Biomedical subjects

J M Ingham

Publications and source records attributed to J M Ingham.

4 recordsLinked to original sources

PubMed1998

Pain and the barriers to its relief at the end of life: a lesson for improving end of life health care.

Pain among cancer patients is a common distressing symptom that frequently affects physical functioning, social interaction, psychological status, and quality of life. Despite the extensive body of knowledge available regarding cancer pain assessment and management, it often remains untreated, thereby diminishing the quality of patient care at the end of life. Recommendations on how to remove these barriers, as well as to improve care of the dying in general, need to be implemented by the U.S. government.

Activities of Daily Living↗

PubMed1996

Symptom assessment.

Medical intervention aims to eliminate disease, to mitigate disease effect, and maximize quality of life. Throughout the course of illness, accurate symptom assessment is imperative if these goals are to be achieved. Symptom scales may facilitate this process in the clinical setting. Many valid scales are available for research, and investigators must be familiar with a methodology that can quantify the impact of therapies on symptoms, symptom distress, and overall QOL.

Evaluation Studies as Topic↗

PubMed1995

Opioid pharmacotherapy in the management of cancer pain: a survey of strategies used by pain physicians for the selection of analgesic drugs and routes of administration.

BACKGROUND: This survey documents the strategies used by pain control physicians in the selection of opioid drugs and routes of administration in the management of inpatients referred to a cancer pain service. METHODS: The following approaches were prospectively evaluated during the treatment of 100 consecutive inpatients: 1) the influence of the evaluation of the goals of care on decision making, 2) selection of opioid drugs, 3) indications for changing opioid drugs and the frequency with which this strategy is used, and 4) selection of route of administration. RESULTS: Eighty of the 100 patients underwent a total of 182 changes in drug, route, or both drug and route before discharge or death. The major reasons for change were to improve the convenience of treatment regimen in the setting of adequate pain relief (31.4%), diminish side effects in the setting of controlled pain (25.0%), reduce the invasiveness of therapy in the setting of controlled pain (19.3%), and simultaneously improve pain control and reduce opioid toxicity (17.7%). When opioid toxicity was the reason for change, physicians changed the opioid drug in 71% of cases and the route in 29%. When convenience or invasiveness were targeted, the physicians changed the route in 61% of cases and the opioid in 39%. Forty-four patients required one or more change in the opioid, and 20 required 2 or more changes (range, 2-6 changes). At the time of discharge (n = 82), morphine was more commonly selected than hydromorphone or fentanyl (39% vs. 23% vs. 17%) and the routes of administration were oral (57%), transdermal (18%), intravenous (18%), subcutaneous (5%), and intraspinal (4%). Therapeutic changes were associated with improvement in physician-recorded pain intensity and a lower prevalence of cognitive impairment, hallucinations, nausea and vomiting, and myoclonus among patients who were discharged from the hospital. CONCLUSIONS: These data illustrate the application of strategies for selections of opioid drugs and their route of administration that are recommended in current guidelines for the management of cancer pain.

Adult↗

PubMed1995

Cardiovascular autonomic insufficiency in a patient with metastatic malignancy.

A case of cardiovascular autonomic insufficiency is described in a cachectic 70-year-old man with widely metastatic small-cell tumor. The patient experienced disabling syncopal episodes in association with severe postural hypotension. Tests of cardiovascular autonomic insufficiency were abnormal. The introduction of fludrocortisone and the use of elastic stockings produced palliation of the symptomatology, but his condition deteriorated and he died. Autopsy demonstrated unexpectedly extensive tumor invasion of autonomic nervous tissue. Although cardiovascular autonomic insufficiency (CAI) has been described in association with malignancy and malnutrition, local tumor invasion of autonomic nervous tissue and radiation injury may have been other possible, albeit unusual, etiologic factors. This case illustrates the differential diagnosis of hypotension and CAI in patients with advanced metastatic malignancy and also emphasizes the need for autopsy studies when speculating as to the cause of CAI in this group of patients.

Aged↗