One hundred eleven patients with advanced cancer and pain newly referred to a palliative care center completed the Brief Pain Inventory (BPI) weekly for up to 4 weeks. The aims were (a) to review the numbers and causes of pain, (b) to consider the usefulness of the BPI in the evaluation of pain in cancer patients, and (c) to determine the impact of treatment. A total of 370 pains were recorded initially, a median of 3 per patient; 85% had more than 1 pain and more than 40% had 4 or more pains. Causes of pain were cancer (46%), debility (29%), treatment (5%), concurrent disorder (8%), and no stated cause (12%). The top 10 individual causes accounted for 73% of the pains. Seventy-six (68%) of the patients completed two BRIs, but only 46 (41%) completed 5. After 4 weeks, the median number of pains had fallen to 1.5; 78% still had more than 1 pain, but only 20% had 4 or more pains. Intensity of pain also declined, particularly in the first 2 weeks. With their last BPI, 23% had become completely pain free and a further 27% achieved acceptable relief (worst pain scores 1-4), compared with none and 24% initially. Of those who completed all five BPIs, the final respective figures were 22% and 29%. In contrast, 23% of patients still had unacceptable severe pain noted on their last BPI (worst pain scores 8-10), compared with 36% initially. Of those who completed five BPIs, the final figure was 20%. Highly significant correlations were observed between all seven interference factors and present, worst, and average pain intensities. After 4 weeks, the pattern was more variable, particularly in relation to present pain, suggesting that interference factors may have a limited utility as a measure of satisfactory pain management. Many patients did not answer all the questions in the BPI. It was concluded that the BPI is not brief enough for routine clinical use, and that the short form of the BPI (BPI-SF) is too short. A pain diary card will be developed comprising mainly pain scores, a pain relief score and a satisfaction with pain management score.
SUMMARYA study was conducted to assess the acceptability of patients with cancer holding a shared care record. A total of 43 patients with advanced cancer and an estimated life expectancy of more than 3 months were recruited from outpatients attending Michael Sobell House Hospice, Oxford, and from three group practices.Personal interviews and questionnaires were completed by patients and their relatives on two occasions. Professional carers were interviewed by telephone and completed a questionnaire on one occasion. The main outcome measure was: reported attitude to, and utilisation of, the record over a period of 12 weeks.The majority of patients used the record throughout the study. At the second interview, 12 of the 30 surviving patients (41%) were seeing their G.P., and 16 (53%) a community nurse, at least weekly. They had also undertaken a median of five out-patient visits to specialists. Approximately half the patients (SO%, 95% CI 31-69%), relatives (48%, 95%CI 33-63%). and professionals (58%, 95% CI28-85%) reported that the record helped them a great deal. The diary and medication pages were the most useful features of the record.Our findings suggest that patient held shared-care records are acceptable and helpful for those with advanced cancer in the community.
The drug charts of 100 inpatients with terminal cancer were reviewed to determine laxative use at the beginning of week 2. Sixty-two per cent of patients received an oral laxative regularly. Of these, 37 (60%) received codanthrusate or codanthramer, 14 (23%) received senna and 13 (21 %) lactulose. Eight patients received two laxative preparations concurrently. Thirty-seven patients needed rectal measures. About half of those not taking a strong opioid required a regular laxative, compared with three-quarters of those on a strong opioid. The median daily dose of codanthrusate was two capsules for patients not on an opioid and four capsules for patients on a strong opioid (range 1-6). There was no correlation between the dose of morphine and that of codanthrusate. All patients on a strong opioid who did not receive a regular laxative had a specific reason for not doing so.
Objectives: To test the feasibility of adopting and evaluating a systematic case-finding approach to the early diagnosis of hereditary haemochromatosis (HHC) in primary care, and to estimate the prevalence of presenting conditions for which HHC testing could be offered. Methods: Systematic identification of, and genotyping for, C282Y and H63D mutations in patients presenting in primary care with possible symptoms of HHC during a 4-week period to 1 of 14 doctors in Oxfordshire. Results: From a total of 4,022 consultations, 169 (4.2%; 95% CI: 3.6–4.8) adult patients had possible symptoms of HHC. Of these, 88 (2.2%; 95% CI: 1.7–2.6) were aged 25–70 and were offered genotyping for HHC, of whom 60 agreed to be tested. There were no C282Y homozygotes (0%; 95% CI: 0–6.0), no C282Y/H63D compound heterozygotes (0%; 95% CI: 0–6.0), 2 H63D homozygotes with normal iron indices (3.3%%; 95% CI: 0.4–11.5) and 3 C282Y heterozygotes (5.0%; 95% CI: 1.0–13.9). Conclusions: This study raises doubts about a case-finding approach to early diagnosis of HHC in primary care. The non-specific nature and high prevalence of possible symptoms of HHC in primary care mean that many patients would require testing to identify a single case. Whether this offers a more cost-effective alternative to population screening requires further study.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.