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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We conducted a survey among two random samples of Dutch doctors in order to determine whether they acted prudently with regard to euthanasia and assisted suicide. The doctors completed an anonymous questionnaire and those who at one time or another had applied euthanasia or assisted suicide (52%) were asked about several aspects of the requirements for prudent practice. 'Pointless suffering' was the most important and most common reason for requesting euthanasia or assisted suicide; 'pain' was rarely the most important reason. In 7% of the cases alternative forms of treatment were still available; these were hardly ever therapeutic. A total of 12% of the doctors had applied euthanasia or assisted suicide without having had any kind of consultation or discussion with a colleague, a nurse or any other health care professional; 26% had not issued a certificate testifying to death from natural causes. We conclude that some of the family doctors do not observe the procedural requirements, but that the majority satisfies the material requirements for prudent practice.
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PMID:Euthanasia and assisted suicide. II. Do Dutch family doctors act prudently? 150 98

Zoladex plus flutamide significantly delays the time to progression (subjective, objective, first progression) compared with orchiectomy, but no difference in survival (death from all causes or from malignant disease) could be detected. Thus, a delay in the appearance of progression has not improved survival. In fact, the duration of survival after progression tends to be shorter on Zoladex plus flutamide. There is thus no evidence to suggest any survival benefit with Zoladex plus flutamide. The quality control of our data revealed acknowledged problems in defining responses in patients with advanced prostate cancer. The review of the Bone Scan Committee provided the data for Tables 5 to 7. These data must provoke some reflections and emphasize once again the heterogeneity of the studied patient population. Table 4 on pain response after 4 weeks is just one of the many items to be analyzed by the committees for response criteria and quality of life. We expect that the other trials face similar problems. More work and patience are needed to obtain a firm answer to this clinical problem. These efforts will never be wasted, however, because the combined results of these trials will increase our knowledge of the treated history of prostate cancer and will, we hope, indicate a net treatment benefit in some subsets of patients. An individually tailored treatment for each patient selected from the anonymous mass of cases of advanced prostate cancer would be the highest reward of our continued collaboration with all the study groups.
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PMID:Total androgen ablation: European experience. The EORTC GU Group. 182 44

In order to assess the suffering of patients who died at home and with whom family doctors participated in euthanasia or assisted suicide, an exploratory, descriptive, retrospective study was carried out regarding primarily the period 1986-1989. Data were collected via anonymous written inquiry among an at random sample of family doctors in North Holland (n = 521), and family doctors in the rest of the Netherlands (n = 521). With reference to the last case of euthanasia or assisted suicide they had encountered questions were included about physical and emotional suffering, signs and symptoms and life expectation. Correlations and differences were analysed by means of the chi2-test. The response to the inquiry was 67% (non-responders did not otherwise differ from responders): 228 (North Holland), 160 (rest of the Netherlands) cases could be analysed. Most patients suffered physically as well as emotionally. The most frequently mentioned aspect was 'general weakness or tiredness'. Also 'dependence or being in need of help', loss of dignity, humiliation' and 'pain' were often present to a (very) large extent. At the time the procedure was carried out the life expectation in almost two-thirds of the cases was less than 2 weeks; in 10% of the cases it was more than 3 months. For several reasons, this investigation reduces the possibilities of extrapolation. Further investigation is necessary to determine whether this picture of suffering is specific of this category of patients.
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PMID:[Euthanasia and assisted suicide by physicians in the home situation. 2. Suffering of the patients]. 192 91

In Bordeaux University (France), oncology teaching was individualized in 1972, and an optional oncology course devoted to general practice was created in 1980. To evaluate the adequacy of these two oncology classes for general practitioners and so to adapt our current teaching, we sent to each of 1,219 general practitioners (GP's) of Gironde (county of the southwest of France) an anonymous questionnaire about oncology teaching in prevention, screening and cancer detection, cancer management, and curriculum balance. We received 688 (56.4%) responses. GPs said that as undergraduates, they were insufficiently instructed about screening programs (65%), pain control (80%), palliative care (50%) and fundamental or biological data (greater than 55%). This situation, which showed signs of improvement from 1975 on, has improved even more since 1985. General practitioners, as well as undergraduates, are not yet adequately educated about cancer for general practice, so we have to adapt better our current teaching for undergraduates and those in continuing medical education.
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PMID:A survey in general practice about undergraduate cancer education: results from Gironde (France). 193 94

Vaux, a consultant in medical ethics, reflects on the issue of physician-administered euthanasia raised in JAMA's controversial article, "It's over, Debbie" (1988 Jan 8; 259(2): 272). He asks if the death of the young terminal cancer patient was really a case of morally acceptable double-effect euthanasia, resulting from the anonymous resident's use of morphine primarily to relieve her pain with death as an unfortunate side effect. Vaux argues that, while the cardinal purpose of medicine is "to save and sustain life and never intentionally to harm or kill," and while euthanasia must be proscribed in principle, "in exceptional cases it may be abided in deed."
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PMID:Debbie's dying: mercy killing and the good death. 334 90

