Search PubMed⌕ Search

Biomedical subjects

E Bruera

Publications and source records attributed to E Bruera.

At least 199 records · Page 11Linked to original sources
PubMed1994

New developments in the assessment of pain in cancer patients.

Pain occurs in more than 80% of cancer patients before death. During recent years major progress has taken place in our techniques for the adequate assessment of cancer pain. Major prognostic factors associated with the pain syndrome have been recognized. In addition, other prognostic factors associated with the characteristics of the patient have been defined. Valid tools have been developed that allow for the assessment of most of the prognostic variables associated with analgesic response. During recent years a major effort has been made to integrate the pain syndrome within the other complex symptoms that are often present in patients with advanced cancer. The interaction of pain and analgesic treatment with other symptoms and their management is discussed. Finally, areas where future research should focus in the area of the diagnosis and assessment of pain are discussed.

Adult↗
PubMed1994

The assessment of constipation in terminal cancer patients admitted to a palliative care unit: a retrospective review.

Constipation is a frequent and distressing complication in patients with advanced cancer. However, very few studies have reviewed the assessment and management of these patients. The purpose of this study was to review the documentation and assessment and diagnosis of constipation in patients admitted to a Palliative Care Unit, and the correlation between those findings and radiological evidence of stool in the colon. The records of 122 consecutive patients admitted to the Palliative Care Unit, Edmonton General Hospital were reviewed in order to assess the physician's and the nurse's record of symptoms, physical findings, and diagnosis and treatment of constipation. All patients also underwent a flat abdominal radiograph that scored for the presence of stool in the colon (0 = no stool; and 12 = stool occupying all the lumen of the four quadrants of the colon). The radiograph was scored blindly by two different physicians. Of 103 evaluable patients, a rectal exam was reported only in 42. Correlation between the assessment by the two physicians' radiograph score was high (0.78, P nd nurses' diagnosis of constipation, the presence of laxative treatment, the number of days since the last bowel movement, and the source of the admission (hospital vs home) were not associated with higher radiological scores for constipation. Assessment is insufficient in this population at high risk for severe constipation. Radiological examination may be necessary for adequate diagnosis in some patients. More research is needed in this area.

Aged↗
PubMed1994

Symptom control in terminally ill patients with malignant bowel obstruction (MBO).

The inadequacy of prolonged conservative management with nasogastric suction and intravenous fluids for terminally ill patients with bowel obstruction has long been recognized. Using previous reports and our experience on the Palliative Care Unit at the Edmonton General Hospital, we have developed a basic approach to bowel obstruction management. In a review of 100 consecutive patients who died on our Palliative Care Unit, 15 required medical management for bowel obstruction. Evaluation of these cases suggests that intensive medical management can provide good symptom control without using intravenous lines and with minimal use of nasogastric tubes.

Aged↗
PubMed1994

A prospective comparison study between a butterfly needle and a Teflon cannula for subcutaneous narcotic administration.

To evaluate the hypothesis that subcutaneous sites initiated with the Teflon cannula would have longer durations and be more comfortable for the patient than the butterfly needle, we performed a prospective randomized crossover trial to compare the 25-gauge butterfly needle to a Teflon cannula with a 26-gauge introducer needle and a 24-gauge cannula. The analysis of 20 patients showed that duration of the subcutaneous site was significantly longer with the Teflon cannula. Both patients and nurses preferred the Teflon cannula because it did not need to be changed as frequently. There was no difference reported in the level of comfort.

Aged↗
PubMed1994

Psychostimulants as adjuvant analgesics.

Psychostimulants have multiple roles in the adjuvant treatment of pain. This article reviews the pharmacology of different agents in this class. Studies will be discussed that demonstrate the efficacy of these drugs in potentiating opioid analgesia, counteracting opioid-induced sedation and cognitive impairment, allowing dose escalation in difficult pain syndromes, and alleviating symptoms of depression. Practical guidelines will be suggested, and areas for future research indicated.

Analgesics↗
PubMed1994

The use of hypodermoclysis for rehydration in terminally ill cancer patients.

The need to treat dehydration in terminally ill patients to minimize symptom distress remains a controversial issue. Hypodermoclysis (HDC) is a simple technique for rehydration that offers many advantages over the intravenous route. In this prospective open study of 100 consecutive patients who died on a palliative care unit, we recorded our indications for, and use of, HDC. Of the 100 patients, 69 received HDC for an average of 14 +/- 18 days during an average admission of 35 +/- 41 days. The 31 patients who did not receive HDC had an average admission of 22 +/- 24 days, and appeared to have different characteristics than the HDC group. HDC was well tolerated in most patients at an average volume of 1203 +/- 505 mL/day. These results confirm that HDC for dehydration is a safe and effective technique and suggest the need for further research to clarify the role of rehydration in assisting symptom control.

Aged↗
PubMed1994

Proximal muscle weakness in a patient with hepatocellular carcinoma.

Asthenia and generalized weakness are common in cancer patients. There are multiple causes for these symptoms. We describe a case of rapid onset of proximal muscle weakness in a patient with hepatocellular carcinoma. The differential diagnosis of muscle weakness in the palliative care patient is reviewed. The discussion centers on steroid myopathy and its treatment.

Asthenia↗
PubMed1994

Corticosteroids as adjuvant analgesics.

Corticosteroids have multiple effects as adjuvant drugs in pain management. Their pharmacologic characteristics will be described. Studies documenting the efficacy of corticosteroids for different pain syndromes and other cancer-related symptoms will be reviewed. Practical guidelines will be given and directions for future research suggested.

Adrenal Cortex Hormones↗
PubMed1994

Ethical issues in palliative care research.

During the last 10 years interest in palliative care research has grown. This interest has brought about an awareness of the unique ethical issues related to research in this special population. Issues related to the vulnerability of patients and families, consent protocols, unstable mental status, and the invasiveness of assessments have been discussed. Unfortunately, devastating physical and psychosocial distress continue to afflict the majority of cancer patients before death. Although our current knowledge of palliative care allows us to help a significant number of patients and families, there are a number of symptoms that are currently intractable. Further, a 50% increase in the number of cancer deaths in Canada is expected between 1990 and the year 2000 (11). Therefore, one of the major ethical issues we must confront during the coming decade is whether we can afford not to make a major commitment to research in palliative care. We are aware that maintaining the status quo of patient care is unacceptable. However, until now, administrators, governments, and clinicians have planned palliative care programs to have only service and some teaching components. And traditional research-sponsoring agencies have not allocated priority to palliative care in their funding strategies. The palliative care community must take the initiative in this debate.

Ethics, Medical↗