Friday, 23 May 2008

Journal of pain and symptom management, Mar 2008 (epub: 28 Jan 2008), vol. 35, no. 3

Haloperidol as a palliative anti-emetic in a toddler: an evidence base challenge.
p. 235-8
Case-Reports, Letter.

Perceptions of specialized inpatient palliative care: a population- based survey in Japan.
p. 275-82
Sanjo-Makiko, Miyashita-Mitsunori, Morita-Tatsuya, Hirai-Kei et al
This study aimed to clarify and compare the awareness and perceptions of the specialized inpatient palliative care service. A cross- sectional questionnaire survey was performed on the general population selected by stratified two-stage random sampling (n=2,548) and bereaved families who actually received specialized inpatient palliative care at 12 palliative care units (PCUs) in Japan (n=513). The respondents reported their awareness and perceptions of PCUs. Thirty-eight percent of the general population answered that they had considerable or moderate knowledge of PCUs, but 24% answered that they had no knowledge. Bereaved families who received PCU care (PCU- bereaved families) were likely to have better perceptions of PCUs than the general population: alleviates pain (68% of the general population and 87% of PCU-bereaved families agreed), provides care for families (67% and 86%, respectively), and provides compassionate care (67% and 87%, respectively). Both groups, however, expressed concerns about PCUs: a place where people only wait to die (30% and 40%, respectively) and shortens the patient's life (8% and 17%, respectively). These perceptions were associated with overall satisfaction with received care, and differed among the 12 PCUs. In conclusion, public awareness of PCUs was insufficient in Japan. Although PCU-bereaved families were generally likely to have better perceptions of PCUs than the general population, both groups shared concerns that a PCU was a place where people only wait to die. To facilitate appropriate use of specialized palliative care services, more efforts to inform the general population about the actual palliative care system are needed. In addition, the role of PCUs might be reconsidered in terms of the continuum of cancer care.

Intravenous morphine for breakthrough (episodic-) pain in an acute palliative care unit: a confirmatory study.
p. 307-13
Mercadante-Sebastiano, Intravaia-Giuseppe, Villari-Patrizia et al
The aim of this prospective cohort study was to confirm the safety of intravenous morphine (IV-M) used in doses proportional to the basal opioid regimen for the management of breakthrough pain and to record the nurse compliance on regularly recording data regarding breakthrough pain treated by IV-M. Over a one-year period, 99 patients received IV-M for breakthrough pain during 116 admissions. The IV-M dose was 1/5 of the oral daily dose, converted using an equianalgesic ratio of 1/3 (IV/oral). For each episode, nurses were instructed to routinely collect changes in pain intensity and emerging problems when pain became severe (T0), and to reassess the patient 15minutes after IV-M injection (T15). Nurses were unaware of the aim of the study and just followed department policy. In total, 945 breakthrough events treated by IV-M were recorded and the mean number of events per patient per admission was eight (95% confidence interval (CI) 6.9-9.5). The mean dose of IV-M was 12mg (95% CI 9-14mg). In the 469 events (49.6%) with a complete assessment, a decrease in pain of more than 33% and 50% was observed in 287 (61.2%) and 115 (24.5%) breakthrough events, respectively. The mean pain intensity decreased from 7.2 (T0) to 2.7 (T15). In eight episodes, no changes in pain intensity were observed and a further dose of IV-M was given. The remaining patients did not require further interventions. No clinical events requiring medical intervention were recorded. In this confirmatory study, IV-M was administered for the management of breakthrough pain in doses proportional to the basal opioid regimen to all patients, including older patients and those requiring relatively large doses. This did not result in life- threatening adverse effects in a large number of patients and was effective in most cases. The role of nurses is of paramount importance in monitoring and collecting data and gathering information for audit purposes on the unit.
Clinical-Trial, Journal-Article.

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