End-of-life care - Knowledge

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the effectiveness of interpersonal communication interventions during end-of-life care. Research suggest that many patients prioritize proper symptom management, avoidance of suffering, and care that aligns with ethical and cultural standards. Specific conversations can include discussions about cardiopulmonary resuscitation (ideally occurring before the active dying phase as to not force the conversation during a medical crisis/emergency), place of death, organ donation, and cultural/religious traditions. As there are many factors involved in the end-of-life care decision-making process, the attitudes and perspectives of patients and families may vary. For example, family members may differ over whether life extension or life quality is the main goal of treatment. As it can be challenging for families in the grieving process to make timely decisions that respect the patient's wishes and values, having an established advanced care directive in place can prevent over-treatment, under-treatment, or further complications in treatment management.

529:. The research found that individuals with a severe mental illness were unlikely to receive the most appropriate end of life care. The review recommended that there needs to be close partnerships and communication between mental health and end of life care systems, and these teams need to find ways to support people to die where they choose. More training, support and supervision needs to be available for professionals working in end of life care; this could also decrease prejudice and stigma against individuals with severe mental illness at the end of life, notably in those who are homeless. In addition, studies have shown that minority patients face several additional barriers to receiving quality end-of-life care. Minority patients are prevented from accessing care at an equitable rate for a variety of reasons including: individual discrimination from caregivers, cultural insensitivity, racial economic disparities, as well as medical mistrust. 582:

diverse patient populations. Studies have shown that people who identify as religious also report higher levels of well-being. Religion has also been shown to be inversely correlated with depression and suicide. While religion provides some benefits to patients, there is some evidence of increased anxiety and other negative outcomes in some studies. While spirituality has been associated with less aggressive end-of-life care, religion has been associated with an increased desire for aggressive care in some patients. Despite these varied outcomes, spiritual and religious care remains an important aspect of care for patients. Studies have shown that barriers to providing adequate spiritual and religious care include a lack of cultural understanding, limited time, and a lack of formal training or experience.

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demands. This review also highlighted how nurses who had difficulty giving care to their older patients perceived them as "weak, disabled, inflexible, and lacking cognitive or mental ability". Another systematic review considering structural and individual-level effects of ageism found that ageism led to significantly worse health outcomes in 95.5% of the studies and 74.0% of the 1,159 ageism-health associations examined. Studies have also shown that one's own perception of aging and internalized ageism negatively impacts their health. In the same systematic review, they included this factor as part of their research. It was concluded that 93.4% of their total 142 associations about self-perceptions of aging show significant associations between ageism and worse health.

690:. In all, 58% of deaths occurred in an NHS hospital, 18% at home, 17% in residential care homes (most commonly people over the age of 85), and about 4% in hospices. However, a majority of people would prefer to die at home or in a hospice, and according to one survey less than 5% would rather die in hospital. A key aim of the strategy therefore is to reduce the needs for dying patients to have to go to hospital and/or to have to stay there; and to improve provision for support and palliative care in the community to make this possible. One study estimated that 40% of the patients who had died in hospital had not had medical needs that required them to be there. 98:

specifically noting the improved patient and surrogate satisfaction with communication and decreased clinician distress. However, there is a notable lack of empirical data about what outcome improvements patients experience, as there are considerable discrepancies in what constitutes as advanced care planning and heterogeneity in the outcomes measured. Advanced care planning remains an underutilized tool for patients. Researchers have published data to support the use of new relationship-based and supported decision making models that can increase the use and maximize the benefit of advanced care planning.

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resource showing which services were available and grouped them according to their intended purpose and benefit to the patient. They also stated that currently in the UK palliative services are only available to patients with a timeline to death, usually 12 months or less. They found these timelines to often be inaccurate and created barriers to patients accessing appropriate services. They call for a more holistic approach to end of life care which is not restricted by arbitrary timelines.

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may undergo in the future. The living will will typically take effect when a patient is terminally ill with low chances of recovery. A durable power of attorney for healthcare allows a person to appoint another individual to make healthcare decisions for them under a specified set of circumstances. Combined directives, such as the "Five Wishes", that include components of both the living will and durable power of attorney for healthcare, are being increasingly utilized.

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that there may be very little or no difference in satisfaction of the person needing care for longer term (6 months). The number of people who are admitted to hospital during an end-of-life care program is not known. In addition, the impact of home-based end-of-life care on caregivers, healthcare staff, and health service costs is not clear, however, there is weak evidence to suggest that this intervention may reduce health care costs by a small amount.

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Veterans Affairs Medical Centers, and the study found increased orders for opioid medication post-pathway implementation, as well as more orders for antipsychotic medications, more patients undergoing palliative care consultations, more advance directives, and increased sublingual drug administration. The intervention did not, however, decrease the proportion of deaths that occurred in an ICU setting or the utilization of restraints around death.

7361: 5989: 7371: 834:. Government resources for palliative care doubled in 2000, and in 2007 Belgium was ranked third out of 52 countries worldwide in terms of resources for palliative care. (Together with the United Kingdom and Ireland) to raise public awareness under the auspices of EoL 6 According to the Lien Foundation report, Belgium ranks 5th (out of 40 countries worldwide) for the overall level of 649:

a family member or friend. Women were also more likely to have provided palliative care over their lifetimes, with 16% of women reporting having done so, compared with 10% of men. These caregivers helped terminally ill family members or friends with personal or medical care, food preparation, managing finances or providing transportation to and from medical appointments.

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End-of-life care is an interdisciplinary endeavor involving physicians, nurses, physical therapists, occupational therapists, pharmacists and social workers. Depending on the facility and level of care needed, the composition of the interprofessional team can vary. Health professional attitudes about

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has a particular significance in end of life care, and is considered an essential part of palliative care by the WHO. In palliative care, responsibility for spiritual care is shared by the whole team, with leadership given by specialist practitioners such as pastoral care workers. The palliative care

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found that 13% of Canadians (3.7 million) aged 15 and older reported that at some point in their lives they had provided end-of-life or palliative care to a family member or friend. For those in their 50s and 60s, the percentage was higher, with about 20% reporting having provided palliative care to

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as "the stereotypes (how we think), prejudice (how we feel) and discrimination (how we act) towards others or ourselves based on age." A systematic review in 2017 showed that negative attitudes amongst nurses towards older individuals were related to the characteristics of the older adults and their

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While not possible for every person needing care, surveys of the general public suggest most people would prefer to die at home. In the period from 2003 to 2017, the number of deaths at home in the United States increased from 23.8% to 30.7%, while the number of deaths in the hospital decreased from

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are an organizational tool used by healthcare professionals to clearly define the roles of each team-member and coordinate how and when care will be provided. These pathways are utilized to ensure best practices are being utilized for end-of-life care, such as evidence-based and accepted health care

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Patients and families may also struggle to grasp the inevitability of death, and the differing risks and effects of medical and non-medical interventions available for end-of-life care. People might avoid discussing their end-of-life care, and often the timing and quality of these discussions can be

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and durable power of attorney for healthcare. A living will includes a person's decisions regarding their future care, a majority of which address resuscitation and life support but may also delve into a patient's preferences regarding hospitalization, pain control, and specific treatments that they

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Advances in medicine in the last few decades have provided an increasing number of options to extend a person's life and highlighted the importance of ensuring that an individual's preferences and values for end-of-life care are honored. Advanced care planning is the process by which a person of any

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as an area where quality of care has previously been "very variable," and which has not had a high profile in the NHS and social care. To address this, a national end of life care programme was established in 2004 to identify and propagate best practice, and a national strategy document published

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patients and healthcare professionals evaluated physician attitudes and preferences towards end-of-life care conversations. The study found that physicians found difficulty initiating end-of-life conversations with their heart failure patients, due to physician apprehension over inducing anxiety in

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patients and clinicians often occur when a person with COPD has advanced stage disease and occur at a low frequency. To prevent interventions that are not in accordance with the patient's wishes, end-of-life care conversations and advanced care directives can allow for the care they desire, as well

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End-of-life care conversations are part of the treatment planning process for terminally ill patients requiring palliative care involving a discussion of a patient's prognosis, specification of goals of care, and individualized treatment planning. A recent Cochrane review (2022) set forth to review

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was established in the 1990s, which divided the country into areas of 30, where palliative care networks were responsible for coordinating palliative services. Home care was provided by palliative support teams, and each hospital and care home recognized to have a palliative support team. In 1999,

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In the case of critically ill babies, parents are able to participate more in decision making if they are presented with options to be discussed rather than recommendations by the doctor. Utilizing this style of communication also leads to less conflict with doctors and might help the parents cope

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Physicians generally have favorable attitudes towards Advance Directives, which are a key facet of end-of-life care. Medical doctors who have more experience and training in end-of-life care are more likely to cite comfort in having end-of-life-care discussions with patients. Those physicians who

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practice, and by home care agencies such as Hospice. High-certainty evidence indicates that implementation of home-based end-of-life care programs increases the number of adults who will die at home and slightly improves their satisfaction at a one-month follow-up. There is low-certainty evidence

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about prescribing could help people manage their symptoms at home. A named professional to support and guide patients and carers through the healthcare system could also improve the experience of care at home at the end of life. A synthesised review looking at palliative care in the UK created a

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increasing popularity, the 2016 Cochrane Review, which only analyzed one trial, showed limited evidence in the form of high-quality randomized clinical trials to measure the effectiveness of end-of-life care pathways on clinical outcomes, physical outcomes, and emotional/psychological outcomes.

