Palliative medicine
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Breathlessness secondary to both cancer and non-malignant disease is a distressing, exhausting symptom which, to date, has been difficult to control. This paper reports a chart review undertaken on patients referred to the Ottawa Civic Hospital's Palliative Care Service over the 18-month period from 1 January 1992 to 30 June 1993. ⋯ The treatment was found to be effective, safe and convenient for the majority of the patients studied. In addition, nebulized opioids have been demonstrated as a treatment modality which is feasible for self-administration by the patient at home.
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Palliative medicine · Oct 1994
The assessment of need for bereavement follow-up in palliative and hospice care.
This paper describes a postal survey of palliative care services and teams which were identified in the 1992 Directory of Hospice Services in the UK and Ireland. Its aims were to investigate how units assess the need for bereavement follow-up, and to determine the nature and extent of services provided for bereaved adults. We sent out 397 questionnaires, of which 187 were returned, a response rate of 47%. ⋯ Of the remaining 125 units, 58 (46%) reported basing their decisions on clinical impressions. Content analysis of the formal assessment instruments revealed 39 subcategories, which were broadly grouped into three areas: circumstantial factors at or near to the time of death, personal factors and social factors. Recommendations are made for further study.
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Palliative medicine · Jan 1994
Safety and efficacy of nebulized lignocaine in patients with cancer and breathlessness.
Although anecdotal reports suggest nebulized lignocaine may help breathlessness in patients with cancer this has not been examined formally. We report a pilot study comparing nebulized lignocaine 100 mg and 200 mg with saline in six patients with cancer who were breathless at rest. ⋯ The effort of breathing (measured on a visual analogue scale) did not differ between treatments, whereas the distress of breathing was less after saline than after either dose of lignocaine. These findings do not support the reported benefits of nebulized lignocaine.
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Palliative medicine · Jan 1994
Case ReportsEpidural infection associated with epidural catheterization in a cancer patient with back pain: case report.
Single epidural injections of local anaesthetic/steroid mixtures and epidural catheterization are useful in controlling pain when other measures fail. However, epidural infection is a recognized risk of these procedures, but can be difficult to diagnose. This case report illustrates the complexity of diagnosis and management of epidural infection.
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Palliative medicine · Jan 1994
The influence of general practitioner community hospitals on the place of death of cancer patients.
All deaths from cancer were identified from death certificates in the Exeter Health District for a period of one year. Place of death, age, cancer type and access to general practitioner community hospital beds and the domiciliary hospice service were recorded. There were 1022 deaths attributable to cancer (parts 1a, 1b or 1c of the death certificate) who were patients of general practitioners in the health district. ⋯ Access to the domiciliary hospice services in areas with community beds was not associated with any significant change in the place of death. General practitioners cared for 74% of cases at the time of death in areas with access to community hospital beds and for 51% of cases without such access, which was a significant difference (p < 0.001). It therefore appears that community hospitals play a major role in the terminal care of cancer patients and access to such beds is associated with a decrease in cancer deaths occurring in specialist services beds.