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The main goal of palliative care is to relieve suffering. Opioids are an essential part of the pharmacological options required to address suffering by helping to relieve the pain and chronic breathlessness that may be experienced by someone with a life-limiting illness. This paper considers the recent history and current issues of the 'opioid crisis' providing recommendations to which regulatory and peak bodies can work with the Australian government, ensuring consistent adherence to WHO guidelines maintaining access to evidence based opioid management for palliative care patients whilst actively avoiding unintended suffering restricted access can cause. The recommendations are as follows: Review of the Palliative Care schedule of the Pharmaceutical Benefit Scheme Support of prescribers with current evidence, clinical practice guidelines and regulatory frameworks National opioid prescribing policies promoting linkages between palliative care and pain and addiction specialists. National real time monitoring of all opioid prescriptions Palliative care involvement in all opioids stewardship programs in acute services. Reform Medical Benefits Schedule to improve access for primary and other speciality practitioners to provide palliative care services. Compulsory palliative care education in undergraduate medical, nursing and allied health tertiary courses. Adequate, consistent stock of evidence based opioids for palliative care in community pharmacies and residential aged care facilities. These recommendations provide the regulatory guidance required to ensure persons with life limiting illness have continued access to safe and effective medication that can relieve suffering. [ABSTRACT FROM AUTHOR]

The Cochrane Library of Systematic Reviews is published quarterly. It now contains 2435 complete reviews. 1606 protocols of reviews and 5340 one page summaries of systematic reviews published in the general medical literature. In addition there are citations of 454.449 randomized controlled trials, 20 methodology reviews and 7059 cited papers in the Cochrane methodology register. The health technology assessment database contains 4620 citations. This edition of the Library contains 79 new reviews of which 6 have potential relevance for practitioners in pain and palliative medicine. [ABSTRACT FROM AUTHOR]

Cochrane Library of Systematic Reviews is published quarterly. It now contains 3094 complete reviews, 1707 protocols for reviews in production and 6817 one page summaries of systematic reviews published in the general medical literature. In addition there are citations of 495,000 randomized controlled trials, and 9,458 cited papers in the Cochrane methodology register. The health technology assessment database contains 6,817 citations. This edition of the Library contains 97 new reviews of which 9 have potential relevance for practitioners in pain and palliative medicine. [ABSTRACT FROM AUTHOR]

The Cochrane Library of Systematic Reviews is published quarterly. It now contains 2356 complete reviews, 1569 protocols of reviews and 5205 one page summaries of systematic reviews published in the general medical literature. In addition there are citations of 446,156 randomised controlled trials, 19 methodology reviews and 6855 cited papers in the Cochrane methodology register. The health technology assessment database contains 4548 citations. In this edition of the Library, there were 107 new reviews of which six have direct or potential relevance for practitioners in pain and palliative medicine. In 2004, the format of the citation has changed with the move to publication of the Cochrane Library by John Wiley & Sons. Citations will probably change again in the future as currently there is no indication of the date when a review was first published. [ABSTRACT FROM AUTHOR]

The Cochrane Library of Systematic Reviews is published quarterly. Issue two for 2004 of the library was published in April 2004. The Cochrane Library now contains 1,999 complete reviews, 1,441 protocols of reviews, and 4,645 one-page summaries of systematic reviews published in the general (non-Cochrane) medical literature. In addition there are citations of 405,580 randomized controlled trials, 18 methodology reviews and 5,414 cited papers in the Cochrane methodology register. The health technology assessment database now contains 3,848 citations. This edition of the Library contains the results of an extensive search for randomized controlled trials (RCTs) on EMBASE. The latest library contains 78 new reviews, 10 of which are considered relevant to practitioners in pain and palliative care. References are published in the same format as the citation for Cochrane reviews. [ABSTRACT FROM AUTHOR]

