9780521672498

Palliative Neurology

by
  • ISBN13:

    9780521672498

  • ISBN10:

    052167249X

  • Edition: 1st
  • Format: Paperback
  • Copyright: 2005-12-19
  • Publisher: Cambridge University Press
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Supplemental Materials

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Summary

Palliative care affirms the value of holistic support for persons facing death from advanced disease. This handbook aims to provide succinct and practical advice on the management of major neurological disorders in both their supportive and terminal phases, recognizing that these conditions are increasing in prevalence in virtually every society as the proportion of elderly persons grows. It demonstrates how the discomforts encountered in dementia, stroke, Parkinson's disease, ALS, Huntington's disease, muscular dystrophies and multiple sclerosis can benefit from the same comprehensive approach to palliation as has evolved in specialist care for cancer.

Table of Contents

Foreword xiii
Note on drugs and abbreviations xvii
Section I Palliative management
1(42)
Introduction to palliation
3(9)
Palliation, palliative care and palliative management
3(1)
`Hospice' and palliation in advanced cancer
4(1)
Palliative management in neurology: an increasingly recognized need
5(1)
Different trajectories of care for cancer and neurological disease
6(2)
Palliation and neuroscience
8(4)
Characteristics of palliation
12(8)
It is patient-centred
12(2)
It provides truthful information concerning disease status and prognosis
14(1)
It offers support for family members
14(2)
It maintains comprehensive care
16(1)
It ensures continuity of care
16(1)
It relies on teamwork and networking
17(1)
It adjusts its approach in recognition of deterioration
18(1)
It includes bereavement support
18(2)
Nodal points in decision-making
20(5)
Introducing a palliative management approach
20(1)
Introducing palliative interventions
21(1)
Timing the onset of the terminal phase
22(1)
Referral to a palliative care team
23(1)
Writing a `do not resuscitate' order
23(1)
Introducing bereavement care
24(1)
Common deficiencies in palliative management
25(8)
Poor communication
25(4)
Rigid professional boundaries
29(1)
Ineffective networking
30(1)
Poorly developed teamwork
31(1)
Failure to maintain an accessible clinical record
32(1)
Common themes in palliation practice
33(10)
Holism
33(1)
Recording of observations
34(2)
Finding the best answer: innovation and experiment
36(1)
Appropriate therapy regimens
36(1)
Support of carers
37(3)
Working alongside complementary and alternative medicine
40(3)
Section II Major discomforts in advanced neurological illness
43(82)
Fatigue
45(2)
Problems with muscles and movement
47(18)
Weakness
47(2)
Disorders of muscle tone and contraction
49(6)
Seizures
55(4)
Involuntary movements
59(2)
Drug-induced movement disorders
61(2)
Syncope and falls
63(2)
Bulbar symptoms
65(5)
Impaired speech
65(1)
Dysphagia
65(3)
Fear of choking
68(1)
Drooling
68(2)
Respiratory symptoms
70(7)
Dyspnoea
70(1)
Hypoventilation
71(1)
Assisted ventilation
72(2)
Cough
74(1)
Retained secretions
75(2)
Gastrointestinal symptoms
77(12)
Dry mouth
77(1)
Candida infection
78(1)
Dysphagia
78(1)
Gastro--oesophageal reflux
78(1)
Nausea and vomiting
79(3)
Bowel dysfunction
82(4)
Nutrition and hydration
86(3)
Urological symptoms
89(6)
Urinary retention
90(1)
Urgency and bladder spasm
91(1)
Urinary incontinence
92(1)
Sexual dysfunction
93(2)
Pain
95(16)
Types and mechanisms of pain
95(1)
The importance of early control of pain
96(1)
Pain in neurology
97(3)
Management of nociceptive pain
100(5)
Neuropathic pain
105(2)
Opioids in chronic pain
107(1)
Central pain
108(1)
Other strategies for difficult pain
109(2)
Cognitive, behavioural and psychological symptoms
111(9)
Cognitive impairment
111(1)
Delirium, agitation and restlessness
112(2)
Depression
114(1)
Anxiety
115(1)
Insomnia
116(2)
Grief and bereavement
118(2)
Miscellaneous symptoms
120(5)
Temperature control and pyrexia
120(1)
Sweating (hyperhidrosis)
120(1)
Pruritis
121(1)
Hiccups
122(1)
Headache
123(2)
Section III Major neurological conditions requiring palliation
125(76)
Cerebrovascular disease: stroke
127(5)
Supportive phase
127(3)
The terminal phase
130(2)
Demyelinating disease
132(10)
Supportive phase
133(6)
The terminal phase
139(3)
Parkinson's disease and related disorders
142(6)
The Supportive phase
142(3)
The phase of transition
145(1)
The terminal phase
146(2)
Dementia
148(7)
Symptom management in dementia
149(3)
The terminal phase
152(3)
Amyotrophic lateral sclerosis (motor neurone disease)
155(11)
The palliative approach
155(1)
Telling the bad news of ALS
156(2)
Supportive phase
158(5)
The terminal phase
163(3)
Incurable Infections of the nervous system
166(12)
Rabies
166(2)
Creutzfeldt--Jakob disease
168(2)
HIV-acquired immunodeficiency syndrome
170(1)
The supportive phase of HIV infection
171(2)
The need for consistent supervision
173(1)
The terminal phase of HIV-AIDS
174(4)
Muscular dystrophy
178(5)
The supportive phase of care
178(1)
Transition to the terminal phase: the issue of ventilation
179(4)
Neuropathies
183(3)
Huntington's disease
186(5)
Supportive care of Huntington's disease
187(1)
The terminal phase
188(3)
Cerebral neoplasms
191(6)
The Supportive phase
192(2)
The terminal phase
194(3)
Sequelae of traumatic brain injury
197(4)
The Supportive phase
197(1)
The terminal phase
198(3)
Section IV Ethical issues
201(22)
Consent and decision-making
203(2)
Advance directives
205(2)
Proxy decision-making
207(2)
Ethical issues in states of disordered consciousness
209(9)
Coma
209(1)
Persistent vegetative state (PVS)
209(3)
Minimally conscious state (MCS)
212(1)
Locked-in syndrome (LIS)
212(2)
The management of PVS
214(4)
Terminal sedation
218(1)
Euthanasia
219(4)
Section V Appendices
223(30)
Practical aspects of home care
225(5)
Necessary supports
225(1)
The home environment
226(1)
Education for home carers
227(1)
Common questions raised by home carers
227(1)
Advantages of home care
228(1)
The importance of a record in the home
228(2)
Characteristics of an effective palliation service
230(4)
An accepted place in National Health Planning
230(1)
Palliation services are organized on a population basis
231(1)
Palliation teams are established and maintained
231(1)
Education for palliation is established
232(2)
Suggested further reading
234(7)
General texts
234(1)
Web sites
235(1)
Journal articles
236(5)
Medications referred to in the text
241(12)
Index 253

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