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In the United Kingdom, end-of-life care pathways are based on the Liverpool Care Pathway. Originally developed to provide evidence based care to dying cancer patients, this pathway has been adapted and used for a variety of chronic conditions at clinics in the UK and internationally. Despite its

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The BEACON Project group developed an integrated care pathway entitled the Comfort Care Order Set, which delineates care for the last days of life in either a hospice or acute care inpatient setting. This order set was implemented and evaluated in a multisite system throughout six United States

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Although physicians make official decisions about end-of-life care, nurses spend more time with patients and often know more about patient desires and concerns. In a Dutch national survey study of attitudes of nursing staff about involvement in medical end-of-life decisions, 64% of respondents

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Spiritual, cultural, and religious beliefs may influence or guide patient preferences regarding end-of-life care. Healthcare providers caring for patients at the end of life can engage family members and encourage conversations about spiritual practices to better address the different needs of

808:'s annual $ 327 billion budget ($ 88 billion) in 2006 goes to care for patients in their final year of life. For the over-65s, between 1992 and 1996, spending on those in their last year of life represented 22% of all medical spending, 18% of all non-Medicare spending, and 25 percent of all 97:

Advanced care planning often includes preferences for CPR initiation, nutrition (tube feeding), as well as decisions about the use of machines to keep a person breathing, or support their heart or kidneys. Many studies have reported benefits to patients who complete advanced care planning,

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may affect their behavior. They may feel guilty about past events in their relationship with the dying person or feel that they have been neglectful. These common emotions can result in tension, fights between family members over decisions, worsened care, and sometimes (in what medical

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Family members are often uncertain as to what they should be doing when a person is dying. Many gentle, familiar daily tasks, such as combing hair, putting lotion on delicate skin, and holding hands, are comforting and provide a meaningful method of communicating love to a dying person.

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Bailey, F. Amos; Williams, Beverly R.; Woodby, Lesa L.; Goode, Patricia S.; Redden, David T.; Houston, Thomas K.; Granstaff, U. Shanette; Johnson, Theodore M.; Pennypacker, Leslye C.; Haddock, K. Sue; Painter, John M.; Spencer, Jessie M.; Hartney, Thomas; Burgio, Kathryn L. (June 2014).

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It is typically a continual process, with ongoing discussions about a patient's current prognosis and conditions as well as conversations about medical dilemmas and options. A person will typically have these conversations with their doctor and ultimately record their preferences in an

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Sudore, Rebecca L.; Lum, Hillary D.; You, John J.; Hanson, Laura C.; Meier, Diane E.; Pantilat, Steven Z.; Matlock, Daniel D.; Rietjens, Judith A. C.; Korfage, Ida J.; Ritchie, Christine S.; Kutner, Jean S.; Teno, Joan M.; Thomas, Judy; McMahan, Ryan D.; Heyland, Daren K. (May 2017).

732:(NIHR) has addressed these areas of need. Examples highlight inequalities faced by several groups and offers recommendations. These include the need for close partnership between services caring for people with severe mental illness, improved understanding of barriers faced by 176:); breathing that is irregular and shallow; decreased number of breaths per minute; breathing that alternates between rapid and slow (caused by congestion from decreased fluid consumption, a buildup of waste products in the body, and/or a decrease in circulation to the organs). 89:. An advance healthcare directive is a legal document that either documents a person's decisions about desired treatment or indicates who a person has entrusted to make their care decisions for them. The two main types of advanced directives are a 479:

protocols, and to list the required features of care for a specific diagnosis or clinical problem. Many institutions have a predetermined pathway for end of life care, and clinicians should be aware of and make use of these plans when possible.

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signed a document which declared people "should have access to personalised care which focuses on the preferences, beliefs and spiritual needs of the individual." As of 2017, more than 47% of the 500,000 deaths in the UK occurred in hospitals.

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In 2006 just over half a million people died in England, about 99% of them adults over the age of 18, and almost two-thirds adults over the age of 75. About three-quarters of deaths could be considered "predictable" and followed a period of

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Family members may also be coping with unrelated problems, such as physical or mental illness, emotional and relationship issues, or legal difficulties. These problems can limit their ability to be involved, civil, helpful, or present.

249:. High doses of opioids can cause respiratory depression, and this risk increases with concomitant use of alcohol and other sedatives. Careful use of opioids is important to improve the patient's quality of life while avoiding overdoses. 956: 1487:

Ryan, Rebecca E; Connolly, Michael; Bradford, Natalie K; Henderson, Simon; Herbert, Anthony; Schonfeld, Lina; Young, Jeanine; Bothroyd, Josephine I; Henderson, Amanda (2022-07-08). Cochrane Consumers and Communication Group (ed.).

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Belgium ranked second (after the United Kingdom) in the number of palliative care beds per capita. In 2001, there was an active palliative care support team in 72% of hospitals and a specialized nurse or active support team in 50%

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Predicting death is difficult, which has affected estimates of spending in the last year of life; when controlling for spending on patients who were predicted as likely to die, Medicare spending was estimated at 5% of the total.

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EoLC is most commonly provided at home, in the hospital, or in a long-term care facility with care being provided by family members, nurses, social workers, physicians, and other support staff. Facilities may also have

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in the US) is often likely to be used, to deliver a steady low dose of medication. In some settings, such as the home or hospice, sublingual routes of administration may be used for most prescriptions and medications.

45:. End-of-life care can be provided in the hours, days, or months before a person dies and encompasses care and support for a person's mental and emotional needs, physical comfort, spiritual needs, and practical tasks. 4534:

Dixon KC, Ferris R, Kuhn I, Spathis A, Barclay S (February 2021). "Gypsy, Traveller and Roma experiences, views and needs in palliative and end of life care: a systematic literature review and narrative synthesis".

304:"). While apparently not painful for the patient, the association of this symptom with impending death can create fear and uncertainty for those at the bedside. The secretions may be controlled using drugs such as 1697: 60:

In most developed countries, medical spending on people in the last twelve months of life makes up roughly 10% of total aggregate medical spending, while those in the last three years of life can cost up to 25%.

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In 2015 and 2010, the UK ranked highest globally in a study of end-of-life care. The 2015 study said "Its ranking is due to comprehensive national policies, the extensive integration of palliative care into the

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Belgium's first palliative home care team was established in 1987, and the first palliative care unit and hospital care support teams were established in 1991. A strong legal and structural framework for

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Edwards A, Pang N, Shiu V, Chan C (December 2010). "The understanding of spirituality and the potential role of spiritual care in end-of-life and palliative care: a meta-study of qualitative research".

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Moolenaar F, Koning B, Huizinga T (1979). "Biopharmaceutics of rectal administration of drugs in man. Absorption rate and bioavailability of phenobarbital and its sodium salt from rectal dosage forms".

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Confusion about time, place, and/or identity of loved ones; restlessness; visions of people and places that are not present; pulling at bed linen or clothing (caused in part by changes in the patient's

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Skin becoming cool to the touch, particularly the hands and feet; skin may become bluish in color, especially on the underside of the body (caused by decreased circulation to the extremities).

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for everyone regardless of who they are, where they live or their circumstances, and the need to maximise comfort and wellbeing. Informed and timely conversations are also highlighted.

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Last-year-of-life expenses constituted 22 percent of all medical, 26 percent of Medicare, 18 percent of all non-Medicare expenditures, and 25 percent of Medicaid expenditures.

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spending for the poor. These percentages appears to be falling over time, as in 2008, 16.8% of all medical spending on the over 65s went on those in their last year of life.

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Coleman AM (November 2013). "Physician attitudes toward advanced directives: a literature review of variables impacting on physicians attitude toward advance directives".

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standard documentation template. A more detailed discussion of common symptoms and potential mitigation options can be found in the U.S. National Cancer Institute's PDQ

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Changes in breathing (indicate neurologic compromise and impending death) and accumulation of upper airway secretions (resulting in crackling and gurgling breath sounds)

4383: 2979: 710: 4731:"Supporting patient access to medicines in community palliative care: on-line survey of health professionals' practice, perceived effectiveness and influencing factors" 415:

is one preferred route of delivery of medications when it has become difficult for patients to swallow or to take pills orally, and if repeated medication is needed, a

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Decreased need for food and fluids, and loss of appetite (caused by the body's need to conserve energy and its decreasing ability to use food and fluids properly).

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shaft allows the device to be placed safely and remain comfortably in the rectum for repeated administration of medications or liquids. The catheter has a small

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care teams that will provide end-of-life care services. Decisions about end-of-life care are often informed by medical, financial and ethical considerations.

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guidelines introduced religion and spirituality among the factors which physicians shall take into account for assessing palliative care needs. In 2016, the

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How B.J. Miller, a doctor and triple amputee, used his own experience to pioneer a new model of palliative care at a small, quirky hospice in San Francisco.

4155: 4816:"An exploration of the experiences of professionals supporting patients approaching the end of life in medicines management at home. A qualitative study" 4062: 5199:

Andrew, Erin VW; Cohen, Joachim; Evans, Natalie; Meñaca, Arantza; Harding, Richard; Higginson, Irene; Pool, Robert; Gysels, Marjolein (February 2013).

