End of Life Care in the ICU: From advanced disease to bereavement

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Graeme Rocker, Kathleen Puntillo, Élie Azoulay, Judith Nelson
OUP Oxford, Jan 28, 2010 - Medical - 416 pages
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The Oxford Specialist Handbooks series provides readers with clear, concise information on all that is needed to successfully train in the medical sub-specialties. Each book gives an overview of clearly defined procedures, skills, guidelines, and technologies and provides practical tips and case studies to supplement hands-on experience. Where appropriate, each book complements the revised curriculum as developed by the Specialist Advisory Committees. As palliative medicine does not have the resources to care for all patients with malignant and non-malignant chronic disease, government guidelines have pushed for its inclusion on the curriculum of most medical and surgical specialties. All specialties are being encouraged to become actively engaged in managing end of life care for their own patients. End of life care in the ICU presents its own unique challenges, and this book highlights real clinical issues which need to be addressed if quality palliative care within ICUs is to be consistently delivered. It details strategies and evidence-based advice on the nature of effective palliative care in the ICU setting, dealing with issues such as diagnosing the dying, communicating with patients and families, the support of families and carers, multidisciplinary team work, TPN and fluids, dialysis, inotropic support, autonomy, dignity, effective symptom control, practical ethics and the process of decision making, management of dying, and bereavement care. This book is ideal for doctors, nurses, and allied health professionals working in the ICU and palliative care.

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About the author (2010)


Dr Graeme Rocker is a Professor of Medicine, a Respirologist and a Senior Clinical Research Scholar at Dalhousie University, Halifax, Nova Scotia. He graduated from the Oxford University Clinical Medical School and did most of his postgraduate training in Oxford or Nottingham. His research into Adult Respiratory Distress Syndrome led to a Doctorate from the University of Oxford in 1989. He received a Masters degree in Bioethics from the University of Toronto in 2001.
Dr Rocker was President of the Canadian Critical Care Society 2002- 2004 and secretary of the Canadian Critical Care Trials Group from 1998-2002. Dr Rocker has focused his recent end of life care research activities on patients and diseases that fall outside of traditional palliative medicine and is cross-appointed locally in the Division of Palliative Medicine in Halifax. Dr Judith Nelson received her JD from Harvard Law School and MD from New York University School of Medicine. She completed internal medicine residency and fellowship in pulmonary and critical care medicine at Mount Sinai School of Medicine in New York City, where she joined the faculty of the Division of Pulmonary/Critical Care Medicine of the Department of Medicine in 1992. Dr. Nelson is Associate Director of the Medical Intensive Care Unit of Mount Sinai Hospital and a member of the faculty of the Hertzberg Palliative Care Institute in Mount Sinai's Brookdale Department of Geriatrics and Adult Development. Her subspecialty certifications include Palliative Medicine as well as Pulmonary Disease and Critical Care Medicine.
Kathleen Puntillo is Professor and Co-Director of the Critical Care/Trauma graduate program at University of California San Francisco School of Nursing. She maintains an active program of research on pain in critically ill patients; procedural pain; symptoms in ICU patients at high risk of dying; and ICU palliative care. She regularly provides nursing care to ICU patients in partnership with ICU nurses. She has numerous publications and has been invited to give numerous presentations on pain, other symptoms, and end-of-life topics, both in the United States and internationally. Elie Azoulay, MD, PhD is Professor of Medicine at the University of Paris 7, France, as well as the Director assistant of the medical ICU at the Saint-Louis Teaching Hospital in Paris. He is a member of the Ethics Section of ESICM and on the editorial board of Intensive Care Medicine. From his background of respiratory care physician, he is mostly interested in pulmonary complications in immunocompromized patients. He has also largely contributed to the literature reporting improvements in survival of critically ill cancer patients. Furthermore, he serves as the Director of the French FAMIREA study group, which is aimed at improving the effectiveness of communication with family members of ICU patients.

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