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Biomedical subjects

R G Twycross

Publications and source records attributed to R G Twycross.

At least 19 recordsLinked to original sources
PubMed1996

A 5-year review of a lymphoedema service.

Data for 714 patients referred during a 5-year period to a specialist lymphoedema service in Oxford, UK, have been recorded on a database. The annual number of new patients almost doubled from 103 to 195. In addition to initial assessments, there were over 1000 follow-up appointments per year. Most patients were seen as out-patients. Fifty-six per cent of the referrals were from Oxfordshire and the rest from further afield. The two largest groups referring patients to the service were general practitioners (43%) and the radiotherapy department (26%). Most referrals were female (84%), and the main cause of lymphoedema was cancer and cancer treatments (68%). After 2 years, only 15% of patients were still attending the clinic regularly. The number of patients receiving intensive treatment increased by almost 40%. These findings emphasize the need to target resources and expertise selectively in order to provide an optimal service to patients needing specialist help.

Adolescent↗
PubMed1996

Euthanasia: going Dutch?

My experience in 25 years as a hospice doctor have reinforced my belief that when everything is taken into account--physical, psychological, social and spiritual--euthanasia is not the answer. This belief is enhanced by what I see happening in the Netherlands. However, lest it be thought that I have become hardened and indifferent to suffering let me add that, although firmly opposed to euthanasia, I consider that: (i) a doctor who has never been tempted to kill a patient probably has had limited clinical experience or is not able to empathize with those who suffer (ii) a doctor who leaves a patient to suffer intolerably is morally more reprehensible than the doctor who performs euthanasia A doctor has twin obligations to preserve life and to relieve suffering. Preserving life is increasingly meaningless when a terminally ill patient is close to death, and the emphasis on relieving suffering becomes paramount. Even here, however, the doctor is obliged to achieve his objective with minimum risk to the patient's life. This means that treatment to relieve pain and suffering which coincidentally might bring forward the moment of death by a few hours or days is acceptable (the principle of double effect), but administering a drug such as potassium or curare, with the primary intention of causing death, is not.

Aged↗
PubMed1995

Management of pain in skeletal metastases.

Bone metastases can cause pain in several ways, including bone destruction, compression of nerve roots and spinal cord, and reactive muscle spasm. Pain management is correspondingly diverse, including primary and secondary analgesics, physical and psychologic nondrug methods, and modification of daily activities. Careful evaluation of the neuropathologic mechanisms underlying the patient's pain is the first step, followed by an explanation to the patient. Palliative radiation therapy is generally the preferred treatment, in addition to drug therapy with a combination of a nonsteroidal antiinflammatory drug and an opioid used in accordance with the World Health Organization Method for Relief of Cancer Pain. Alternative strategies are needed for neuropathic and functional muscle pains that are opioid resistant. Pain management is only 1 part of palliative care that also addresses psychologic, social, and spiritual aspects of suffering.

Analgesics↗
PubMed1994

Monitoring drug use in palliative care.

A computerized system for monitoring drug use which makes use of the British National Formulary (BNF) drug categories and a departmental formulary (DF) has been developed. Data entry takes less than one week of secretarial time per annum. Details of drug use in 385 patients three weeks after referral to a National Health Service palliative care unit over five years form the basis of this report. The median number of drugs per patient was five, with a maximum of 11; 97% of the drugs were from the DF. Analgesics were the commonest category of drugs used. The 10 most commonly used drugs included three analgesics (morphine, co-proxamol, flurbiprofen), two laxatives (co-danthrusate, lactulose), dexamethasone, metoclopramide, ranitidine, temazepam and amitriptyline/dothiepin. Seventeen per cent of patients received two preparations from the same second level BNF category (analgesics excluded). The concurrence was questionable in about half of these, and mostly related to the use of laxatives or to hypnotics and anxiolytics. Several unexpected inclusions in the top 10 drugs illustrate the need for quantification rather than pontification about drug use in palliative care. Examination of duplicate prescribing provides a forum for examining ways of simplifying drug regimens.

Adult↗
PubMed1991

Oral opioids in the treatment of cancer pain.

Persistent severe cancer pain should be treated with opioid drugs, principally morphine. It can be administered orally, rectally and parenterally. Morphine is metabolised in the liver mainly to glucuronides, of which morphine-6-glucuronide is a powerful analgesic. Oral morphine should be administered regularly and in individualized doses. The use of morphine is frequently accompanied by adverse effects such as constipation, nausea, vomiting and sedation. Management of these is critical for successful pain treatment. Although alternatives are available none has any clear advantage over morphine in cancer pain, and should be reserved for special situations. Oral morphine is successful in more than 90% of cancer pain patients. Slow release morphine sulphate tablets (MS Contin) are often the best choice. For the few patients who need parenteral medication, continuous subcutaneous morphine sulphate infusion is generally the most suitable. Some pains are morphine resistant, especially those due to nerve injury. In these cases pain is best treated with tricyclic antidepressants and/or anticonvulsants.

Drug Tolerance↗
PubMed1991

Palliative care.

Explore the source record for details and available documents.

Confusion↗
PubMed1989

Care of the patient with advanced cancer: a course for clinical medical students at Oxford.

The objectives and content of a five-day course for final-year medical students at a palliative care unit in Oxford are described. The principal tutors comprise a physician, a psychiatrist, and a senior nurse. A philosopher, two chaplains, a bereavement officer, and a family practitioner also take part. Topics include pain and symptom management, psychosocial care, teamwork, and ethics. The sessions vary in structure from didactic lecture to group work. In addition to the acquisition of new knowledge, the course gives the students an opportunity to examine their own feelings in relation to cancer and the care of the dying. Although this is stressful, the course is highly regarded.

Curriculum↗
PubMed1988

Opioid analgesics in cancer pain: current practice and controversies.

Pain is a complex somato psychic experience that requires a multimodality approach to treatment. Pharmacologically, pain in cancer can be divided into opioid non-responsive, opioid partially responsive, opioid responsive (but do not use opioids) and opioid responsive (do use opioids). Three concepts govern the use of analgesics in opioid responsive pains: 'by the mouth', 'by the clock' and 'by the ladder'. Adjuvant drugs may also be necessary. Morphine is the strong opioid of choice for cancer pain. In patients unable to take oral medication, morphine can be administered by suppository, by injection or peridurally. Useful alternative strong opioids include phenazocine, hydromorphone and buprenorphine. A number of controversial issues are discussed. These include the oral to parenteral potency ratio of morphine; the main site of metabolism of morphine; the relative merits of morphine and diamorphine; the risk of respiratory depression; the development of tolerance; and the risk of addiction.

Analgesics↗
PubMed1988

The management of pain in cancer: a guide to drugs and dosages.

Pain is a complex somato-psychic experience, and all pains do not respond equally to opioid analgesics. Muscle and deafferentation pains are best eased by alternative treatments. Bone pain responds best to the combined use of morphine and an NSAID. Nerve compression often necessitates the concurrent use of a corticosteroid. Few patients need neurolytic or neuro-ablative procedures. Opioid use is governed by three key principles: "By the mouth," "by the clock," and "by the ladder." Morphine remains the strong opioid of choice for most patients. Respiratory depression is not a problem, nor is tolerance. Addiction (psychological dependence) does not occur in patients with opioid responsive pains.

Analgesics↗