Palliative medicine
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Palliative medicine · Oct 1995
Dying from cancer: results of a national population-based investigation.
To describe the quality of care received in the last year of life by people who die from cancer, focusing particularly on symptom control, communication with health professionals, and care in the community. ⋯ There is still some way to go before all dying cancer patients receive high quality care. Education in the principles of palliative care is needed at all levels of the NHS if high standards are to be reached. In addition, adequate resources are required to meet the social and health care needs of cancer patients at home. There is, as yet, no room for complacency about the care of dying cancer patients.
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A survey of all district health authorities in England was conducted in order to describe current patterns of needs assessment and contract setting for palliative care services. Outcome measures included the completion of needs assessments in the past five years, the type of data used for needs assessment, and recommendations for service development. Copies of contracts for palliative care services were requested and analysed according to duration of contract, and audit requirements. ⋯ Of those that had undertaken needs assessment, about one-quarter were planning more review work, and most of the reports expressed the need for more information on many aspects of palliative care. Copies of contracts with specialist palliative care providers were supplied by 38 health authorities, with the majority being of only one year's duration. Although conducted within an English context, the study findings have wider implications for the process of effective health care purchasing.
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Palliative medicine · Oct 1995
Clinical TrialBlood transfusion and its benefits in palliative care.
The value of blood transfusion as a supportive treatment in haematological disease and oncology is well established and is seen as an essential part of treatment. The place of blood transfusion in the alleviation of symptoms within palliative care units is less well established. There has been no evaluation of its benefits in terms of symptom relief and impact on the quality of life. ⋯ The group of patients entered into the study were anaemic in comparison with our normal patient population, but the degree of improvement seen did not correlate with the degree of anaemia prior to transfusion. We conclude that transfusion does offer symptom relief and improvement in well-being in patients with advanced malignant disease. It should be considered as a worthwhile option in palliative treatment of weakness, dyspnoea and impaired overall sense of well-being, when associated with anaemia.
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Diamorphine and bupivacaine are commonly used together for spinal analgesia, although stability data relating to the mixture of the two drugs have not actually been established. We therefore performed a stability study using high performance liquid chromatography for both drugs and the British Pharmacopoeia 2,6-dimethylaniline limit test for bupivacaine, over a period of eight days and at room temperature. ⋯ We found no significant change in concentration of either drug, and the 2,6-dimethylaniline limit test was well within set limits. We therefore conclude that it is safe to combine these two drugs in this way.