Patients with advanced, irreversible disease need palliative care in both developing and developed countries. The philosophy of palliative care is universal. Despite differences among individuals and cultural groups, basic needs, cares, and wants are common to humankind. For truly effective palliative care, cultural subtleties and nuances must be considered. Challenging assumptions based on one's own culture is essential to the development of knowledge and insight into others. Keeping open minds about what is new or different within different cultures where we provide care can extend and intensify quality of care. This paper reflects the author's experience as a New Zealand Nurse and of her visit to the Pain and Palliative Care Clinic in Calicut, India. This was a journey that crossed cultural boundaries and it illustrates the importance of building bridges to care. [ABSTRACT FROM AUTHOR]

In June and July 2001, Dr. Nell Muirden traveled from Melbourne, Australia to Port Moresby General Hospital and Angau Memorial Hospital located in Lae, in Papua New Guinea. This visit was sup, ported through an International Association for Hospice and Palliative Care Traveling Fellowship. Dr. Muirden's visit greatly increased awareness about cancer pain and the importance of palliative care and pain relief in cancer and other terminally ill patients. She developed a discussion paper relating to the drugs needed for palliative care and the changes that should be made. The Pharmaceutical Advisory Committee subsequently adopted these recommendations, which will lead to a better range of medications to treat pain becoming available throughout Papua New Guinea. [ABSTRACT FROM AUTHOR]

The provision of palliative care for convicted criminals ignites debate about morality and equality. The New Zealand prison population includes a higher proportion of smokers, Maori (native New Zealanders), and intravenous drug users than is found in the general community; prisoners as a group are therefore at greater risk of developing a terminal illness. The sparse literature mostly originates from America, which necessitates consideration of the relevance to corrections systems in other societies. This paper examines some of the issues surrounding the provision of palliative care for prisoners in the New Zealand correction system. These issues may challenge some of the basic principles on which modem hospice care has been developed. [ABSTRACT FROM AUTHOR]

The Cochrane Library of Systematic Reviews is published monthly online (http://www.thecochranelibrary.com). The library currently contains 7332 complete reviews and 2520 protocols for reviews in production. In addition, there are citations of 1,055,253 randomized controlled trials and 15,764 cited papers in the Cochrane Methodology Register. The Health Technology Assessment database contains some 17,000 citations. The impact factor of the Cochrane Library stands at 6.1. This report attempted to identify all relevant reviews published in the 2 months to May 31, 2017. Eight reviews have been identified that have potential relevance for practitioners in pain and palliative medicine. Readers are encouraged to access the full report for any articles of interest, as only a brief commentary is provided. [ABSTRACT FROM AUTHOR]

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online (). The July 2013 issue (3rd DVD for 2013) contains 5631 complete reviews, 2337 protocols for reviews in production and 24,500 short summaries of systematic reviews published in the general medical literature. In addition there are citations of 704,000 randomized controlled trials, and 15,700 cited papers in the Cochrane Methodology Register. The Health Technology Assessment database contains some 12,000 citations. One hundred and thirty-five new reviews have been published in the previous three months of which nine have potential relevance for practitioners in pain and palliative medicine. The impact factor of the Cochrane Library stands at 5.715. Readers are encouraged to access the full report for any articles of interest as only a brief commentary is provided. [ABSTRACT FROM AUTHOR]

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2008 contains 3625 complete reviews, 1921 protocols for reviews in production, and 9025 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 549,000 randomized controlled trials, and 10,900 cited papers in the Cochrane methodology register. The health technology assessment database contains 7500 citations. This edition of the Library contains 84 new reviews of which 5 have potential relevance for practitioners in pain and palliative medicine. [ABSTRACT FROM AUTHOR]

The Cochrane Library of Systematic Reviews is published quarterly. Issue 2 2009 contains 3737 complete reviews, 1939 protocols for reviews in production, and 9403 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 564,000 randomized controlled trials, and 11,000 cited papers in the Cochrane methodology register. The health technology assessment database contains 7591 citations. This edition of the Library contains 112 new reviews of which 6 have potential relevance for practitioners in pain and palliative medicine. [ABSTRACT FROM AUTHOR]

