AIDS--an unfolding tragedy.
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Biomedical subjects
Publications and source records attributed to A M Broude.
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Pain control is recognised as perhaps the most important single objective in the patient with terminal disease. Cancer, cardiovascular disease and obstructive airways disease are foremost among many causes of pain requiring control in the terminal phase. Spiritual, emotional, religious and socio-economic factors are important in raising or lowering the pain threshold. Analgesic strategies include use of drugs, neurosurgery, radiotherapy and supportive measures which may be brought to bear singly or in combination as required. Pain is clinically classified as being acute or chronic, by the type of patient, and by a series of common pain syndromes and their pathological mechanisms. General concepts of control of pain and discomfort in disease are discussed, together with a brief comment on epidemiology, in the first part of the article. Rationale is then discussed under the following headings: (i) principles of pain control; (ii) causes of pain; and (iii) analgesic modalities and factors impinging on their efficacy.
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When terminally ill care patients are referred for hospice care, the hospice nurse is ideally the first contact person and makes the preliminary assessment. The entry portion of a case-sheet when completed will provide the following information: (i) demographic data; (ii) phasing; (iii) problem areas; (iv) strategies suggested; and (v) input of other care-providing team (CPT) members. Formal in-depth assessment takes place as soon as possible. The input of medical and paramedical CPT members is noted and correlated at weekly case discussion groups which will provide ongoing suggestions, guidelines and internal support.
A deficiency in general medical care for terminally ill patients is recognized. A hospice care-providing team has been formed to obviate this urgent problem. Logistics dictate that hospice care can be implemented most effectively in the home environment. Home hospice care is therefore promoted as the ideal situation for most terminally ill patients.
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