ABSTRACT
To increase the knowledge of the final phase of acute myeloid leukaemia (AML) a retrospective review of the medical and nursing records of 106 adult patients with AML who had died in 1995-1997 was made. A total of 27 patients were treated with curative intent at the time of death and 79 patients were prescribed palliative care. From the documentation, an evaluation of the frequency and severity of bleeding and pain episodes was made during their last week in life, and the occurrence of infection criteria was studied. Notations on bleeding were found in 44%, infection in 71% and pain in 76% of the patients. In 54% of the morphine administration days, no information on the effect of given morphine treatment was registered. To give AML patients in the final phase, the best possible treatment, skills in palliative medicine and palliative care are important.
Subject(s)
Hemorrhage/physiopathology , Infections/physiopathology , Leukemia, Myeloid/drug therapy , Leukemia, Myeloid/physiopathology , Pain/physiopathology , Palliative Care/methods , Acute Disease , Aged , Aged, 80 and over , Analgesics, Opioid/therapeutic use , Attitude to Death , Cause of Death , Female , Humans , Leukemia, Myeloid/mortality , Male , Middle Aged , Morphine/therapeutic use , Quality of Life , Retrospective Studies , Terminal Care/methodsABSTRACT
Exercise and improved diet is known to be beneficial in the management of type 2 (non-insulin dependent) diabetes mellitus. In practice, however, it is difficult for patients to implement these changes unaided. We hypothesized that a lifestyle modification programme involving residential visits would result in beneficial effects on glycaemic control and lipid profile. Three hundred and four individuals with type 2 diabetes participated in a lifestyle modification programme, involving three residential visits (2 weeks, 1 week and one 3-day visit) spaced over 31 weeks. The subjects were all referred for treatment following repeated failure to achieve metabolic control in primary care settings. Participants received information and practical guidance regarding exercise training, nutrition, as well as stress management and psychological counselling. Clinical parameters were determined at each visit. After completion of the programme, subjects showed significant improvements in glycaemic control (P<0.0001). Oxygen uptake was significantly improved (P<0.0001) and blood pressure (P<0.0001), body mass index (P<0.0001) and serum cholesterol (P<0.001) was significantly reduced, while HDL cholesterol (P<0.05) was significantly increased. There were no changes in LDL cholesterol values. Subjects also reported increased well-being and reduced stress. In conclusion, a 31-week lifestyle modification programme results in marked improvements in glycaemic control, blood pressure and well-being in subjects with type 2 diabetes. Thus, this type of lifestyle modification programme is a powerful treatment option to reduce risk factors associated with diabetes and diabetic complications, even in patients who have not responded to conventional diabetic therapy.
