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Biomedical subjects

N I Cherny

Publications and source records attributed to N I Cherny.

At least 19 recordsLinked to original sources
PubMed2000

Cancer patient expectations of and communication with oncologists and oncology nurses: the experience of an integrated oncology and palliative care service.

The purpose of this study was to evaluate ambulatory cancer patients' knowledge of their diagnosis and stage, their expectations of medical and nursing staff, and issues related to communication with the professional staff. A structured interview was conducted with each of 103 consecutive cancer patients attending the Oncology Day Hospital of the Shaare Zedek Medical Center. There were 77 women and 26 men, and their median age was 56 (18-86) years. Their religious status was elicited: 48% described themselves as religious, 25% as traditional, and 27% as secular. According to their physicians, 41 were in remission, 11 had stable disease, 47 had progressive disease and in 4 the disease status was unknown. Patients tended to underestimate the status of their disease: among those with progressive disease, 36% stated that their disease was stable or in remission. Overwhelmingly, patients expected that their oncologists should be patient and skilled in diagnostic procedures (98%), tactful, considerate and therapeutically skilled (90-95%), and skilled in the management of pain and the psychosocial consequences of cancer (75-85%). When there is bad news to be transmitted, 92% of patients indicated that they would want disclosure, while 6% indicated that they would want the news withheld from them but passed on to their family members. Most patients were very satisfied with the clarity of the information they received about their disease (85%) and the sensitivity with which it was transmitted (90%). Although 88% of patients reported that they relied on their oncologist for therapeutic decision making, 45% indicated that they had sought a second opinion and 32% reported seeking the opinion of a rabbinical medical broker. Almost all, 97%, of patients indicated that they felt comfortable seeking advice from their oncologist, and the oncologist was the staff member most often sought out for both information (69%) and support (66%). The data indicate high patient expectations of nursing and medical oncology staff members' skills and behaviors. Despite expressing a high level of satisfaction, a substantial percentage of patients had an inaccurate understanding of their disease status.

Adult↗
PubMed2000

Diagnostic investigations in cancer pain.

Defining the specific cause of pain in patients with cancer often has substantial therapeutic and prognostic implications. This process often requires the use of specific diagnostic investigations. Here we critically review the diagnostic investigations used in the evaluation of common pain problems in patients with cancer. Familiarity with this information facilitates the development of efficient and rational diagnostic strategies.

Back Pain↗
PubMed1999

Cancer pain: knowledge and attitudes of physicians in Israel.

The effectiveness of cancer pain therapy is influenced by the attitudes and knowledge of the treating physicians. As part of a quality improvement project in the management of cancer pain, a survey of 236 medical practitioners was conducted. One hundred seventy-six respondents (74.5%) completed the survey. Fifty-two percent treated patients with cancer pain several times a week or more. Whereas 57.7% of physicians stated that 76-100% of patients could achieve a satisfactory outcome from analgesic therapy, only 17.2% of respondents reported that > 75% actually achieve a satisfactory outcome in their own experience. Unsatisfactory outcome was ascribed to inadequate pain relief (59.7%), or excessive central nervous system (CNS) side effects (43.3%). According to the responding physicians, the major barriers to effective relief include inadequate assessment of the pain and pain relief (65.3%), inadequate knowledge of pain therapy (57.9%), and physician reluctance to prescribe opioids (49.1%). Questions evaluating physician knowledge identified widely prevalent knowledge deficits in pain physiology, risk of addiction, use of adjuvant analgesics, opioid dosing, and treatment of side effects. Specialists in oncology tended to evaluate their knowledge more highly than others (P < 0.05). Despite this, there was no significant knowledge difference between oncologists and noncancer specialists. The data highlight some of the barriers to the successful management of cancer pain in Israel, the prevalence of knowledge deficits, and the common disparity between clinicians' self-assessment of clinical competence and their ability to respond correctly to questions on the management of cancer pain.

Adult↗
PubMed1996

Palliative medicine and the medical oncologist. Defining the purview of care.

The fusion of palliative medicine and medical oncology, in practice and in education, can provide a better standard of patient care, reduce the risk of oncologist burnout, and increase the likelihood of patient family and physician satisfaction. There need be no gulf between these disciplines, and only together do they represent truly comprehensive cancer care. The realization of this fusion will require the participation of individual clinicians, program directors, and the policy makers for cancer centers, professional organizations, and the health care regulatory authorities. It is a logical next step in the evolution of medical oncology.

Hospice Care↗
PubMed1996

Invasive techniques in the management of cancer pain.

Familiarity with potentially useful anesthetic and neurosurgical techniques is important in the management of patients who are unable to achieve a satisfactory balance between analgesia and side effects from systemic analgesic therapies. The ability to make specific recommendations is limited by the paucity of controlled data, incorporating details of pain syndromes, prior therapies, validated pain assessment, meticulous reporting of adverse effects, and longitudinal follow-up.

Analgesia, Epidural↗
PubMed1996

Guidelines in the care of the dying cancer patient.

