Palliative medicine
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Palliative medicine · Jan 1993
Comparative StudyCharacteristics of clients referred to home, hospice and hospital palliative care services in Western Australia.
Perth, in Western Australia, has three major palliative care services: a home care service, a freestanding hospice and a purpose-built palliative care unit in a teaching hospital. A retrospective study of patients referred to these services over a six-month period was carried out to find how they were used. The records of 176 clients were compared, which showed that there were some differences between the client groups referred to each of the services. ⋯ Lung cancer accounted for more male admissions (29%) to all services, while breast and lung cancer were more common among women, with a mixed pattern of referral. Lack of private insurance did not seem to influence the choice of service. Overall the clients of the inpatient services were older, had more nursing needs and were less likely to have someone to care for them, characteristics which health services facing an ageing population need to consider.
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There are many ethical decisions to be made during palliative care of a patient with motor neurone disease. These may concern the physical and psychosocial care of the patient and will become highlighted when death approaches. By close involvement of the patient and his/her family with the interdisciplinary team the most appropriate decisions on the patient's care can be made.
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Palliative medicine · Jan 1993
Case Reports Clinical TrialSubcutaneous ketorolac--a new development in pain control.
Pain due to advanced malignant disease does not always respond to opioids, or the possible use of opioids may be limited by the occurrence of adverse effects. This paper describes the successful use of ketorolac, a new nonsteroidal anti-inflammatory drug, given by continuous subcutaneous infusion. Seven patients with pain due to advanced malignant disease taking opioid analgesia were considered to have inadequate symptom control because of opioid unresponsiveness (n = 1), opioid-related adverse effects (n = 2) or both (n = 4). All patients became symptom-free with the introduction of ketorolac by subcutaneous infusion and the total daily opioid requirement was substantially reduced in three and reduced to zero in four patients.
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Palliative medicine · Jan 1993
Validity of the support team assessment schedule: do staffs' ratings reflect those made by patients or their families?
This study aimed to assess the validity of the Support Team Assessment Schedule (STAS), a measure of the outcome of palliative care, through comparisons with the views of patients and family members. STAS ratings completed by two support teams were compared with (1) patients' ratings and (2) family member/carer ratings of seven (of the total 17 STAS) items, collected by independent interviewers. Of 183 patients referred to the teams, 84 (46%) were interviewed and 99 (54%) could not be contacted. ⋯ Team ratings were usually closer to those of the patients than to those of the family member; a team rating often lay between the patient's and family member's rating. The STAS is a measure of professional assessment which is independent from, although based on, the patient and family. The results support the validity of STAS as a measure of the outcome of palliative care from the perspective of a palliative care team.
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Palliative medicine · Jan 1993
Multidisciplinary management from day one: the Neuro-care approach to motor neurone disease.
The Neuro-care approach offers a holistic, multidisciplinary, patient-centred, continuous strategy of care to unselected groups of neurological patients and their families including those with motor neurone disease (MND). The strategy for MND patients is an adapted version of one piloted on patients with Parkinson's disease. Between April 1990 and September 1992 12 MND patients were diagnosed, of whom five have died. ⋯ The maintenance of patients in the community and the lack of resort to permanent institutional care are also recorded. Ethical issues arising during the project are discussed and the problems of measuring outcomes of care are acknowledged. General conclusions for MND management are drawn.