Search PubMed⌕ Search

Biomedical subjects

I Finlay

Publications and source records attributed to I Finlay.

At least 37 records · Page 2Linked to original sources
PubMed1996

Improving analgesic prescribing in a general teaching hospital.

Patients suffering from cancer and human immunodeficiency virus (HIV) disease at a teaching hospital were found to have poorly controlled pain. Many were prescribed inappropriate analgesia. A palliative care service was established to provide symptom control for patients and education for staff. Educational materials were developed, didactic teaching organized, and one-to-one education by case discussion provided to improve patient management. A repeat survey to evaluate the service showed an increase in the use of appropriate opioids, such as morphine and diamorphine, and a decrease in the use of buprenorphine and papaveretum, which are less suitable for use in chronic cancer pain. The acceptability of the guidelines and rapid availability of a palliative care opinion has improved analgesic prescribing.

Adolescent↗
PubMed1996

Facilitating the care of terminally Ill children.

Life-threatening illness is fortunately rare in children. Some children, however, will need palliative care for symptom control; psychological support may be needed by the child and the child's family; and families may require help with decisions about life-prolonging treatment. Providing consistent high-quality care for a relatively uncommon problem is difficult. Adult palliative care services, liaison with pediatricians can help provide this care.

Adolescent↗
PubMed1996

Job stress and satisfaction among palliative physicians.

A national questionnaire-based survey has found that palliative physicians report lower levels of burnout and similar levels of psychiatric morbidity than those reported by consultants in other specialties. To try to explain these findings, this study compared the sources of job stress and satisfaction reported by consultant palliative physicians with those reported by consultants working in four other specialties: surgery, gastroenterology, radiology and oncology. Stressful and satisfying aspects of work were assessed using questionnaires designed specifically for the study. The response rate for the palliative physicians was 126/154 (82%) and for the consultants in the other specialties 882/1133 (78%). Palliative physicians reported that feeling overloaded and its effect on home life made the greatest contribution to their job stress, and having good relationships with patients, relatives and staff made the greatest contribution to their job satisfaction. However, compared with the other specialist groups, palliative physicians reported less stress from overload (p < 0.001) and more satisfaction from having good relationships (p < 0.001). They also reported less stress and more satisfaction with the way they are managed and resourced (both p < 0.001). Hospital-based palliative physicians reported more stress and less satisfaction from their management and resources than their colleagues working in hospices (both p = 0.05). Thirty-five percent of palliative physicians felt insufficiently trained in communication skills and 81% felt insufficiently trained in management skills. Burnout was more prevalent among consultants who felt insufficiently trained in communication and management skills than among those who felt sufficiently trained. It is important therefore that effective training in communication and management skills are provided and that, at the very least, existing levels of resourcing and management practices within palliative medicine are maintained in order that physicians working in the specialty are able to provide care to dying patients without prejudicing their own mental health.

Adult↗
PubMed1996

The provision of a palliative care service in a teaching hospital and subsequent evaluation of that service.

A survey at a large tertiary referral hospital showed that patients with cancer and HIV disease had poorly controlled symptoms. A palliative care service was introduced, employing a doctor and part-time pharmacist. The doctor was available to see and advise about terminally ill patients. With the pharmacists, an educational programme of meetings, teaching sessions and information leaflets was developed. One year after the introduction of the service a repeat survey all patients with cancer or HIV disease was carried out. Problems on admission were similar in both surveys, but fewer patients' symptom scores deteriorated during their hospital stay. There was a significantly increased use of appropriate opioid analgesics and NSAIDs. Staff were satisfied with the service.

Attitude of Health Personnel↗
PubMed1995

Efficacy and pharmacokinetics of a new controlled-release morphine sulfate 200-mg tablet.

Nineteen of 25 patients (14 female) with advanced malignant disease completed a randomized controlled trial of a new high-dose (200 mg) tablet formulation of controlled-release morphine. Compared with the currently available 100-mg tablets there were no differences in pain severity or adverse effects with the new formulation. In four patients, full 12-hr plasma morphine concentration profiles at steady state were obtained and showed no significant differences between the same dose provided as 100-mg and 200-mg tablets in Cmax, tmax, or other pharmacokinetic indices.

Adolescent↗
PubMed1995

Rehydration in palliative and terminal care: if not--why not?

Patients who are in the last few days of life are often too frail to take oral fluids and nutrition. This may be due entirely to the natural history of their disease, although the use of sedative drugs for symptom relief may contribute to a reduced level of consciousness and thus a reduced oral intake. Rehydration with intravenous (i.v.) fluids is the usual response in acute care settings, whereas the hospice movement has often argued against this approach. The issues are complex and involve not only physical, psychological and social concerns, but also ethical dilemmas. A review of the literature gives conflicting reports of the physical discomfort that may be attributed to dehydration in dying patients. There are many confounding variables, including the concomitant use of antisecretory drugs, mouth breathing and oral infection. It remains unproven whether i.v. fluids offer symptomatic relief in this situation. Hospice doctors are concerned that the use of i.v. fluids gives confusing messages to relatives about the role of medical intervention at this stage in a patient's illness. A drip may cause a physical barrier between a patient and their loved one at this important time. The use of other methods of fluid replacement are discussed. In the absence of definitive research in this area, the balance of the burdens and benefits of such treatment remains subjective. The prime goal of any treatment in terminal care should be the comfort of the patient. Decisions should be made on an individual basis, involving both patients and their carers wherever possible. Prolonging life in such circumstances is of secondary concern and i.v. fluids given in this context may be futile. The ethical dilemmas of withholding and withdrawing medical treatment in addition to those of conducting research in this area are discussed.

