Management of cancer pain. A practical approach

One in five deaths in Australia is due to cancer. Pain is an important symptom in many of these patients, but it is often either unrelieved or poorly controlled. Misconceptions about the nature of cancer pain and its control are detailed, and the practical management of these patients is discussed in the light of personal experience. Proper use of older therapeutic methods is still important, as recent advances allow better results only in a minority of cases. Special attention is given to the use of regular oral doses of morphine. Many of the interacting factors affecting pain perception are considered, so that the sense of impotence in those faced with the management of a progressive incurable disease may be reduced through an understanding of the causes of pain and its correct management.     

临床实践教学与医患沟通

患者是医学教学最主要的资源,加强与病人心理沟通,取得病人合作,是保护好这个教学资源的唯一方法。教师在临床教学中引导医学生在临床实践中学习与患者的沟通技巧,是一门新的重要课题。本研究要求医师在医患沟通中起主导作用,提倡“沟通第一,技术第二”的医疗服务理念。尊重病人的基本权益,寻找通俗和谐的沟通技巧,减少医患纠纷,建立平等和谐的医患关系,更好为广大病患者服务。     

A practical approach to managing community dwellers with Alzheimer's disease

This article will review multiple strategies and treatment options that can be utilized by clinicians to address the ever-changing and varied needs of community dwelling elders with Alzheimer's disease and those of their families. Comprehensive assessment and the judicious use of medications, together with other nonpharmacological interventions, may lessen the burden of care on families and decrease the likelihood of institutionalization.     

循证医学信息的实用检索方法

临床医生查找信息的原因通常有两个:一是更新知识,保持与医学的发展同步;二是解决临床工作中与病人相关的问题.由于浩瀚的信息量使临床医生快速获得高质量的信息非常困难,所以,文章就此介绍了临床循证医学信息的有用性、新的信息源及检索和获取有用性信息的实用方法.     

晚期肿瘤患者临终关怀的护理效果

目的 观察晚期肿瘤患者临终关怀的护理效果.方法 回顾性分析2015年8月—2016年9月我院收治的晚期肿瘤患者42例,将其随机平分为2组,每组患者21例,对试验组患者采取临终关怀护理模式,对照组患者采取常规护理模式,比较2组临床护理效果.结果 试验组患者临终时期的生活质量评分(79.8±3.6)分,患者与家属对护理的满意度95.2%,均显著高于对照组.试验组患者住院期间病死率和日平均费用显著优于对照组.结论 临终关怀护理模式在晚期肿瘤患者护理中的应用,能够有效提高患者与家属对护理工作满意度、提高晚期肿瘤患者临终前的生活质量,有利于降低住院期间的病死率、减少住院费用,值得临床推广.     

A practical approach to the investigation of the hyperprolactinaemic patient.

Pituitary function was assessed in 39 patients with previously untreated hyperprolactinaemia. Primary hypothyroidism, drug-induced hyperprolactinaemia and chronic renal failure were excluded in all patients. All of the 22 patients (group 1), who had either a normal pituitary fossa or a minor radiological change on lateral skull X-ray, had completely normal pituitary function with the exception of 2 who were partially growth hormone-deficient. However, 9 of the 17 patients with macroadenomas (group 2) had a deficit of one or more anterior pituitary hormones. After the lateral skull X-ray 13 patients in group 1 had further neuroradiological investigations. In only one was a minor abnormality noted which had not been observed on the plain film and this was not of practical significance. In centres where hyperprolactinaemic patients with a normal pituitary fossa or a minor radiological change on lateral skull X-ray are treated with bromocriptine, further neuroradiological investigations and dynamic tests of pituitary function are not required.     

Teaching medical ethics symposium. A student-led approach to teaching.

It is increasingly agreed that ethics has a place in undergraduate medical education. There is, however, debate about how it should be taught, and by whom. We present our experience of teaching ethics in a general practice module over six years. During this period there has been a shift from a teacher-centred to a student-centred approach in which students choose ethical issues to explore within a framework provided. The issues raised are discussed with examples, and the future directions of our ethics teaching outlined.     

A specialty-specific approach to appraisal of audiovisual teaching materials.

The number of audiovisual teaching materials for medical audiences has enormously grown during the past 10 years. To help medical educators become aware of what is available, and to help them select useful materials the Audiovisual Review Committee was established in 1974; its members serve on a voluntary basis, meeting twice a year to review 16mm. films, videotapes, and tape-slide programs. During the period 1974-78 a total of 160 audiovisual programs were reviewed; of these 47 were highly recommended, and only 14 were judged of limited value. AVLINE, the audiovisual on-line program conducted by the National Library of Medicine at NIH, provides a data base with references to over 5000 audiovisual programs, most of which, however, are not geared to family practice needs.     

The terminal care of patients with lung cancer

Lung cancer is the commonest form of malignant disease seen at St Christopher''s Hospice. More than 35% of the male and about 8% of the female cancer patients are admitted with this diagnosis. This means that each year approximately 100 patients with lung cancer are amitted and cared for at the hospice. The more common symptoms experienced by 185 consecutive terminal lung cancer patients admitted to St Christopher''s Hospice are listed in Table 1.     

Penicillin allergy: a practical approach to management.

Although penicillin is nontoxic, it is highly immunogenic and is the most common drug that causes allergic reactions. A previous reaction to penicillin has been shown to be unreliable in predicting sensitivity in 75% to 90% of patients. To more accurately test for penicillin allergy, diagnostic skin test reagents have been developed; these include the major determinant (benzylpenicilloyl-polylysine) and the minor determinant mixture (penicillin G potassium, benzylpenicilloate sodium and benzylpenicilloyl-N-propylamine). Penicillin skin testing has been shown to be safe and useful in predicting immediate IgE-mediated reactions (overall predictive value 99%). Reactions that occur when patients are challenged with penicillin are mild or accelerated urticarial reactions. We outline a practical and rational therapeutic approach based on the current understanding of penicillin allergy.