The Cochrane Library of Systematic Reviews is published quarterly. Issue Three for 2008 contains 3539 complete reviews, 1868 protocols for reviews in production, and 8349 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 540,000 randomized controlled trials, and 10,000 cited papers in the Cochrane methodology register. The health technology assessment database contains 7400 citations. This edition of the Library contains 75 new reviews, of which 7 have potential relevance for practitioners in pain and palliative medicine. [ABSTRACT FROM AUTHOR]

TheCochrane Library of Systematic Reviewsis now only published monthly online (http://www.thecochranelibrary.com). The methods for searching have changed and are in flux. This report attempted to identify all relevant reviews published in the last 3 months to March 30, 2017. The current version contains 7243 complete reviews and 2544 protocols for reviews in production. In addition, there are citations of 1,036,153 randomized controlled trials (first time passing the million mark) and 15,700 cited papers in the Cochrane Methodology Register. The Health Technology Assessment database contains some 17,000 citations. Six reviews have been identified that have potential relevance for practitioners in pain and palliative medicine. The impact factor of theCochrane Librarystands at 6.1. Readers are encouraged to access the full report for any articles of interest, as only a brief commentary is provided. [ABSTRACT FROM AUTHOR]

The Cochrane Library of Systematic Reviews is published monthly online and in a DVD format four times a year. The April 2010 issue contains 6049 complete reviews, 1924 protocols for reviews in production, and 11887 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of over 608,000 randomized controlled trials, and 12,700 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7700 citations. This edition of the Library contains 91 new reviews, of which 9 have potential relevance for practitioners in pain and palliative medicine. [ABSTRACT FROM AUTHOR]

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine. [ABSTRACT FROM AUTHOR]

TheCochrane Library of Systematic Reviewsis published quarterly as a DVD and monthly online (http://www.thecochranelibrary.com). The October 2015 issue (fourth DVD for 2015) contains 6622 complete reviews, 2429 protocols for reviews in production, and 36,600 short summaries of systematic reviews published in the general medical literature (this short summary database is no longer being updated). In addition, there are citations of 848,000 randomized controlled trials, and 15,700 cited papers in the Cochrane Methodology Register. The Health Technology Assessment database contains some 15,000 citations. One hundred and nine new reviews have been published in the previous 3 months, of which six have potential relevance for practitioners in pain and palliative medicine. The impact factor of theCochrane Librarystands at 5.939. Readers are encouraged to access the full report for any articles of interest as only a brief commentary is provided. [ABSTRACT FROM AUTHOR]

The Cochrane Library of Systematic Reviews is published quarterly. Issue 3 2009 contains 3916 complete reviews, 1905 protocols for reviews in production, and 10,894 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 587,000 randomized controlled trials, and 11,800 cited papers in the Cochrane methodology register. The health technology assessment database contains 7947 citations. This edition of the Library contains 90 new reviews, of which 11 have potential relevance for practitioners in pain and palliative medicine. [ABSTRACT FROM AUTHOR]

International policy initiatives have called for recognition of pain management and palliative care as basic humans rights. This paper describes the rationale for and realization of major changes in Mexican health law to help assure availability of such services to the citizenry of that nation. The necessity for appropriate symptom control and safeguards against inappropriate initiation or cessation of care are defined. [ABSTRACT FROM AUTHOR]

The section presents summaries of several papers on pain and palliative care pharmacotherapy. The first article provided an overview regarding core principles of legitimacy as applied to online pharmacy websites. The second article answered questions from patients concerning intraspinal medicine pumps and spinal cord stimulators. Another paper presented questions from patients about opioid therapy and medication withdrawal.

The section presents summaries of several studies on pain and palliative care pharmacotherapy. The first study provided an understanding of the chronic pain experience by patients. The second study described progress in improved pain management, inequalities in pain treatment and the importance of good pain management education. Another paper discussed the importance and findings in the management of pain in palliative care.

