Constipation: patient perceptions compared to diagnostic tools.
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Cathartics↗
Biomedical subjects
Iain Lawrie
Publications and source records attributed to Iain Lawrie.
How do palliative medicine physicians assess and manage depression.
Depression is a significant symptom for approximately 25% of palliative care patients, but is frequently unrecognized and untreated. This study was carried out to determine how senior doctors working in palliative medicine in the UK assessed and managed depression in their patients. A questionnaire was sent to all palliative care units with a designated consultant or medical director. Questions were asked about assessment and management of depression (pharmacological and nonpharmacological); difficulties encountered, qualifications and current post. The response rate was 63%; two-thirds (90) of respondents were consultants and a further 21 medical directors. The majority (73%) routinely assessed for depression with 27% using the Hospital Anxiety and Depression (HAD) Scale and 10% asking the patient 'are you depressed'? The most frequently prescribed medication was SSRI (80%). Less than 6% prescribed psychostimulants. Respondents reported difficulties with the assessment and management of depression which mainly focused on distinguishing symptoms of depression from sadness and whether it was appropriate to treat patients when life expectancy was short. Difficulties were identified in accessing psychiatric input by 47%. Depression is identified as being a difficult symptom to manage by many senior palliative care physicians in the UK and suggestions are made as to how some of theses issues can be addressed.
Consultants↗
Breakthrough strong opioid analgesia prescription in patients using transdermal fentanyl admitted to a hospice.
Durogesic (fentanyl) patches have revolutionized pain relief, but patients still require breakthrough medication. A retrospective analysis of in-patient admission notes at a 25-bed hospice over a six-month period was carried out. Details of analgesia being used on admission for both background and breakthrough pain were obtained, and the appropriateness of the breakthrough dose for those patients using transdermal fentanyl was determined. During the study period 278 patients were admitted to the hospice and 56 (20 percent) were using transdermal fentanyl. Of these, 35 (62 percent) were prescribed strong opioid analgesia--the dose of breakthrough medication prescribed was appropriate in 11 patients (31 percent). Rescue dosing was less than recommended, in relation to prescribed transdermal fentanyl strength in 21 patients (60 percent) and greater than recommended in one patient (3 percent). In this study, short-acting strong opioid analgesia was not always prescribed for patients using transdermal fentanyl, and when they were prescribed, this was in the appropriate dose range in less than a third of patients.
Administration, Cutaneous↗