ABSTRACT
Purpose: The purpose of this study is to evaluate hangeshashinto rinse for oral discomfort in terminally-ill cancer patients and to compare the effectiveness of hangeshashinto rinse with or without honey rinse. Methods: Patients with oral discomfort were randomized to receive either hangeshashinto rinse or hangeshashinto with honey rinse as first-line treatment. Patients performed oral rinse three to five times a day for 2 weeks. Further, oral wetness, halitosis, oral mucositis, mouth discomfort, compliance of rinse were then evaluated before and after the intervention. Results: 144 patients were enrolled during this period and 22 patients completed the study (hangeshashinto 13 / hangeshashinto with honey 9). After the intervention, oral wetness was improved, and end-tidal concentration of hydrogen sulfide was decreased in both cases. Although there was no statistically significant difference, oral discomfort by subjective and objective evaluations, also and symptom of oral mucositis were improved. Other volatile sulfur compounds decreased. Frequency of rinsing between groups receiving hangeshashinto or hangeshashinto with honey did not differ, however, the acceptability was slightly better in the honey combination group. Conclusion: Both hangeshashinto rinse and hangeshashinto with honey rinse reduced end-tidal concentration of hydrogen sulfide and improved oral wetness. Oral rinse by hangeshashinto or hangeshashinto with honey may be effective for oral discomfort in terminally-ill cancer patients.
ABSTRACT
Since bibliographic items had an error, it corrects as follows. <BR><BR>p.158, upper right of a page<BR>(Error) Palliative Care Research 2012; 8(1): 158-67<BR>(Correct) Palliative Care Research 2013; 8(1): 158-67<BR><BR>p.158, center of a page<BR>(Error) Palliat Care Res 2012; 8(1): 158-67<BR>(Correct) Palliat Care Res 2013; 8(1): 158-67<BR><BR>p.164, center of a page<BR>(Error) Palliat Care Res 2012; 8(1): 158-67<BR>(Correct) Palliat Care Res 2013; 8(1): 158-67
ABSTRACT
<b>Purpose</b>: The research is aimed at the evaluation of management of pain in elderly cancer patients receiving home-based care. <b>Methods</b>: A questionnaire of 29 questions was developed and 323 home-care physicians were invited to answer the questionnaire with an online system from January 19 to 25 2011. According to answers from the general physicians, we compared the differences of answers about managements of cancer pain between two groups (>75 years old cancer patients with or without cognitive disorder) by Pearson's chi-square test. <b>Results</b>: In a the question “Are patients able to appropriately express their cancer pain?”, the ratio of physicians' answers was different;, positive answers in the patients' group with cognitive disorder was significantly lower than those without cognitive disorder (<i>p</i>=0.0043). In other questions “Do physicians feel difficulty of assessment of analgesic effect of opioids?” and “Do physicians feel difficulty of dose-selection and adjustment of opioids?”, positive answers in patients' group with cognitive disorder were more dominant than those without cognitive disorder (<i>p</i><0.0001 each). Further, in the question “Do physicians feel cancer pain management is well-done?”, positive answers were significantly lower in patients with cognitive disorder than those without cognitive disorder (<i>p</i><0.0001). <b>Conclusion</b>: With the analyses of the answers from the physicians, we found that physicians felt difficulty of both the assessment of pain and analgesic effect of opioids in patients with cognitive disorder. It should be required for the physicians to improve pain management, especially to the patients with cognitive disorder.
ABSTRACT
This is a report on a case of delirium due to a small amount of ketamine with voriconazole. A 58 year old male was treated for multiple myeloma and hip pain due to an extramedullary tumor following the administration of oxycodone, and voriconazole was administrated for his suspected mycotic pneumonia. His pain was refractory, so we started the administration of a small dose of ketamine (4 mg/hr) for analgesia, added to oxycodone. About 30 hours later, the delirium appeared but he complained of worsening hip pain, so we added 2 mg of ketamine rapidly. Immediately after the additional administration of ketamine, his delirium became more serious. We think the reason why a small amount of ketamine induced delirium is an interaction of ketamine and voriconazole. Ketamine is metabolized to norketamine, which is thought to be more harmless than ketamine, by cytochrome P 450 (CYP) (a part of by CYP3A4) and voriconazole is an inhibitor of CYP3A4. In cases of patients treated with voriconazole, ketamine should be more carefully administrated.