The Cochrane Library is published quarterly. Issue 1, 2008, contains 3,385 complete reviews, 1,786 protocols for reviews in production, and 7,048 one-page summaries of systematic reviews published in the general medical literature. In addition there are citations of 527,000 randomized controlled trials, and 10,000 cited papers in the Cochrane methodology register. The health technology assessment database contains 7,177 citations. This edition of the Library contains 86 new reviews of which 7 have potential relevance for practitioners in pain and palliative medicine. [ABSTRACT FROM AUTHOR]

The National Consensus Project (NCP) 2004 Clinical Practice Guidelines for Quality Palliative Care defines eight domains of care essential for palliative care clinical practice. The National Quality Forum (NQF) 2006 document entitled A National Framework and Preferred Practices for Palliative and Hospice Care Quality: A Consensus Report is based on the NCP Guidelines. The NQF document identifies 38 evidence-based preferred practices for palliative care. This paper demonstrates how the Guidelines and Preferred Practices may be operationalized by pharmacotherapists to better treat symptoms of debilitating or chronic illnesses falling under Domain 2 of the Guidelines, "Physical Care," Specifically, dementia and dyspnea are used as illustrative examples. [ABSTRACT FROM AUTHOR]

The Cochrane Library of Systematic Reviews is published quarterly. Issue 3 2007 contains 3197 complete reviews, 1744 protocols for reviews in production and 6312 one-page summaries of systematic reviews published in the general medical literature. In addition there are citations of 503,000 randomized controlled trials, and 9628 cited papers in the Cochrane methodology register. The health technology assessment database contains 6817 citations. This edition of the Library contains 103 new reviews of which 11 have potential relevance for practitioners in pain and palliative medicine. [ABSTRACT FROM AUTHOR]

The Cochrane Library of Systematic Reviews is published quarterly. It now contains 2,893 complete reviews, 1,646 protocols for reviews in production and 5,758 one page summaries of systematic reviews published in the general medical literature. In addition there are citations of 479,462 randomized controlled trials, 22 methodology reviews and 8,790 cited papers in the Cochrane methodology register. The health technology assessment database contains 6,175 citations. This edition of the Library contains 109 new reviews of which eight have potential relevance for practitioners in pain and palliative medicine. [ABSTRACT FROM AUTHOR]

The Cochrane Library, of Systematic Reviews is published quarterly. It now contains 2785 complete reviews, 1625 protocols of reviews and 5574 one page summaries of systematic reviews published in the general medical literature. In addition there are citations of 477,942 randomized controlled trials, 23 methodology reviews and 8408 cited papers in the Cochrane methodology register, The health technology assessment database contains 6011 citations. This edition of the Library contains 111 new reviews of which 9 have potential relevance for practitioners in pain and palliative medicine. [ABSTRACT FROM AUTHOR]

The article reports on the vote of the American Medical Directors Association (AMDA) House of Delegates to reaffirm a resolution from Kansas AMDA delegation that evolved from the AMDA White Paper on Palliative Care and Hospice in Long Term Care. The priority of providing quality end-of-life care was affirmed by the House of Delegates. The essential role of the long-term-care attending physician and medical director in directing provision when a hospice participates in the long-term care of a resident is emphasized in the resolution.

As the average life span of Americans increases, there is a tremendous need for geriatric-specific information and resources, especially for those older adults with life-limiting illnesses. Emerging literature underscores the differences in palliative and end-of-life approaches between younger and older adults in treating symptoms, understanding issues related to psychosocial and spiritual well-being, and alleviating caregiver burden. Hundreds of internet sites currently exist that pertain to geriatrics, and health professionals now have access to evidence-based clinical care guidelines, guides for education and training, and networks to support patients and their families. Even consumer-oriented organizations have assumed responsibility for informing patients and families and outlining supportive care services for patients and families. This paper reports the results of a systematic evaluation and critique of 15 websites, and summarizes their unique contributions clinical care guidelines, teaching materials and training opportunities, effective models of care, and advice on dealing with the complex emotional, social and financial issues facing older adults at the end-of-life. [ABSTRACT FROM AUTHOR]

