Palliative medicine
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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.
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Requirements for healthcare professionals in the United Kingdom to undertake continuing education are discussed. For nurses, midwives and many career-grade doctors, formal arrangements are in place; for other professionals, continuing education is recommended but not yet a formal requirement. In order to explore what is available, courses, conferences and seminars advertised in the Hospice Information Service's publication Choices for the academic year September 1994 to July 1995 are reviewed in terms of number, intended audience, participants and duration. ⋯ Issues of approval, quality assurance and evaluation are addressed. Suggestions are offered with regard to future financing of courses, and co-ordination of planning and provision. It is suggested that the National Council for Hospice and Specialist Palliative Care might encourage increasing co-operation between units in the provision of education.
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Three contrasting views are presented in three short papers: that a short period of oncology training should be mandatory for trainees in palliative medicine; that many disciplines are important in palliative medicine and training programmes should be tailored to the needs of individuals while recognizing that there will always need to be close cooperation between oncology and palliative medicine; and that a short period of training in palliative medicine should be mandatory for those wishing to pursue a career in oncology.
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Palliative medicine · Jan 1996
Letter Case Reports5HT3 receptor antagonists and pruritus due to cholestasis.