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Bailey, F. Amos; Allen, Rebecca S.; Williams, Beverly R.; Goode, Patricia S.; Granstaff, Shanette; Redden, David T.; Burgio, Kathryn L. (July 2012).

451:, allowing for small flush volumes to get medication to the rectum. Small volumes of medications (under 15mL) improve comfort by not stimulating the 316:. Rattle may not be controllable if caused by deeper fluid accumulation in the bronchi or the lungs, such as occurs with pneumonia or some tumours. 6350: 379:

and stool softeners are used to prevent constipation. In patients with constipation, the dose of laxatives will be increased to relieve symptoms.

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Higginson IJ, Sen-Gupta GJ (2000-09-01). "Place of care in advanced cancer: a qualitative systematic literature review of patient preferences".

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39.7% to 29.8%. Home-based end-of-life care may be delivered in a number of ways, including by an extension of a primary care practice, by a

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Decreased oral intake and impaired swallowing (caused by general physical weakness and metabolic disturbances, including but not limited to

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age is able to provide their preferences and ensure that their future medical treatment aligns with their personal values and life goals.

5440: 1828:"Parents are meaningfully involved in decisions on the care of their critically ill baby when they are given options not recommendations" 147:

Decreased socialization and withdrawal (caused by decreased oxygen to the brain, decreased blood flow, and mental preparation for dying).

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Spirituality is thought to be of increased importance to an individual's wellbeing during a terminal illness or toward the end-of-life.

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patients, the uncertainty in a patient's prognosis, and physicians awaiting patient cues to initiate end-of-life care conversations.

435:. The catheter was developed to make rectal access more practical and provide a way to deliver and retain liquid formulations in the 7405: 6355: 5364: 4500: 3120: 757: 714: 558: 4453:"End of life care for people with severe mental illness: Mixed methods systematic review and thematic synthesis (the MENLOC study)" 4203: 3922: 3021:"End of life care for people with severe mental illness: Mixed methods systematic review and thematic synthesis (the MENLOC study)" 1916: 5955: 4576:"Estimating the prevalence of chronic conditions in children who die in England, Scotland and Wales: a data linkage cohort study" 4088: 3955: 4332: 3448: 2394:

de Boer AG, Moolenaar F, de Leede LG, Breimer DD (1982). "Rectal drug administration: clinical pharmacokinetic considerations".

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In 2021 the National Palliative and End of Life Care Partnership published their six ambitions for 2021–26. These include fair

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thought patients preferred talking with nurses than physicians and 75% desired to be involved in end-of-life decision making.

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The following are some of the most common potential problems that can arise in the last days and hours of a patient's life:

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have more exposure to end-of-life care also have a higher likelihood of involving nurses in their decision-making process.

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Gozalo, Pedro; Teno, Joan M.; Mitchell, Susan L.; Skinner, Jon; Bynum, Julie; Tyler, Denise; Mor, Vincent (2011-09-29).

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Spending on those in the last twelve months accounts for 8.5% of total aggregate medical spending in the United States.

282:. Symptoms may also sometimes be alleviated by rehydration, which may reduce the effects of some toxic drug metabolites. 86: 1490:"Interventions for interpersonal communication about end of life care between health practitioners and affected people" 589:

who provide spiritual support and grief counseling to patients and families of all religious and cultural backgrounds.

6365: 5926: 5771: 5474: 5024: 4208: 699: 4648:"Place of death of children and young adults with a life-limiting condition in England: a retrospective cohort study" 5046:"Medical expenditures during the last year of life: findings from the 1992-1996 Medicare current beneficiary survey" 4973:"Medical expenditures during the last year of life: findings from the 1992-1996 Medicare current beneficiary survey" 3790:"End-of-life care conversations with heart failure patients: a systematic literature review and narrative synthesis" 2345:

Bartz, Lena; Klein, Carsten; Seifert, Andreas; Herget, Iris; Ostgathe, Christoph; Stiel, Stephanie (October 2014).

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Marlow, Neil; Shaw, Chloe; Connabeer, Kat; Aladangady, Narendra; Gallagher, Katie; Drew, Paul (17 September 2020).

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Waldrop DP, Meeker MA (2012-11-01). "Communication and advanced care planning in palliative and end-of-life care".

872: 1231: 6732: 6602: 5970: 5916: 5699: 5639: 5521: 3303:"A knowledge synthesis of culturally- and spiritually-sensitive end-of-life care: findings from a scoping review" 2716:

Chan RJ, Webster J, Bowers A, et al. (Cochrane Pain, Palliative and Supportive Care Group) (February 2016).

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Darkened urine or decreased amount of urine (caused by slowing of kidney function and/or decreased fluid intake).

129: 4696:"Nurses and pharmacists are key to improving access to end of life medicines for people being cared for at home" 4287:"An overview of the spiritual importances of end-of-life care among the five major faiths of the United Kingdom" 4163: 1537:

Steinhauser, K. E.; Clipp, E. C.; McNeilly, M.; Christakis, N. A.; McIntyre, L. M.; Tulsky, J. A. (2000-05-16).

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Low food intake and opioid use can lead to constipation which can then result in agitation, pain, and delirium.

7395: 5965: 5829: 5568: 4418:"Team work and proactive healthcare could help people with severe mental illness receive good end-of-life care" 4057: 805: 475: 4248:"United States Tied for 9th Place in Economist Intelligence Unit's First Ever Global 'Quality of Death' Index" 1384: 698:, a strong hospice movement, and deep community engagement on the issue." The studies were carried out by the 5322:"Coroners Court of Queensland. Findings of investigation. Non-inquest findings into the death of David Orton" 1204: 427:

Another means of medication delivery, available for use when the oral route is compromised, is a specialized

7210: 7205: 7133: 7055: 6340: 5864: 4501:"A highly personalised approach to end of life care is needed to help Gypsy, Traveller and Roma communities" 3068:

Krakauer EL, Crenner C, Fox K (January 2002). "Barriers to optimum end-of-life care for minority patients".

2007:"A systematic review of the prevalence of signs of impending death and symptoms in the last 2 weeks of life" 695: 658: 440: 5479:

The program explores the medical, ethical, and social issues surrounding end-of-life care in America today.

5352: 3876: 931: 561:") a long-absent family member arrives while a patient is dying to demand inappropriately aggressive care. 7245: 7138: 6878: 6784: 6749: 6370: 6181: 6097: 5901: 3839:"Attitudes of nursing staff towards involvement in medical end-of-life decisions: a national survey study" 3621: 2899: 2091: 412: 345:(sometimes levomepromazine is used as second-line to alleviate both agitation and of nausea and vomiting). 5333: 1940: 1089:"Defining Advance Care Planning for Adults: A Consensus Definition From a Multidisciplinary Delphi Panel" 7128: 7050: 6863: 6759: 6695: 6660: 6104: 6072: 5890: 5791: 5428: 4087:. UK Department of Health. July 2008. pp. paragraphs 1.1 and 1.7-1.14 (pages 26-27). Archived from 432: 305: 3741:"Association between education in EOL care and variability in EOL practice: a survey of ICU physicians" 258:, terminal anguish, restlessness (e.g. thrashing, plucking, or twitching). Typically controlled using 4729:

Latter S, Campling N, Birtwistle J, Richardson A, Bennett MI, Ewings S, et al. (September 2020).

2347:"Subcutaneous administration of drugs in palliative care: results of a systematic observational study" 578:

approach to spiritual care may, however, be transferred to other contexts and to individual practice.

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Drowsiness, increased sleep, and/or unresponsiveness (caused by changes in the patient's metabolism).

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Chang, E.-Shien; Kannoth, Sneha; Levy, Samantha; Wang, Shi-Yi; Lee, John E.; Levy, Becca R. (2020).

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advises that the presence of some of the following signs may indicate that death is approaching:

7018: 4355:"Ambitions for Palliative and End of Life Care: A national framework for local action 2021-2026" 4130: 4105: 3900: 4013:"Living and Dying Well: A national action plan for palliative and end of life care in Scotland" 2107:

Canadian Nurses Association. "Position Statement: Providing Care at The End of Life," 2008, p.3

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response of the rectum and can increase the overall

