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Biomedical subjects

N Coyle

Publications and source records attributed to N Coyle.

At least 37 records · Page 2Linked to original sources
PubMed1995

Supportive care program, pain service, Memorial Sloan-Kettering Cancer Center.

Advanced cancer patients being cared for at home, with severe pain and multiple symptoms, strain the resources of individual community practitioners and family members. Supportive care programs, such as that developed by the Pain Service at Memorial Sloan-Kettering Cancer Center (New York), with good communication and liaison work between hospital and community, add a much needed dimension to pain and symptom control for these patients and their families, as well as ongoing support to community physicians and nurses.

Cancer Care Facilities↗
PubMed1994

Symptom prevalence, characteristics and distress in a cancer population.

Despite the importance of symptom control in the cancer population, few studies have systematically assessed the prevalence and characteristics of symptoms or the interactions between various symptom characteristics and other factors related to quality of life (QOL). As part of a validation study of a new symptom assessment instrument, inpatients and outpatients with prostate, colon, breast or ovarian cancer were evaluated using the Memorial Symptom Assessment Scale and other measures of psychological condition, performance status, symptom distress and overall quality of life. The mean age of the 243 evaluable patients was 55.5 years (range 23-86 years); over 60% were women and almost two-thirds had metastatic disease. The Karnofsky Performance Status (KPS) score was < or = 80 in 49.8% and 123 were inpatients at the time of assessment. Across tumour types, 40-80% experienced lack of energy, pain, feeling drowsy, dry mouth, insomnia, or symptoms indicative of psychological distress. Although symptom characteristics were variable, the proportion of patients who described a symptom as relatively intense or frequent always exceeded the proportion who reported it as highly distressing. The mean (+/- SD range) number of symptoms per patient was 11.5 +/- 6.0 (0-25); inpatients had more symptoms than outpatients (13.5 +/- 5.4 vs. 9.7 +/- 6.0, p < 0.002) and those with KPS < or = 80 had more symptoms than those with KPS > 80 (14.8 +/- 5.5 vs. 9.2 +/- 4.9, p < 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Delirium as a contributing factor to "crescendo" pain: three case reports.

Cancer patients occasionally experience periods of rapidly escalating pain--"crescendo" pain--that may present a challenge in assessment and management. Although these episodes are often associated with progressive neoplasm, any of a variety of other processes may be involved. Delirium is a potentially treatable and frequently unrecognized factor. We present three patients who illustrate this relationship between delirium and a crescendo pattern of cancer pain.

Adenocarcinoma↗
PubMed1994

The Memorial Symptom Assessment Scale: an instrument for the evaluation of symptom prevalence, characteristics and distress.

The Memorial Symptom Assessment Scale (MSAS) is a new patient-rated instrument that was developed to provide multidimensional information about a diverse group of common symptoms. This study evaluated the reliability and validity of the MSAS in the cancer population. Randomly selected inpatients and outpatients (n = 246) with prostate, colon, breast or ovarian cancer were assessed using the MSAS and a battery of measures that independently evaluate phenomena related to quality of life. Symptom prevalence in the 218 evaluable patients ranged from 73.9% for lack of energy to 10.6% for difficulty swallowing. Based on a content analysis, three symptoms were deleted and two were added; the revised scale evaluates 32 physical and psychological symptoms. A factor analysis of variance yielded two factors that distinguished three major symptom groups and several subgroups. The major groups comprised psychological symptoms (PSYCH), high prevalence physical symptoms (PHYS H), and low prevalence physical symptoms (PHYS L). Internal consistency was high in the PHYS H and PSYCH groups (Cronback alpha coefficients of 0.88 and 0.83, respectively), and moderate in the PHYS L group (alpha = 0.58). Although the severity, frequency and distress dimensions were highly intercorrelated, canonical correlations and other analyses demonstrated that multidimensional assessment (frequency and distress) augments information about the impact of symptoms. High correlations with clinical status and quality of life measures support the validity of the MSAS and indicate the utility of several subscale scores, including PSYCH, PHYS, and a brief Global Distress Index. The MSAS is a reliable and valid instrument for the assessment of symptom prevalence, characteristics and distress. It provides a method for comprehensive symptom assessment that may be useful when information about symptoms is desirable, such as clinical trials that incorporate quality of life measures or studies of symptom epidemiology.

Adult↗
PubMed1994

Subcutaneous opioid infusions at home.

