Palliative medicine
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Palliative medicine · Sep 2012
ReviewEvidence for orthopaedic surgery in the treatment of metastatic bone disease of the extremities: a review article.
The decision to offer orthopaedic surgery to patients with metastatic bone disease is often difficult and requires an understanding of the underlying disease, the patient's needs or wishes, the expected outcomes and the principles of surgery. ⋯ Timely and appropriate surgical intervention reliably alleviates pain and improves quality of life and can be undertaken with few complications in most patients. Although most procedures can be undertaken by non-specialists, consultation with other members of the multidisciplinary team is mandatory, and in complex cases, referral to a specialist orthopaedic oncology centre can be helpful.
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Palliative medicine · Sep 2012
Opioid switching to methadone: a pharmacoepidemiological study from a national prescription database.
Opioid switching to methadone is reported frequently to improve pain control in patients with an unacceptable balance between pain control and side effects during treatment with first line opioids, but carries a risk of drug accumulation and respiratory depression. To justify this risk it is required that less risky treatments are tried beforehand and that a sufficiently large proportion of patients experience a long-lasting improvement in pain control. ⋯ Opioid switching to methadone appears to provide a long lasting improvement in pain control in a significant proportion of patients. However, the study raises concerns that treatment options with less risk are not being exhausted prior to switching to methadone.
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Palliative medicine · Sep 2012
Do beta-blockers alter dyspnea and fatigue in advanced lung cancer? A retrospective analysis.
Dyspnea is common in lung cancer and may be partially attributable to increased ventilatory drive due to muscle weakness. The sympathetic component of this pathway might be mitigated by β-blockers. ⋯ Dyspnea and fatigue are prevalent and increased in the presence of COPD and anemia. No association between β-blocker use and dyspnea or fatigue scores was observed. This may be attributable to inadequate dosing or to retrospective bias.
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Palliative medicine · Sep 2012
ReviewManagement of chronic cough in patients receiving palliative care: review of evidence and recommendations by a task group of the Association for Palliative Medicine of Great Britain and Ireland.
Chronic cough is a disruptive and exhausting symptom, reported as very distressing in a quarter of those in their last year of life. Existing guidelines for management of chronic cough primarily deal with the commonest benign causes of cough: asthma; eosinophilic bronchitis; gastro-oesophageal reflux disease; rhinosinusitis. ⋯ These recommendations (Grade D) include simple linctus, therapeutic trial of sodium cromoglycate and then prescription of an opioid or opioid derivative (dextromethorphan, morphine or codeine). Further research is clearly and urgently required in this area for more effective approaches to managing cough, tested in trials that have sufficient size, power and validity.
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Palliative medicine · Sep 2012
ReviewAssessing constipation in palliative care within a gastroenterology framework.
Constipation is common and distressing in palliative care. Despite this, approaches to assessment and subsequent treatment are most remarkable for the numbers who fail adequate palliation. ⋯ Current approaches to assessing constipation in palliative care are very different to those recommended by gastroenterology guidelines. However, modified approaches may be tolerable to palliative care patients and offer the chance of developing targeted palliation.