Articles: palliative-care.
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Palliative medicine · Sep 1998
The attitude of health care professionals toward the availability of hospice services for cancer patients and their carers in Saudi Arabia.
The main objectives of this study were to assess cancer care and the need for establishing hospice/palliative care for cancer patients and their carers in Saudi Arabia. Six-hundred-and-ninety-five participants (136 cancer patients, 161 informal carers, and 398 health care professionals) were recruited from oncology centres in four major regions of Saudi Arabia. ⋯ It was also reported that the shortage of drugs used in cancer management, the severe restriction of prescribing narcotic analgesics and lack of cancer care knowledge were the major impediments to providing good cancer care. Thus, the strong inter-relationship among Saudi families, the present poor status of cancer care, cancer patients' and their carers' acceptability of hospice services and of the willingness of health care professionals to receive training in palliative care, illustrate the need for initiating the provision of palliative care services in the Saudi health system.
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Palliative medicine · Sep 1998
Do hospital palliative care teams improve symptom control? Use of a modified STAS as an evaluation tool.
The support team assessment schedule (STAS) has previously been validated as an evaluation tool for community palliative care teams and inpatient units. This study reports on use of an expanded STAS (E-STAS) to determine symptom prevalence and outcome for inpatients and outpatients referred to a multiprofessional hospital palliative care team. E-STAS forms were completed on patients at referral and twice weekly thereafter. ⋯ Of the symptoms assessed on referral, the most common were psychological distress 93%, anorexia 73%, pain 59%, mouth discomfort 59%, depression 40%, constipation 36%, breathlessness 32%, nausea 24% and vomiting 13%. In the 122 patients where three or more assessment were completed, statistically significant improvements from first to last assessment were seen in all symptoms except depression. This study suggests that E-STAS may be a useful tool to evaluate interventions by a hospital palliative care team in patients with advanced disease.
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We constructed a UK-based decision model of palliative care for terminally ill cancer patients who were switched from a weak to a strong opioid so that the expected direct healthcare costs in the UK could be estimated from the time a patient commenced a strong opioid until death. ⋯ The expected cost of palliative care in the UK healthcare setting ranged from approximately 2500 Pounds to 4000 Pounds (1500 Pounds to 6000 Pounds in the sensitivity analysis) depending on the length of survival after patients switch from weak to strong opioids. Since opioids account for only 2 to 8% of expected costs, factors other than economic issues, such as tolerability profile, patient preference and convenience of use, should form the basis of clinical decision-making between opioids with similar analgesic efficacy.
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Sixty-four patients with painful metastatic breast cancer in bone were treated with 2 MBq/kg of strontium-89 chloride as a single intravenous injection. Patients were followed with records of medication, hematology parameters, serial bone and Sr-89 bremsstrahlung images and with a point pain score scale (10-0). The response was assessed during a 6-month period of follow-up. ⋯ Furthermore no additional painful metastases on their bone scintigraphic images were observed. The selective strontium-89 local uptake in metastatic sites was also confirmed directly by bremsstrahlung scans which were absolutely comparable to the respective 99mTc bone scans. Precautions have been taken against Sr-89 contamination from the patients' blood or excretions.
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Case Reports
Chronic pain management--upper visceral malignancies coeliac plexus block with CT scanning--a case report.
Coeliac plexus block has been described more than seventy years ago and is widely used for chronic pain management in upper visceral malignancies. The technique described here is a posterior approach using CT scan guidance with absolute ethyl alcohol. A case illustration of a patient with carcinoma of pancreas managed with coeliac plexus block for pain control is presented.