The Cochrane Library of Systematic Reviews is published quarterly. Issue four for 2004 of the library was published in October 2004. The Cochrane Librao, now contains 2170 complete reviews, 1500 protocols of reviews and 4918 one-page summaries of systematic reviews published in the general medical literature. In addition there are citations of 427,807 randomised controlled trials, 18 methodology reviews and 5968 cited papers in the Cochrane methodology register. The health technology assessment database contains 4395 citations. In this edition of the Library issued in October 2004, there were 96 new reviews of which 12 have potential relevance for practitioners in pain and palliative medicine. Regular readers will note that the format of the citation has changed with the move to publication of The Cochrane Library, by John Wiley & Sons. Citations will probably change again in the future as currently there is no indication of the date when a review was first published. [ABSTRACT FROM AUTHOR]

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online (). The January 2015 issue (first DVD for 2015) contains 6277 complete reviews, 2355 protocols for reviews in production, and 34,000 short summaries of systematic reviews published in the general medical literature. In addition, there are citations of 832,000 randomized controlled trials, and 15,700 cited papers in the Cochrane Methodology Register. The Health Technology Assessment database contains some 14,000 citations. One hundred and ten new reviews have been published in the previous 3 months, of which six have potential relevance for practitioners in pain and palliative medicine. The impact factor of the Cochrane Library stands at 5.939. Readers are encouraged to access the full report for any articles of interest, as only a brief commentary is provided. [ABSTRACT FROM AUTHOR]

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online (). The October 2013 issue (fourth DVD for 2013) contains 5737 complete reviews, 2352 protocols for reviews in production, and 26,000 short summaries of systematic reviews published in the general medical literature. In addition, there are citations of 714,000 randomized controlled trials, and 15,700 cited papers in the Cochrane Methodology Register. The Health Technology Assessment database contains some 12,000 citations. One hundred and six new reviews have been published in the previous 3 months, of which seven have potential relevance for practitioners in pain and palliative medicine. The impact factor of the Cochrane Library stands at 5.715. Readers are encouraged to access the full report for any articles of interest, as only a brief commentary is provided. Systematic reviews published in the October 2013 Issue of the Cochrane Library address anticonvulsants for fibromyalgia, naproxen with or without an antiemetic for acute migraine headaches in adults, sumatriptan plus naproxen for acute migraine attacks in adults, pharmacological treatment for pain in Guillain-Barré syndrome, transdermal fentanyl for cancer pain, interventions for the reduction of prescribed opioid use in chronic noncancer pain, and topiramate for neuropathic pain and fibromyalgia in adults. [ABSTRACT FROM AUTHOR]

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online (). The January 2014 issue (1st DVD for 2014) contains 5840 complete reviews, 2342 protocols for reviews in production, and 28,000 short summaries of systematic reviews published in the general medical literature. In addition, there are citations of 763,000 randomized controlled trials, and 15,700 cited papers in the Cochrane Methodology Register. The Health Technology Assessment database contains some 13,000 citations. Ninety-four new reviews have been published in the previous 3 months, of which five have potential relevance for practitioners in pain and palliative medicine. The impact factor of the Cochrane Library stands at 5.715. Readers are encouraged to access the full report for any articles of interest, as only a brief commentary is provided. [ABSTRACT FROM AUTHOR]

Malignant bowel obstruction is a common complication of advanced gastrointestinal, gynecologic, and genitourinary tumors. Patients present with nausea, vomiting, abdominal pain, and constipation. Cross-sectional imaging is essential to make a diagnosis of bowel obstruction. Initial management is conservative with fluid replacement, electrolyte replacement, bowel rest and sometimes nasogastric decompression. Numerous advanced options exist for definitive management, though none are overly promising but nevertheless may improve quality and quantity of life. Surgical bypass, endoscopic stenting, and endoscopic decompression are some of the options with variable efficacy and are employed in select patients. Chemotherapy may be utilized if the bowel obstruction resolves to reduce tumor burden in a limited number of patients. Parenteral nutrition is an option and should typically be used in surgical patients with good functional and nutritional status with limited tumor burden or curative intent. Palliative care and hospice should be discussed in patients with advanced malignancy who present with peritoneal carcinomatosis or multiple levels of obstruction. Overall prognosis of malignant bowel obstruction is poor, and median survival ranges from 26 to 192 days. [ABSTRACT FROM AUTHOR]

