Articles: palliative-care.
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Palliative medicine · Jan 1994
Case ReportsSuccessful use of methadone in nociceptive cancer pain unresponsive to morphine.
Morphine is the mainstay of pain control in cancer patients. We describe three patients in whom adequate analgesia was not obtained with morphine, and discuss the role of morphine metabolites and the use of methadone as an alternative strong opioid analgesic.
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The objective of this study was to repeat part of a survey carried out the previous year and to describe and quantify the hospice and palliative care inpatient units throughout Great Britain and Ireland for the year 1991, this also to include a survey of palliative care day centres and hospital support services. Questionnaires were sent to 346 hospice and palliative care services in Great Britain and Ireland. Replies were analysed by the Hospice Information Service. ⋯ It also describes provision of day centre places and types of services offered. An initial assessment is made of the different types of hospital palliative care support services available. An estimate of the number of patients receiving palliative care in inpatient units and in day care centres is made.
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Five situations have been presented to consider whether there are interventions which are "not done in palliative care". No attempt was made to cover all possible circumstances. The only limits which emerged are (a) an absolute limitation on criminal action and (b) a relative limitation on non-beneficial treatment. Determination of what is non-beneficial is subject to various considerations: firstly, not recommending non-beneficial interventions; secondly, giving special allowance for experimental interventions in properly conducted trials; and, thirdly, accepting the patient's right to gamble on a trial of therapy.
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Support Care Cancer · Jan 1994
Editorial Case ReportsPalliative care in high-tech medicine: defining the point of no return.