Tidsskrift for den Norske lægeforening : tidsskrift for praktisk medicin, ny række
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Nausea/vomiting and constipation are frequent symptoms among patients with advanced disease and short survival expectancy. The aim of this paper is to present the aetiology, diagnostic work-up, prophylaxis and treatment of these symptoms in palliative patients, based on a literature review and clinical experience. Nausea/vomiting is not a diagnosis, but symptoms with multiple causes. ⋯ Stool softening laxatives should be administered, (polyethylene glycol or lactulose), and if needed, combined with a bowel stimulant (bisacodyl or sodium picosulphate). Opioid use is among the most common causes of constipation and prescription of opioids should always be accompanied by prescription of laxatives. Exceptions are diarrhoea, ileostomy and dying patients.
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Delirium has an abrupt onset and represents an emergency. The symptoms of delirium include reduced consciousness, cognitive failure and altered psychomotor activity. In this paper, we present delirium in palliative care based on a literature review and clinical experience. ⋯ The type and amount of treatment depends upon the patient's life expectancy. Causal treatment is a goal unless the delirium is part of the dying process. Symptom control is generally achieved by haloperidol and regulation of stimuli.
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The purpose of this article is to describe the prevalence of chronic pain in traumatized refugees. Further, we sought to identify the possible associations between pain and psychosocial factors, reported traumatic events, and posttraumatic stress disorder. ⋯ Forty-seven (65%) patients reported they had problems with chronic pain; out of these, 34 (72%) reported they experienced severe pain. No significant association was found between type or number of traumatic event and chronic pain. Significant association was found between severe chronic pain, posttraumatic stress disorder, anxiety and depression scores, general assessment of functioning, and medium/low social support. A significant association was found between severe chronic pain and the frequency of consultations with a general practitioner. Inquiry about and treatment for chronic severe pain should be included in the rehabilitation of traumatized refugees.
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Tidsskr. Nor. Laegeforen. · Feb 2006
Review Comparative Study[Monitoring in acute cerebral infarction].
Cerebral ischaemia is potentially reversible during the first few hours. Monitoring of physiological variables such as temperature, blood pressure, heart rhythm, oxygen saturation and cerebral blood flow may be important for efficient treatment and reduction of the infarct volume. ⋯ Two pilot studies indicate that continuous monitoring in intensive stroke units improves outcome compared with conventional stroke units. Future studies must draw the balance between continuous monitoring and mobilization in the early phase of ischaemic stroke.
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All doctors in clinical practice have to face dying patients. In order to give help to the patient and his nearest family, the doctor needs knowledge about the dying process and how to relieve suffering. Based on relevant literature and own clinical experience, we discuss the challenges of identifying the terminal phase, ethical issues concerning medical treatment, and how to offer adequate symptom relief. ⋯ Drugs that may be useful in relieving suffering are described with dosing proposals. Family members have to be helped as well with information and reassurance. A Norwegian Standard for Palliation focusing on the organisation of palliative and terminal care has recently been published.