Palliative medicine
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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.
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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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Palliative medicine · Jul 1995
Comparative StudyThe McGill Quality of Life Questionnaire: a measure of quality of life appropriate for people with advanced disease. A preliminary study of validity and acceptability.
This is the first report on the McGill Quality of Life Questionnaire (MQOL), a questionnaire relevant to all phases of the disease trajectory for people with a life-threatening illness. This questionnaire differs from most others in three ways: the existential domain is measured; the physical domain is important but not predominant; positive contributions to quality of life are measured. ⋯ Construct validity of the subscales is demonstrated through the pattern of correlations with the items from the Spitzer Quality of Life Index. The importance of measuring the existential domain is highlighted by the finding that, of all the MQOL subscales and Spitzer items, only the meaningful existence subscale correlated significantly with a single item scale rating overall quality of life.
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Palliative medicine · Jul 1995
A regional survey of opioid use by patients receiving specialist palliative care.
A study was conducted to determine the patterns of opioid use in patients under the care of specialist palliative care (SPC) teams in Trent Region, both in the community and in inpatient settings. The design was a survey of point prevalence by case note and drug chart review. The case notes and prescription records of 1007 patients were reviewed, and data collected on age, sex, diagnosis, date of referral, care settings, opioid form and dose on referral, and most recent opioid form and dose. ⋯ The highest prevalence of potent opioid prescribing was in hospice IPUs, largely owing to the use of parenteral diamorphine. Conversely, IPUs had the lowest prevalence of weak opioids. Staff caring for patients with cancer must consider the need for downward as well as upward titration of opioid dosages.