The Cochrane Library of Systematic Reviews is published quarterly as a DVD but monthly online. The April 2011 issue (second DVD for 2011) contains 4594 complete reviews, 2008 protocols for reviews in production, and 14,602 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 645,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains nearly 10,000 citations. Seventy-nine new reviews have been published in the last 3 months, of which eight have potential relevance for practitioners in pain and palliative medicine. [ABSTRACT FROM AUTHOR]

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine. [ABSTRACT FROM AUTHOR]

The Cochrane Library of Systematic Reviews is published quarterly as a DVD but monthly online. The October issue for 2010 (3rd DVD for 2010) contains 4407 complete reviews, 1962 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition there are citations of 635,000 randomized controlled trials, and 13,721 cited papers in the Cochrane methodology register. The health technology assessment database contains over 8900 citations. Ninety-eight new reviews have been published in the last 3 months of which nine have potential relevance for practitioners in pain and palliative medicine. [ABSTRACT FROM AUTHOR]

Cochrane Library of Systematic Reviews is published quarterly. Issue 2 2008 contains 3464 complete reviews, 1856 protocols for reviews in production, and 8131 one-page summaries of systematic reviews published in the general medical literature, In addition there are citations of 533,000 randomized controlled trials, and 10,000 cited papers in the Cochrane methodology register. The health technology assessment database contains 7400 citations. This edition of the Library contains 80 new reviews, of which 8 have potential relevance for practitioners in pain and palliative medicine. The Cochrane Library has been awarded an ISI impact factor of 4.654. [ABSTRACT FROM AUTHOR]

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 2007 contains 3298 complete reviews, 1755 protocols for reviews in production and 6761 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 522,000 randomized controlled trials and 10,000 cited papers in the Cochrane methodology register. The health technology assessment database contains 6087 citations. This edition of the Library contains 101 new reviews of which 7 have potential relevance for practitioners in pain and palliative medicine. [ABSTRACT FROM AUTHOR]

The Cochrane Library of Systematic Reviews is published quarterly. It now contains 3009 complete reviews, 1668 protocols of reviews and 5931 one page summaries of systematic reviews published in the general medical literature. In addition there are citations of 489,167 randomized controlled trials, 22 methodology reviews and 9048 cited papers in the Cochrane methodology register. The health technology assessment database contains 6358 citations. This edition of the Library contains 104 new reviews of which 6 have potential relevance for practitioners in pain and palliative medicine. [ABSTRACT FROM AUTHOR]

TheCochrane Library of Systematic Reviewshas been published quarterly as a DVD and monthly online (http://www.thecochranelibrary.com). The final October 2016 issue (4th DVD for 2016) contains 7068 complete reviews and 2467 protocols for reviews in production. In addition, there are citations of 973,000 randomized controlled trials, and 15,700 cited papers in the Cochrane Methodology Register. The Health Technology Assessment database contains some 16,000 citations. One hundred and seventeen new reviews have been published in the previous 3 months, of which three have potential relevance for practitioners in pain and palliative medicine. The impact factor of the Cochrane Library stands at 6.1. Readers are encouraged to access the full report for any articles of interest, as only a brief commentary is provided. The CD version of theCochrane Librarywill be discontinued and theLibrarywill only available online in the future. [ABSTRACT FROM AUTHOR]

This section offers news briefs on pharmacotherapy as of December 2014. A clinical trial found that patients with advanced cancer had significant survival advantage with early, telephone-based concurrent oncology palliative care. The American Hospice Foundation has shut down at the end of June 2014. A report says that almost half of soldiers in a U.S. Army infantry brigade returning to the U.S. from Afghanistan experienced pain and 13% reported the use of opioids.

