British medical journal (Clinical research ed.)
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The role of a five-day ward was examined as part of an audit of the work of a general surgical unit. The four levels of care for elective operations were main ward, five-day ward, major day care, and minor day care. In a prospective study 2000 consecutive patients were followed through their hospital courses from the first referral to the surgical clinic to the postoperative follow-up visit. ⋯ Four per cent of the five-day ward patients required transfer to the main ward and 3.3% required readmission. Patients managed in the five-day ward were on average younger and the conditions less urgent than those in the main ward. We conclude that a five-day ward can fulfil a large and important part of a general surgical service provided that its function is closely integrated with other parts of the service and that patients are accurately assessed in the outpatient clinic.
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Br Med J (Clin Res Ed) · Mar 1981
Patient-controlled dose regimen of methadone for chronic cancer pain.
Fourteen patients with severe cancer pain participated in a trial of methadone given in a fixed dose (10 mg) but at intervals selected by the patients themselves during the loading phase. The aim was to achieve rapid pain relief while avoiding the risk of toxicity from accumulation of methadone. As expected, the dosage intervals increased gradually over the first few days of treatment, the daily dose decreasing from 30-80 mg on the first day to 10-40 mg at the end of the week. ⋯ Eleven patients reported complete or almost complete pain relief and elected to continue with methadone after the study. In no case was treatment withdrawn because of intoxication. From these findings a patient-controlled dosage regimen of oral methadone may be an effective and safe alternative to parenteral narcotic medication, adjusting both for individual variation in pain intensity and for pharmacokinetics.
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Br Med J (Clin Res Ed) · Mar 1981
Patient reactions to long-term outpatient treatment with continuous subcutaneous insulin infusion.
Fourteen of the first 15 insulin-dependent diabetics to be treated in our unit by three weeks or more of outpatient continuous subcutaneous insulin infusion with a portable syringe pump completed a questionnaire about their reactions to the system. Motivation was more important to a favourable response than occupation or intelligence. Most patients thought that diabetic control was better with the pump than conventional injection treatment and several felt subjectively better. ⋯ Psychological reactions to the infusion and difficulties with interpersonal relationships were identified; these must be clearly appreciated and discussed with patients and family before and during treatment. Nine of the 14 patients said they would undertake continuous subcutaneous infusion for one year and a further two said they would do so if the infuser was smaller. These results provide guidance on future technological development of continuous subcutaneous insulin infusion and indicate that the major constraint to long-term trials of the present system is the size of the pump.