Burden Of Palliative Care Research Articles

Effect of Erythropoiesis-Stimulating Agent Therapy in Patients Receiving Palliative Care of Chronic Kidney Disease.

Despite the increasing use of erythropoiesis-stimulating agent (ESA) in patients receiving dialysis, few studies have examined the benefits of ESA for patients with chronic kidney disease receiving palliative care. We designed a retrospective observational study to evaluate the effect of ESA in treating anemia of renal disease among adult patients receiving palliative care instead of dialysis. The primary objective was to assess whether ESA can reduce the transfusion burden and hospitalization. Thirty-nine patients receiving ESA were matched with a control group of 39 patients without ESA. Their mean age and glomerular filtration rates were 76.7 (10.2) years and 11.6 (5.7) mL/min/1.73 m2, respectively. Baseline hemoglobin levels were comparable in the ESA and control groups; their corresponding values were 10.2 (1.5) and 10.1 (1.4) g/dL. During 1-year observation period, 34 units of red cell transfusion occurred in patients receiving ESA, whereas 128 units of red cell were transfused to patients in control group. Patients in the control group had higher transfusion rate (incidence rate ratio [IRR]: 3.63; 95% confidence interval [CI]: 2.49-5.31; P < .00001) and higher admission rates (IRR: 2.34; 95% CI: 1.80-3.03; P < .000001) than the ESA group even after adjustment for comorbidities. High disease burden of palliative care among patients with stage 4 to 5 chronic kidney disease was reflected by transfusion requirement and hospitalization rates, both of which were shown to be significantly ameliorated by ESA treatment.

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The current situation in education and training of health-care professionals across Africa to optimise the delivery of palliative care for cancer patients.

The need for palliative care education remains vital to contribute to the quality of life of patients, both adults and children, with cancer in Africa. The number of patients with cancer continues to rise, and with them the burden of palliative care needs. Palliative care has been present in Africa for nearly four decades, and a number of services are developing in response to the HIV/AIDS epidemic. However, the needs of cancer patients remain a challenge. Education and training initiatives have developed throughout this time, using a combination of educational methods, including, more recently, e-learning initiatives.The role of international and national organisations in supporting education has been pivotal in developing models of education and training that are robust, sustainable, and affordable. Developing a material for education and professional development needs to continue in close collaboration with that already in production in order to optimise available resources. Seeking ways to evaluate programmes in terms of their impact on patient care remains an important part of programme delivery. This article reviews the current situation.

Morphine use in the last six days of life of patients with HIV/AIDS at the inpatient unit of a South African hospice implementing the ICHC model

AbstractBackgroundSeventy-five per cent of the world's HIV/AIDS population resides in Sub-Saharan Africa. South Africa, along with the rest of Sub-Saharan Africa, is experiencing an increasing disease and palliative care burden as a result of the HIV/AIDS pandemic. At present there is no cure for AIDS and access to antiretroviral treatment is limited.HIV/AIDS is the largest single cause of death in South Africa, accounting for 30% of deaths in 2000. An estimated 20 000 of the approximately 5 350 000 infected South Africans receive antiretroviral treatment.To cope with the rising need for AIDS-related health services, a comprehensive, integrated approach to health care is advocated, with a shift in focus from hospital care to home-based care. The Department of Health supports a community home-based care (ICHC) model as one of five models of care. It is based on similar principles to palliative care and was piloted at seven hospices in South Africa. This study was conducted in the inpatient unit (IPU) of a ...