Articles: palliative-care.
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Gan To Kagaku Ryoho · Dec 2000
Case Reports[Home drug therapy for a patient who rejected use of morphine--management of dyspnea and pain by codeine phosphate].
We encountered a terminal lung cancer patient with severe back pain and dyspnea who refused the use of morphine, and succeeded in home palliative care with the use of an original prescription (CA), the main ingredient of which was codeine phosphate.
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To ensure the success of a new curriculum at an institution, information about the educational needs of learners, available resources, and potential obstacles needs to be systematically collected and analyzed prior to the development and implementation of the actual curriculum. This process, known as needs assessment, is important in the development of palliative care training for internal medicine residents, because internal medicine has only recently begun to address these issues in a formalized way and palliative care is a relatively new topic in medical education and clinical medicine. Therefore, institutional issues and resistance, lack of knowledge and appropriate attitudes among trainees and faculty, and a paucity of educational models for individual internal medicine training programs present potential obstacles. ⋯ The needs assessment revealed the following educational, clinical, and institutional information: 1) interns had very little exposure to palliative care in medical school; 2) there was no formalized system formal education and clinical exposure; 3) tremendous interest in palliative care education existed; 4) patients, families, physicians, and nurses perceived a need to improve the quality of palliative care; and 5) there are several political, logistical, and resource (time and financial) obstacles that needed to be addressed. An institution-specific needs assessment is an important part of the successful development and implementation of any new curriculum for medical residents and was specifically necessary for our palliative care program. As a result of the needs assessment process, a curriculum consisting of ten units of case-based and problem-based teaching was successfully implemented.
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Although morphine is the mainstay of pharmacological therapy in cancer pain, it remains feared and suboptimally used. Different formulations and the advent of 'new' opioids facilitate the attainment of pain control. ⋯ The optimal application of opioids is governed by their clinical pharmacology and hindered by unfounded fears and misunderstanding. Different formulations within different types of opioids augment a favourable balance in the pain relief versus adverse effects equation and used within a four point approach, should serve to deliver optimal pain control.
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Developing high-quality patient-centred palliative care involving different professions in a local health care situation is a challenging task. It is difficult to establish co-operation on the allocation of resources to individual patients throughout the phases of disease. There are financial constraints, but also incongruities between the various levels of the health care system. Doctors' participation in cancer care is hidden in various tasks, and the contribution of GPs can be difficult to grasp. Patient-centred cancer care requires local co-operation; the intention in public health policy is to let the GP and the primary care nurse provide continuity of care, with the GP in the role of co-ordinator and organiser. ⋯ There is a sizeable potential for quality improvement in local palliative cancer care and in the vertical and horizontal communication between the professional groups involved.