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Biomedical subjects

P Strang

Publications and source records attributed to P Strang.

At least 19 recordsLinked to original sources
PubMed2001

Spiritual thoughts, coping and 'sense of coherence' in brain tumour patients and their spouses.

When a person is diagnosed with a life-threatening disease, existential questions are easily triggered. The aims of this study were to explore to what extent brain tumour patients and their next of kin were able to cope, understand and create meaning in their situation, to explore whether spirituality could be supportive and to analyse whether these concepts are related to Antonovsky's concept of sense of coherence. Using a purposive sampling technique, 20 patients and 16 of their next of kin took part in tape-recorded interviews. A content and context analysis was performed using a hermeneutic approach. We found that comprehensibility was to a large extent constructed by the patient's own thoughts and theories, despite an insecure situation. Manageability was achieved by active information-seeking strategies, by social support and by coping, including positive reinterpretation of the situation. Meaningfulness was central for quality of life and was created by close relations and faith, as well as by work. A crucial factor was whether the person had a 'fighting spirit' that motivated him or her to go on. As only three patients were believers, trust in God had generally been replaced by a belief and confidence in oneself, in science, in positive thinking and by closeness to nature. Sense of coherence as a concept can explain how exposed persons handle their situation. In its construction, sence of coherence integrates essential parts of the stress/coping model (comprehensibility, manageability) and of spirituality (meaning).

Adaptation, Psychological↗
PubMed2000

[Quality of life is the most important goal of nutritional support of the dying].

In early palliative stages effective nutrition can improve well-being. In late stages and in dying patients excessive amounts of proteins and lipids may induce nausea and vomiting, due to cachexia and subsequent changes in the metabolism. Excessive hydration may give rise to oedema and dyspnoea. In these late stages the patient rarely feels hungry or thirsty. The goal should therefore be to do good, not to harm and to respect the autonomy of the patient. Thus, the well-being of the patient should be in focus: to avoid hunger, thirst, nausea, vomiting, oedemas and dyspnoea. The consequences are that small amounts of carbohydrates and water often constitute the optimum for these patients.

Dietary Carbohydrates↗
PubMed2000

Qualitative research methods in palliative medicine and palliative oncology--an introduction.

Qualitative research methods can be used as a complement to quantitative methods in palliative research. Possible applications are 1) for the induction of hypotheses, 2) for the development of quality-of-life instruments, 3) for the exploration of complex phenomena and personal experiences, 4) for studying attitudes, 5) for the observation of interactions and 6) for validation of quantitative results. Depending on the context and the research question, different qualitative methods such as hermeneutics, phenomenology, grounded theory or phenomenography might be used. The assumptions, the main steps and the methods are briefly described, with some examples from palliative situations.

Humans↗
PubMed2000

Brain tumours in Sweden 1996: care and costs.

OBJECTIVES: Brain tumours cause considerable concern due to a high mortality and there are increasing efforts to provide adequate care, sometimes outside hospitals. Health care utilisation, direct costs of care, and the indirect social cost of morbidity and early mortality caused by brain tumours in Sweden in the year 1996 was analysed. METHODS: Quantification of ambulatory care, care in hospital, long term and palliative/terminal care, drug consumption, temporary as well as long term morbidity, and mortality from comprehensive national data sources. Direct costs were calculated using 1996 charges. Indirect costs were calculated by sex and age specific salaries. A sensitivity analysis considered the impact of alternative estimates of each item. RESULTS: Indirect costs were 75% of the total and were caused mainly by early mortality. Direct costs were predominantly for care in hospital, long term care, and home health care. Among direct costs, astrocytomas III-IV and meningiomas accounted for 42% and 30% respectively. CONCLUSIONS: The cost of illness from brain tumours reflects the characteristics of these malignancies. Despite their low incidence rate, the economic impact caused by high mortality among young persons is a predominant trait. Costs of acute hospital care and also long term care and home care are considerable.

