Palliative medicine
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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.
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Palliative medicine · Jan 1994
The impact on community palliative care services of a hospital palliative care team.
This retrospective study examined the influence of a hospital palliative care team on the activity of a local hospice home care team over a four-year period from May 1989 to April 1993 in East Leeds. The increasing referral to death interval observed in home care patients over this period appears to be due to the presence of the hospital team. The increasing work-load of the home care team generated by the hospital team is discussed with reference to solutions to meet this increasing demand. A district or regional planning strategy is recommended to co-ordinate existing and potential palliative care services.
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The theories of loss and grief described by Freud and Bowlby have provided considerable interest in anticipatory grief. Anticipatory grief is assumed to be akin to post-death grief, but commencing prior to the loss of the loved one. 'Grief work' completed during the anticipatory period is purported to mitigate against abnormal grief reactions after death and enhance adjustment to loss. Research conducted to investigate the link between anticipatory grief and postbereavement adjustment has not, however, yielded conclusive findings. ⋯ The physiological, psychological, interpersonal and sociocultural factors evident in the terminal situation serve to highlight the existence of many previously unconsidered variables which may determine the anticipatory grief experience. Until the influence of these determining variables is acknowledged and researchers learn to look beyond the parameters of the traditional models of grief, the costs and/or benefits of the anticipatory period will remain largely undefined. A good starting point may be the adoption of the alternative label, 'terminal response'.
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Palliative medicine · Jan 1994
Case ReportsSuccessful use of methadone in nociceptive cancer pain unresponsive to morphine.
Morphine is the mainstay of pain control in cancer patients. We describe three patients in whom adequate analgesia was not obtained with morphine, and discuss the role of morphine metabolites and the use of methadone as an alternative strong opioid analgesic.