Articles: palliative-care.
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Palliative medicine · Mar 1998
The use of the Edmonton Symptom Assessment Scale (ESAS) within a palliative care unit in the UK.
The Edmonton Symptom Assessment scale (ESAS) was used on 1004 occasions to assess 71 patients with advanced malignant disease admitted to a palliative care unit in the UK over a six-week period. The median length of inpatient stay was eight days (range 1-36) and the median survival from start of ESAS to death was 16 days (range 2-202). ⋯ When scores were analysed retrospectively over five days according to outcome (death--group 1, or discharge--group 2) there was a significant improvement in pain scores in group 2 but no change in overall score, and a significant deterioration in activity, drowsiness and appetite in group 1 with no change in overall score. ESAS did not seem an appropriate tool in this group of patients as the total symptom scores were so often biased by the inevitable increase in individual symptom scores immediately prior to death.
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In the palliative care of patients with motor neurone disease (MND) symptoms are encountered that can be helped by the use of strong opioid medication. A retrospective survey of the 32 patients dying of MND at the Wisdom Hospice who required opioids showed that 75% received oral opioids, 94% received parenteral opioids and 72% received both oral and parenteral opioids. The median oral morphine dose was 60 mg/24 h, with a median duration of 51 days and the median parenteral dose was 180 mg/24 h with a median duration of use of three days. The results show that strong opioids can be used safely and effectively in the palliative care of patients with MND.
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Case Reports Clinical Trial
Clinical evaluation of paresthesia steering with a new system for spinal cord stimulation.
The goal was to evaluate, in a clinical study, the predicted performance of the transverse tripolar system for spinal cord stimulation, particularly the steering of paresthesia, paresthesia coverage, and the therapeutic range of stimulation. ⋯ The clinical performance of transverse tripolar stimulation is in accordance with the characteristics predicted by computer modeling. It enables finer control of paresthesia than that achieved by polarity changes in conventional spinal cord stimulation systems.
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J Pain Symptom Manage · Mar 1998
Integration of palliative medicine at the Medical College of Wisconsin 1990-1996.
Palliative medicine is an emerging world-wide discipline. This article describes efforts at the Medical College of Wisconsin (MCW) to develop programs to enhance palliative medicine education and clinical care. ⋯ Palliative medicine activities have included both the academic medical center and community health agencies. MCW has integrated palliative medicine into its academic environment so that trainees at all education levels now have opportunities for didactic and clinical end-of-life care education.
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E-type prostaglandins (PGE1) can effectively maintain the patency of the ductus arteriosus in neonates. Its use, therefore can be life saving in infants born with ductus dependent congenital heart disease. Although PGE1 is available for over two decades in western world, it has been introduced in India only since April, 1995. ⋯ Unfortunately the high cost of the drug prohibits its wide spread and long term use. PGE1 is a life saving drug for infants born with ductus dependent congenital cardiac malformations. It helps in stabilizing these patients prior to further surgical palliation or correction.