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Archived from 3626:National Institute on Aging 3502:Journal of Clinical Nursing 3236:National Institute on Aging 3153:Journal of Clinical Nursing 2904:National Institute on Aging 2567:BMJ (Clinical Research Ed.) 1788:10.1183/23120541.00068-2016 1543:Annals of Internal Medicine 1209:National Institute on Aging 1150:Annals of Internal Medicine 936:National Institute on Aging 909:National Institute on Aging 700:Economist Intelligence Unit 491:Home-based end-of-life care 362:or, in the United Kingdom, 325:Typically controlled using 245:or, in the United Kingdom, 7427: 5447:. UK Department of Health. 5023:Appleby J (10 July 2011). 4748:10.1186/s12904-020-00649-3 3952:UK National Health Service 3927:UK National Health Service 3111:Erickson KA (2013-01-01). 2563:"Integrated care pathways" 2467:"Integrated care pathways" 1976:10.1089/109662103768253713 1404:10.1016/j.ijlp.2015.01.008 955:Francis N (10 July 2011). 873:Physician assisted suicide 868:Children's palliative care 755: 745:electronic patient records 723:access to end of life care 536: 354:Typically controlled with 229:Typically controlled with 68: 7355: 6733:Consciousness after death 6656: 6220: 5983: 5917:Public health informatics 5830:Electronic health records 5700:Supervised injection site 5640:Allied health professions 5544: 5499:Resources in your library 5355:. In Kastenbaum R (ed.). 4913:: bmjspcare–2021–003066. 4833:10.1186/s12904-020-0537-z 4539:: bmjspcare–2020–002676. 4469:10.1177/02692163211037480 4063:Public Accounts Committee 3855:10.1016/j.pec.2013.09.018 3758:10.1007/s00134-011-2400-4 3707:10.1186/s12909-016-0819-6 3320:10.1186/s12877-016-0282-6 3037:10.1177/02692163211037480 2784:10.1007/s11606-013-2724-6 2396:Clinical Pharmacokinetics 2320:American Family Physician 2301:National Cancer Institute 2254:10.1191/0269216304pm881oa 1438:Balaban RB (March 2000). 1024:10.1377/hlthaff.2017.0174 734:Gypsy, Traveller and Roma 569:Spirituality and religion 527:major depressive disorder 407:Medication administration 130:National Cancer Institute 7406:Medical aspects of death 7134:Personification of death 6356:People by cause of death 5217:10.1177/0269216311429619 5050:Health Services Research 4977:Health Services Research 4396:10.3310/collection_49245 3659:10.1177/1049909112464544 3419:10.1177/0269216310375860 2992:10.3310/collection_49245 2579:10.1136/bmj.316.7125.133 2483:10.1136/bmj.316.7125.133 2314:Albert RH (March 2017). 2023:10.1177/1049909112468222 702:and commissioned by the 557:professionals call the " 476:Integrated care pathways 7211:Death-positive movement 7056:Post-mortem photography 6336:Causes of death by rate 6264:Death by natural causes 5865:Medical image computing 5815:Artificial intelligence 5276:10.1136/bmj.326.7379.30 5168:10.1126/science.aar5045 5062:10.1111/1475-6773.01113 4989:10.1111/1475-6773.01113 3745:Intensive Care Medicine 696:National Health Service 659:UK Department of Health 575:Pastoral/spiritual care 517:, including those with 7246:Fascination with death 6884:Reincarnation research 6879:Out-of-body experience 6341:Notable deaths by year 6182:Immunogenic cell death 6098:Temporal lobe necrosis 5902:Translational medicine 3206:. 2015. Archived from 2837:10.1089/jpm.2000.3.287 2125:www.sahealth.sa.gov.au 2092:Liverpool Care Pathway 858:Liverpool Care Pathway 413:subcutaneous injection 76:Advanced care planning 7051:Post-mortem chemistry 6864:Near-death experience 6760:Desecration of graves 6696:Postmortem caloricity 6661:Beating heart cadaver 6105:Programmed cell death 6073:Liquefactive necrosis 5891:Computational biology 5792:Universal precautions 5301:Harrington S (2018). 4137:National Audit Office 4112:National Audit Office 3806:10.3399/bjgp11X549018 3694:BMC Medical Education 1657:10.1056/NEJMsa1100347 1610:10.1089/jpm.2011.0321 1273:10.1056/NEJMsa0907901 756:Further information: 715:UK Minister of Health 443:. Its small flexible 306:hyoscine butylbromide 7241:Festival of the Dead 7139:Dying-and-rising god 7094:Chinese burial money 6983:Prohibition of dying 6935:Death-qualified jury 6701:Post-mortem interval 6361:Premature obituaries 6068:Coagulative necrosis 5885:Behavior informatics 5399:"End of Life Issues" 3508:(23–24): 4105–4116. 3159:(19–20): 3609–3624. 2877:10.1056/NEJMc1911892 1232:"Advance Directives" 399:, and in some cases 211:in the legs and arms 7301:Philosophy of death 7166:Death from laughter 6466:Perinatal mortality 6207:Mitotic catastrophe 6187:Ischemic cell death 6130:Intrinsic apoptosis 6078:Gangrenous necrosis 5869:imaging informatics 5777:Cultural competence 5320:Lock J (May 2018). 5205:Palliative Medicine 5160:2018Sci...360.1462E 5154:(6396): 1462–1465. 4820:BMC Palliative Care 4793:10.3310/alert_41179 4735:BMC Palliative Care 4708:10.3310/alert_46494 4625:10.3310/alert_46991 4513:10.3310/alert_48747 4457:Palliative Medicine 4430:10.3310/alert_49015 4094:on 2 February 2010. 4017:Scottish Government 3981:. 26 November 2008. 3961:on 2 February 2010. 3881:www23.statcan.gc.ca 3572:2020PLoSO..1520857C 3407:Palliative Medicine 3025:Palliative Medicine 2242:Palliative Medicine 1840:10.3310/alert_45227 967:on 13 January 2012. 740:or deprived areas. 664:Scottish Government 471:Integrated pathways 216:Symptoms management 7347:Thanatosensitivity 7251:Hierarchy of death 7191:Death notification 7099:Coins for the dead 7031:Forensic pathology 6915:Capital punishment 6869:Near-death studies 6461:Mortality salience 6093:Fibrinoid necrosis 6063:Avascular necrosis 5855:Health informatics 5630:Healthcare science 5429:"End of life care" 5380:The New York Times 4955:Death With Dignity 4878:10.3310/post_50369 4614:; Lay summary in: 4224:"Quality of death" 4131:"End of Life care" 4106:"End of Life care" 4039:. 14 October 2008. 3514:10.1111/jocn.13939 3166:10.1111/jocn.15411 2072:on 28 January 2017 1947:. 30 October 2002. 863:My body, my choice 544:Family and friends 7383: 7382: 7119:Death anniversary 7114:Death and culture 6958:Dying declaration 6940:Death certificate 6847: 6846: 6709: 6708: 6561:Neuropreservation 6351:Natural disasters 6322: 6321: 6001: 6000: 5765:Skills / training 5689:Teaching hospital 5485:Library resources 4463:(10): 1747–1760. 4291:Clinical Medicine 4166:on 9 October 2015 4019:. 2 October 2008. 4001:. 21 August 2008. 3031:(10): 1747–1760. 2870:(24): 2369–2370. 2573:(7125): 133–137. 2477:(7125): 133–137. 1776:ERJ Open Research 1739:10.1111/jgs.14711 1651:(13): 1212–1221. 