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THE SUNDAY TIMES BESTSELLER 'Impossible to read with dry eyes or an unaltered mindset' Sunday Times How should we think of death and how can we prepare for it? With the End in Mind is a book for us all: the grieving and bereaved, the ill and the healthy. By turns touching and tragic, funny and wise, it tells powerful human stories of life and death. Eric, the retired head teacher who even with Motor Neurone Disease gets things done. Sylvie, 19 and diagnosed with leukaemia, sewing a cushion for her mum to hold after she has died. Nelly and Joe, two people enduring loneliness to shield their beloveds from distress. A powerful and emotional book based on a lifetime's clinical experience, With the End in Mind offers calm, wise advice on how to face death, live fully and find a model for hope in dark times.
In Death, Dying, and Organ Transplantation: Reconstructing Medical Ethics at the End of Life, Miller and Truog challenge fundamental doctrines of established medical ethics. They argue that the routine practice of stopping life support technology in hospitals causes the death of patients and that donors of vital organs (hearts, lungs, liver, and both kidneys) are not really dead at the time that their organs are removed for life-saving transplantation. These practices are ethically legitimate but are not compatible with traditional rules of medical ethics that doctors must not intentionally cause the death of their patients and that vital organs can be obtained for transplantation only from dead donors. In this book Miller and Truog undertake an ethical examination that aims to honestly face the reality of medical practices at the end of life. They expose the misconception that stopping life support merely allows patients to die from their medical conditions, and they dispute the accuracy of determining death of hospitalized patients on the basis of a diagnosis of "brain death" prior to vital organ donation. After detailing the factual and conceptual errors surrounding current practices of determining death for the purpose of organ donation, the authors develop a novel ethical account of procuring vital organs. In the context of reasonable plans to withdraw life support, still-living patients are not harmed or wronged by organ donation prior to their death, provided that valid consent has been obtained for stopping treatment and for organ donation. Recognizing practical difficulties in facing the truth regarding organ donation, the authors also develop a pragmatic alternative account based on the concept of transparent legal fictions. In sum, Miller and Truog argue that in order to preserve the legitimacy of end-of-life practices, we need to reconstruct medical ethics.
This book focuses on the features of pelvic pain in the different cancer diseases, the pain assessment tools, as well as the pharmacological and non-pharmacological approaches. Pelvic cancer pain is a common and debilitating symptom, and pain control is a one among the main therapeutic goals throughout the duration of the disease. Because pelvic cancer pain due to primitive cancer, recurrence or metastasis is a complex clinical pathology, no single technique is often guaranteed to produce a complete pain relief. Thus, there are many treatment options, but in most cases a correct approach to pain control should be provided by a multidisciplinary team under the responsibility of a pain specialist coordinating several professionals. This book will aid several figures of practitioners, like anesthesiologists, oncologists or surgeons, in making the correct decisions in individual patients affected by cancer pain due to pelvic diseases.
