Palliative medicine
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Palliative medicine · Sep 2012
ReviewEvidence for orthopaedic surgery in the treatment of metastatic bone disease of the extremities: a review article.
The decision to offer orthopaedic surgery to patients with metastatic bone disease is often difficult and requires an understanding of the underlying disease, the patient's needs or wishes, the expected outcomes and the principles of surgery. ⋯ Timely and appropriate surgical intervention reliably alleviates pain and improves quality of life and can be undertaken with few complications in most patients. Although most procedures can be undertaken by non-specialists, consultation with other members of the multidisciplinary team is mandatory, and in complex cases, referral to a specialist orthopaedic oncology centre can be helpful.
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Palliative medicine · Sep 2012
Drug interactions in palliative care--it's more than cytochrome P450.
This study aims to identify the combination of substances with high potential for drug interactions in a palliative care setting and to provide concise recommendations for physicians. ⋯ Data on the potential for drug-drug interactions in palliative case is extremely scarce, but drug interactions can be limited if a few facts are considered. A synopsis of the findings of these studies is presented as concise recommendation to minimize drug interactions.
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Palliative medicine · Sep 2012
Motor Neurone Disease family carers' experiences of caring, palliative care and bereavement: an exploratory qualitative study.
Motor Neurone Disease (MND) is a neurodegenerative disease with a sudden onset, a rapid progression, a profile of complex disabilities and fatal consequences. Caring for a person with MND is an unremitting commitment, yet little research has examined the experiences and needs of carers for palliative care and bereavement care. ⋯ The study provided a basis for more research into the role palliative care services has in supporting MND carers before and after the death of their spouse and in particular the provision of more tailored respite and bereavement support.
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Palliative medicine · Sep 2012
Symptom clusters in patients with advanced cancer: sub-analysis of patients reporting exclusively non-zero ESAS scores.
Advanced cancer patients often experience multiple concurrent symptoms, which can have prognostic effects on patients' quality of life. Including patients who did not experience all of the symptoms measured by an assessment tool may interfere with accurate symptom cluster identification. Varying statistical methods may also contribute to inconsistencies of cluster results. ⋯ The composition of symptom clusters varied depending on if patients with non-zero scores were excluded at baseline and on the statistical method employed. Identifying valid clusters may prove useful for bettering symptom diagnosis and management for cancer patients.
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Palliative medicine · Sep 2012
Opioid switching to methadone: a pharmacoepidemiological study from a national prescription database.
Opioid switching to methadone is reported frequently to improve pain control in patients with an unacceptable balance between pain control and side effects during treatment with first line opioids, but carries a risk of drug accumulation and respiratory depression. To justify this risk it is required that less risky treatments are tried beforehand and that a sufficiently large proportion of patients experience a long-lasting improvement in pain control. ⋯ Opioid switching to methadone appears to provide a long lasting improvement in pain control in a significant proportion of patients. However, the study raises concerns that treatment options with less risk are not being exhausted prior to switching to methadone.