1344:10.1111/jgs.16801 1267:(13): 1211–1218. 1099:(5): 821–832.e1. 738:ethnic minorities 642:Statistics Canada 511:systematic review 358:, like morphine, 16:(Redirected from 7418: 7373: 7372: 7363: 7362: 7343: 7328:Assisted suicide 7226:Death trajectory 7041:Mortuary science 7036:Funeral director 7027: 6993:Suspicious death 6765:Eternal oblivion 6551:Cryopreservation 6490: 6479: 6417:Infant mortality 6407:Excess mortality 6309:Terminal illness 6294:Lazarus syndrome 6279:End-of-life care 6230:Accidental death 6083:Caseous necrosis 6046: 6028: 6021: 6014: 6005: 5991: 5990: 5879:Neuroinformatics 5820:Connected health 5531: 5524: 5517: 5508: 5490:End of life care 5478: 5477:. 22 April 1997. 5460: 5448: 5436: 5424: 5408: 5386: 5370: 5347: 5338: 5328: 5327:. pp. 1–13. 5326: 5316: 5297: 5287: 5245: 5244: 5196: 5190: 5189: 5179: 5139: 5133: 5132: 5122: 5105:(3–4): 717–747. 5090: 5084: 5083: 5073: 5056:(6): 1625–1642. 5041: 5035: 5034: 5020: 5014: 5013: 5000: 4983:(6): 1625–1642. 4968: 4959: 4958: 4947: 4941: 4940: 4922: 4902: 4896: 4895: 4893: 4892: 4862: 4856: 4855: 4845: 4835: 4811: 4805: 4804: 4777: 4771: 4770: 4760: 4750: 4726: 4720: 4719: 4692: 4686: 4685: 4675: 4643: 4637: 4636: 4613: 4603: 4571: 4565: 4564: 4531: 4525: 4524: 4497: 4491: 4490: 4480: 4448: 4442: 4441: 4414: 4408: 4407: 4380: 4374: 4373: 4371: 4369: 4359: 4351: 4345: 4344: 4342: 4340: 4322: 4282: 4276: 4275: 4262: 4256: 4255: 4254:(Press release). 4244: 4238: 4237: 4220: 4214: 4213: 4200: 4194: 4193: 4191: 4189: 4184:. 6 October 2015 4174: 4173: 4171: 4152: 4146: 4145: 4127: 4121: 4120: 4102: 4096: 4095: 4093: 4086: 4078: 4072: 4071: 4068:House of Commons 4054: 4041: 4040: 4027: 4021: 4020: 4009: 4003: 4002: 3989: 3983: 3982: 3969: 3963: 3962: 3960: 3949: 3941: 3935: 3934: 3933:on 4 March 2010. 3929:. Archived from 3919: 3913: 3912: 3910: 3908: 3897: 3891: 3890: 3888: 3887: 3873: 3867: 3866: 3834: 3828: 3827: 3817: 3800:(582): e49–e62. 3785: 3779: 3778: 3760: 3736: 3730: 3729: 3719: 3709: 3685: 3679: 3678: 3642: 3636: 3635: 3633: 3632: 3618: 3612: 3611: 3601: 3583: 3551: 3542: 3541: 3493: 3487: 3486: 3484: 3483: 3469: 3463: 3462: 3460: 3459: 3445: 3439: 3438: 3401: 3395: 3394: 3384: 3352: 3343: 3342: 3332: 3322: 3298: 3289: 3288: 3252: 3246: 3245: 3243: 3242: 3228: 3222: 3221: 3219: 3218: 3212: 3201: 3193: 3187: 3186: 3168: 3144: 3135: 3134: 3108: 3102: 3101: 3065: 3059: 3058: 3048: 3016: 3010: 3009: 3007: 3006: 2976: 2970: 2969: 2959: 2927: 2914: 2913: 2911: 2910: 2896: 2890: 2889: 2879: 2855: 2849: 2848: 2820: 2814: 2813: 2803: 2762: 2756: 2755: 2745: 2728:(11): CD008006. 2713: 2707: 2706: 2696: 2671:(11): CD008006. 2656: 2650: 2649: 2639: 2615: 2609: 2608: 2598: 2558: 2552: 2551: 2511: 2505: 2504: 2494: 2462: 2456: 2455: 2434: 2428: 2427: 2391: 2385: 2384: 2366: 2342: 2336: 2335: 2311: 2305: 2304: 2299:. 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Archived from 952: 946: 945: 943: 942: 928: 919: 918: 916: 915: 901: 883:Robert Martensen 523:bipolar disorder 381:Methylnaltrexone 351:(breathlessness) 31:End-of-life care 21: 7426: 7425: 7421: 7420: 7419: 7417: 7416: 7415: 7396:Palliative care 7386: 7385: 7384: 7379: 7351: 7337: 7281:Museum of Death 7231:Dignified death 7186:Death messenger 7161:Death education 7077: 7021: 7007: 6945:Declared death 6893: 6843: 6800:Online mourning 6705: 6671:Cadaveric spasm 6652: 6597: 6539: 6530:Skeletonization 6470: 6402:Child mortality 6397:Birthday effect 6385: 6318: 6314:Unnatural death 6245:Brainstem death 6216: 6155:Pseudoapoptosis 6037: 6032: 6002: 5997: 5979: 5933: 5932: 5931: 5849: 5796: 5760: 5736:Overutilization 5704: 5695:Pharmacy school 5661:Assisted living 5649: 5603: 5540: 5535: 5505: 5504: 5503: 5493: 5492: 5488: 5463: 5451: 5439: 5427: 5411: 5397: 5394: 5389: 5373: 5367: 5350: 5336: 5331: 5324: 5319: 5313: 5300: 5270:(7379): 30–34. 5257: 5253: 5251:Further reading 5248: 5198: 5197: 5193: 5141: 5140: 5136: 5092: 5091: 5087: 5043: 5042: 5038: 5022: 5021: 5017: 4970: 4969: 4962: 4949: 4948: 4944: 4904: 4903: 4899: 4890: 4888: 4864: 4863: 4859: 4813: 4812: 4808: 4779: 4778: 4774: 4728: 4727: 4723: 4694: 4693: 4689: 4645: 4644: 4640: 4615: 4573: 4572: 4568: 4533: 4532: 4528: 4499: 4498: 4494: 4450: 4449: 4445: 4416: 4415: 4411: 4382: 4381: 4377: 4367: 4365: 4357: 4353: 4352: 4348: 4338: 4336: 4284: 4283: 4279: 4274:. 15 July 2010. 4264: 4263: 4259: 4246: 4245: 4241: 4229:Lien Foundation 4222: 4221: 4217: 4202: 4201: 4197: 4187: 4185: 4176: 4169: 4167: 4154: 4153: 4149: 4129: 4128: 4124: 4104: 4103: 4099: 4091: 4084: 4080: 4079: 4075: 4056: 4055: 4044: 4029: 4028: 4024: 4011: 4010: 4006: 3991: 3990: 3986: 3971: 3970: 3966: 3958: 3947: 3943: 3942: 3938: 3921: 3920: 3916: 3906: 3904: 3899: 3898: 3894: 3885: 3883: 3875: 3874: 3870: 3836: 3835: 3831: 3787: 3786: 3782: 3738: 3737: 3733: 3687: 3686: 3682: 3644: 3643: 3639: 3630: 3628: 3620: 3619: 3615: 3566:(1): e0220857. 3553: 3552: 3545: 3495: 3494: 3490: 3481: 3479: 3471: 3470: 3466: 3457: 3455: 3447: 3446: 3442: 3403: 3402: 3398: 3354: 3353: 3346: 3300: 3299: 3292: 3263:(S6): S11–S13. 3254: 3253: 3249: 3240: 3238: 3230: 3229: 3225: 3216: 3214: 3210: 3199: 3195: 3194: 3190: 3146: 3145: 3138: 3123: 3110: 3109: 3105: 3067: 3066: 3062: 3018: 3017: 3013: 3004: 3002: 2978: 2977: 2973: 2942:(7): CD009231. 2929: 2928: 2917: 2908: 2906: 2898: 2897: 2893: 2857: 2856: 2852: 2822: 2821: 2817: 2764: 2763: 2759: 2715: 2714: 2710: 2658: 2657: 2653: 2617: 2616: 2612: 2560: 2559: 2555: 2513: 2512: 2508: 2464: 2463: 2459: 2436: 2435: 2431: 2393: 2392: 2388: 2344: 2343: 2339: 2313: 2312: 2308: 2303:. 9 March 2009. 2291: 2290: 2277: 2239: 2238: 2231: 2222: 2220: 2212: 2211: 2207: 2199: 2188: 2184: 2183: 2168: 2158: 2156: 2147: 2146: 2139: 2130: 2128: 2119: 2118: 2111: 2106: 2102: 2089: 2085: 2075: 2073: 2059: 2058: 2054: 2004: 2003: 1999: 1957: 1956: 1952: 1939: 1938: 1934: 1925: 1923: 1915: 1914: 1910: 1860: 1859: 1855: 1826: 1825: 1821: 1769: 1768: 1764: 1720: 1719: 1715: 1706: 1704: 1702:Washington Post 1695: 1694: 1690: 1638: 1637: 1633: 1591: 1590: 1586: 1549:(10): 825–832. 