Palliative medicine
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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.
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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
Do beta-blockers alter dyspnea and fatigue in advanced lung cancer? A retrospective analysis.
Dyspnea is common in lung cancer and may be partially attributable to increased ventilatory drive due to muscle weakness. The sympathetic component of this pathway might be mitigated by β-blockers. ⋯ Dyspnea and fatigue are prevalent and increased in the presence of COPD and anemia. No association between β-blocker use and dyspnea or fatigue scores was observed. This may be attributable to inadequate dosing or to retrospective bias.
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Palliative medicine · Sep 2012
Junior doctors' learning and development in foundation year 1 posts in palliative medicine.
The ability to provide good palliative care to patients is increasingly recognised as a core clinical skill that all doctors should possess. Few junior doctors, however, feel competent in breaking bad news, pain relief and the care of dying patients by the time they are fully registered to practice. ⋯ F1 posts in palliative medicine in the UK have positive influences on perceived generic skills development and practice. These findings might encourage the development of more rotations incorporating palliative medicine in the future.
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We present the case of a 30-year-old patient with pontine glioblastoma multiforme, World Health Organisation grade IV (WHO IV). This case is of particular interest in terms of the patient's use of social media as a medium of expression. This popular form of communication raises important clinical, ethical and social issues relating to confidentiality and the nature of the physician-patient relationship in a unique context.