Best practice & research. Clinical obstetrics & gynaecology
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Gynaecological malignancies affect the respiratory system both directly and indirectly. Malignant pleural effusion is a poor prognostic factor: management options include repeated thoracentesis, chemical pleurodesis, symptomatic relief of dyspnoea with oxygen and morphine, and external drainage. Parenchymal metastases are typically multifocal and respond to chemotherapy, with a limited role for pulmonary metastatectomy. ⋯ Identification and treatment of gastroesophageal reflux, sinusitis, and asthma can improve many patients' coughs. Chest wall pain responds to local radiotherapy, nerve blocks or systemic analgesia. Case examples illustrate ways to address quality of life issues.
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Best Pract Res Clin Obstet Gynaecol · Apr 2001
ReviewAcute and chronic pain management in palliative care.
Every palliative care patient should have the expectation that acute and chronic pain management will be an integral part of their overall care. However, in all too many instances, the pain of cancer is often grossly under-treated. This issue is of concern because more than 80% of patients with cancer pain can find adequate relief through the use of simple pharmacological methods. ⋯ Physicians with the basic skills of assessment and treatment will be able to control the symptoms in the majority of cancer pain patients. However, there are still some patients who may require other modalities to control their moderate to severe pain. A thorough understanding of all pain management options will help the gynaecological oncologist to maintain an acceptable quality of life for their patients throughout the therapeutic and palliative phases of care.
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Best Pract Res Clin Obstet Gynaecol · Apr 2001
Review Case ReportsGuidelines for an acceptable euthanasia procedure.
The Netherlands is one of the very few countries that has guidelines for the practice of euthanasia. Each year there are about 9700 explicit requests for euthanasia or physician-assisted suicide (EAS), of which approximately 3600 patients are agreed upon in The Netherlands. Other countries have criticized the Dutch policy concerning EAS. ⋯ Additionally, part of the criticism is based on the regulation of the euthanasia procedure in The Netherlands. This chapter describes the guidelines for the procedure for euthanasia in The Netherlands, and focuses on some of the practical problems and issues of euthanasia. Also, the current situation concerning euthanasia and physician-assisted suicide in The Netherlands is summarized and described.