1536: 1535: 1531: 1486: 1485: 1481: 1437: 1436: 1427: 1387: 1382: 1381: 1377: 1325: 1324: 1320: 1311: 1310: 1306: 1254: 1253: 1249: 1240: 1238: 1230: 1229: 1222: 1213: 1211: 1203: 1202: 1195: 1143: 1142: 1138: 1085: 1084: 1080: 1053:Nursing Outlook 1050: 1049: 1040: 1004: 1003: 996: 987: 985: 983:medlineplus.gov 977: 976: 972: 954: 953: 949: 940: 938: 930: 929: 922: 913: 911: 903: 902: 895: 891: 844: 827:palliative care 822: 760: 754: 704:Lien Foundation 672:chronic illness 655: 638: 633: 608: 595: 571: 546: 541: 535: 507: 498:palliative care 493: 473: 409: 280:benzodiazepines 276:levomepromazine 218: 126: 104: 78: 73: 67: 28: 23: 22: 15: 12: 11: 5: 7424: 7422: 7414: 7413: 7408: 7403: 7398: 7388: 7387: 7381: 7380: 7378: 7377: 7367: 7356: 7353: 7352: 7350: 7349: 7344: 7332: 7331: 7330: 7320: 7319: 7318: 7308: 7303: 7298: 7293: 7288: 7283: 7278: 7273: 7268: 7263: 7258: 7253: 7248: 7243: 7238: 7233: 7228: 7223: 7218: 7213: 7208: 7203: 7198: 7193: 7188: 7183: 7178: 7173: 7168: 7163: 7158: 7153: 7148: 7147: 7146: 7141: 7136: 7126: 7121: 7116: 7111: 7106: 7101: 7096: 7091: 7089:Apparent death 7085: 7083: 7079: 7078: 7076: 7075: 7070: 7069: 7068: 7058: 7053: 7048: 7043: 7038: 7033: 7028: 7015: 7013: 7009: 7008: 7006: 7005: 7000: 6995: 6990: 6985: 6980: 6975: 6970: 6965: 6960: 6955: 6950: 6942: 6937: 6932: 6927: 6922: 6920:Cause of death 6917: 6912: 6910:Administration 6907: 6901: 6899: 6895: 6894: 6892: 6891: 6886: 6881: 6876: 6871: 6866: 6861: 6855: 6853: 6849: 6848: 6845: 6844: 6842: 6841: 6836: 6831: 6826: 6825: 6824: 6819: 6809: 6804: 6803: 6802: 6792: 6787: 6782: 6777: 6772: 6767: 6762: 6757: 6752: 6747: 6746: 6745: 6740: 6730: 6725: 6719: 6717: 6711: 6710: 6707: 6706: 6704: 6703: 6698: 6693: 6688: 6683: 6681:Death erection 6678: 6673: 6668: 6663: 6657: 6654: 6653: 6651: 6650: 6645: 6640: 6635: 6630: 6625: 6624: 6623: 6618: 6616:Natural burial 6607: 6605: 6599: 6598: 6596: 6595: 6590: 6585: 6580: 6575: 6570: 6565: 6564: 6563: 6558: 6547: 6545: 6541: 6540: 6538: 6537: 6532: 6527: 6522: 6517: 6512: 6507: 6502: 6496: 6494: 6487: 6476: 6472: 6471: 6469: 6468: 6463: 6458: 6457: 6456: 6449:Mortality rate 6446: 6441: 6434: 6429: 6427:Maternal death 6424: 6419: 6414: 6409: 6404: 6399: 6393: 6391: 6387: 6386: 6384: 6383: 6378: 6373: 6371:Unusual deaths 6368: 6363: 6358: 6353: 6348: 6343: 6338: 6332: 6330: 6324: 6323: 6320: 6319: 6317: 6316: 6311: 6306: 6304:Organ donation 6301: 6296: 6291: 6286: 6281: 6276: 6271: 6266: 6261: 6260: 6259: 6252:Clinical death 6249: 6248: 6247: 6237: 6232: 6227: 6221: 6218: 6217: 6215: 6214: 6209: 6204: 6199: 6194: 6189: 6184: 6179: 6174: 6169: 6164: 6163: 6162: 6157: 6152: 6147: 6142: 6137: 6132: 6127: 6122: 6117: 6112: 6102: 6101: 6100: 6095: 6090: 6085: 6080: 6075: 6070: 6065: 6054: 6052: 6043: 6039: 6038: 6033: 6031: 6030: 6023: 6016: 6008: 5999: 5998: 5996: 5995: 5984: 5981: 5980: 5978: 5973: 5968: 5963: 5958: 5956:United Kingdom 5953: 5952: 5951: 5941: 5939: 5935: 5934: 5930: 5929: 5924: 5919: 5914: 5909: 5904: 5899: 5894: 5888: 5882: 5876: 5871: 5861: 5860: 5859: 5857: 5851: 5850: 5848: 5847: 5842: 5837: 5832: 5827: 5825:Digital health 5822: 5817: 5812: 5810:3D bioprinting 5806: 5804: 5798: 5797: 5795: 5794: 5789: 5784: 5779: 5774: 5772:Bedside manner 5768: 5766: 5762: 5761: 5759: 5758: 5753: 5748: 5743: 5738: 5733: 5728: 5723: 5718: 5712: 5710: 5706: 5705: 5703: 5702: 5697: 5692: 5681:Medical school 5678: 5673: 5668: 5663: 5657: 5655: 5651: 5650: 5648: 5647: 5642: 5637: 5632: 5627: 5622: 5617: 5611: 5609: 5605: 5604: 5602: 5601: 5596: 5591: 5586: 5581: 5576: 5571: 5566: 5561: 5556: 5551: 5545: 5542: 5541: 5536: 5534: 5533: 5526: 5519: 5511: 5502: 5501: 5495: 5494: 5483: 5482: 5481: 5480: 5461: 5449: 5437: 5435:. 29 May 2018. 5425: 5423:on 2010-11-18. 5409: 5393: 5392:External links 5390: 5388: 5387: 5371: 5365: 5348: 5329: 5317: 5312:978-1478917410 5311: 5298: 5254: 5252: 5249: 5247: 5246: 5211:(2): 131–143. 5191: 5134: 5099:Fiscal Studies 5085: 5036: 5015: 4960: 4942: 4897: 4857: 4806: 4772: 4721: 4687: 4658:(8): 780–785. 4638: 4619:. 2021-07-20. 4586:(8): e005331. 4566: 4526: 4492: 4443: 4409: 4375: 4346: 4277: 4257: 4239: 4236:on 2010-07-18. 4215: 4195: 4147: 4122: 4097: 4073: 4042: 4022: 4004: 3984: 3964: 3936: 3914: 3903:. July 9, 2013 3892: 3868: 3829: 3780: 3751:(3): 404–412. 3731: 3680: 3653:(7): 696–706. 3637: 3613: 3543: 3488: 3464: 3440: 3413:(8): 753–770. 3396: 3367:(4): 386–397. 3344: 3307:BMC Geriatrics 3290: 3247: 3223: 3188: 3136: 3121: 3103: 3076:(1): 182–190. 3060: 3011: 2986:. 2022-03-31. 2971: 2915: 2891: 2850: 2831:(3): 287–300. 2815: 2778:(6): 836–843. 2757: 2708: 2651: 2630:(5): 940–955. 2610: 2553: 2506: 2457: 2429: 2402:(4): 285–311. 2386: 2357:(4): 540–547. 2337: 2326:(6): 356–361. 2306: 2275: 2248:(3): 195–201. 2229: 2205: 2166: 2137: 2109: 2100: 2083: 2052: 2017:(6): 601–616. 1997: 1970:(4): 605–613. 1950: 1932: 1921:www.cancer.org 1908: 1873:(2): 184–188. 1853: 1819: 1762: 1733:(3): e70–e75. 1713: 1688: 1631: 1604:(7): 751–759. 1584: 1529: 1479: 1450:(3): 195–200. 1425: 1375: 1338:(1): 234–244. 1318: 1304: 1247: 1220: 1193: 1156:(4): 256–261. 1136: 1078: 1059:(6): 365–369. 1038: 1011:Health Affairs 994: 979:"Hospice Care" 970: 947: 920: 892: 890: 887: 886: 885: 880: 875: 870: 865: 860: 855: 850: 843: 840: 821: 818: 796:Washington D.C 753: 750: 674:– for example 654: 653:United Kingdom 651: 637: 634: 632: 629: 607: 604: 594: 591: 570: 567: 545: 542: 534: 531: 515:mental illness 506: 503: 492: 489: 472: 469: 441:administration 417:syringe driver 408: 405: 385: 384: 367: 366: 352: 346: 331:metoclopramide 323: 317: 310:glycopyrronium 286: 283: 268:antipsychotics 253: 250: 227: 217: 214: 213: 212: 205: 196: 190: 183: 180: 177: 170: 167: 164: 161: 154: 151: 148: 145: 141: 125: 124:Signs of dying 122: 103: 100: 77: 74: 66: 63: 26: 24: 14: 13: 10: 9: 6: 4: 3: 2: 7423: 7412: 7409: 7407: 7404: 7402: 7399: 7397: 7394: 7393: 7391: 7376: 7368: 7366: 7358: 7357: 7354: 7348: 7345: 7341: 7336: 7333: 7329: 7326: 7325: 7324: 7321: 7317: 7314: 7313: 7312: 7309: 7307: 7304: 7302: 7299: 7297: 7294: 7292: 7289: 7287: 7284: 7282: 7279: 7277: 7274: 7272: 7269: 7267: 7264: 7262: 7259: 7257: 7254: 7252: 7249: 7247: 7244: 7242: 7239: 7237: 7234: 7232: 7229: 7227: 7224: 7222: 7219: 7217: 7214: 7212: 7209: 7207: 7204: 7202: 7199: 7197: 7194: 7192: 7189: 7187: 7184: 7182: 7179: 7177: 7174: 7172: 7169: 7167: 7164: 7162: 7159: 7157: 7154: 7152: 7149: 7145: 7142: 7140: 7137: 7135: 7132: 7131: 7130: 7127: 7125: 7124:Death anxiety 7122: 7120: 7117: 7115: 7112: 7110: 7109:Darwin Awards 7107: 7105: 7102: 7100: 7097: 7095: 7092: 7090: 7087: 7086: 7084: 7080: 7074: 7071: 7067: 7066:Biostratinomy 7064: 7063: 7062: 7059: 7057: 7054: 7052: 7049: 7047: 7044: 7042: 7039: 7037: 7034: 7032: 7029: 7025: 7020: 7017: 7016: 7014: 7010: 7004: 7001: 6999: 6996: 6994: 6991: 6989: 6986: 6984: 6981: 6979: 6978:Necropolitics 6976: 6974: 