The care of patients in the final stages of cancer requires a high level of clinical vigilance and skill to ensure that the passage from life to death is as free from suffering as possible. Patients who are dying have a right to adequate relief of physical and psychological symptoms, and they and their families have a right to adequate support. The care of patients and their families requires (1) interdisciplinary cooperation of a healthcare team incorporating physicians, nurses, social workers, and other auxiliary supports, and (2) a high level of clinical flexibility to address the evolving needs of the patient and family. Participation in this process challenges the clinician's emotional resources and medical skills. There is, however, the potential for professional satisfaction in helping to orchestrate a "good death," because the relief of suffering is at the very heart of medicine. Familiarity with guidelines in the care of the dying can reduce the potential for distress in this important clinical endeavor.

Adaptation, Psychological↗
PubMed1996

The problem of inadequately relieved suffering.

A request for euthanasia or assistance in suicide usually derives from severe patient distress and indicates significant suffering. Although the Hippocratic purview of medicine requires that suffering be acknowledged, its causes be identified, and that steps be taken to provide adequate relief, an appreciation of the diversity of factors that may contribute to suffering underscores the need for methodical assessment and familiarity with a range of therapeutic strategies. It may be argued that when other options to effectively relieve suffering are available, euthanasia and assisted suicide fall outside of the purview of Hippocratic medicine. Given the existence of other options, the capacity for human maleficence, and the lack of resources currently allocated to the relief of suffering, this paper presents a number of reservations regarding the legalization of euthanasia and assisted suicide. In addition, it is suggested that the current community focus on the issue of inadequately relieved suffering should be harnessed to work toward the provision of care that would diminish the impression that elective death is necessary to ensure adequate relief.

Caregivers↗
PubMed1996

Opioid analgesics: comparative features and prescribing guidelines.

The term 'opioid' is a generic term for naturally occurring, semisynthetic and synthetic drugs which combine with opioid receptors to produce physiological effects and which are stereospecifically antagonised by naloxone. For clinical purposes, opioids can be classified according to their receptor interactions (agonist, partial agonist, agonist-antagonist and antagonist), the pain intensity for which they are conventionally used (moderate or severe), and their half-life (short or long). Pure agonists conventionally used for moderate pain, short and long half-life pure agonists conventionally used for severe pain, mixed agonist-antagonists and partial agonist opioids are described in detail. The effective clinical use of opioid drugs requires familiarity with drug selection, routes of administration, dosage guidelines and potential adverse effects. Opioids are unequivocally indicated in the management of severe acute pain and moderate to severe pain associated with cancer. There is increasing acceptance of the role of opioids in the management of recurring acute pain, chronic nonmalignant pain of organic origin and severe neuropathic pain. The selection of opioids is influenced by pain intensity, pharmacokinetic and formulary considerations, previous adverse effects and the presence of coexisting disease. Some patients will require sequential trials of several different opioids before a drug which is effective and well tolerated is identified. Opioid agents should be administered by the most comfortable and convenient route that meets the specific needs of the patient. The regimen for opioid medications should generally provide around-the-clock analgesia with provision for rescue doses for the management of exacerbations of the pain not covered by the regular dosage. At all times, uncontrolled pain should be addressed by gradual increase in the opioid dose until either pain control is achieved or intolerable and unmanageable adverse effects supervene. The management of pain with opioid analgesics demands frequent patient assessment and a readiness to re-evaluate the therapeutic plan in the setting of either inadequate relief or adverse effects.

Analgesics, Opioid↗
PubMed1994

Opioid responsiveness of cancer pain syndromes caused by neuropathic or nociceptive mechanisms: a combined analysis of controlled, single-dose studies.

We performed a combined analysis of the results from four controlled single-dose relative-potency studies to assess the impact of inferred pain mechanism on the response to an opioid drug. A total of 168 patients received 474 administrations of either morphine or heroin, and we assessed the analgesic response during a 6-hour period with visual analog scales. We summarized this as a total pain relief (TOTPAR) score. Two experienced pain clinicians reviewed information about pain characteristics and designated each case according to the inferred pain mechanism (neuropathic, nociceptive, or mixed) and the degree of confidence in the inferred mechanism (definite versus probable/possible). They grouped the cases as follows: nociceptive pain only (n = 205), neuropathic pain only (n = 49), and mixed (n = 220). We compared pain relief achieved by patients with different mechanisms, with TOTPAR adjusted for significant covariates (duration of prior opioid administration, doses of opioid administered in the previous 48 hours, pain intensity at the start of the study, BUN:creatinine ratio, and dose of administered opioid). The adjusted mean TOTPAR score of the group with any neuropathic pain was significantly lower than that of the group with nociceptive pain only (26.1 versus 20.4, p = 0.02). The score of the group with definite nociceptive pain alone (adjusted mean TOTPAR = 28.0) was significantly higher than scores of the groups with possible/probable nociceptive pain (TOTPAR = 19.9), mixed mechanisms (TOTPAR = 20.2), definite neuropathic pain alone (TOTPAR = 20.6), and possible/probable neuropathic pain alone (TOTPAR = 22.9).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