Palliative medicine
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Palliative medicine · Jan 1993
Should hospices offer respite admissions to patients with motor neurone disease?
The provision of inpatient respite care for patients with motor neurone disease (MND) in hospices is variable. Some institutions are concerned about accepting patients who may need long-term care. Some see 'respite' care as simply a short residential stay with little nursing or medical input being necessary. ⋯ Most patients were discharged home after respite admissions and the median stay in the hospice (15 days) was identical to that of cancer patients. We conclude that respite admissions to the hospice were valuable both for MND patients and their carers. Units not currently involved in this work may wish to reconsider their position.
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There is considerable debate surrounding the provision of life-sustaining treatment to those unable themselves to give consent. This article examines the issues involved from a legal perspective, and discusses two proposed solutions: the 'advance directive' and the 'health care proxy'. It is concluded that a legislative framework should be set up in order to give advance directives a legal status.
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Palliative medicine · Jan 1993
Case Reports Clinical TrialSubcutaneous ketorolac--a new development in pain control.
Pain due to advanced malignant disease does not always respond to opioids, or the possible use of opioids may be limited by the occurrence of adverse effects. This paper describes the successful use of ketorolac, a new nonsteroidal anti-inflammatory drug, given by continuous subcutaneous infusion. Seven patients with pain due to advanced malignant disease taking opioid analgesia were considered to have inadequate symptom control because of opioid unresponsiveness (n = 1), opioid-related adverse effects (n = 2) or both (n = 4). All patients became symptom-free with the introduction of ketorolac by subcutaneous infusion and the total daily opioid requirement was substantially reduced in three and reduced to zero in four patients.