ABSTRACT
Opioids and benzodiazepines are cornerstones of the pharmacological management of pain and agitation in palliative medicine. Oral drug delivery is the most popular route of administration, with the subcutaneous route typically utilized where oral medications are not tolerated or are ineffective. Intranasal drug delivery offers an important alternative administration route, with benefits including ease of administration, tolerability and avoidance of needle use, and is particularly useful in the community, where medications may be administered by lay carers or by patients themselves. Intranasal diamorphine and intranasal midazolam both have demonstrated efficacy and safety in adult and pediatric cohorts, however there is limited research into their use in managing pain and agitation in palliative care. We describe the management of three patients under the community palliative care team who received intranasal diamorphine, two of whom also received intranasal midazolam, to manage breakthrough symptoms of pain and agitation at home. In each case, the patient or their relative was taught how to prepare and administer the relevant intranasal medication. This case series demonstrates that for selected patients, diamorphine and midazolam administered intranasally by patients or lay carers at home is efficacious, acceptable and generally well tolerated.
Subject(s)
Heroin , Midazolam , Administration, Intranasal , Adult , Child , Heroin/therapeutic use , Humans , Pain/drug therapy , Palliative CareABSTRACT
INTRODUCTION: It is estimated that 8% of cancer patients could benefit from advanced pain management techniques; some 12,000 patients per year in the UK. In 2002, Linklater et al. surveyed palliative medicine consultants to assess their access and attitude to such techniques, finding under-utilization with a lack of formal arrangements for referral. We report a survey of pain specialist anaesthetists on the same topic. METHOD: Postal questionnaire survey of lead anaesthetists in UK pain clinics. RESULTS: 106 responses were received from 170 questionnaires sent (62%). Referral rates from palliative medicine to pain clinics were low; only 31% of respondents received more than 12 per year. Joint consulting arrangements were rare, but were associated with more referrals. Only 25% of anaesthetists' job plans had time allocated for palliative medicine referrals, but where present this correlated positively with referrals received (P <0.002). Total interventions were estimated at less than 1000 per year. DISCUSSION: There is evidence of under-referral of patients for advanced pain management procedures with a lack of integrated services.
Subject(s)
Analgesics/administration & dosage , Anesthesiology , Delivery of Health Care , Palliative Care/methods , Practice Patterns, Physicians' , Adult , Health Care Surveys , Humans , Middle Aged , Needs Assessment , United KingdomSubject(s)
Granuloma Inguinale/pathology , Adolescent , Adult , Aged , Barbados , Biopsy , Diagnosis, Differential , Female , Granuloma Inguinale/diagnosis , Granuloma Inguinale/therapy , Humans , Male , Middle AgedABSTRACT
The clinicopathological features of fifteen cases of granuloma inguinale diagnosed over a six-year period (1980-1985) are reported. The biopsy sites included cervix uteri, penis, vulva, perineum, anus, endometrium and vaginal wall, in decreasing order of frequency. The incidence was roughly equal in both sexes with an age range of 16-78 years. In females, the most frequent clinical diagnosis was carcinoma. The findings indicate that the clinical and histopathological diagnosis of granuloma inguinale entails a high degree of suspicion in a community where the disease is uncommon (AU)
Subject(s)
Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Granuloma Inguinale/pathology , Biopsy , Diagnosis, Differential , Granuloma Inguinale/diagnosis , Granuloma Inguinale/therapy , BarbadosABSTRACT
The clinicopathological features of fifteen cases of granuloma inguinale diagnosed over a six-year period (1980-1985) are reported. The biopsy sites included cervix uteri, penis, vulva, perineum, anus, endometrium and vaginal wall, in decreassisng order of frequency. The incidence was roughly equal in both sexes with an age range of 16-78 years. In females, the msot frequent clinical diagnosis was carcinoma. The findings indicate that the clinical and histopatological diagnosis of granuloma inguinale entails a high degree of suspcion in a community where the disease in uncommon
