Articles: palliative-care.
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J Pain Symptom Manage · Apr 2001
Cancer pain management skills among medical students: the development of a Cancer Pain Objective Structured Clinical Examination.
Recent surveys suggest that most physicians have inadequate knowledge to assess and manage cancer pain; however, the important domain of clinical performance has not yet been clearly evaluated. The Objective Structured Clinical Examination (OSCE) has become a widely- used and accepted method to evaluate the clinical abilities of medical students. The purpose of this study was to develop and test a Cancer Pain OSCE for medical students evaluating their clinical competence in the area of cancer pain management. ⋯ We conclude that the Cancer Pain OSCE is a useful performance-based tool to test individual skills in the essential components of cancer pain assessment and management. Of the four components of the Cancer Pain OSCE, medical students performed best on the cancer pain history and performed poorly on the cancer pain physical examination. Information gained from this study will provide a foundation on which future small-group medical student structured teaching will be based.
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Gynaecological malignancies affect the respiratory system both directly and indirectly. Malignant pleural effusion is a poor prognostic factor: management options include repeated thoracentesis, chemical pleurodesis, symptomatic relief of dyspnoea with oxygen and morphine, and external drainage. Parenchymal metastases are typically multifocal and respond to chemotherapy, with a limited role for pulmonary metastatectomy. ⋯ Identification and treatment of gastroesophageal reflux, sinusitis, and asthma can improve many patients' coughs. Chest wall pain responds to local radiotherapy, nerve blocks or systemic analgesia. Case examples illustrate ways to address quality of life issues.
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Best Pract Res Clin Obstet Gynaecol · Apr 2001
ReviewAcute and chronic pain management in palliative care.
Every palliative care patient should have the expectation that acute and chronic pain management will be an integral part of their overall care. However, in all too many instances, the pain of cancer is often grossly under-treated. This issue is of concern because more than 80% of patients with cancer pain can find adequate relief through the use of simple pharmacological methods. ⋯ Physicians with the basic skills of assessment and treatment will be able to control the symptoms in the majority of cancer pain patients. However, there are still some patients who may require other modalities to control their moderate to severe pain. A thorough understanding of all pain management options will help the gynaecological oncologist to maintain an acceptable quality of life for their patients throughout the therapeutic and palliative phases of care.
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Palliative care professionals are increasingly exposed to, and under pressure to participate in, research to promote evidence-based practice. This may pose challenges and tensions within normal working practices. ⋯ By reflecting on their experiences and the difficulties they encountered, primarily with regard to obtaining informed consent from patients to take part in the research, this article explores issues relevant to practitioners and researchers when conducting palliative care research involving patients. It concludes by suggesting guidelines for conducting good quality research.
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This article examines the impact legislative developments in the UK have had, and are likely to have, on health care in general and how specialist palliative care providers may need to adapt to these changes. The focus of adaptation is on communication and multidisciplinary teamwork. A brief review of the previous Conservative government's reforms offers a background to understanding how the current Labour government agendas affecting health and social care have been developed. Ideas are put forward to ensure that specialist palliative care provision is maintained and developed within the current structure of the health service.