Ann Acad Med Singap
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Ann Acad Med Singap · Mar 1994
ReviewDyspnoea in advanced malignancies: a palliative care approach.
The incidence of dyspnoea in advanced malignancies varies from 48-78.6% in different studies. A systematic approach enables the clinician to separate non-malignant causes from those due to complications of malignancy. ⋯ Nebulised anaesthetics are alternatives, while the value of other drugs is uncertain. Oxygen therapy and treatment of anxiety are important components.
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Poorly controlled cancer pain is a significant public health problem throughout the world. There are many barriers that lead to undertreatment of cancer pain. One important barrier is inadequate measurement and assessment of pain. ⋯ It also queries the patient about pain relief, pain quality, and patient perception of the cause of pain. This paper describes the development of the Brief Pain Inventory and the various applications to which the BPI is suited. The BPI is a powerful tool and, having demonstrated both reliability and validity across cultures and languages, is being adopted in many countries for clinical pain assessment, epidemiological studies, and in studies of the effectiveness of pain treatment.
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Ann Acad Med Singap · Mar 1994
ReviewManagement of common opioid side effects during long-term therapy of cancer pain.
For most patients with cancer pain, the primary goal of opioid pharmacotherapy is a satisfactory balance between analgesia and side effects. Consequently, the assessment and treatment of opioid side effects is a fundamental aspect of therapy, which may increase the likelihood of a favourable treatment outcome, potentially allow higher and more efficacious opioid doses, and improve quality of life by reducing other uncomfortable symptoms. This review describes the presentation, assessment and management of adverse neuropsychological and gastrointestinal effects due to opioid drugs. These common side effects pose the major challenge for the clinician who undertakes the long-term opioid therapy of patients with cancer pain.
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Spirituality plays an integral role in the care of the terminally ill. Hospice philosophy promotes patient/family centred care that is palliative, holistic and interdisciplinary. ⋯ Some issues related to the role of spirituality in medicine and hospice care include the difference between spirituality and religion, the patient-physician relationship, provision of spiritual care, and who provides this care. Guidelines for spiritual caregiving include self-knowledge of one's own spiritual needs, authenticity and honesty and respect for the beliefs and practices of the patient and family.
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Ann Acad Med Singap · Mar 1994
Recent progress in cancer pain management and palliative care in Japan.
One out of every four deaths in Japan is due to cancer, so that health-care workers and the lay public have gradually become aware of the importance of cancer pain relief and palliative care in recent years. In 1984, the feasibility and effectiveness of the WHO method for relief of cancer pain was demonstrated in Japanese cancer patients. ⋯ These activities resulted in a 35-fold increase in the annual consumption of morphine preparations for medical purposes between 1979 and 1992. However, the annual consumption per capita is still much smaller than that in other developed countries, indicating the need for further information dissemination and professional education in the implementation of palliative care programmes.