Articles: palliative-care.
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The new specialty of palliative medicine is now recognized as making a significant contribution, not only to the practice of cancer medicine, but also to the care of terminal disease. This article reports an enquiry into the current teaching of palliative medicine in undergraduate curricula in Britain. A questionnaire concerning palliative medicine teaching was sent in December 1992 to undergraduate deans of all medical schools, colleges and faculties (hereafter referred to as schools). ⋯ Eleven per cent of schools regularly asked questions on palliative medicine in final examinations; half occasionally did so, but 30% reported that there was never a question on palliative medicine in finals. In the light of recent publications by the General Medical Council and the Standing Medical Advisory Committee and Standing Nursing and Midwifery Advisory Committee, I urge that increasing attention be paid to teaching the subjects represented by palliative medicine and to examining it. I suggest that the recently published core curriculum will enable this to be carried out more effectively.
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Randomized Controlled Trial Comparative Study Clinical Trial
Enhancement of pain control with ketorolac tromethamine in patients with sickle cell vaso-occlusive crisis.
Twenty one patients with sickle cell disease admitted to the hospital with the pain of vaso-occlusive crisis (VOC) were treated by continuous IV infusion of ketorolac or normal saline for up to 5 days. All patients received supplemental IM injections of meperidine, 100 mg, as necessary, but not more frequently than every 3 hr. Over the 5 days the ketorolac treated patients (KT) required 33% less meperidine than did the placebo treated patients (PL), P = 0.04, and had significantly better pain relief as assessed by categorical, visual analog, and pain relief scales. ⋯ Adverse events were mainly related to the digestive system. This study showed that continuous infusion of ketorolac significantly reduced total meperidine requirement and that the analgesia produced by this combination was superior to that produced by meperidine alone. Further evaluation of this drug in the management of sickle cell VOC is warranted.
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Self-expanding metallic stents (Wallstents) were implanted in 44 ureters in 31 patients suffering from malignant ureteral obstruction. The causes of obstruction were lymph node metastases or primary tumors of the pelvis. ⋯ After 4 to 6 weeks, the stents were incorporated into the wall of the ureter. In a follow-up period from 1 to 27 months, tumor-associated hydronephrosis was prevented in all patients by implantation of the Wallstents.
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Ugeskrift for laeger · Apr 1994
Case Reports[Treatment of cancer pain with continuous opioid via spinal catheters].
Continuous intrathecal morphine treatment of cancer pain is reviewed on the basis of a literature search. Clinical, pharmacological and technical aspects are described, and the indications and potential complications are discussed. Three case histories illustrate the practical conduct and problems. The authors conclude that continuous intrathecal morphine treatment offers significant therapeutical advantages, when pain relief is not provided by conventional methods.
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Ugeskrift for laeger · Apr 1994
Case Reports[Continuous subcutaneous morphine to patients with terminal cancer. Analgesia at home].
Since 1992 it has been possible for cancer patients in the county of Southern Jutland to receive terminal care in their own homes. An essential part of this management is effective pain relief; more than 60% of cancer patients have chronic pain. ⋯ The patient may be treated in this latter manner for long periods of time. A case story is described where a cancer patient was treated with continuous subcutaneous morphine in his home for more than 257 days without complications or major side-effects.