RESUMO
Objectives: To establish the awareness of palliative medicine in Pakistani doctors through a questionnaire
Methods: A questionnaire was developed after consultation with the professionals working in palliative medicine. It was distributed, by hand, to a convenience sample of doctors who worked at various teaching hospitals in Pakistan. The distribution and collection of questionnaires was carried out within six months
Results: The results suggested that 74% doctors felt that cancer was the commonest reason for the palliative care teams to be involved. Forty five percent mentioned tht pain control was their prime job; 54% said that they had some experience of palliative medicine; 64% wanted to be involved in palliative medicine; 60% thought that they broke bad news properly to the patients; 59% were satisfied with their own performance while dealing with an incurable patient [57% said that they had heard about a hospice]. There was a wide range of drugs for the cancer pain
Conclusion: Amongst Pakistani doctors, there is a lack of training in palliative medicine. A significant number of doctors are interested and they are willing to have more training in pain control, breaking bad news, communication skills and terminal care
RESUMO
To determine the value of Helicobacter pylori [Hp] serology in diagnosis of active Hp infection in patients with documented duodenal ulcer [DU] and to directly compare the efficacy and side-effects profiles of metronidazole or tinidazole in a triple therapy regimen to eradicate active Hp infection. Prospective, single-blinded, randomised trial. One hundred patients from General Practice with documented DU and Hp seropositivity had a C14 Urea Breath Test [UBT]. Those who tested positive were randomised to receive one-week, twice daily omeprazole 20 mgs and clarithromycin 250 mgs in combination with metronidazole 400 mgs [OCM] or tinidazole 500 mgs [OCT]. Eradication was confirmed by a repeat UBT. Eighty five sero-positive patients had a positive pre-treatment UBT. On intention to treat basis, OCT [100%] had a significantly better eradication rate than OCM [87.8%], p = 0.023. There was no difference in side effects. [1] Positive Hp serology in patients with DU does not always mean active infection and [2] for patients in the community with active Hp and DU disease OCT is significantly better than OCM for eradicating Hp
Assuntos
Humanos , Masculino , Feminino , Infecções por Helicobacter/diagnóstico , Infecções por Helicobacter/tratamento farmacológico , Úlcera Duodenal/tratamento farmacológico , Úlcera Duodenal/diagnóstico , Metronidazol , Quimioterapia Combinada , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
Eradication of Helicobacter pylori [Hp] will cure most Hp positive duodenal ulcers [DU]. However, after such treatment, patients often continue to get dyspeptic symptoms. The effects of Hp eradication in patients with proven DU on gastro-oesophageal reflux disease [GORD] symptoms are controversial. Aims: To study any changes in patient's symptoms following eradication of Hp in the setting of chronic DU and its effects on the need for continuing treatment for acid suppression. Eighty out of 85 patients [94%] from general practice with documented successfully eradicated Hp with a week long triple therapy regimen. Their symptoms and requirement for acid suppression treatment were studied at enrolment and after successful eradication of Hp for a median of 17 months. Eighty one% patients had improvement in ulcer-type symptoms. 21% developed new GORD symptoms. 68% discontinued long-term acid-suppression treatment. 79% requiring continued acid suppression therapy had new or continued GORD symptoms. Patients in the community with Hp positive DU disease after eradication, 81% patients got symptomatic improvement, two third discontinued their acid suppressing therapy but 21% developed new GORD symptoms. Among those who required continued acid suppression, 79% had GORD symptoms