Biomedical subjects

Declan Walsh

Publications and source records attributed to Declan Walsh.

58 records · Page 4Linked to original sources

PubMedDate not supplied

Communication in palliative medicine: a pilot study of a problem list to capture complex medical information.

We developed a one-page, structured problem list to facilitate communication of complex patient information in palliative medicine. The problem list was developed to provide a concise record of the complex problems presented by patients with advanced disease. It was also seen as a mechanism to facilitate interdisciplinary and multidisciplinary communication and continuity of care in the hospital and in the community. One hundred consecutive patients, who were newly referred to our palliative medicine program, were prospectively surveyed to gain clinical experience with the problem list. Ninety patients had cancer diagnoses. The median age was 69 (range 20-90 years), the male to female ratio was 2:1, and the median Eastern Cooperative Oncology Group (ECOG) performance status was 3 (range 0-4). The population was 78 percent Caucasian. The median number of symptoms per patient was 5 (range 0-13), which was similar for cancer and noncancer patients. Overall, gastrointestinal symptoms and pain were the most common symptoms. Pain was more common in cancer patients, and respiratory problems were the most common among noncancer patients. Noncancer patients had better performance status. Based on this experience, we believe a problem list facilitates succinct communication of complex patient information essential to optimal patient care. Proposed modifications are discussed.

Adult↗

PubMedDate not supplied

The adverse effects of morphine: a prospective survey of common symptoms during repeated dosing for chronic cancer pain.

Little information is available about the incidence, prevalence, or severity of morphine side effects during repeated individualized dosing for chronic cancer pain, although it has been widely used in this way for more than 30 years. The authors' aim was to describe the prevalence of symptoms possibly attributable to morphine side effects in a convenience sample of patients with pain due to advanced cancer. They used a prospective survey of inpatients and outpatients on regularly dosed morphine, with a questionnaire administered weekly for 4 weeks. Forty-two of 56 eligible patients completed at least the first questionnaire, with 30 completing all 4. Dry mouth was the most common symptom reported (point prevalence, 95%); this was often moderate to severe in intensity (57%) and was the most persistent symptom (period prevalence, 20%). Sedation and constipation were frequent (point prevalence, 88%) and was often moderate or severe at some point (55% and 62%, respectively) but had low period prevalence. Nausea was reported by less than half the patients. Myoclonus was common (point prevalence, 83%) but was usually mild and not persistent. Total daily morphine dose had little impact on side-effect patterns. Constipation, dysphoria, myoclonus, nausea, and sedation were more likely to be severe following dose increases. In conclusion, although constipation, nausea, and sedation are well described as side effects of morphine administration, others such as dry mouth and myoclonus appear to be underestimated. Validated patient-based measures of opioid side effects are needed.

Adult↗

PubMedDate not supplied

Parenteral morphine prescribing patterns among inpatients with pain from advanced cancer: a prospective survey of intravenous and subcutaneous use.

Prescribing patterns for parenteral morphine for symptom control in advanced cancer were studied in 50 consecutive hospital admissions (27 men, 23 women, median age, 62 years). Patients were interviewed daily (median time, 9 days) concerning analgesia while they were receiving parenteral morphine. Five major inpatient prescribing patterns were identified: (1) intravenous to oral, (2) intravenous to subcutaneous, (3) intravenous only, (4) subcutaneous only, and (5) mixed. The intravenoustooral group had more stable pain control than the intravenous-to-subcutaneous group. Pain control was good in the mixed group, suggesting that flexibility in the route of administration contributes to better pain control. Patients with neuropathic pain required higher doses of morphine. These patterns of parenteral morphine application reflect the complexity of the challenge presented by the various cancer pain syndromes. Physicians should be knowledgeable about the appropriate and flexible use of different routes of administration for morphine and other opioids.

Administration, Oral↗

PubMedDate not supplied

The financial benefits of acute inpatient palliative medicine: an inter-institutional comparative analysis by all patient refined-diagnosis related group and case mix index.

Financial comparisons of acute care hospital services are possible using the Centers for Medicare & Medicaid Services case mix index (CMI) and All Patient Refined-Diagnosis Related Group (APR-DRG) data. We compared The Cleveland Clinic's Inpatient Palliative Medicine (CCIPM) acute care unit's CMI and APR-DRG data with national and peer institution data. Total mean charges per admission to the CCIPM unit were 7,800 dollars lower than at other peer institutions despite an equivalent severity of illness and longer length of stay and higher mortality in the CCIPM unit. The lower charges were due primarily to lower laboratory and pharmaceutical charges. We conclude that an acute inpatient palliative medicine unit operating within a comprehensive integrated palliative medicine program is cost-effective in providing specialized care for people with advanced disease.

Acute Disease↗