Aust Fam Physician
-
Although morphine is the mainstay of pharmacological therapy in cancer pain, it remains feared and suboptimally used. Different formulations and the advent of 'new' opioids facilitate the attainment of pain control. ⋯ The optimal application of opioids is governed by their clinical pharmacology and hindered by unfounded fears and misunderstanding. Different formulations within different types of opioids augment a favourable balance in the pain relief versus adverse effects equation and used within a four point approach, should serve to deliver optimal pain control.
-
Review Case Reports
Pain management in palliative care. Reviewing the issues.
Cancer pain remains significantly undertreated despite being one of the most prevalent and feared symptoms associated with cancer. Approximately 90% of patients can have their cancer pain controlled through relatively simple measures. ⋯ Each component of the pain experience is addressed using a four point approach to pain and involves pharmacological and nonpharmacological measures. The general practitioner's role is pivotal in optimal cancer pain management. This is the first of two articles by Kiran Virik and Paul Clare on pain management in palliative care. The second, outlining treatment options, will appear in the December issue of Australian Family Physician.
-
Suffering threatens the integrity of the person, never more so in palliative care than when existential distress is left unaddressed. ⋯ Each existential challenge operates across a spectrum of response from successful adaptation to morbid complication. Clinical responses to such predicaments and their complications described herein, are exemplified by the demoralisation syndrome and its treatment. Boundary violations that arise from a 'burnt out' clinician can be avoided. Our goal is to ameliorate suffering and help our patients accomplish a more peaceful journey during their dying.
-
Community acquired pneumonia (CAP) occurs in approximately two per 1000 of the adult population per year. About 2% of adult overnight hospital admissions are due to CAP and there is a continuing mortality rate of 7-10%. ⋯ Clinical and radiological assessments are unable to identify the nature of the causative organism. However, knowledge of the patient risk profile and a clinical severity assessment enable appropriate management decisions to be made. Early antibiotic therapy according to the guidelines and appropriate supportive management should reduce CAP mortality. It is essential that the CAP patient is followed to ensure radiological resolution. The incidence of community acquired pneumonia (CAP) can be reduced by rigid application of National Health and Medical Research Council (NH&MRC) vaccination recommendations for pneumococcal and influenza immunisation.