TheCochrane Library of Systematic Reviewsis published quarterly as a DVD and monthly online (http://www.thecochranelibrary.com). The April 2016 issue (2nd DVD for 2016) contains 6875 complete reviews, 2417 protocols for reviews in production, and 36,600 short summaries of systematic reviews published in the general medical literature (this short summary database is no longer being updated). In addition, there are citations of 934,000 randomized controlled trials, and 15,700 cited papers in the Cochrane Methodology Register. The Health Technology Assessment database contains some 16,000 citations. One hundred and twenty-nine new reviews have been published in the previous 3 months, of which three have potential relevance for practitioners in pain and palliative medicine. The impact factor of theCochrane Librarystands at 5.939. Readers are encouraged to access the full report for any articles of interest, as only a brief commentary is provided. [ABSTRACT FROM AUTHOR]

The global prevalence of heart failure (HF) is increasing. Advancements in guideline-directed medical and device therapy have resulted in improved survival. Thus, there are more patients living – and living longer – with advanced HF. Only a small proportion of these patients are deemed appropriate for advanced surgical intervention (mechanical circulatory support or heart transplantation), and even if offered, some may decline such interventions if not aligned with their overall goals and values. Therefore, a growing number of patients with advanced HF receive chronic intravenous inotropic support (CIIS) for palliation of symptoms. Despite increased use, clinical evidence supporting use of palliative inotropes remains limited. However, available data suggest improvements in functional class, health-related quality of life (HRQoL) indicators, symptom burden, hemodynamic parameters, and possibly rehospitalization. While initial concerns regarding increased mortality have been assuaged in the modern era of guideline-directed medical therapy, palliative inotropes are certainly not without burden. Risks of infection and medication-related adverse effects, need for routine laboratory monitoring, frequent dressing changes, and presence of a reliable caregiver must be carefully considered prior to initiation. This review addresses pharmacology, guideline recommendations, benefits and burdens, considerations related to hospice and end-of-life care, and future directions of CIIS in advanced HF care. [ABSTRACT FROM AUTHOR]

Opioids and benzodiazepines are cornerstones of the pharmacological management of pain and agitation in palliative medicine. Oral drug delivery is the most popular route of administration, with the subcutaneous route typically utilized where oral medications are not tolerated or are ineffective. Intranasal drug delivery offers an important alternative administration route, with benefits including ease of administration, tolerability and avoidance of needle use, and is particularly useful in the community, where medications may be administered by lay carers or by patients themselves. Intranasal diamorphine and intranasal midazolam both have demonstrated efficacy and safety in adult and pediatric cohorts, however there is limited research into their use in managing pain and agitation in palliative care. We describe the management of three patients under the community palliative care team who received intranasal diamorphine, two of whom also received intranasal midazolam, to manage breakthrough symptoms of pain and agitation at home. In each case, the patient or their relative was taught how to prepare and administer the relevant intranasal medication. This case series demonstrates that for selected patients, diamorphine and midazolam administered intranasally by patients or lay carers at home is efficacious, acceptable and generally well tolerated. [ABSTRACT FROM AUTHOR]

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online (). The April 2013 issue (2nd DVD for 2013) contains 5484 complete reviews, 2341 protocols for reviews in production, and 22,600 short summaries of systematic reviews published in the general medical literature. In addition, there are citations of 692,000 randomized controlled trials, and 15,700 cited papers in the Cochrane methodology register. The health technology assessment database contains some 12,000 citations. Ninety-four new reviews have been published in the previous 3 months, of which four have potential relevance for practitioners in pain and palliative medicine. The impact factor of the Cochrane Library stands at 5.715. Readers are encouraged to access the full report for any articles of interest, as only a brief commentary is provided. [ABSTRACT FROM AUTHOR]