6971: 6969: 6966: 6964: 6961: 6959: 6956: 6954: 6951: 6949: 6948: 6943: 6941: 6938: 6936: 6933: 6931: 6928: 6926: 6923: 6921: 6918: 6916: 6913: 6911: 6908: 6906: 6903: 6902: 6900: 6896: 6890: 6887: 6885: 6882: 6880: 6877: 6875: 6872: 6870: 6867: 6865: 6862: 6860: 6857: 6856: 6854: 6850: 6840: 6837: 6835: 6832: 6830: 6827: 6823: 6820: 6818: 6815: 6814: 6813: 6812:Reincarnation 6810: 6808: 6805: 6801: 6798: 6797: 6796: 6793: 6791: 6788: 6786: 6783: 6781: 6778: 6776: 6773: 6771: 6768: 6766: 6763: 6761: 6758: 6756: 6753: 6751: 6748: 6744: 6741: 6739: 6736: 6735: 6734: 6731: 6729: 6726: 6724: 6721: 6720: 6718: 6716: 6715:Other aspects 6712: 6702: 6699: 6697: 6694: 6692: 6689: 6687: 6684: 6682: 6679: 6677: 6674: 6672: 6669: 6667: 6666:Body donation 6664: 6662: 6659: 6658: 6655: 6649: 6646: 6644: 6641: 6639: 6636: 6634: 6633:Dismemberment 6631: 6629: 6626: 6622: 6619: 6617: 6614: 6613: 6612: 6609: 6608: 6606: 6604: 6600: 6594: 6591: 6589: 6586: 6584: 6581: 6579: 6578:Mummification 6576: 6574: 6571: 6569: 6566: 6562: 6559: 6557: 6554: 6553: 6552: 6549: 6548: 6546: 6542: 6536: 6535:Fossilization 6533: 6531: 6528: 6526: 6525:Decomposition 6523: 6521: 6518: 6516: 6513: 6511: 6508: 6506: 6503: 6501: 6500:Pallor mortis 6498: 6497: 6495: 6491: 6488: 6486: 6485: 6480: 6477: 6473: 6467: 6464: 6462: 6459: 6455: 6452: 6451: 6450: 6447: 6445: 6442: 6440: 6439: 6435: 6433: 6430: 6428: 6425: 6423: 6420: 6418: 6415: 6413: 6410: 6408: 6405: 6403: 6400: 6398: 6395: 6394: 6392: 6388: 6382: 6379: 6377: 6374: 6372: 6369: 6367: 6364: 6362: 6359: 6357: 6354: 6352: 6349: 6347: 6344: 6342: 6339: 6337: 6334: 6333: 6331: 6329: 6325: 6315: 6312: 6310: 6307: 6305: 6302: 6300: 6297: 6295: 6292: 6290: 6287: 6285: 6282: 6280: 6277: 6275: 6272: 6270: 6267: 6265: 6262: 6258: 6255: 6254: 6253: 6250: 6246: 6243: 6242: 6241: 6238: 6236: 6233: 6231: 6228: 6226: 6223: 6222: 6219: 6213: 6210: 6208: 6205: 6203: 6200: 6198: 6195: 6193: 6190: 6188: 6185: 6183: 6180: 6178: 6175: 6173: 6170: 6168: 6165: 6161: 6158: 6156: 6153: 6151: 6148: 6146: 6143: 6141: 6138: 6136: 6133: 6131: 6128: 6126: 6123: 6121: 6118: 6116: 6113: 6111: 6108: 6107: 6106: 6103: 6099: 6096: 6094: 6091: 6089: 6086: 6084: 6081: 6079: 6076: 6074: 6071: 6069: 6066: 6064: 6061: 6060: 6059: 6056: 6055: 6053: 6051: 6047: 6044: 6040: 6036: 6029: 6024: 6022: 6017: 6015: 6010: 6009: 6006: 5994: 5986: 5985: 5982: 5977: 5974: 5972: 5969: 5967: 5964: 5962: 5959: 5957: 5954: 5950: 5947: 5946: 5945: 5944:United States 5942: 5940: 5936: 5928: 5925: 5923: 5920: 5918: 5915: 5913: 5910: 5908: 5905: 5903: 5900: 5898: 5895: 5893:in healthcare 5892: 5889: 5887:in healthcare 5886: 5883: 5881:in healthcare 5880: 5877: 5875: 5872: 5870: 5866: 5863: 5862: 5858: 5856: 5852: 5846: 5843: 5841: 5838: 5836: 5833: 5831: 5828: 5826: 5823: 5821: 5818: 5816: 5813: 5811: 5808: 5807: 5805: 5803: 5799: 5793: 5790: 5788: 5785: 5783: 5780: 5778: 5775: 5773: 5770: 5769: 5767: 5763: 5757: 5754: 5752: 5749: 5747: 5744: 5742: 5739: 5737: 5734: 5732: 5729: 5727: 5724: 5722: 5719: 5717: 5714: 5713: 5711: 5707: 5701: 5698: 5696: 5693: 5690: 5686: 5682: 5679: 5677: 5674: 5672: 5669: 5667: 5664: 5662: 5659: 5658: 5656: 5652: 5646: 5643: 5641: 5638: 5636: 5633: 5631: 5628: 5626: 5623: 5621: 5618: 5616: 5613: 5612: 5610: 5606: 5600: 5597: 5595: 5592: 5590: 5587: 5585: 5582: 5580: 5577: 5575: 5572: 5570: 5567: 5565: 5562: 5560: 5557: 5555: 5552: 5550: 5547: 5546: 5543: 5539: 5532: 5527: 5525: 5520: 5518: 5513: 5512: 5509: 5500: 5497: 5496: 5491: 5486: 5476: 5472: 5471: 5470:Thirteen/WNET 5466: 5462: 5458: 5454: 5450: 5446: 5442: 5438: 5434: 5430: 5426: 5422: 5418: 5414: 5410: 5406: 5405: 5400: 5396: 5395: 5391: 5385: 5381: 5377: 5372: 5368: 5366:0-02-865689-X 5362: 5358: 5354: 5349: 5346: 5342: 5335: 5330: 5323: 5318: 5314: 5308: 5304: 5299: 5295: 5291: 5286: 5281: 5277: 5273: 5269: 5265: 5261: 5256: 5255: 5250: 5242: 5238: 5234: 5230: 5226: 5222: 5218: 5214: 5210: 5206: 5202: 5195: 5192: 5187: 5183: 5178: 5173: 5169: 5165: 5161: 5157: 5153: 5149: 5145: 5138: 5135: 5130: 5126: 5121: 5116: 5112: 5108: 5104: 5100: 5096: 5089: 5086: 5081: 5077: 5072: 5067: 5063: 5059: 5055: 5051: 5047: 5040: 5037: 5032: 5031: 5026: 5019: 5016: 5012: 5008: 5004: 4999: 4994: 4990: 4986: 4982: 4978: 4974: 4967: 4965: 4961: 4956: 4952: 4946: 4943: 4938: 4934: 4930: 4926: 4921: 4916: 4912: 4908: 4901: 4898: 4887: 4883: 4879: 4875: 4871: 4870:NIHR Evidence 4867: 4861: 4858: 4853: 4849: 4844: 4839: 4834: 4829: 4825: 4821: 4817: 4810: 4807: 4802: 4798: 4794: 4790: 4786: 4785:NIHR Evidence 4782: 4776: 4773: 4768: 4764: 4759: 4754: 4749: 4744: 4740: 4736: 4732: 4725: 4722: 4717: 4713: 4709: 4705: 4701: 4700:NIHR Evidence 4697: 4691: 4688: 4683: 4679: 4674: 4669: 4665: 4661: 4657: 4653: 4649: 4642: 4639: 4634: 4630: 4626: 4622: 4618: 4611: 4607: 4602: 4597: 4593: 4589: 4585: 4581: 4577: 4570: 4567: 4562: 4558: 4554: 4550: 4546: 4542: 4538: 4530: 4527: 4522: 4518: 4514: 4510: 4506: 4505:NIHR Evidence 4502: 4496: 4493: 4488: 4484: 4479: 4474: 4470: 4466: 4462: 4458: 4454: 4447: 4444: 4439: 4435: 4431: 4427: 4423: 4422:NIHR Evidence 4419: 4413: 4410: 4405: 4401: 4397: 4393: 4389: 4388:NIHR Evidence 4385: 4379: 4376: 4363: 4356: 4350: 4347: 4334: 4330: 4326: 4321: 4316: 4312: 4308: 4304: 4300: 4296: 4292: 4288: 4281: 4278: 4273: 4272: 4267: 4261: 4258: 4253: 4249: 4243: 4240: 4235: 4231: 4230: 4225: 4219: 4216: 4211: 4210: 4205: 4199: 4196: 4183: 4179: 4165: 4161: 4157: 4151: 4148: 4143: 4141: 4138: 4132: 4126: 4123: 4118: 4116: 4113: 4107: 4101: 4098: 4090: 4083: 4077: 4074: 4069: 4065: 4064: 4059: 4053: 4051: 4049: 4047: 4043: 4038: 4037: 4036:Nursing Times 4032: 4026: 4023: 4018: 4014: 4008: 4005: 4000: 3999: 3994: 3988: 3985: 3980: 3979: 3974: 3968: 3965: 3957: 3953: 3946: 3940: 3937: 3932: 3928: 3924: 3918: 3915: 3902: 3896: 3893: 3882: 3878: 3872: 3869: 3864: 3860: 3856: 3852: 3848: 3844: 3840: 3833: 3830: 3825: 3821: 3816: 3811: 3807: 3803: 3799: 3795: 3791: 3784: 3781: 3776: 3772: 3768: 3764: 3759: 3754: 3750: 3746: 3742: 3735: 3732: 3727: 3723: 3718: 3713: 3708: 3703: 3699: 3695: 3691: 3684: 3681: 3676: 3672: 3668: 3664: 3660: 3656: 3652: 3648: 3641: 3638: 3627: 3623: 3617: 3614: 3609: 3605: 3600: 3595: 3591: 3587: 3582: 3577: 3573: 3569: 3565: 3561: 3557: 3550: 3548: 3544: 3539: 3535: 3531: 3527: 3523: 3519: 3515: 3511: 3507: 3503: 3499: 3492: 3489: 3478: 3474: 3468: 3465: 3454: 3450: 3444: 3441: 3436: 3432: 3428: 3424: 3420: 3416: 3412: 3408: 3400: 3397: 3392: 3388: 3383: 3378: 3374: 