The Voluntary Euthanasia (Legalization) Bill (1936) revisited.

In view of the continuing debate on euthanasia, the restrictions and safeguards which were introduced into the Voluntary Euthanasia (Legislation) Bill 1936 are discussed. Proposals for a new Terminal Care and Euthanasia Bill are suggested, based on some of the principles of the Mental Health Act 1983.     

Factors associated with analgesic and psychotropic medications use by community-dwelling older people with chronic pain

OBJECTIVE: The present study sought to examine use prevalence and factors associated with use of analgesic and psychotropic medications in community-dwelling older people with chronic non-malignant pain. METHOD: The study group comprised 193 community-dwelling older people with daily chronic non-malignant pain who were selected from a random sample of 1,000 older people in Melbourne. RESULTS: The use prevalence for the study group was 63% for analgesics and 39% for psychotropic medications, which is higher than the general older population without chronic pain (p < 0.00001). More women with chronic pain used analgesics, while psycho-social factors such as problems with sleeping and living at home alone were found to be associated with an increased use of psychotropic medications. CONCLUSION: A high proportion of community-dwelling older people with chronic non-malignant pain use analgesic and psychotropic medications. IMPLICATIONS: These findings provide the basis for further investigation into the level and appropriateness of analgesic and psychotropic medication use by older people with chronic pain.     

Development of a pain attitudes questionnaire to assess stoicism and cautiousness for possible age differences

This study aimed to develop a pain attitudes questionnaire (PAQ) and examine its reliability and validity for use in assessing the constructs of stoicism and cautiousness relevant to pain perception. The questionnaire was administered to 373 healthy community-dwelling individuals who were subsequently divided into four age groups to test for differences in stoicism and cautiousness, two attitudes that have previously been claimed to influence pain perception and report among older adults. Factor analysis revealed that two dimensions of stoicism and two dimensions of cautiousness are measured by the scale, with reticence and superiority characterizing the first construct and self-doubt and reluctance characterizing the second. There was support for the scale's reliability and validity. Age-related increase in degree of reticence to pain, self-doubt, and reluctance to label a sensation as painful was found, emphasizing the need for careful consideration of pain attitudes in older patients who may underreport their pain symptoms.     

Age-related differences in the endogenous analgesic response to repeated cold water immersion in human volunteers

Recent animal studies using stress-induced analgesia have suggested a general age-related decline in endogenous pain inhibitory systems. The aim of the current study was to examine age-related differences in the magnitude of endogenous analgesia in human volunteers, using psychophysical measures of neuroselective electrical, and thermal CO(2) laser induced pain thresholds, before, immediately after and 1 h after repeated cold water immersion of the hand. Sensory detection thresholds did not differ between age groups indicating that the functional integrity of primary afferent sensory fibres appears to be intact in older people. Consistent with many previous studies, older adults required a higher intensity of noxious stimulation in order to first report the presence of pain. The cold water immersion task was effective in eliciting a powerful analgesic response, regardless of age; pain thresholds were shown to increase by up to 100% immediately after the cold pressor test. This effect was relatively transient with thresholds returning to baseline within 1 h. The magnitude of analgesic response, however, was found to be significantly less in older people. Age differences in the efficacy of endogenous analgesic systems may be expected to reduce the ability of older adults to cope with severe persistent pain states and may help explain some of the variation in the literature on pain report.     

Endovascular stent graft repair of mycotic aneurysms of the thoracic aorta

Traditional open surgical repair for mycotic aneurysms of the thoracic aorta is associated with significant morbidity and mortality. Endovascular repair has been reported as an alternative treatment in patients with mycotic thoracic aneurysms. This article reports our experience of endovascular stent graft placement in three patients with mycotic aneurysms of the thoracic aorta and compares the results with similar reports on the literature.     

Prevalence of Analgesic and Psychotropic Medication Use by Older People with Chronic Pain

Objective: The aim of the study was to examine the profile of analgesic and psychotropic medication use in community dwelling older people with chronic pain of non‐malignant origin. Method: Two groups of older people with chronic pain were compared. The first group comprised 193 from a random sample of 1,000 community dwelling older people. The second group comprised 150 consecutive patients from a pain management centre for older people. Results: The overall use prevalence of analgesic and psychotropic medications was similar in the two study groups. However, significant differences in use prevalence of sub categories of analgesic and psychotropic medications were found between the two study groups. The referred patients with neurological and non‐musculoskeletal conditions as the main causes of pain were more likely to use narcotics and anti‐depressants, while the community sample with the majority having musculoskeletal pain was more likely to use non‐steroidal anti‐inflammatory drugs. Conclusion: The differences regarding the use of analgesic and psychotropic medications between the two study groups appear to be associated with different causes of pain.     

Photoperiodic variation in substance P induced plasma extravasation in the rat

Photoperiodic variation in plasma extravasation was examined following exogenous perfusion of substance P over a vacuum-induced blister base on the rat hind footpad. The results showed a generalised suppression of plasma extravasation during the dark or active phase of the light/dark cycle which appears to be independent of the circadian fluctuations in endogenous corticosterone. These findings emphasise the need to consider photoperiodic conditions as a possible source of variability in neurogenic inflammatory responses.     

A double-blind clinical trial to compare the efficacy of an active based cream F14001 against a placebo non-active based cream for the treatment of pressure ulcers in a population of elderly subjects

A double-blind clinical trial was conducted to compare the efficacy of an active based cream against a placebo non-active based cream in the healing of superficial pressure ulcers in a population of geriatric hospital patients and residents in community nursing homes. The active group showed a small significant beneficial effect at week four. The overall results of the trial also demonstrated a significant improvement in ulcer size over the duration of the trial period in both active and placebo groups.