Cough associated with cancer or nonmalignant chronic disease is common and distressing. Levodropropizine, a peripherally acting drug, has been used as an alternative antitussive to opioids. The authors aimed to determine the efficacy and safety of levodropropizine in relieving cough associated with cancer or nonmalignant chronic disease. The authors searched five databases and hand searched relevant journals to identify randomized and nonrandomized controlled trials assessing the antitussive effect of levodropropizine for cough associated with cancer, chronic obstructive pulmonary disease (COPD), interstitial lung disease, or chronic heart failure. Study quality was assessed using a modified version of the Centre for Reviews and Dissemination criteria. The search yielded 58 references. Six were checked in more detail, and four studies were included. Two were randomized controlled trials (RCTs) testing levodropropizine against dihydrocodeine and moguisteine, and two were nonrandomized placebo-controlled studies, all with important limitations and high risk of bias. Levodropropizine was significantly more effective than placebo in reducing cough frequency and severity, and equally effective as dihydrocodeine or moguisteine. It was generally well tolerated. The authors conclude that the evidence for the antitussive efficacy of levodropropizine in these patients is scarce, and is further limited by the methodological weaknesses of the primary studies. Further well-designed research is needed to support its use. [ABSTRACT FROM AUTHOR]

A notable and welcome increase in palliative care research has led to a multitude of ethical issues and concerns for researchers, clinicians, patients (subjects) and their family members (who also might be subjects), granting agencies, and professional journals. This edition of "Palliative Care Pearls" summarizes the recommendations from a work group that met at the National Institutes of Health in September, 2002. The primary purpose for that meeting was to explore the unique characteristics of this research population and the ethical concerns that might require tailoring of "standard" clinical research processes. The proceedings culminated in a document from which open discourse and a more formal set of guidelines might emanate to both foster more and better research, while providing protections for research subjects. This 62 page long monograph was published as a supplement to the Journal of Pain and Symptom Management (April, 2003). It includes six "plenary" papers, each that focuses on a distinct ethical domain of palliative care research and concludes with a set of recommendations and research questions. These might best be viewed as hypotheses that need to be tested or further explored. [ABSTRACT FROM AUTHOR]

Pharmacotherapy is essential in palliative medicine. Besides potential benefits, pharmacotherapy also poses potential risks that need to be minimized for patient safety. Pharmacists can play an important role in identifying, solving, and avoiding drug-related problems (DRPs). The aim of this study was to evaluate pharmaceutical interventions on safety of drug therapy in patients in an inpatient palliative care unit. All patients admitted to a palliative care unit over a 12-month period were screened for eligibility (ie, life expectancy >4 weeks). To identify and assess DRPs, patients' pharmacotherapy was evaluated by a pharmacist according to various aspects (eg, drug selection, dose selection, or treatment duration according to the Pharmaceutical Care Network Europe classification for DRPs). During the 12-month period, 41 patients were included. Patients received a median of 11 (range, 1–22) different drugs. Overall, 207 DRPs were documented (median 5 DRPs/patient). After recording a DRP, the pharmacist directly intervened 290 times in order to solve the DRP, which was successful in 181/207 (88%). Clinically relevant DRPs are common in palliative medicine. The systematic assessment can support therapy decisions. This can result in optimized drug therapy, subsequently having a positive effect on symptom control and quality of life. [ABSTRACT FROM AUTHOR]

Introduces a segment in the 'Journal of Pain and Palliative Care Pharmacotherapy' which will address outcomes research and pharmacoeconomics in pain and palliative care. Goal of the segment; Common types of outcomes research that are relevant to pain and symptom control; Discussion on the factors involved in pharmacokinetics.

Presents news briefs concerning palliative and pain care, as of June 2002. Results of a study that examined the prevalence and characteristics of hospital-based palliative care programs; Launch of a Web site by the National Coalition for Cancer Survivorship and the Leukemia & Lymphoma Society; Information on a study that examined the differences in back pain interventions among different races.