The first comprehensive, clinically focused guide to help hospitalists and other hospital-based clinicians provide quality palliative care in the inpatient setting. Written for practicing clinicians by a team of experts in the field of palliative care and hospital care, Hospital-Based Palliative Medicine: A Practical, Evidence-Based Approach offers: * Comprehensive content over three domains of inpatient palliative care: symptom management, communication and decision making, and practical skills, * Detailed information on assessment and management of symptoms commonly experienced by seriously ill patients, * Advise on the use of specific communication techniques to address sensitive topics such as prognosis, goals of care, code status, advance care planning, and family meetings in a patient- and family-centered manner, * Targeted content for specific scenarios, including palliative care emergencies, care at the end of life, and an overview of post-hospital palliative care options, * Self-care strategies for resilience and clinician wellness which can be used to help maintain an empathic, engaged, workforce and high quality patient care, * A consistent chapter format with highlighted clinical pearls and pitfalls, ensuring the material is easily accessible to the busy hospitalist and associated hospital staff. This title will be of use to all hospital clinicians who care for seriously ill patients and their families. Specialist-trained palliative care clinicians will also find this title useful by outlining a framework for the delivery of palliative care by the patient s front-line hospital providers. Also available in the in the Hospital-Based Medicine: Current Concepts series: Inpatient Anticoagulation Margaret C. Fang, Editor, 2011 Hospital Images: A Clinical Atlas Paul B. Aronowitz, Editor, 2012 Becoming a Consummate Clinician: What Every Student, House Officer, and Hospital Practitioner Needs to Know Ary L. Goldberger and Zachary D. Goldberger, Editors, 2012 Perioperative Medicine: Medical Consultation and Co-Management Amir K. Jaffer and Paul J. Grant, Editors, 2012 Clinical Care Conundrums: Challenging Diagnoses in Hospital Medicine James C. Pile, Thomas E. Baudendistel, and Brian J. Harte, Editors, 2013 Inpatient Cardiovascular Medicine Brahmajee K. Nallamothu and Timir S. Baman, Editors 2013
The Oxford Handbook of Palliative Care returns for a third edition, maintaining the concise yet comprehensive format suited to the busy practitioner for quick access to key information, and fully updated to reflect changes in the palliative care landscape. Featuring an increased emphasis on non-malignant diseases such as dementia, this authoritative text combines evidence-based care with the bedside experience of experienced palliative care professionals to give the reader a complete overview of the physical, emotional, and spiritual aspects of care for the end-of-life patient. Symptom management is covered in detail, with updated formulary tables and syringe driver protocols, and a new chapter on international perspectives to broaden the reader's perception of methods for delivering end-of-life care. The third edition of the Oxford Handbook of Palliative Care is the essential companion for all of those working with adults, children, and families with palliative care needs, in both hospital and community settings. The following correction has been made online and will be included in the first reprint. Readers can get in touch with us directly using the contact details on the back of the book or at our online form via the address below with questions or comments: https://global.oup.com/academic/category/medicine-and-health Chapter 5. Page 109 The dose for Hyoscine butylbromide sc has been amended in line with NICE guidance (https://bnf.nice.org.uk/drug/hyoscine-butylbromide.html): '20-120 mg 4 hourly' has been corrected to '20-80mg 4 hourly'.
The International Handbook of Art Therapy in Palliative and Bereavement Care offers a multicultural and international perspective on how art therapy can be of help to individuals, groups, families, communities, and nations facing death and dying as well as grief and loss. Over 50 art therapists from around the world write about the transforming power of art therapy in the lives of those facing terminal illness, dementia, loss, and grief. They offer practical descriptions and techniques for working with adults and children to guide professionals, including those new to using art therapy and creative approaches in end-of-life care services. This international handbook is essential reading for arts therapists, social workers, medical personnel, faith leaders, and psychologists interested in a collaborative and accessible approach to working with patients and families affected by loss.
Mitochondria produce the chemical energy necessary for eukaryotic cell functions; hence mitochondria are an essential component of health, playing roles in both disease and aging. More than 80 human diseases and syndromes are associated with mitochondrial dysfunction; this book focuses upon diseases linked to these ubiquitous organelles. Accumulation of mitochondrial DNA damage results in mitochondrial dysfunction through two main pathways. Mutation in mitochondrial DNA causes diseases such as Kearns-Sayre syndrome and Pearson syndrome. Mutation in chromosomal DNA causes diseases such as Parkinson's disease and schizophrenia. These and many other diseases are reviewed in this book. Key Features Presents the detailed structure of mitochondria, mitochondrial function, roles of oxidants and antioxidants in mitochondrial dysfunction. Includes summary of both causes and effects of these diseases. Discusses current and potential future therapies for mitochondrial dysfunction diseases Explores a wide variety of diseases caused by dysfunctional mitochondria.
The Hospice Companion is a guide to the processes of care during the intensive, interpersonal experiences of hospice work. This resource highlights the mission and values of modern-day hospice through the individual and combined efforts of the field's most valuable asset, the hospice professional. This easy-to-navigate clinical decision support tool for caregivers of those with life-limiting illnesses allows for personal and professional growth and a deeply gratifying sense of accomplishment as you proceed in the all-important work of caring for the dying. The third edition of The Hospice Companion features a thoroughly current guide to clinical processes and symptom management, providing hospice professionals with a concise summary of changes that have influenced clinical practice over the last several years. Moreover, feedback from hospice social workers has been incorporated into the section on personal, social, and environmental processes and guidance on integrative and non-pharmacologic interventions have been added.
In the Middle East, as in other countries in the developing world, there is now a wide acceptance that palliative care is an important public health issue that should be integrated into the mainstream of cancer care as well as other life-threatening diseases. Nowadays, it is recognised as a human right issue that patients and families have the right to receive this care. The WHO defined palliative care as the active total care of the patient's body, mind and spirit; whereby health care providers need to evaluate and alleviate the patient's physical, psychological and social distress. Such care encompasses a broad, multidisciplinary approach that includes both the family and the community and is provided in a range of settings, from the hospital, to the community health centre, to home. This unique and timely book captures the progress and vision of many dedicated groups throughout the Middle East and the USA who have been working to advocate for and develop palliative care services in the region. Each of the book's chapters describes the efforts and challenges professionals have been experiencing as they address the palliative care needs of patients with life-limiting illnesses. Each country's specific chapter details the current state of palliative care services and describes the various approaches that led to the development of a range of services in hospital-based sites to community and home-based care services.
50 Studies Every Palliative Care Doctor Should Know presents key studies that have shaped the practice of palliative medicine. Selected using a rigorous methodology, the studies cover topics including: palliative care, symptom assessment and management, psychosocial aspects of care and communication, and end-of-life care. For each study, a concise summary is presented with an emphasis on the results and limitations of the study, and its implications for practice. An illustrative clinical case concludes each review, followed by brief information on other relevant studies. This book is a must-read for health care professionals and anyone who wants to learn more about the data behind clinical practice.
This book examines the central structures in medicine-medical knowledge, economics, technological innovation, and medical authority-from the perspective of an ethics of care. The author analyzes each of these structures in detail before considering the challenges they present to end of life care. The perspective of an ethics of care allows for a careful focus on how these structures affect the capacity of the health care system to provide the care patients need, on the impact they have on the relationships between patients and care-givers, and on how they affect the care-givers in terms of their own sense of identity and capacity for care. This book offers one of the first focused discussions of an ethics of care across a wide range of social issues and structures in contemporary medicine. It will be of keen interest to advanced students and scholars in bioethics and health care ethics who are interested in these important issues.
The syringe driver is a simple and cost-effective method of delivering a continuous subcutaneous infusion (CSCI). A CSCI provides a safe and effective way of drug administration and can be used to maintain symptom control in patients who are no longer able to take oral medication. There have been several developments in this field since the third edition of this highly successful book. The text in this edition has been completely revised, incorporating new treatment options and an extensive list of new compatibility data. This book serves as a valuable reference source, providing comprehensive review of syringe driver use and administration of drugs by CSCI. The first chapter provides an overview of syringe drivers and CSCIs, including a useful array of frequently asked questions. The second chapter provides information about the chemistry of drug incompatibility and degradation. The third chapter comprises revised and referenced information relating to most drugs likely to be administered by CSCI using a syringe driver. The fourth chapter discusses the control of specific symptoms that are often encountered when CSCIs are required. The fifth and final chapter contains an extensive, referenced list of compatibility and stability data relating to drug combinations administered by CSCI.
The new global cancer data suggests that the global burden has risen to 18.1 million new cases per year and 9.6 million cancer deaths per year. A number of factors appear to be driving this increase, in particular, a growing and aging global population and an increase of exposure to cancer risk factors linked to social and economic development. For rapidly-growing economies, the data suggests a shift from poverty- or infection-related cancers to those associated with lifestyles more typical in industrialized countries. There is still large geographical diversity in cancer occurrence and variations in the magnitude and profile of the disease between and within world regions. There are specific types of cancer that dominate globally: lung, female breast and colorectal cancer, and the regional variations in common cancer types signal the extent to which societal, economic and lifestyle changes interplay to deferentially impact on the profile of this most complex group of diseases. Unfortunately, despite advances in cancer care, a significant proportion of patients at home, experience sub-optimal outcomes. Barriers to successful treatment outcomes include, but are not limited to: access to oncologists in the primary health centers, non-adherence, lack of experienced oncology and palliative care nurses in the community, inadequate monitoring and the lack of training of family and pediatric physicians. Telemedicine approaches, including telephone triage/education, telemonitoring, teleconsultation and status tracking through mobile applications, have shown promise in further improving outcomes, in particular for chronic cancer patients following their hospitalization. Lessons can be learned from existing hospices in North America, the United Kingdom, Australia, Centers of Excellence in African (Uganda) and modern community services in India (Kerala). An important goal of this book is to describe and encourage professionals to develop new community programs in palliative care, which include training and empowering physicians and nurses in the community on the principles of palliative care. The Middle East Cancer Consortium (MECC) together with the American Society of Clinical Oncology (ASCO) and the American Oncology Nursing Society (ONS) have conducted multiple courses ranging from basic palliative care to more specialized training in palliative care for multiple nationalities in Europe, Asia and Africa. Our experience clearly indicates that, to promote such activities, one needs strong leadership and confirmed political will to support the endeavor. The new book will emphasize the importance of having a core of multiple stakeholders including community leaders, government, NGOs and media to be actively involved in advocating for the cause and generating public awareness. This text will provide the reader with a comprehensive understanding of the outside-of-the-hospital treatment of cancer patients by medical, paramedical and volunteer personnel. In doing so, this text will encourage the creation of new palliative care services improving upon the existing ones and stimulate further research in this field. Part 1 of the text will begin with an overview of the current state of affairs of services provided to cancer patients while being cared for by primary health centers. It will also review the current literature regarding medical and psychological-based therapy options in the community for cancer patients at different stages of their disease. Part 2 will address the unique role of the community nurse, within the framework of the multidisciplinary team treating the patient, in the attempt to provide optimal evaluation and care in very challenging situations (such as with terminal patients). Part 3 will provide insightful models of this new discipline and serve as a valuable resource for physicians, nurses, social workers and others involved in the care of cancer patients. The book will take a multidisciplinary approach, integrating clinical and environmental data for practical management to enhance the efficacy of treatment while relieving suffering. Part 4 will also discuss the application of modern technological approaches to track symptoms, quality of life, diet, mobility, duration of sleep and medication use (including pain killers) in chronic cancer patients in the community. Part 5 of the book will also be devoted to modes of developing a collaborative program between governmental and non-governmental organization sectors. This includes volunteer workers in close collaboration with medical professionals for providing emotional and spiritual support, nursing care, nutritional support and empowering family caregivers. Such a model makes palliative care in the community a "people's movement", thus transferring part of the responsibility and ownership to the community.
Looking after children with life-limiting conditions is very difficult for both parents and health care professionals. This second edition of Paediatric Palliative Medicine is full of easily-accessible, detailed information , and covers all aspects of the care of children with life-limiting illnesses. It is designed to equip clinicians with the knowledge, and its evidence base, to improve clinical care. Using the bestselling Oxford Specialist Handbook format to deliver practical and concise information, this handbook facilitates bedside delivery of effective palliative medicine to children. It includes a quick reference drug formulary and detailed information on medical conditions and symptom control. There are also specific management plans to guide professionals, whether the child is in their own home, in a hospital, or a hospice. Many children with long term conditions have symptoms which need management, and the principles of palliative care for children need to be known by all who are involved in their care. The unique significance of this handbook is its capacity to guide professionals who have not trained or had experience of caring for the dying child, as well as for students and trainees interested in paediatric palliative care. Children's palliative medicine encompasses symptom control but is not limited to it. This handbook also provides a wealth of information on the philosophy and models that support delivery of palliative medicine to children, as well as the learning and coping skills required in palliative care. Fully updated with an expanded formulary and a new chapter on the intensive care unit, this new edition continues to be the authoritative reference tool in paediatric palliative care.
Now fully revised and in its fourth edition, the Oxford Handbook of Oncology has been the essential go-to guide for students and practitioners in oncology for over a decade. The scientific basis and diagnosis of cancers is covered, as well as drugs, biomarkers, and the presentation and psychosocial aspects of oncology. Concise, practical, and comprehensive, there is no better companion for both common conditions and challenging emergencies. The field of oncology has surged forward since the last edition was published and the Oxford Handbook of Oncology has been fully revised and updated to reflect these recent advances so you can be sure that the vital information you need is in your hands. This handbook incorporates changes such as the understanding of the science of cancer, novel therapies in breast, lung, renal, and melanoma, molecular sub-classification of common solid cancers, personalized therapy approaches, new agents in hard to treat cancers, the benefits of new technologies in radiotherapy, and the emerging data on the importance of the immune response. Written by experts in the field to ensure that it is grounded in real life clinical practice, this handbook provides a concise guide to all aspects of oncology for all students, nurses, and junior faculty responsible for the care of cancer patients, while also providing further reading and highlighting areas of controversy for those who need a more detailed understanding.
Death is the destiny we all share. This will not change. But the way we die, which had been the same for many generations, has changed drastically in a relatively short time for those in developed countries with access to healthcare. For generations, if people were lucky enough to reach old age, not having died in infancy or childhood, in childbirth, in war, or by accident, they would take to bed, surrounded by loved ones who cared for them, and fade into death. Most likely, they would have seen their parents and grandparents die the same way, so this manner of dying would be familiar. It was part of the natural cycle of life. Now less than 25 per cent of Americans die at home, at much older ages than people would have dreamed of in past generations, often after surviving many illnesses and even diseases that would have been terminal for their grandparents. We are fortunate to live (and die) today, supported by myriad scientific, medical, and technological advancements. But we also face new problems as a result of the new way that we die. We cannot look forward to a peaceful waning when we know our lives will likely end in hospitals, having endured very expensive care, rather than at home with family. We have to decide what decisions we want our loved ones, or care-givers, to make when we cannot choose for ourselves. We have to think about whether in any circumstances we would seek physician-assisted death. We know we face other questions as well, but we may not even know where to start. In the face of these decisions, we can feel daunted and afraid. The best remedy is information and planning. In this book, Gregory Eastwood - a physician who has cared for dying patients, served as an ethics consultant, and taught end of life issues to medical and other health profession students - draws from his substantial experience with patients and families to provide the information that will help us think clearly about the choices and issues we will face at the end of our lives, and the end of our loved ones'. With sensitivity and profound insight, Eastwood guides us through all the important questions about death and dying in straightforward, clear language and through real-life stories. Throughout, he shows us how we can take ownership of the way we want to die, when we must die, and feel more in control as death approaches.
Effective palliative care that rests on a sound ethical foundation requires ongoing discussions about patient and family values and preferences. This is especially important when addressing care at end-of-life including artificial nutrition and hydration, withdrawal of life-sustaining therapies and palliative sedation as well as requests for assistance in hastening death. The eighth volume in the HPNA Palliative Nursing Manuals series, Legal and Ethical Aspects of Palliative Care, provides an overview of critical communication skills and formal organizational mechanisms, such as ethics committees and interdisciplinary rounds, required for decisions in ethical dilemmas which respect diversity in the views of colleagues, as well as patients. The content of the concise, clinically focused volumes in the HPNA Palliative Nursing Manuals series is one resource for nurses preparing for specialty certification exams and provides a quick-reference in daily practice.
Improved cancer treatment and survival rates have resulted in a growing number of cancer survivors who live years, and even decades, after their cancer diagnosis. Insights into what the experience of cancer survivorship looks like and how it can be navigated are much sought after by cancer survivors and their families, loved ones, and communities as they chart this unfamiliar and often lonely territory. Approximately 53% of cancer patients are diagnosed when 65 years or older, yet no attempt to explore the experience of older cancer survivors has been made. Dr. Alice. Kornblith, an esteemed social psychologist with extensive experience working with cancer patients, aims to address this need in Older Survivors of Cancer: Feeling Understood by Sharing Experiences. This thoughtful, respectful book seeks to reduce older cancer patients' and survivors' feeling of aloneness and of not being understood by sharing narratives of other older cancer survivors' experiences. Narratives were gathered specifically for this book and relate experiences across different cancer diagnostic groups, phases of cancer and gender. Throughout, the reader learns how cancer affected their lives-physically, psychologically, spiritually, and socially-during each phase of their cancer journey. Commentary by Dr. Kornblith provides context and lessons learned from the narratives.
Participatory research is a relatively new method of researching practice especially within palliative care. It differs from other methodologies in that there is an expectation of action within the research process. The values that underpin participatory research are collaboration, empowerment, and reflection. In the current climate of collaboration and working with people in healthcare, participatory research methods are gaining increasing interest when there is a desire to bring about change. Organisational change is becoming an important focus as we look at ways of not only reducing costs but at the same time improving quality of care. While palliative care puts the patient and family at the centre, Participatory Research in Palliative Care discusses a new research methodology that puts practitioners at the heart of the research process as collaborators who work together with researchers to resolve problems in practice. Divided into three sections, it provides theoretical groundings of action research, a greater focus on exemplars from studies within palliative care, and discusses prominent issues when using such a methodology. All three sections are illustrated by an action research study undertaken by the author within a palliative care setting. Participatory Research in Palliative Care is written by international, multi-disciplinary authors who explore a collaborative approach to embark on research. It will appeal to health and social care professionals, academics undertaking research within palliative care, and the management of organisations where people with end of life care needs are cared for, including long-term care homes.
The importance of spiritual well-being and the role of "meaning" in moderating depression, hopelessness and desire for death in terminally-ill cancer and AIDS patients has been well-supported by research, and has led many palliative clinicians to look beyond the role of antidepressant treatment in this population. Clinicians are focusing on the development of non-pharmacologic interventions that can address issues such as hopelessness, loss of meaning, and spiritual well-being in patients with advanced cancer at the end of life. This effort led to an exploration and analysis of the work of Viktor Frankl and his concepts of logotherapy, or meaning-based psychotherapy. While Frankl's logotherapy was not designed for the treatment of patients with life-threatening illnesses, his concepts of meaning and spirituality have inspired applications in psychotherapeutic work with advanced cancer patients, many of whom seek guidance and help in dealing with issues of sustaining meaning, hope, and understanding cancer and impending death in the context of their lives. Individual Meaning-Centered Group Psychotherapy (IMCP), an intervention developed and rigorously tested by the Department of Psychiatry & Behavioral Sciences at Memorial Sloan-Kettering Cancer Center, is a seven-week program that utilizes a mixture of didactics, discussion and experiential exercises that focus around particular themes related to meaning and advanced cancer. Patients are assigned readings and homework that are specific to each session's theme and which are utilized in each session. While the focus of each session is on issues of meaning and purpose in life in the face of advanced cancer and a limited prognosis, elements of support and expression of emotion are inevitable in the context of each group session. The structured intervention presented in this manual can be provided by a wide array of clinical disciplines, ranging from chaplains, nurses, palliative care physicians, to counselors, psychotherapists, social workers, graduate psychology students, psychologists and psychiatrists.
Rooted in everyday hospital medicine, Palliative Skills for Frontline Clinicians addresses the challenges of delivering complex care to patients living with serious illnesses. Spanning emergency medicine, internal medicine, surgery and various subspecialties, each chapter reads like a story, comparing usual care with a step-by-step palliative-based approach. This case-based book features a multidisciplinary, palliative-trained authorship, including neurologists, nephrologists, emergency physicians, surgeons, intensivists, and obstetricians. Divided into four parts, Palliative Skills for Frontline Clinicians outlines common clinical scenarios across settings and specialties to highlight unmet needs of patients with potentially terminal illnesses. Each case is broken down into the usual standard approach, and delves into detail regarding different palliative interventions that can be appropriate in those scenarios. These are meant to be practice changing; down to the actual words used to communicate with patients. In addition to the book's focus on the principles of palliative care and the "art" of treating the patient, approaches to communication with the patient's families for the best long-term outcomes are discussed. Concise and pragmatic, Palliative Skills for Frontline Clinicians is meant to be practice changing. It provides readers with both a new conceptual framework, as well as actual words to communicate with patients and medication doses for symptom management. It is an invaluable resource for non-palliative trained clinicians who wish to strengthen their palliative care skills.
