: 24/04/14 Link Error: Report It

 

Undesirable drug interaction in palliative medicine

The importance of drug interactions in palliative care is acquiring more and more practical importance. In the polytherapy used in palliative care, drugs can induce a number of interactions and increase the risk of unwanted drug reactions. This paper discusses the importance of drug-drug interactions in clinical practice.

Source: czasopisma.viamedica.pl
Clinical Resource: Journal Article
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Last Checked: 24/04/14 Link Error: Report It

 

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