Dehydration↗
PubMed1995

Pressure sore prevention in a hospice.

This study investigated the influence on the number of pressure sores developing in patients nursed in a hospice when three levels of pressure support were used in association with a risk assessment tool. The study was designed as phase one of an epidemiological study examining the use of a modified Norton scoring system. This was followed by a second phase of the study, when patients were allocated to pressure sore support systems according to their risk assessment score. A total of 327 patients entered, 223 in phase one and 104 in phase two. A significant reduction in the development of pressure sores was observed in the second phase of the study.

Aged↗
PubMed1992

Oral carriage of yeasts, coliforms and staphylococci in patients with advanced malignant disease.

Many patients with advanced cancer have oral problems, some of which may have a microbiologic basis. The oral flora in such patients has not, however, been characterized. This study has assessed the prevalence of yeasts, coliforms and coagulase positive staphylococci in the oral flora of 197 patients with advanced cancer. Both imprint cultures (n = 197) and oral rinses (n = 161) were collected. Yeasts were isolated from the mouths of 83% of the patients, coliforms from 49.1% and coagulase-positive staphylococci from 28%. All these percentages are considerably in excess of reported levels for healthy individuals. The results indicate a loss of colonization resistance of the oral mucosa in terminal cancer, with potential implications for the development of mouth care regimes for such patients.

Adult↗
PubMed1992

Planning palliative care services.

An audit was conducted to assess the use of, and satisfaction with, local services for the care of the dying, which have developed over the past seven years in South Glamorgan. These services include hospice inpatient, outpatient and day care facilities, home care specialist nursing, volunteer services and domiciliary medical consultations. All general practitioners in the district were surveyed about the services by postal questionnaire; respondents represented most of the practices in the district. The results show a variable level of uptake of services for those well established (excluding paediatric oncology), including a high level of satisfaction with the available services. The results identify a lack of provision for patients dying from a non-malignant disease.

Attitude of Health Personnel↗
PubMed1992

[Your child is dead].

To determine parents' views on how the death of their child should have been handled, a retrospective questionnaire survey was carried out among parents who had experienced the death of a child: 120 bereaved parents, all members of a charitable organisation of bereaved parents participated voluntarily in the study; 122 children's deaths were described; the largest single group was due to road traffic accidents, 16 were suicides, and eight were murders. Twice as many interviews were rated as sympathetically or reasonably handled than badly or offensively handled (68 vs 34). The interview ratings depended on the sensitivity and personal skills of the interviewers rather than on their previous contact or professional position; police were rated as more sympathetic than doctors and nurses. Of 109 respondents, 81 had seen their child's body, 44 of whom thought that sufficient time had been denied. Of the 28 parents who did not see the body, 17 subsequently stated their regret. In 82 parents, organ donation had not been discussed. Only 16 parents recorded any follow-up support from hospital staff and very few support at the time. The consistency of the responses suggests a serious need to revise the in-service training and education of the police and health professionals in their approach to informing of death; organ donation should be discussed sensitively and parents allowed time with their dead child with fewer restrictions.

Attitude of Health Personnel↗
PubMed1991

Your child is dead.

OBJECTIVE: To determine parent's views on how death of their children should have been handled. DESIGN: Retrospective questionnaire survey of parents who had experienced death of their child. SETTING: Charitable organisation of bereaved parents. SUBJECTS: 150 bereaved parents, all members of the organisation, of whom 120 (80%) participated voluntarily in the study. MAIN OUTCOME MEASURES: Child's age; date and cause of death; details of person breaking the news and handling of the interview; time parents spent with dead child, their attitude to requests for organ donation, and follow up support received. RESULTS: 122 children's deaths were described; the largest single group was due to road traffic accidents, 16 were suicides, and eight were murders. Twice as many interviews were rated as sympathetically or reasonably handled as badly or offensively handled (68 v 34). The interview ratings depended on the sensitivity and personal skills of the interviewers rather than on their previous contact or professional position; police were rated as more sympathetic than doctors and nurses. Of 109 respondents, 81 had seen their child's body, 44 of whom thought that sufficient time had been denied. Of the 28 parents who did not see the body, 17 subsequently stated their regret. In 82 parents organ donation had not been discussed. Only 16 parents recorded any follow up support from hospital staff and very few support at the time. CONCLUSIONS: The consistency of the responses suggests a serious need to revise the in service training and education of the police and health professionals in their approach to informing of death; organ donation should be discussed sensitively and parents allowed time with their dead child with fewer restrictions.

Attitude to Death↗