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Palliative Medicine
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Opioids are commonly used to control background pain. This usually requires regular prescribing. Doses should be adequate and titrated upwards until pain is controlled. Medication should be prescribed ‘as required’ for any additional breakthrough pain.
Pain Management
Published in Margaret O’Connor, Sanchia Aranda, Susie Wilkinson, Palliative Care Nursing, 2018
The temporal assessment involves a description of how the pain feels over time. This includes a description of the onset, duration, and frequency of the pain. These should be considered in association with an assessment of factors that exacerbate or relieve the pain. Nurses should pay particular attention to the following temporal factors (Portenoy & Hagen 1989). Incident pain: This is pain that occurs with movement or activity. Incident pain is usually predictable and can be prevented with doses of analgesics administered at an appropriate interval before the painful activity.Breakthrough pain: This is an unpredictable exacerbation of pain that occurs against a background of constant pain that is otherwise controlled.End-of-dose pain: This is pain that occurs just before the next dose of analgesic is due. This indicates a need to increase the dose or to decrease the interval of administration.
Pain that persists or becomes out of control
Published in Wesley C. Finegan, Angela McGurk, Wilma O’Donnell, Jan Pederson, Elizabeth Rogerson, Care of the Cancer Patient, 2018
Wesley C. Finegan, Angela McGurk, Wilma O’Donnell, Jan Pederson, Elizabeth Rogerson
Is the patient getting the drug at all, or in adequate doses? Assess the following: absorption. Is the drug not being absorbed due to vomiting, faulty adhesion of a transdermal patch or failure of subcutaneous infusion or other equipment?breakthrough pain requiring medicationcompliance. Fear of addiction to opioids in cancer pain relief is common but unfounded. Reassurance is essential.
Clinical observation of regular intermittent epidural injection combined with different puncture points in suppressing breakthrough pain in labour analgesia
Published in Journal of Obstetrics and Gynaecology, 2019
Chunli Wu, Baolin Shi, Hong Jiang
The observation indexes were – (1) HR, BP, RR, SpO2 and FHR. (2) The VAS and a modified Bromage scores at different time points before analgesia (T0), 10 minutes (T1), 20 minutes (T2), 30 minutes (T3) and 60 minutes (T4) after the analgesia (timing was started immediately after the test dose was injected), 7–8 cm uterine orifice (T5), and whole was uterine open (T6), (0 point: the hip, knee and ankle can be fully flexed; one point: the knee and ankle can be flexed; two points: only the ankle can be flexed; three points: none of the above joints can be flexed); 60 minutes after analgesic, the scores were recorded once every one hour until the end of delivery. (3) After the sensation block plane was analgesic (with athalposis as the standard), the scores were recorded once every 10 minutes for the first 30 minutes, and then once every one hour until the end of delivery. (4) The occurrence of breakthrough pain. (5) Doses of ropivacaine and sufentanil. (6) The analgesic time (from the implementation of epidural analgesia to the medicine withdrawal due to a whole uterine opening), labour duration, and the delivery mode. (7) A maternal oxytocin dosage and a postpartum haemorrhage. (8) The prevalence of hypotension, itching, nausea, vomiting or other adverse reactions. (9) The neonatal weight and the Apgar scores at the 1st and 5th min after a birth recorded. (10) Maternal satisfaction score (0 point: dissatisfactory, 100 points: very satisfied).
Quality assurance guidelines for interstitial hyperthermia
Published in International Journal of Hyperthermia, 2019
H. Dobšíček Trefná, M. Schmidt, G. C. van Rhoon, H. P. Kok, S. S. Gordeyev, U. Lamprecht, D. Marder, J. Nadobny, P. Ghadjar, S. Abdel-Rahman, A. M. Kukiełka, V. Strnad, M. D. Hurwitz, Z. Vujaskovic, C. J. Diederich, P. R. Stauffer, J. Crezee
Interstitial Hyperthermia treatments are performed under the supervision of a radiation oncologist who has been adequately trained in either brachytherapy and/or theory and clinical practice of interstitial hyperthermia. The physician is responsible for all clinical aspects of the hyperthermia treatment (e.g., diagnosis, imaging, patient selection, treatment prescription, fractionation, documentation). The physician is responsible for implantation of an appropriate high-quality hyperthermia catheters implant. This includes complete coverage of the target volume, protection of organs at risk, and optimal separation and parallel orientation of catheters. The physician should understand the limitations of interstitial heating technology when placing the implant catheters, to ensure optimal insertion length, alignment, and density for both radiation and hyperthermia considerations. In case of a challenging location, the physician can invite a surgeon to place the implant catheters. Further, the physician also takes care of additional medications for pain management and breakthrough pain if needed.
The Feasibility and Safety of No Placement of Urinary Catheter Following Lung Cancer Surgery: A Retrospective Cohort Study With 2,495 Cases
Published in Journal of Investigative Surgery, 2021
Yutian Lai, Xin Wang, Kun Zhou, Jianhuan Su, Guowei Che
There are some limitations to this study that should be considered, as this is a retrospective study rather than a prospective study. First, there was no strict criterion for surgeons to determine the group of patients who would not undergo urinary catheter placement, which indicated that most of patients without urinary catheter was chosen based on surgeons’ empiric, and selective bias existed. For example, younger patients with better health status might be more likely be selected to avoid placement of urinary catheter during surgery, although baseline was comparable between the two groups. Another issue was the analgesia approach. Analgesia approaches, particularly epidural infusions include local anesthetics in conjunction with opioids and is considered to be associated with POUR. However, epidural analgesia was not applied in thoracic surgery in our hospital, which indicated that we could not investigate the feasibility of non-placement of urinary catheter in patient undergoing epidural thoracic anesthetics (ETA). Moreover, some opioids including dizosin or meperidine hydrochloride sometime were used for breakthrough pain but we did not collect the relevant data, which might have confounded the conclusions. Finally, more detailed and profound research is required to confirm the benefits provided by avoiding urinary catheterization, as a higher proportion of POUR was found in the non-UC group. Meanwhile, further study, including randomized controlled trail with larger sample size or prospective study is needed to validate our conclusions and to build assessment model for screening patients suitable for non-placement of urinary catheter after surgery.