ABC of Palliative Care by Marie Fallon, Geoffrey Hanks

By Marie Fallon, Geoffrey Hanks

This fresh variation of ABC of Palliative Care pulls jointly the main up to date info in this complicated, multidisciplinary sector in a pragmatic, trouble-free demeanour. absolutely up-to-date, it bargains with the very important social and mental points for palliative care of individuals with incurable illnesses together with caliber of existence, conversation and bereavement issues.

This authoritative, functional identify can be useful to the expanding numbers of medical professionals, senior and expert nurses, and all these well-being execs who take care of melanoma sufferers in the clinic, at domestic or in a hospice.

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Sample text

Progestogens (for example, megestrol acetate 480 mg a day or medroxyprogesterone acetate 1000 mg a day) can improve appetite in about 70% of patients and can also result in increased food intake and weight gain in a smaller proportion (about 20%) of patients. Such effects may in part be due to corticosteroid-like activity: improved wellbeing and reduced fatigue have been reported in trials with progestational agents. Sometimes early satiety will respond at least temporarily to the use of prokinetic agents (such as metoclopramide).

Early recognition and prophylactic measures are better than trying to reverse an advanced situation. Good clinical judgment is paramount to identify all reversible factors that may be contributing to the patient’s wasting syndrome. In particular, if nausea and vomiting can be controlled with regular antiemetics (or surgery if there is a defined mechanical obstruction), malabsorption treated with enzyme supplements, constipation treated with laxatives, pain well controlled with the minimum of sedation, and depression treated with antidepressants then this sets the background for optimal appetite and function of the gastrointestinal tract.

Complementary therapies may have a role—for instance, there is good evidence for the efficacy of acupuncture in the management of nausea. Antiemetics and other useful drugs Pharmacological management of nausea and vomiting includes the use of drugs to block the emetogenic reflex in the brain stem (antiemetics), drugs to promote peristalsis in the upper gastrointestinal tract (prokinetic agents), drugs to reduce the volume of gastrointestinal secretions (antisecretory agents), and adjuvant drugs—for example, corticosteroids.

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