Brain Neoplasms↗
PubMed2000

Death anxiety in brain tumour patients and their spouses.

When a person is diagnosed with a severe disease, it seems plausible that existential questions and death anxiety are easily intensified. The aims of this study were to explore whether this is the case, to what extent patients and their next of kin experience death anxiety, and how these experiences are expressed. Following a purposive sampling technique, 20 patients with brain tumours and 15 of their next of kin took part in interviews. A content and context analysis were performed using a hermeneutic approach, in order to identify and analyse main categories. Six main categories common to patients and their next of kin emerged during the process: (1) emotional reactions that could be related to death anxiety and included general anxiety, anguish, sadness, hope and despair; (2) existential fear, existential anxiety and existential pain; (3) contradictions; (4) trigger situations; (5) coping strategies related to death anxiety; and (6) new values for life. Besides these categories, a further category emerged, experiences characteristic of the next of kin. The study shows that both the patients and their next of kin are preoccupied with existential thoughts and death anxiety. The problems are easily overlooked as the death anxiety is not always expressed directly. Staff need to be more aware of these situations in order to provide existential support.

Adult↗
PubMed1999

[Midazolam (Dormicum) in terminal anxiety and agitation. The last choice alternative in palliative care].

Although midazolam has been proposed for the treatment of a variety of conditions such as anxiety, dyspnoea, hiccups and status epilepticus, terminal agitation is the only condition where its use is based on a reasonably large number of published clinical studies. A causal approach is generally recommended. Whenever possible, the aetiological condition (pain, fever, constipation, etc.) should be corrected. Such general measures as ensuring a peaceful, familiar environment, and the use of a night light, fluid therapy to counteract dehydration, and antipyretics for fever are beneficial. When symptomatic treatment is needed, drugs with little anticholinergic effect are to be recommended. The use of benzodiazepines as single drug treatment may exacerbate the condition. Haloperidol or risperidone (which has fewer side effects) are recommended. If the agitation is marked, a common strategy is to add lorazepam. Chlormethiazole is an alternative. Subcutaneous midazolam should be reserved for refractory cases. Attention should be paid to dosage, reduced doses being given to the elderly, patients on opioid medication, and patients with impaired liver or renal function. Overdosage may induce deep sedation, and result in carbon dioxide retention and subsequently heart failure and pulmonary oedema which may be fatal.

Anti-Anxiety Agents↗
PubMed1999

[Cancer-related pain requires targeted treatment. Analgesics are not the only therapeutic alternative].

Although analgetic treatment, based on modifications of the three-step approach recommended by the WHO, remains the cornerstone of cancer pain control, other treatment options are also needed to improve pain relief in severe cases. The article consists in a discussion of such treatment alternatives, a guiding principle being that, where causal treatment is possible, symptomatic effects are likely to be more manifest and more enduring than if treatment is confined to symptom management. The tumour biological basis of the analgesic or anti-inflammatory potential of steroids, palliative radiotherapy, bisphosphonates, and even such modalities as hormonal manipulation in metastatic prostate cancer, or chemotherapy are also discussed, as are calcitonin and stabilising orthopaedic measures.

Analgesics↗
PubMed1999

[Palliative medicine. A new research field with specific demands].

Palliative care is not merely a question of treating symptoms irrespective of cause, but is ideally based on proper analysis, treatment and evaluation. Education, quality assurance, clinical development and research are needed to improve palliative care. Education and research should be focussed on all four dimensions--the physical, the emotional, the social, and the existential. Research should be designed to address specific issues--for example, how anxiety and mood disturbances in (previously healthy) patients in palliative care differ from anxiety and depression in a psychiatric setting, in patients with a history of psychiatric problems. Efforts need to be made to link significant clinical problems and basic science. Not until we understand the underlying mechanisms (e.g., the involvement of cytokines in mediating cachexia), will it be possible to develop new treatment strategies for problematic symptoms.

Crisis Intervention↗