Articles: palliative-care.
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Using an action research approach, the author worked with district nurses to enable them to identify their own palliative care education needs and to plan the appropriate education programme, with reflective practice enabling the identification of further education needs. This approach overcame some of the problems of pre-planned, unresponsive palliative care education programmes. ⋯ The knowledge gained from reflective practice is as relevant to nursing as the knowledge derived from academic theories. Reflective practice within palliative care education facilitates learning in a relatively new field of practice and generates a greater understanding of the complexities of palliative care and associated education needs.
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J Pain Symptom Manage · May 1997
Comparative Study Clinical TrialA prospective, within-patient, crossover study of continuous intravenous and subcutaneous morphine for chronic cancer pain.
The dose, efficacy, and side effects of continuous intravenous infusion (CIVI) of morphine were compared with continuous subcutaneous infusion (CSCI) of morphine in patients with chronic cancer pain. Eligible patients were referred to the Palliative Care Program and were receiving a stable dose of CIVI of morphine. The design was a within-patient, one-way crossover; in which each patient provided data before and after a switch from CIVI to CSCI of morphine. "Rescue" doses were 50% of the hourly dose given every 2 hours as needed. ⋯ Of the eight participants who were not maintained on the same i.v. and s.c. dose, all had adequate pain control and a similar side-effect profile on a higher s.c. morphine dose. These data suggest that the i.v. and s.c. routes are equianalgesic for most patients when administered as a continuous infusion. Pain control and side-effect profiles are quite similar and acceptable. s.c. morphine is an excellent alternative to i.v. morphine in both inpatients and outpatients requiring parenteral morphine for pain.
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Approximately one half of prescribed radiotherapy is given for palliation of symptoms due to incurable cancer. Distressing symptoms including pain, bleeding, and obstruction can often be relieved with minimal toxic effects. Painful osseous metastasis is common in oncologic practice. ⋯ Approximately 75% of the cases of superior vena cava syndrome are due to lung cancer, and small-cell lung cancer is the most common histologic type. A histologic diagnosis should be obtained before treatment is started, because detection of lymphoma or small-cell carcinoma would necessitate systemic therapy. Eighty percent of the patients with vena cava syndrome due to malignant disease achieve symptom relief with a brief, fractionated, palliative course of rad
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Lijec̆nic̆ki vjesnik · May 1997
Case Reports[Treatment of malignant bile duct obstruction with a metal stent. Case report].
In the case report we describe endoscopic implantation of endoprosthesis in the periampullar area in a 87 year old female patient with obstructive jaundice and cholangitis caused by pancreatic tumour. This is the first time that this procedure was successfully performed in Croatia.