RESUMO
Unscheduled acute hospital admissions and subsequent deaths in hospitals of patients considered palliative are increasing, despite many patients' preference to die at home. A large proportion of these patients are admitted via acute medical units or emergency departments. The integration of primary and secondary care within Wales should enhance the delivery of end-of-life care at home but unscheduled admission for patients with palliative care needs remains prevalent. The aim of our study was to explore the characteristics amongst patients who die shortly after unscheduled hospital admission. A retrospective, observational study was conducted in all unscheduled admissions at end-of-life at a single health board in South Wales, UK over a period of one month. The result showed that 47% of patients who died within 48hrs of unscheduled admission are considered to be palliative. The majority of these patients were admitted via 999 ambulances and out of normal working hours (65%). They were elderly (median age 80) and had a poor performance status (78%). Over 1/3 (39%) were admitted from a nursing or residential home. Less than a quarter (22%) had an advance care plan in place.
Assuntos
Planejamento Antecipado de Cuidados/normas , Serviços Médicos de Emergência , Mau Uso de Serviços de Saúde , Hospitalização/estatística & dados numéricos , Assistência Terminal , Doente Terminal , Idoso , Idoso de 80 Anos ou mais , Serviços Médicos de Emergência/métodos , Serviços Médicos de Emergência/normas , Feminino , Mau Uso de Serviços de Saúde/prevenção & controle , Mau Uso de Serviços de Saúde/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Humanos , Masculino , Cuidados Paliativos/métodos , Cuidados Paliativos/organização & administração , Estudos Retrospectivos , Assistência Terminal/métodos , Assistência Terminal/organização & administração , Doente Terminal/classificação , Doente Terminal/estatística & dados numéricos , País de Gales/epidemiologiaRESUMO
Hypertrophic osteoarthropathy (HOA) is a syndrome most commonly associated with non-small cell lung cancer and consists of periostitis, digital clubbing and painful polyarthropathy. Its symptoms may be disabling and are reportedly difficult to manage effectively with conventional analgesia. We present a case of a lung cancer patient with opioid resistant painful HOA in whom analgesia was achieved with octreotide.
Assuntos
Adenocarcinoma/complicações , Antineoplásicos Hormonais/uso terapêutico , Carcinoma Pulmonar de Células não Pequenas/complicações , Neoplasias Pulmonares/complicações , Octreotida/uso terapêutico , Osteoartropatia Hipertrófica Secundária/tratamento farmacológico , Dor/tratamento farmacológico , Idoso , Humanos , Masculino , Osteoartropatia Hipertrófica Secundária/etiologia , Dor/etiologiaRESUMO
The association between venous thromboembolism and cancer has been recognized for over 140 years. This article reviews current prevention, diagnosis and treatment of cancer-related venous thromboembolism, and highlights emerging anticoagulants and the possible anticancer effects of anticoagulants such as low molecular weight heparins.
