ABSTRACT
Methadone use as a second-line agent for severe cancer-related pain is increasing in the field of hospice and palliative care. It has a number of qualities that make its use favorable, including lack of known active metabolites and presumed relative safety from adverse effects such as opioid-induced neurotoxicity (OIN). This article describes a case of a patient undergoing treatment of severe cancer-related pain who developed OIN in the setting of oral methadone use. As the use of methadone increases, more research into its pharmacologic and pharmacokinetic properties will be necessary.
Subject(s)
Analgesics, Opioid/administration & dosage , Analgesics, Opioid/adverse effects , Methadone/administration & dosage , Methadone/adverse effects , Neoplasms/pathology , Neurotoxicity Syndromes/etiology , Pain/drug therapy , Humans , Male , Middle Aged , Neoplasms/drug therapy , Palliative CareABSTRACT
The innovation now being demanded by Medicare is creating new opportunities for health care organizations to redesign how they deliver care for elderly people. For many years, the VA Health System has experimented with ways to deliver care more effectively and efficiently. Hospital-based postacute and palliative care and home-based primary care are two examples of successful approaches that non-VA providers should be looking at as they move away from fee-for-service reimbursement and invent new care-delivery models.
Subject(s)
Chronic Disease/therapy , Delivery of Health Care/organization & administration , Health Services for the Aged/organization & administration , Home Care Services/organization & administration , Hospitals, Veterans/organization & administration , Rehabilitation Centers/organization & administration , United States Department of Veterans Affairs/organization & administration , Veterans , Aged , Chronic Disease/economics , Cooperative Behavior , Cost-Benefit Analysis , Delivery of Health Care/economics , Health Services for the Aged/economics , Home Care Services/economics , Hospitals, Veterans/economics , Humans , Interdisciplinary Communication , Minnesota , Patient Care Team/economics , Patient Care Team/organization & administration , Primary Health Care/economics , Primary Health Care/organization & administration , Referral and Consultation/economics , Referral and Consultation/organization & administration , Rehabilitation Centers/economics , United States , United States Department of Veterans Affairs/economicsSubject(s)
Community Health Services/organization & administration , Hospitals, Religious/organization & administration , Palliative Care/organization & administration , Community-Institutional Relations , Diffusion of Innovation , Health Services Needs and Demand , Humans , Interinstitutional Relations , Models, Organizational , Patient Care Team/organization & administration , Program Development/methods , Program Development/statistics & numerical data , Protestantism , TanzaniaABSTRACT
In the fight against HIV and AIDS in sub-Saharan Africa, the plight of orphaned and vulnerable children was long overlooked. The first United Nations report on orphans and vulnerable children did not emerge until 2002 after more than two generations of children and youth had struggled to survive with limited family, institutional, or government support. The major social determinants of health for infants and children with one or more parents dying or dead from HIV include pervasive poverty, weak community social support systems, lack of policy commitment by governments or foreign donors, lack of access to anti-retroviral drugs, limited access to schools, and gender. In this paper, we present a model of care and support to the most vulnerable children (MVC) affected by HIV that brings together faith-based institutions in partnership with the government and community volunteers in 13 rural districts of Tanzania. Although still being implemented, the project has a number of valuable lessons learned for program managers, donors, and researchers working with faith-based organizations in the development and delivery of services to the most vulnerable children in a resource-limited setting.
