The communicative impediments associated with delirium generate distress for the patient, their family, and health care practitioners who might have to contend with agitation and difficulty in assessing pain and other symptoms. To manage delirium in patients with cancer, clinicians must be able to diagnose it accurately and undertake appropriate assessment of underlying causes.

Background: The World Health Assembly urges members to build palliative care (PC) capacity as an ethical imperative. Nurses provide PC services in a variety of settings, including the home and may be the only health care professional able to access some disparate populations. Identifying current nursing services, resources, and satisfaction and barriers to nursing practice are essential to build global PC capacity. Objective: To globally examine home health care nurses' practice, satisfaction, and barriers, regarding existing palliative home care provision. Design: Needs assessment survey. Setting/Subjects: Five hundred thirty-two home health care nurses in 29 countries. Measurements: A needs assessment, developed through literature review and cognitive interviewing. Results: Nurses from developing countries performed more duties compared with those from high-income countries, suggesting a lack of resources in developing countries. Significant barriers to providing home care exist: personnel shortages, lack of funding and policies, poor access to end-of-life or hospice services, and decreased community awareness of services provided. Respondents identified lack of time, funding, and coverages as primary educational barriers. In-person local meetings and online courses were suggested as strategies to promote learning. Conclusions: It is imperative that home health care nurses have adequate resources to build PC capacity globally, which is so desperately needed. Nurses must be up to date on current evidence and practice within an evidence-based PC framework. Health care policy to increase necessary resources and the development of a multifaceted intervention to facilitate education about PC is indicated to build global capacity.

The optimal method has not been defined yet for acute pain palliation after MRM. Our study demonstrated that the use of interscalene block in patients undergoing MRM improved pain scores and reduced morphine consumption during the first 24 h postoperatively. The block can be a good alternative to other invasive regional block techniques used for postoperative pain management after MRM.

Purpose: we evaluated the effects of magnesium sulphate infusion on anesthetic requirement, early recovery and postoperative analgesia in desflurane-remifentanil-based, balanced anaesthesia. Methods: 60, ASA (American Society of Anesthesiologists) group 1-2 patients who were scheduled for laparoscopic cholecystectomy were randomly divided into two groups. Before anesthesia, the magnesium-treated group (n = 30) received a 15 min infusion of 40 mg/kg of magnesium sulphate followed by 10 mg/kg/h by continuous i.v. infusion during the operation. The same volume of isotonic saline was administered to the control group (n = 30). Anesthesia was induced with propofol, remifentanil and vecuronium, and maintained with desflurane 3-6%, O 2 /air and remifentanil infusion. Desflurane was titrated to maintain BIS (bispectral index) values of 40-60. The times from cessation of anesthesia to spontaneous breathing, eye opening, extubation, reaching BIS 70, and Aldrete scores were recorded. After surgery, patients received a patient-controlled, morphine analgesia device. Results: demographic variables were similar. During the 15 min infusion of magnesium sulphate, the BIS value was significantly lower in the magnesium sulphate-treated group. The amounts of propofol and desflurane used were less in the magnesium sulphate-treated group, by 18% and 22% respectively (p<0.05). The groups did not differ with respect to the time taken to reach BIS 70, spontaneous breathing, eye opening and extubation. Alderete and VAS (visual analogue scale) pain scores, and total morphine consumption were significantly lower in the magnesium sulphate-treated group. There were no differences in side effects, but the rate of re-intubation was higher in the group receiving magnesium sulphate (p = 0.03). Conclusion: perioperative use of magnesium sulphate reduced propofol and desflurane consumption, and the postoperative morphine requirement, while causing a delay in recovery by decreasing the Aldrete score.

Summary Objectives: The purpose of this study was to determine the symptoms observed during admission to palliative care in patients that ÖzetAmaç: Bu araştırmanın amacı, palyatif destek verilecek kanser hastalarında palyatif bakıma kabul sırasında görülen semptomları belirlemek, şiddetini ölçmek, hastaneye yatıştan sonra ilk bir haftadaki değişiklikleri kaydederek palyatif bakımın hasta semptomları üzerindeki etkisini değerlendirmektir. Gereç ve Yöntem: Araştırmanın örneklemi, ön uygulama verileri kullanılarak yapılan kitle ortalaması önemlilik testi sonuç-larına göre 108 olarak belirlendi. Hastaneye kabulde, yatışın üçüncü ve yedinci günlerinde Edmonton Semptom Tanılama Ölçeği'ni tamamlayabilen hastalar değerlendirmeye alındı. Verilerin toplanmasında Tanıtıcı Özellikler Anket Formu, Edmonton Semptom Tanılama Ölçeği ve Palyatif Performans Skalası kullanıldı. Bulgular: Hastaların %50' si yatış sırasında ağrı şiddetini 5 ve üzeri olarak tanımlarken yedinci günde bu oranın %6.5 olduğu saptandı. Hastaların ağrı, uykusuzluk, iştahsızlık, kendini iyi hissetme durumu semptomları ortalama değerlerinin hastaneye kabule göre, üçüncü günde ve yedinci günde anlamlı derecede azaldığı belirlendi. Bununla beraber bulantı, endişe, nefes darlığı ve konstipasyon semptomları arasında istatistiksel olarak anlamlı fark bulunmadı. Sonuç: Bu araştırmada kanser hastalarının yaşam kalitesini bozan ağrı, yorgunluk, uykusuzluk, iştahsızlık ve kendini iyi hissetme durumu gibi semptomların şiddetinde palyatif bakım desteği ile hızlı bir düzelme sağlandığı saptandı.Anahtar sözcükler: Hasta; palyatif bakım; semptom.