Illinois family physicians were surveyed to determine the ethical problems they encounter in practice. Family physicians were compared with 2 other primary care groups--general internists and the rapidly disappearing general practitioners. All 1851 physicians on the continuing education mailing list of Southern Illinois University School of Medicine were mailed a questionnaire that elicited anonymous responses. Responses were received from 669 physicians. Respondents selected for the present study were the 131 physicians who identified their specialty as family practice, 53 general practitioners, and 65 general internists. On the average, general practitioners in the study were older (58 years) than the family physicians (50 years) and the general internists (48 years). Proportionately more family physicians and general practitioners than internists were in solo practice, with more general internists in group practice. Family physicians were most likely and internists least likely to provide contraceptive aids to a teenage patient who requests them with or without parental permission. If a woman requested abortion, the behavior of each group of physicians did not vary substantially whatever the age or marital status of the patient. Family physicians and general practitioners were similar in that their most typical response was to refer the patient to a clinic for the abortion. A substantially larger number of internists than family or general practitioners would choose to refer the patient to a colleague. Family physicians reported confronting problems related to reproduction more often than either the general practitioners or the general internists. These problems include abortion, artificial insemination, birth defects, contraception, genetic counseling, sexual issues in general, and sterilization. Family physicians and internists did not differ markedly as to how they deal with informed consent and professional etiquette problems, but both reported encountering them with more frequency than general practitioners. All 3 groups of physicians encountered with equally high frequency problems relating to pain control, telling patients the truth, confidentiality, controlling patients' behavior with medication, and peer review. Family physicians and general internists identified patients' rights as an issue they need to consider very often in their practice.
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PMID:Ethical decision making by family physicians. 668 47

One thousand two hundred women, aged 61, randomly selected from a defined geographical area in South Sweden, were interviewed by an anonymous questionnaire about their urogenital symptoms. Seventy-five percent co-operated, of whom 29.2% admitted to some degree of urinary incontinence and 48.8% some degree of lower genital tract disorder. Stress incontinence symptoms were reported by 11.8% of the women, urge incontinence by 7.9% and both types combined--"mixed" by 9.5%. Four percent of all women (18% of stress incontinence) experienced a loss sufficient to necessitate the wearing of a sanitary napkin or change of under clothing several times a day. Thirteen percent had repeated urinary tract infections. Itch, discharge and smarting pain was reported by 15%. Thirty-eight percent had vaginal dryness and dyspareunia. Only 4% of the women were undergoing estrogen therapy.
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PMID:Prevalence of genito-urinary symptoms in the late menopause. 673 Sep 43

This study of 35 orthopaedic nurses assessed attitudes to pain and its relief. Using an anonymous questionnaire, nurses gave their views on a range of issues from what patients' expectations of post-operative pain should be, to the use and effectiveness of pain assessment tools. The findings suggest that nurses require re-education in various aspects of pain and analgesia provision to ensure that patients do not feel pain unnecessarily and receive appropriate pain relief promptly. The study recommends that pain assessment tools are used by orthopaedic nurses and that further training is required in the pharmacology of analgesic agents.
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PMID:Perceptions of patients' pain: a study assessing nurses' attitudes. 749

An anonymous questionnaire was administered to students at two universities. The questionnaire contained the Social Context of Drinking Scales, the Sensation Seeking Scale, and measures of alcohol use intensity, frequency of alcohol-impaired driving, as well as frequency of riding with an impaired driver. The results revealed significant gender differences in the social context of drinking as well as sensation seeking. High intensity drinkers of each gender were more likely to drink in a context of Social Facilitation and score higher on the sensation seeking subscale--Disinhibition. High intensity men drinkers were more likely to drink in a context of Sex Seeking, whereas high intensity women drinkers tended to drink in a context of Emotional Pain. In general, the Social Context of Drinking Scales were superior to the Sensation Seeking Scales at being able to discriminate high from low intensity drinkers. The implications for targeted prevention programs on college campuses are discussed.
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PMID:Social context and sensation seeking: gender differences in college student drinking motivations. 759 51

This study assessed the health perceptions of self-reported violence victims in an urban minority population attending a walk-in clinic by using an anonymous, 1-week, cross-sectional survey. The Medical Outcome Study Short-Form (MOS SF-20) was used to assess functioning/well being, including the dimensions of physical functioning, role functioning, social functioning, mental health, health perceptions, and pain. Health perception main scores were calculated for each of the six health dimensions in the following four groups: patient-victims, patient-nonvictims, visitor-victims, and visitor-nonvictims. Odds ratios (OR) were calculated to assess the association of violence victimization and functioning/well-being. The mean scores of health status were consistently better among nonvictims for all of the six health concepts measured; patients who were victims showed lower mean scores than nonvictim patients. A similar pattern also was found in visitors' health status scores when victims were compared to nonvictims. The strongest association was found between violence victimization and mental health, and the least association was between the pain score and violence victimization. This study showed a substantial association between poor health and violence victimization in the patient population studied. Intervention is needed to prevent and decrease violence in order to minimize the impact of violence on the health of victims.
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PMID:Violence victims' perception of functioning and well-being: a survey from an urban public hospital walk-in clinic. 759 62


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