Palliative medicine
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Palliative medicine · Apr 1996
Randomized Controlled Trial Clinical TrialAn investigation of the ability of oral naloxone to correct opioid-related constipation in patients with advanced cancer.
A dose-ranging study of the use of oral naloxone in opioid-related constipation in patients with far-advanced cancer is reported. Naloxone doses were calculated as a percentage of the morphine dose each patient was receiving. Seventeen patients entered the first phase of the study, which had a randomised, double-blind design. ⋯ It is concluded that oral naloxone at a daily dose of 20% or more of the prevailing 24 h morphine dose is a potentially valuable therapy for opioid-related constipation. However, opioid withdrawal was observed and it is suggested that initial individual naloxone doses should not exceed 5 mg. Further research is needed into the oral absorption of naloxone, as well as further studies of clinical efficacy and dosing.
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The palliation of cancer-related breathlessness is challenging and complex. An open pilot study was conducted, exploring the safety and efficacy of acupuncture in 20 patients who were breathless at rest and whose breathlessness was directly related to primary or secondary malignancy. Sternal and LI4 acupuncture points were used. ⋯ Seventy per cent (14/20) of patients reported marked symptomatic benefit from treatment; there were significant changes in VAS scores of breathlessness, relaxation and anxiety at least up to 6 hours post acupuncture which were measured to be maximal at 90 minutes (p < 0.005, p < 0.001, respectively). There was a significant reduction in respiratory rate, which was sustained for 90 minutes post acupuncture (p < 0.02). The therapeutic value of acupuncture in the management of breathlessness requires further evaluation.
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The undergraduate education of health professionals has legitimately broad but ultimately conflicting aims. There is a need to reformulate how professionals work, think and learn, and for this analysis to inform undergraduate programmes. Palliative care is not strongly placed politically to influence these developments, yet the contribution it can make is enormous, through allowing students the opportunity to experience what it does and to reflect on that experience.
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Palliative medicine · Apr 1996
Randomized Controlled Trial Clinical TrialA randomized controlled trial of the cost-effectiveness of a district co-ordinating service for terminally ill cancer patients.
The objective of this paper is to compare the cost effectiveness of a co-ordination service with standard services for terminally ill cancer patients with a prognosis of less than one year. We designed a randomized controlled trial, with patients randomized by the general practice with which they were registered. Co-ordination group patients received the assistance of two nurse coordinators whose role was to ensure that patients had access to appropriate services. ⋯ In conclusion, the co-ordination service for cancer patients who were terminally ill with a prognosis of less than one year was more cost effective than standard services, due to achieving the same outcomes at lower service use, particularly inpatient days in acute hospital. Assuming that the observed effects are real, improved co-ordination of palliative care offers the potential for considerable savings. Further research is needed to explore this issue.
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The objective was to compile data on therapeutic approaches employed in palliative care in Australia, including practices relating to combining drugs in syringe drivers for administration by subcutaneous infusion. A questionnaire, with a reply-paid envelope, was sent to 130 teaching hospitals and palliative care services throughout Australia. Ninety-six responses were received (74% response rate). ⋯ Only 48% of the palliative care services had a policy on combining drugs in syringe drivers for administration by subcutaneous infusion and 34% had an upper limit on the number of drugs combined in syringe drivers. Twenty-nine per cent of respondents had encountered problems (e.g. incompatibilities) when combining drugs in syringe drivers for administration by subcutaneous infusion. This study has revealed considerable variation in the practice of therapeutics and the combining of drugs in syringe drivers for administration by subcutaneous infusion in palliative care.