The article deals with an analysis of availability of narcotic analgesics for the patients in the Russian Federation. The analysis was based on datafrom official sources on the scopes of opioids delivery in different regions of the Russian Federation and showed an extremely limited availability of narcotic analgesics for the patients in the Russian Federation. We found that availability of narcotic analgesics in Russia is hundreds times lower than the same indexes in European countries with various level of economic activity and in the USA. The analysis showed ten most progressive Russian regions where the use of opioids in the noninvasive forms has become part of systematic clinical practice according to WHO recommendations as well as 10 ten most backward regions where these drugs are hardly used despite of high figures of case death rates from cancer. We made a list of most needed modern Russian and internationally produced drugs according to international data and personal experience. Drugs from this list can be effectually used for the chronic pain therapy in oncology. The most advanced drugs that are soon will be produced are also named. The article describes high priority measures that have already been done to improve current situation and measures to be executed in the future.
Opportunities for cancer prevention in adolescents range from limitation of sun exposure to the use of human papillomavirus vaccines. Those who develop malignant disease experience longer waiting times for diagnosis and treatment than do children, especially when referred to adult treatment centers, and they are less frequently enrolled in clinical trials. More attention to developmentally appropriate psychological support, enhancement of compliance/adherence, health promotion, and palliative care is needed. Improving cancer surveillance and control in adolescents in North America will require co-ordinated national efforts, involving pediatric and adult health care providers, institutions, and multiple levels of government.
Do-not-resuscitate (DNR) orders allow home care clients to communicate their own wishes over medical treatment decisions, helping to preserve their dignity and autonomy. To date, little is known about DNR orders in palliative home care. Basic research to identify rates of completion and determinants of DNR orders has yet to be examined in palliative home care.
The purpose of this exploratory study was to determine who in palliative home care has a DNR order as part of their advance directive.
Information on health was collected using the interRAI instrument for palliative care (interRAI PC). The sample included 470 home care clients from one community care access centre in Ontario.
This study indicated that a preference to die at home (odds ratio [OR]: 8.29, confidence interval [CI]: 4.55-15.11); close proximity to death (OR: 0.99, CI: 0.99-1.00); daily incontinence (OR: 2.74, CI: 1.05-7.16); and sleep problems (OR: 1.85, CI: 1.02-3.37) are associated with DNR orders. In addition, clients who are more accepting of their situation are 5.67 times (CI: 1.67-19.27) more likely to have a DNR in place.
This study represents an important first step to identifying issues related to DNR orders. In addition to proximity to death, incontinence, and sleep problems, acceptance of one's own situation and a preference to die at home are important determinants of DNR completion. The results imply that these discussions might often depend not only on the health of the clients but also on the clients' acceptance of their current situation and where they wish to die.
In order to be able to discuss the issue of whether or not terminal sedation is, or may be conceived of as, a form of help in dying, one needs to be very clear as to the meaning of the terms "help in dying" and "terminal sedation". In this article, we suggest what we take to be detailed and precise definitions of the two forms of voluntary help in dying--euthanasia and physician-assisted suicide. Our definitions (interpretations) basically draw on the Dutch experience and understanding. The Dutch approach implies that acts of abstention, i.e., withholding and withdrawing treatment, and pain and symptom treatment with possible life-shortening effect, including terminal sedation, are to be considered "normal medical practice". Furthermore, death is seen by almost all parties as having natural causes in all of these acts. We also suggest that "palliative sedation" should substitute the expression "terminal sedation". Furthermore, we discuss on what grounds this treatment strategy may be induced, including a presentation of criteria and guidelines that must be met; the issue of documentation of the strategy; palliative sedation in the light of the ethical principle of double effect; and in what way euthanasia could be concealed as palliative sedation. In closing, we comment briefly on the phenomenon of large differences between published cohorts with regard to the frequency of use of palliative sedation. This treatment strategy is open to be challenged both clinically and ethically, and all parties would benefit from a continuous debate over the legitimacy of, and the clinical need for, palliative sedation.
As debate about the legalization of marijuana continues in Canada, physicians are joining the fray. