By Stephen McPhee, Margaret A. Winker, Michael W. Rabow, Steven Z. Pantilat, Amy J. Markowitz

ISBN-10: 0071637958

ISBN-13: 9780071637954

ISBN-10: 0071637966

ISBN-13: 9780071637961

From one of many world’s major scientific journals comes the definitive evidence-based, full-color advisor to end-of-life and palliative care "...represents a massive milestone within the evolution of take care of individuals with complex disease—-for which its editors and authors and JAMA can be rightly proud. it's really good that JAMA had the foresight to put up a sequence in this subject, which, as medication has turn into extra technologically complicated and subspecialized, is usually ignored and, occasionally worse, avoided....this booklet could be important for front-line clinicians, and certainly all overall healthiness care practitioners—as care on the shut of lifestyles is part of just about all of medicine’s specialties and settings."--Irene J. Higginson, BMBS, PhD, FPPHM, FRCP; Dept. of Palliative Care, coverage, & Rehabilitation; Cicely Saunders Institute; King's university London (from the foreword) a brand new addition to the JAMAevidence sequence, Care on the shut of existence: proof and event deals evidence-based and medical specialist counsel on taking good care of sufferers with life-limiting sickness, incorporating the phrases and views of affected sufferers, their households, and treating clinicians. equipped by way of those genuine medical circumstances, the publication relies at the acclaimed 7-year sequence of forty two articles, initially released in JAMA as “Perspectives on Care on the shut of Life,” and now completely up-to-date as chapters and that includes large never-before-published fabric. Care on the shut of lifestyles covers are a variety of medical syndromes, ailment approaches, conversation demanding situations, health-care supply settings, and matters confronted via sufferers, together with withdrawal of dialysis and different life-sustaining measures, cross-cultural ways, and the function of chemotherapy. in the course of the booklet, emphasis is at the ideas of palliative care, with the sufferer and relations on the middle of care, and with awareness given to all problems—physical, mental, social, and non secular. Reflecting this concentration, each one bankruptcy starts off with a sufferer case research to introduce the scientific challenge, through “perspectives” that draw on vast, real-world discussion among clinicians, sufferers, and households. across the world popular authors then assessment the common demanding situations illustrated through the case, supplying state of the art, evidence-based evaluation and remedy ways. beneficial properties totally revised and up-to-date textual content with new facts and references, together with the quest method for every chapter’s replace Evidence-based orientation provides the present country of information within the care of terminally sick sufferers and help for his or her households and caregivers useful medical assistance and methods from foreign specialists in palliative care Self-assessment Q&A, for boosting your wisdom of every chapter’s content material and for getting ready for checks an invaluable word list of acronyms, phrases, and assessments up-to-date assets for every bankruptcy supply present, authoritative resources of diagnostic and remedy info that could assist you optimize palliative care Medline PubMed identity numbers facilitate fast, handy entry to references

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I CHAPTER 2 think I should have made that a little bit more clear to him, in retrospect. DR V (SURGEON): The surgical team was not fully aware of anything that was going on with his condition. Once we opened, we found that he had free air. He had almost a liter of ascites. There was a perforation in his cecum. He had hard cancer, just about everywhere, such that I couldn’t even mobilize his intestine. We stapled off the perforation because I couldn’t mobilize the cecum and the right colon safely.

They just kept him hanging on in agonizing pain for hours, even though I had the do-not-resuscitate document in my hand. DR W (PRIMARY CARE PHYSICIAN): I first met Mr N in my primary care clinic. He had some stomach pain, and a few weeks later, about 2 months before his final hospitalization, he had an episode of gastrointestinal bleeding and went to another hospital where CT scans showed he had a pancreatic mass extending to his large colon. I asked him what his understanding of what his diagnosis was.

Prognoses of seriously ill hospitalized patients on the days before death: implications for patient care and public policy. New Horiz. 1997;5(1):56-61. [PMID: 9017679] 22. Lynn J, Teno J, Harrell F Jr. Accurate prognostication of death: opportunities and challenges for clinicians. West J Med. 1995;163(3):250-257. [PMID: 7571588] 23. Clayton JM, Butow PN, Tattersall MH, et al. Randomized controlled trial of a prompt list to help advanced cancer patients and their caregivers to ask questions about prognosis and end-of-life care.

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Care at the Close of Life: Evidence and Experience by Stephen McPhee, Margaret A. Winker, Michael W. Rabow, Steven Z. Pantilat, Amy J. Markowitz

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