Biomedical subjects

P B Bascom

Publications and source records attributed to P B Bascom.

6 recordsLinked to original sources

PubMed2001

Pulmonary medicine and palliative care.

Gynaecological malignancies affect the respiratory system both directly and indirectly. Malignant pleural effusion is a poor prognostic factor: management options include repeated thoracentesis, chemical pleurodesis, symptomatic relief of dyspnoea with oxygen and morphine, and external drainage. Parenchymal metastases are typically multifocal and respond to chemotherapy, with a limited role for pulmonary metastatectomy. Pulmonary tumour embolism is frequently associated with lymphangitic carcinomatosis, and is most common in choriocarcinoma. Thromboembolic disease, associated with the hypercoagulable state of cancer, is treated with anticoagulation. Inferior vena cava filter placement is indicated when anticoagulation cannot be given, or when emboli recur despite adequate anticoagulation. Palliative care has a major role for respiratory symptoms of gynaecological malignancies. Treatable causes of dyspnoea include bronchospasm, fluid overload and retained secretions. Opiates are effective at relieving dyspnoea associated with effusions, metatases, and lymphangitic tumour spread. Non-pharmacological therapies include energy conservation, home redesign, and dyspnoea relief strategies, including pursed lip breathing, relaxation, oxygen, circulation of air with a fan, and attention to spiritual suffering. Identification and treatment of gastroesophageal reflux, sinusitis, and asthma can improve many patients' coughs. Chest wall pain responds to local radiotherapy, nerve blocks or systemic analgesia. Case examples illustrate ways to address quality of life issues.

Aged↗

PubMed1996

Caring for the terminally Ill.

More than 50% of dying patients do not receive adequate symptomatic relief. Fear of hastening death is the primary reason for physicians' reluctance to prescribe high-dose pain medication. Yet the ethical principle of "double effect" clearly states that palliative care which results in respiratory depression is justified-as long as the goal of management is relief of suffering, rather than death.

Algorithms↗

PubMed1995

Care of the family when the patient is dying.

Families shoulder many burdens during terminal illness. Their needs grow and change as their loved one's illness progresses. We describe specific physician behaviors that can assist families in coping with terminal illness. Early in serious illness, there are the emotional burdens of learning of the illness and coming to accept a terminal diagnosis, of giving up hope of cure. As terminal illness progresses, patients often need family members to help refocus hope despite the inevitability of death. Patients and families need support, guidance, and encouragement to begin planning for many decisions. Although emotional burdens are felt by most family members, families who choose to have their loved one die at home take on enormous direct caregiving burdens as well. They need information and supplies, including specific teaching of caregiving skills and logistic support. After the death of the loved one, family members have bereavement needs that require ongoing support.

Caregivers↗

PubMed1991

Case report: hepatic hydrothorax without ascites.

Pleural effusion due to hepatic cirrhosis and ascites is well known. We describe three patients with right-sided hepatic hydrothorax in the absence of ascites. The formation of pleural fluid in these patients is probably a result of fluid movement from peritoneal to pleural space across diaphragmatic defects before ascites can form. The differential diagnosis of a right-sided transudative pleural effusion in a patient with chronic liver disease with or without ascites includes congestive left ventricular failure and nephrotic syndrome. These diseases are usually ruled out with standard clinical tests. Patients with hepatic hydrothorax should be treated with fluid restriction and diuretics. Patients with severe symptoms due to refractory hepatic hydrothorax might benefit from pleural sclerosis and surgical closure of diaphragmatic defects.

Adult↗

PubMedDate not supplied

Communication between physicians and surviving spouses following patient deaths.

The authors evaluated the perceptions and adjustments of surviving spouses following patient deaths. Of 128 married patients dying in a university hospital in 1983, the surviving spouses of 105 (82%) were personally interviewed a year after the death. The physicians' perspectives were recorded through chart review. Half of all spouses had had no subsequent contact with the physicians who had cared for the decreased, and 55% of spouses still had unanswered questions regarding the death a year later. Survivors of unexpected deaths were found to be at high risk for poor subsequent adjustment. Spouses with poorer adjustments consulted their own physicians more frequently, and used more alcohol and tranquilizers. The results identify areas where improvement is needed in communication with surviving spouses after patients' deaths.

Adaptation, Psychological↗

PubMedDate not supplied

A hospital-based comfort care team: consultation for seriously ill and dying patients.

Access to hospice and palliative care services has been limited primarily to patients in the final stages of malignant terminal illness. Many have recognized the need to expand the scope of care to include other needy populations. This article describes the clinical activities of the Oregon Health Sciences University (OHSU) Comfort Care Team. This physician directed inter-disciplinary team provides consultation for any seriously ill patient with comfort care needs. There is no requirement that patients be in the final stages of a terminal illness, nor that they forego curative or life-prolonging treatments. The initial experience of this team supports the usefulness of a broader focus of care. The majority of patients referred for consultation would not have been served under a traditional palliative care model.

Consultants↗