Palliative care and hospice: one approach.

The establishment of the first department of pain medicine and palliative care in a medical center in the United States is a significant marker in the development and impact of the palliative care movement. The integration of Jacob Perlow Hospice into this department is a milestone in the continued evolution of the hospice movement in the United States, and suggests that an interrelationship and interdependence between palliative care and hospice is one of the characteristics of change for the future.

Issues of access in a diverse society.

Hospices are successful in addressing the needs of middle class, white, elderly persons with cancer who have family members able to care for them at home. However, there is a need to provide better access to care within diverse settings and for diverse populations. Ethnic minorities, marginalized persons and those without stable home environments or living in nontraditional ways are not well served by hospice at the present time. To improve access to hospice care, hospices need to address the distinctive profiles of their staffs and make them more inclusive and representative of the total community for their service area, create a broad range of programs of outreach, build bridges with other programs, develop expanded resources to manage the needs of patients and families, and train volunteers and staff to work in non-traditional home settings.

Managing patients and families at the ending of life: hospice assumptions, structures, and practice in response to staff stress.

Hospice programs do not identify burnout as a significant staff problem, even though there are many significant stressors for staff members doing hospice work. Hospices offer support in a wide variety of ways and settings through their human resources management. All this support is predicated on the assumption that the nature of the work requires it, and that hospice programs are responsible to provide it for staff. Certainly, in a rapidly changing health care environment that increasingly is expecting health care providers to do more with less, all systems of health care delivery will need to examine the management of stress and learn better how to provide a healthy work environment for those who deliver health care. The experience of hospices offers much to assist this process.

Hospice care and palliative care: a perspective from experience.

The establishment of the first Department of Pain Medicine and Palliative Care in a Medical Center in the United States is noteworthy. Since the design of the Department integrates a full-functioning hospice program within it, that has both a dedicated inpatient unit and extensive home care program, this Department represents a milestone in the development of the hospice movement, with full interrelationship between palliative care and hospice care. This paper will explore this interrelationship, its implications, and some of the background.

Sparing and recovery of function in spinal larval frogs (Rana catesbeiana): effect of level of transection.

Bullfrog tadpoles with cervical or midthoracic transection of the spinal cord were allowed to recover for 5 weeks, at which time axonal growth across the transection site was assessed by transport of horseradish peroxidase. Weekly behavioral tests included those for posture, spontaneous locomotion, cutaneously elicited swimming, and intersegmental coordination. Behavioral and electrophysiological assessments suggest that behavioral recovery depends, at least in part, on the growth of fibers across the transection site. Anatomical and behavioral recovery does not appear to differ with the level of spinal transection, but there was greater sparing of posture, spontaneous locomotion, and stimulus-induced locomotion in tadpoles with thoracic transection of the spinal cords.