To the Editor: In their systematic review of specialized palliative care, Dr Zimmerman and colleagues1 defined this as “a service of professionals that provides or coordinates comprehensive care for patients with a terminal illness.” Systematic reviews are better at answering very specific questions than very general questions of an exploratory nature. The authors' unfocused definition allowed them to include studies of interventions such as a monthly telephone or oncology nurse outpatient follow-up visit, a coping intervention for caregivers, or a multidisciplinary palliative care team. I believe that because no palliative care expertise was required, their use of the term specialized palliative care is misleading.
The setting in which these interventions took place included patient homes, outpatient clinics, nursing homes, teaching hospitals, and cancer centers. The population included patients with cancer, congestive heart failure, chronic obstructive pulmonary disease, motor neuron disease, AIDS, and dementia. Among the control groups, in 1 study all patients received hospice care,2 in another there was telephone consultation with a palliative care specialist,3 and in at least 2 more studies4 - 5 patients had access to hospice and home care programs. In these 4 studies, the control group complies with the authors' definition of specialized palliative care service. Therefore, these 4 studies should have been considered a comparison between different types of specialized palliative care services rather than a comparison between a specialized palliative care service and a control group.
It is likely that a more specific definition of the intervention and control groups would have made it difficult to identify many studies. However, as currently written, the review's conclusion that “[t]he evidence for benefit from specialized palliative care is sparse and limited by methodological shortcomings” is limited by its own methodological shortcomings.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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