Ann Acad Med Singap
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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 · May 1993
ReviewCritical care medicine--a review of the outcome prediction in critical care.
Predicting the outcome of critically ill patients has undergone considerable evolution over the last two decades. Economic constraints require the channelling of resources and efforts to patients with reasonable chances of survival. ⋯ The issues surrounding the use of the APACHE score from the literature are discussed. Estimation of specific individual mortality risks have not been as successful as that for large groups of critical care patients in general using the available prognostic scores and until better systems are available, clinical decisions on any individual outcome should not be based on any prognostic score alone.
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Since the birth of Louise Brown in 1978, no other area in clinical practice and medical research has held the public interest to the same extent as the assisted reproductive technologies. This has led to the formation of committees of enquiry, guidelines from professional bodies, the passage of legislation, and the formation of legislative bodies. The ethical issues which arise in the clinical practice of assisted reproduction, the donation of gametes and embryos, and their cryopreservation, surrogacy, and human embryo research are reviewed.
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Sudden cardiac death claims 1,000 lives per day in the United States and cardiovascular disease remains the number one cause of death in the United States. Morbidity and mortality will be reduced when a coordinated response to out-of-hospital cardiac arrest has been achieved nationwide. The implementation of an integrated system, the chain of survival which includes early access via a universal Emergency Medical Service (EMS) number, trained individuals to provide Cardiopulmonary Resuscitation (CPR), widespread early defibrillation and utilisation of automated external defibrillators, and early advanced care will yield survival rates in excess of 30%. The potential for saving 100,000-200,000 lives per year is achievable provided the chain of survival concept is adapted.