'Life is a journey, and so is end of life and we can prepare for it in the same way as we would prepare for any journey, making sure that all loose ends are tied up'. Once a taboo subject, end of life is becoming a 'red-hot' topic as more people realize that the care and arrangements for their own end of life are in their own hands. In addition, new government initiatives in respect of carers and caring and of dementia care are bringing the subject to the fore. This essential guide for carers, be they professional or friends and relations, provides information across a range of concerns surrounding end of life. The book tackles this difficult subject in a practical and caring way, showing how appropriate arrangements can be made to ensure the dying person's wishes about dying and post-death (funerals or celebrations of life and mourning ceremonies) are carried out. From the practical point of view, the book covers making a Will, making an Advance Directive, donating body tissue and organs and giving directions for ones own funeral or life celebration and/or memorial service. From an emotional view point the book discusses grief including anticipatory grief, ways of coping with grief, and the importance of grieving. While invaluable for general readers facing these difficult issues, the book will be of specific interest to carers in residential/nursing homes and in hospitals together with counsellors, palliative care workers and teachers and students on courses in Health and Social Care and Nursing.
This insightful study examines the deeply personal and heart-wrenching tensions among financial considerations, emotional attachments, and moral arguments that motivate end-of-life decisions. America's health care system was built on the principle that life should be prolonged whenever possible, regardless of the costs. This commitment has often meant that patients spend their last days suffering from heroic interventions that extend their life by only weeks or months. Increasingly, this approach to end-of-life care is coming under scrutiny, from a moral as well as a financial perspective. Sociologist Roi Livne documents the rise and effectiveness of hospice and palliative care, and growing acceptance of the idea that a life consumed by suffering may not be worth living. Values at the End of Life combines an in-depth historical analysis with an extensive study conducted in three hospitals, where Livne observed terminally ill patients, their families, and caregivers negotiating treatment. Livne describes the ambivalent, conflicted moments when people articulate and act on their moral intuitions about dying. Interviews with medical staff allowed him to isolate the strategies clinicians use to help families understand their options. As Livne discovered, clinicians are advancing the idea that invasive, expensive hospital procedures often compound a patient's suffering. Affluent, educated families were more readily persuaded by this moral calculus than those of less means. Once defiant of death-or even in denial-many American families and professionals in the health care system are beginning to embrace the notion that less treatment in the end may be better treatment.
One in 70 children are admitted to paediatric intensive care (PIC) at some time during childhood. Most paediatric junior doctors will rotate through PIC, and will be involved in organising acute intensive care for critically ill children. The range of children and their illnesses going through PIC is vast, making it a hugely diverse specialty. A critically ill child will end up there regardless of their underlying disease, and as a result consultants in PIC must be true generalists and need to acquire knowledge and skills in all areas of paediatrics, as well as acquiring significant knowledge of anaesthesia and surgery. From setting up the ventilator, to managing low cardiac output, Paediatric Intensive Care gives practical and realistic advice for children's doctors and nurses in intensive care. Information is presented in easily-accessible '5 minute chunks' to enable you to quickly get the answers you need, with extensive cross-referencing ensuring that different aspects of a particular clinical problem are fully covered. With detailed answers to specific problems and expert guidance on how to manage the complex issues faced in PIC, this handbook is an indispensible guide for all those who provide care to sick children.
Monitoring the Critically Ill Patient is an invaluable, accessible guide to caring for critically ill patients on the general ward. Now fully updated and improved throughout, this well-established and handy reference guide text assumes no prior knowledge and equips students and newly-qualified staff with the clinical skills and knowledge they need to confidently monitor patients at risk, identify key priorities, and provide prompt and effective care. This new edition includes the following five new chapters: * Monitoring the critically ill child * Monitoring the critically ill pregnant patient * Monitoring the patient with infection and related systemic inflammatory response * Monitoring a patient receiving a blood transfusion * Monitoring pain
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