Pain management: lessons from palliative care.

Reducing suffering and helping patients to control their symptoms are key components of palliative care. This commentary will offer a comprehensive definition of palliative care and will present a case history to illustrate how palliative care can benefit patients with chronic pain.

Management of hydrops amnion in a mare resulting in birth of a live foal.

CASE DESCRIPTION: A 19-year-old Thoroughbred mare was evaluated at 265 days of gestation with a markedly distended abdomen and edema of the ventral portion of the abdomen. CLINICAL FINDINGS: The uterus was distended over the pelvic rim, making transrectal palpation of the fetus impossible. Transabdominal ultrasonography revealed excessive amounts of fetal fluid. Results of analysis of fluid obtained via amnio- and allantocentesis confirmed that the amniotic cavity was large. TREATMENT AND OUTCOME: The mare was monitored for signs of weakness of the prepubic tendon and abdominal wall. The fetus and placenta were monitored for signs of stress and pending abortion. Flunixin meglumine and altrenogest were administered to the mare. Parturition was attended and occurred at 321 days' gestation. Postpartum complications in the mare included hypovolemic shock and cardiac arrhythmias. Both conditions were treated, and the mare recovered. The foal was considered small, had bilateral angular limb deformities, and was unable to nurse. The foal was given plasma for failure of passive transfer of immunity. Ten months later, the foal underwent procedures to correct limb deformities. CONCLUSIONS AND CLINICAL RELEVANCE: Hydrops conditions are rare in horses, with hydrops allantois occurring more frequently than hydrops amnion; reportedly result in fetal or neonatal death; and may result in death of or injury to the mare. Close monitoring of maternal and fetal health in combination with supportive treatment of the mare can result in the safe progression of a hydrops pregnancy and the birth of a live foal.

Bringing faculty development to community-based preceptors.

Community-based education of health profession students has increased dramatically, yet providing faculty development to a large, dispersed, and diverse population of community-based faculty is challenging. The authors describe lessons learned from 1997 to 2000 in developing, using, and disseminating a collection of preceptor development materials designed to be relevant to community-based faculty and easy to use. These activities were carried out by the Preceptor Development Program, which was developed by the Mountain Area Health Education Center of Asheville, North Carolina, which works with over 500 community preceptors of health profession students and medical residents. The program includes materials on nine core faculty development topics in a variety of formats: seminars, monographs, Web modules, and one-page summary "thumbnails." Faculty developers can download these free, customizable materials from the Web and are encouraged to adapt them for their own use.