3370: 3366: 3362: 3358: 3351: 3349: 3345: 3340: 3336: 3331: 3326: 3321: 3316: 3312: 3308: 3304: 3297: 3295: 3291: 3286: 3282: 3278: 3274: 3270: 3266: 3262: 3258: 3251: 3248: 3237: 3233: 3227: 3224: 3213:on 2019-03-27 3209: 3205: 3198: 3192: 3189: 3184: 3180: 3176: 3172: 3167: 3162: 3158: 3154: 3150: 3143: 3141: 3137: 3132: 3128: 3124: 3122:9781439908242 3118: 3114: 3107: 3104: 3099: 3095: 3091: 3087: 3083: 3079: 3075: 3071: 3064: 3061: 3056: 3052: 3047: 3042: 3038: 3034: 3030: 3026: 3022: 3015: 3012: 3001: 2997: 2993: 2989: 2985: 2984:NIHR Evidence 2981: 2975: 2972: 2967: 2963: 2958: 2953: 2949: 2945: 2941: 2937: 2933: 2926: 2924: 2922: 2920: 2916: 2905: 2901: 2895: 2892: 2887: 2883: 2878: 2873: 2869: 2865: 2861: 2854: 2851: 2846: 2842: 2838: 2834: 2830: 2826: 2819: 2816: 2811: 2807: 2802: 2797: 2793: 2789: 2785: 2781: 2777: 2773: 2769: 2761: 2758: 2753: 2749: 2744: 2739: 2735: 2731: 2727: 2723: 2719: 2712: 2709: 2704: 2700: 2695: 2690: 2686: 2682: 2678: 2674: 2670: 2666: 2662: 2655: 2652: 2647: 2643: 2638: 2633: 2629: 2625: 2621: 2614: 2611: 2606: 2602: 2597: 2592: 2588: 2584: 2580: 2576: 2572: 2568: 2564: 2557: 2554: 2549: 2545: 2541: 2537: 2533: 2529: 2525: 2521: 2517: 2510: 2507: 2502: 2498: 2493: 2488: 2484: 2480: 2476: 2472: 2468: 2461: 2458: 2453: 2449: 2446:(2): 99–109. 2445: 2441: 2433: 2430: 2425: 2421: 2417: 2413: 2409: 2405: 2401: 2397: 2390: 2387: 2382: 2378: 2374: 2370: 2365: 2360: 2356: 2352: 2348: 2341: 2338: 2333: 2329: 2325: 2321: 2317: 2310: 2307: 2302: 2298: 2294: 2288: 2286: 2284: 2282: 2280: 2276: 2271: 2267: 2263: 2259: 2255: 2251: 2247: 2243: 2236: 2234: 2230: 2219: 2215: 2209: 2206: 2198: 2194: 2187: 2181: 2179: 2177: 2175: 2173: 2171: 2167: 2155: 2151: 2144: 2142: 2138: 2126: 2122: 2116: 2114: 2110: 2104: 2101: 2097: 2093: 2087: 2084: 2071: 2067: 2063: 2056: 2053: 2048: 2044: 2040: 2036: 2032: 2028: 2024: 2020: 2016: 2012: 2008: 2001: 1998: 1993: 1989: 1985: 1981: 1977: 1973: 1969: 1965: 1961: 1954: 1951: 1946: 1945:NCI Factsheet 1942: 1936: 1933: 1922: 1918: 1912: 1909: 1904: 1900: 1896: 1892: 1888: 1884: 1880: 1876: 1872: 1868: 1864: 1857: 1854: 1849: 1845: 1841: 1837: 1833: 1832:NIHR Evidence 1829: 1823: 1820: 1815: 1811: 1806: 1801: 1797: 1793: 1789: 1785: 1781: 1777: 1773: 1766: 1763: 1758: 1754: 1749: 1744: 1740: 1736: 1732: 1728: 1724: 1717: 1714: 1703: 1699: 1692: 1689: 1684: 1680: 1675: 1670: 1666: 1662: 1658: 1654: 1650: 1646: 1642: 1635: 1632: 1627: 1623: 1619: 1615: 1611: 1607: 1603: 1599: 1595: 1588: 1585: 1580: 1576: 1572: 1568: 1564: 1560: 1556: 1552: 1548: 1544: 1540: 1533: 1530: 1525: 1521: 1516: 1511: 1507: 1503: 1499: 1495: 1491: 1483: 1480: 1475: 1471: 1466: 1461: 1457: 1453: 1449: 1445: 1441: 1434: 1432: 1430: 1426: 1421: 1417: 1413: 1409: 1405: 1401: 1397: 1393: 1386: 1379: 1376: 1371: 1367: 1362: 1357: 1353: 1349: 1345: 1341: 1337: 1333: 1329: 1322: 1319: 1314: 1308: 1305: 1300: 1296: 1291: 1286: 1282: 1278: 1274: 1270: 1266: 1262: 1258: 1251: 1248: 1237: 1233: 1227: 1225: 1221: 1210: 1206: 1200: 1198: 1194: 1189: 1185: 1180: 1175: 1171: 1167: 1163: 1159: 1155: 1151: 1147: 1140: 1137: 1132: 1128: 1123: 1118: 1114: 1110: 1106: 1102: 1098: 1094: 1090: 1082: 1079: 1074: 1070: 1066: 1062: 1058: 1054: 1047: 1045: 1043: 1039: 1034: 1030: 1025: 1020: 1016: 1012: 1008: 1001: 999: 995: 984: 980: 974: 971: 966: 962: 958: 951: 948: 937: 933: 927: 925: 921: 910: 906: 900: 898: 894: 888: 884: 881: 879: 876: 874: 871: 869: 866: 864: 861: 859: 856: 854: 853:Death midwife 851: 849: 846: 845: 841: 839: 837: 833: 832:nursing homes 828: 819: 817: 813: 811: 807: 802: 799: 797: 793: 789: 785: 781: 777: 773: 769: 765: 759: 752:United States 751: 749: 746: 741: 739: 735: 731: 726: 724: 719: 716: 712: 707: 705: 701: 697: 691: 689: 685: 681: 677: 676:heart disease 673: 667: 665: 662:in 2008. The 660: 652: 650: 647: 643: 635: 630: 628: 624: 621: 620:heart failure 616: 612: 605: 603: 600: 592: 590: 588: 583: 579: 576: 568: 566: 562: 560: 555: 554:fear of death 550: 543: 540: 532: 530: 528: 524: 520: 519:schizophrenia 516: 512: 504: 502: 499: 490: 488: 484: 480: 477: 470: 468: 466: 462: 458: 454: 450: 446: 442: 438: 434: 430: 425: 422: 421:infusion pump 418: 414: 406: 404: 402: 398: 394: 390: 382: 378: 374: 373: 372: 371: 365: 361: 357: 353: 350: 347: 344: 340: 336: 332: 328: 324: 321: 318: 315: 311: 307: 303: 299: 295: 294:upper airways 291: 287: 284: 281: 277: 273: 269: 265: 261: 257: 254: 251: 248: 244: 243:hydromorphone 240: 236: 232: 228: 226: 223: 222: 221: 215: 210: 206: 204: 200: 197: 195: 191: 188: 184: 181: 178: 175: 171: 168: 165: 162: 159: 158:hypercalcemia 155: 152: 149: 146: 142: 139: 138: 137: 135: 134:United States 131: 123: 121: 117: 114: 108: 101: 99: 95: 92: 88: 82: 75: 72: 64: 62: 58: 56: 52: 46: 44: 40: 36: 32: 19: 7221:Death threat 7104:Dark tourism 7046:Necrobiology 6988:Right to die 6946: 6905:Abortion law 6829:Resurrection 6817:Palingenesis 6714: 6676:Coffin birth 6583:Plastination 6544:Preservation 6520:Putrefaction 6515:Rigor mortis 6510:Algor mortis 6505:Livor mortis 6482: 6438:Memento mori 6436: 6289:Lazarus sign 6278: 6269:Death rattle 6212:Suicide gene 6197:Karyorrhexis 6088:Fat necrosis 5912:Telemedicine 5845:Telemedicine 5840:Nanomedicine 5725: 5676:Nursing home 5489: 5468: 5457:Survivorship 5456: 5444: 5432: 5421:the original 5416: 5402: 5383: 5379: 5356: 5344: 5340: 5302: 5267: 5263: 5208: 5204: 5194: 5151: 5147: 5137: 5102: 5098: 5088: 5053: 5049: 5039: 5028: 5018: 5010: 4980: 4976: 4954: 4945: 4910: 4900: 4889:. Retrieved 4869: 4860: 4823: 4819: 4809: 4784: 4775: 4738: 4734: 4724: 4699: 4690: 4655: 4651: 4641: 4583: 4579: 4569: 4536: 4529: 4504: 4495: 4460: 4456: 4446: 4421: 4412: 4387: 4378: 4366:. Retrieved 4361: 4349: 4337:. Retrieved 4297:(1): 23–31. 4294: 4290: 4280: 4269: 4260: 4251: 4242: 4234:the original 4227: 4218: 4212:. July 2010. 4207: 4198: 4186:. Retrieved 4181: 4168:. Retrieved 4164:the original 4159: 4150: 4134: 4125: 4109: 4100: 4089:the original 4076: 4061: 4034: 4025: 4007: 3996: 3987: 3976: 3967: 3956:the original 3951: 3939: 3931:the original 3926: 3917: 3905:. Retrieved 3895: 3884:. Retrieved 3880: 3871: 3846: 3842: 3832: 3797: 3793: 3783: 3748: 3744: 3734: 3697: 3693: 3683: 3650: 3646: 3640: 3629:. Retrieved 3625: 3616: 3563: 3559: 3505: 3501: 3491: 3480:. Retrieved 3476: 3467: 3456:. Retrieved 3452: 3443: 3410: 3406: 3399: 3364: 3360: 3310: 3306: 3260: 3256: 3250: 3239:. Retrieved 3235: 3226: 3215:. 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