The American journal of hospice & palliative care
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Am J Hosp Palliat Care · Mar 2000
Case ReportsKetamine-fentanyl-midazolam infusion for the control of symptoms in terminal life care.
In this report, we describe nine terminally ill patients with metastatic cancer who were treated with an intravenous infusion consisting of ketamine (2 mg/ml)/fentanyl (5 micrograms/ml)/midazolam (0.1 mg/ml) (K/F/M) to control pain after traditional analgesic therapies were unsuccessful. In addition to pain, all patients exhibited some symptoms of cognitive compromise and agitation. After initiation of the K/F/M infusion, all patients exhibited some degree of qualitative improvement in these symptoms as well as in overall pain control. We feel that these observations warrant reporting of the efficacy of this infusion for the treatment of uncontrolled pain and agitation in terminally ill patients when the traditional methods of pain control are inadequate.
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Death and dying in America has received limited attention in medical education. The Southern Arizona VA Health Care System and the University of Arizona have collaborated with three nonprofit community hospice programs to develop an end-of-life care curriculum. This formal and comprehensive program is offered as a one-month elective to senior medical students, residents and fellows. The goal of the program is to improve clinical skills in caring for the dying patient and foster research in palliative and supportive care.
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Am J Hosp Palliat Care · Mar 2000
Elderly hospice cancer patients' descriptions of their pain experiences.
A qualitative research design was used to identify and describe the pain experience of elderly hospice patients with cancer. Eleven participants over the age of 65 receiving hospice services from a for-profit hospice in east Texas were interviewed in their homes. ⋯ Pain was described as a hierarchy of chronic, acute, and psychological pain, with psychological being the worst. Pharmacological and nonpharmacological strategies were used to decrease their "physical" pain, but participants perceived that there was little they could do about their "psychological" pain.