Palliative medicine
-
Palliative medicine · Jul 1996
Comparative StudyJob stress and satisfaction among palliative physicians.
A national questionnaire-based survey has found that palliative physicians report lower levels of burnout and similar levels of psychiatric morbidity than those reported by consultants in other specialties. To try to explain these findings, this study compared the sources of job stress and satisfaction reported by consultant palliative physicians with those reported by consultants working in four other specialties: surgery, gastroenterology, radiology and oncology. Stressful and satisfying aspects of work were assessed using questionnaires designed specifically for the study. ⋯ Thirty-five percent of palliative physicians felt insufficiently trained in communication skills and 81% felt insufficiently trained in management skills. Burnout was more prevalent among consultants who felt insufficiently trained in communication and management skills than among those who felt sufficiently trained. It is important therefore that effective training in communication and management skills are provided and that, at the very least, existing levels of resourcing and management practices within palliative medicine are maintained in order that physicians working in the specialty are able to provide care to dying patients without prejudicing their own mental health.
-
Ketamine has been shown to have potent analgesic properties at low dosages. Bioavailability is high when it is given parenterally, but low after oral or rectal administration. ⋯ A synergistic effect between ketamine and opioids has been observed in cancer pain patients who have lost an analgesic response to high doses of morphine. Further studies need to be carried out to confirm the benefits of ketamine in cancer pain, and to determine the best route of administration, dosages and the incidence of side effects.
-
The question of whether a coherent tradition in research and research methods (or paradigm) exists in palliative care is explored in this paper through an examination of the discussion and debate surrounding palliative care; attempts at achieving consensus for research through priority setting exercises; and a critical review of published research in palliative care accessed through a systematic review of studies. The findings of this systematic review of 384 published studies are reported. ⋯ More creativity in palliative care research is needed, and the future of palliative care research needs to be determined strategically. A model on which such a strategy might be based is presented.
-
Ketamine has been used parenterally for pain unresponsive to opioids, including neuropathic pain, and has also been used as an alternative analgesic agent after surgery. Although oral administration of ketamine has been used for some time as a single dose, it has not been given by this route on a regular basis. The use of ketamine administered orally is described for two patients with severe neuropathic pain who were intolerant of, or whose pain was unrelieved by, more commonly used agents. Pain relief was achieved without significant side effects.