The ability to provide subcutaneous infusions in the home has had a major impact on patient care. The main indication for this approach in the cancer population is the need for prolonged parenteral administration of an opioid drug. Successful administration begins with proactive consideration of patient selection; choice of pump, drug, mode of infusion, and dosing schedule; the resources of the family and community health-care system; and cost and insurance coverage. Long-term management requires ongoing liaison among the hospital pain management team, home care infusion agency, and community physicians and nurses.

Home Care Services↗
PubMed1992

The euthanasia and physician-assisted suicide debate: issues for nursing.

The role of nursing has yet to be defined in relationship to the controversial issue of euthanasia and physician-assisted suicide. This may be one of the most important issues facing oncology nurses during the next five years. With recent advances in medical technology, patients are fearful that suffering and death will be prolonged. The option of euthanasia and physician-assisted suicide is seen by some to be a right. Oncology nurses, as patient advocates, need to understand the basic issues surrounding this controversy.

Beneficence↗
PubMed1991

Infection as a cause of rapidly increasing pain in cancer patients.

Rapid escalation of cancer-related pain is usually assumed to be due to progression of the neoplasm. Occult local infection is a poorly recognized alternative cause. We describe two patients who developed rapidly increasing pain that was determined in each case to be due to occult local infection. These cases suggest that all patients with rapid escalation of chronic cancer pain should undergo an evaluation to identify a cause of changing nociception, and that infection should be considered among the possible diagnoses. Lack of fever or leukocytosis does not exclude local infection, and empirical treatment with antibiotics is sometimes indicated.

Adenocarcinoma↗
PubMed1991

Controversies in the long-term management of analgesic therapy in patients with advanced cancer.

The management of pain in the patient with advanced cancer requires comprehensive assessment and expertise in the application of many therapeutic techniques. Given the complexity of the problems posed by these patients, it is not surprising that most aspects of palliative care derive from personal anecdote and clinical consensus, rather than well-defined guidelines based on research findings. In the absence of such guidelines, unresolved issues and controversies abound. This review discusses some of the most important of these topics, which range from the overall system of care and quality of assessment to the specifics of pharmacotherapy and other modalities of treatment. In so doing, the rationale for some of the accepted clinical approaches can be clarified, others that are as yet little known can be highlighted, and the issues most in need of further investigation can be defined.

Analgesics↗
PubMed1990

Controversies in the long-term management of analgesic therapy in patients with advanced cancer.

The management of pain in the patient with advanced cancer requires comprehensive assessment and expertise in the application of many therapeutic techniques. Given the complexity of the problems posed by these patients, it is not surprising that most aspects of palliative care derive from personal anecdote and clinical consensus, rather than well-defined guidelines based on research findings. In the absence of such guidelines, unresolved issues and controversies abound. This review discusses some of the most important of these topics, which range from the overall system of care and quality of assessment to the specifics of pharmacotherapy and other modalities of treatment. In so doing, the rationale for some of the accepted clinical approaches can be clarified, others that are as yet little known can be highlighted, and the issues most in need of further investigation can be defined.

Analgesics↗
PubMed1990

Character of terminal illness in the advanced cancer patient: pain and other symptoms during the last four weeks of life.

There is a great variability among advanced cancer patients in the experience of symptoms and their impact on life's activities. A subgroup of difficult patients particularly tax the clinical skills and compassion of practitioners. Although the need for information about these patients is evident, their characteristics have not been explored heretofore. We describe our experience with such patients, a group referred to the Supportive Care Program of the Pain Service at Memorial Sloan-Kettering Cancer Center. Prevalence of pain and other symptoms, patterns of opioid use and routes of drug administration, and the prevalence of suicidal ideation and requests for euthanasia are discussed.

Adult↗
PubMed1989

Continuity of care for the cancer patient with chronic pain.

The care of patients with cancer and chronic pain, often complicated and demanding, strains the resources of a single physician. Continuity of care programs, such as that developed by the Pain Service of Memorial Sloan-Kettering Cancer Center (New York), with good communication and liaison work between hospital and community, add a much needed dimension to the pain management of these patients in the home. Although continuity of care programs resemble hospice programs in philosophy, there are major differences in admission criteria: the program is not restricted to dying individuals; patients may live alone; they may receive active therapy with a focus on cure or remission; and they continue to receive their care, including pain management, within a standard medical system under the supervision of their primary physician and nurse.

Adult↗