Articles: palliative-care.
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Advanced tumors of the hepatic duct bifurcation (Klatskin tumors) present problems to the endoscopist in deciding which procedure to use for palliative treatment of the resulting cholestasis--endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic biliary drainage (PTBD), or both. There are technical difficulties with all forms of treatment for stenoses in the hilar region and intrahepatic bile ducts, and there are as yet no clear data on which type of drainage is feasible or preferable. ⋯ Palliative treatment in patients with advanced Klatskin tumors is still suboptimal, even when combined endoscopic and percutaneous techniques are used in the same institution, allowing treatment to be tailored to the individual patient's needs. There is therefore a need for improvements in existing forms of treatment, as well as for the development of new forms of treatment.
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This study aims at describing the experience of the patients and their family when they are faced with an interdisciplinary team in palliative care. Are the patients and their family aware of the interdisciplinarity within the team and does this organization meet their expectations? We also went deeper into some themes, i.e. pain treatment, notion of safety and the position of the patients and of his relatives as object or subject of the care. We chose the qualitative approach to answer this question. ⋯ At home, the interdisciplinarity is not yet perceived by the subjects and it is striking to see the relatives who wish to "take a break" in their accompaniment of the sick person, even if they feel very guilty and are not very well considered by the care takers. We also noted all what was expressed around the death and the death accompaniment, which raises questions on the role of the team, the limits of this accompaniment and the training of the care takers for this accompaniment. To conclude, this study allowed us to describe an experience rather precisely; we could thus stress the perception by the patients and the families of a team, what, we think, can help the latter in their daily practice but also in a deepened reflection on the interdisciplinarity conditions and the implementation of real team projects, involving the patient and his family.
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To determine the prevalence, incidence, and characteristics of pain connected with AIDS, 95 AIDS patients were enrolled in a prospective longitudinal study and interviewed every six months during a 2-year period or until death. The overall incidence of pain was 88%, and 69% of the patients suffered from constant pain interfering with daily living to a degree described as moderate or severe. The most common pain localizations were: extremities (32%), head (24%), upper gastrointestinal tract (23%) and lower gastrointestinal tract (22%). ⋯ Although the PMI improved significantly during the observation period, the patients felt that pain was not taken seriously by the physicians. However, the patients were convinced that treatment was optimal and, therefore, only 9% of the patients were dissatisfied. Patients were reluctant to take analgesics, primarily because of fear of addiction.
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J Cataract Refract Surg · May 2000
Randomized Controlled Trial Comparative Study Clinical TrialDoes preservative-free lignocaine 1% for hydrodissection reduce pain during phacoemulsification?
To compare preservative-free 1% lignocaine with balanced salt solution (BSS) in alleviating pain during hydrodissection in phacoemulsification cataract surgery. ⋯ There was no significant difference in the pain scores in patients who received BSS or lignocaine 1% solution. Thus, we conclude that hydrodissecting with lignocaine 1% solution does not provide added pain relief during phacoemulsification.