Ugeskrift for laeger
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A 36-year-old female received an epidural analgesia during a normal vaginal delivery. Post delivery she developed a frontal/occipital headache, which worsened in the erect position. Initial treatment with a blood-patch was without symptom relief. ⋯ At a Centre for Headaches she was diagnosed with post dural puncture headache. After treatment with bed rest for 3 days and a second blood-patch she was symptom free. This case highlights the need for an additional blood-patch in specific cases of residual post dural puncture headache.
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Breathlessness (or dyspnoea) is a common symptom in patients with cancer and other advanced progressive illnesses such as cardiac failure, chronic obstructive pulmonary disease and pulmonary fibrosis. It is often distressing for both the patient and the carer. ⋯ Various reversible causes and possible treatments are outlined. A multidisciplinary approach with non-pharmacological and drug-based approaches to symptomatic relief of breathlessness is generally necessary, the latter predominating as death approaches.
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Palliative homecare has been a primary care task for a long time. The introduction of palliative specialist teams has given patients with severe symptoms the possibility of getting qualified help, but has also resulted in a general tendency to exclude primary care from palliative care. Barriers to providing shared care are the organization of palliative care and the working culture of health professionals. Increased focus on shared care research is needed in order to optimise palliative home care.
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It is important for dying patients that their doctors are trained to diagnose that death is near. Typical clinical signs of impending death are described: the patient is bedbound, semicomatose, only able to take sips of fluid and no longer able to take oral drugs. Care of the dying is exclusively focused on palliation. ⋯ The drugs can all be administered by subcutaneous route. Clinical guidelines promote structuring optimal care for the dying. Home death is desired by many patients but so far only achieved by a minority.
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Ugeskrift for laeger · Oct 2007
Historical Article[Specialised palliative medicine...why, where and how?].
Palliative medicine is the medical part of total palliative care and has been a specialty of its own in United Kingdom since 1987. The development of palliative care has been slower in Denmark. The Danish Medical Association for Palliative Medicine was founded in 2001 and in 2003 initiated a theoretical specialist course in palliative medicine with participants from the 5 Nordic countries. Hospices and specialist palliative teams have been established but there is a great need for development of palliative care in hospitals and in the primary care, and a huge need for education and training of professionals, including doctors.