Palliative medicine
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Palliative medicine · Jan 1993
Case Reports Clinical TrialSubcutaneous ketorolac--a new development in pain control.
Pain due to advanced malignant disease does not always respond to opioids, or the possible use of opioids may be limited by the occurrence of adverse effects. This paper describes the successful use of ketorolac, a new nonsteroidal anti-inflammatory drug, given by continuous subcutaneous infusion. Seven patients with pain due to advanced malignant disease taking opioid analgesia were considered to have inadequate symptom control because of opioid unresponsiveness (n = 1), opioid-related adverse effects (n = 2) or both (n = 4). All patients became symptom-free with the introduction of ketorolac by subcutaneous infusion and the total daily opioid requirement was substantially reduced in three and reduced to zero in four patients.
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Palliative medicine · Jan 1993
Case ReportsDecision-making in the respiratory care of amyotrophic lateral sclerosis: should home mechanical ventilation be used?
As respiratory function starts to deteriorate in those with amyotrophic lateral sclerosis, one of the principal questions that has to be answered is whether it it is appropriate to provide ventilatory support. Although expensive, it is perfectly feasible to provide this at home, and this article examines many of the issues surrounding home mechanical ventilation.
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Palliative medicine · Jan 1993
Multidisciplinary management from day one: the Neuro-care approach to motor neurone disease.
The Neuro-care approach offers a holistic, multidisciplinary, patient-centred, continuous strategy of care to unselected groups of neurological patients and their families including those with motor neurone disease (MND). The strategy for MND patients is an adapted version of one piloted on patients with Parkinson's disease. Between April 1990 and September 1992 12 MND patients were diagnosed, of whom five have died. ⋯ The maintenance of patients in the community and the lack of resort to permanent institutional care are also recorded. Ethical issues arising during the project are discussed and the problems of measuring outcomes of care are acknowledged. General conclusions for MND management are drawn.
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Palliative medicine · Jan 1993
Should hospices offer respite admissions to patients with motor neurone disease?
The provision of inpatient respite care for patients with motor neurone disease (MND) in hospices is variable. Some institutions are concerned about accepting patients who may need long-term care. Some see 'respite' care as simply a short residential stay with little nursing or medical input being necessary. ⋯ Most patients were discharged home after respite admissions and the median stay in the hospice (15 days) was identical to that of cancer patients. We conclude that respite admissions to the hospice were valuable both for MND patients and their carers. Units not currently involved in this work may wish to reconsider their position.
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Palliative medicine · Jan 1993
Ethics and the clinician: the daily experience with motor neurone disease.
Ethical issues in health care are typically perceived as arising from extreme situations which do not usually confront the average clinician. However, knowingly or otherwise, clinicians working with motor neurone disease deal daily with ethical issues in the form of value judgements, the application of choice limiting principles and the language of clinician-patient interaction.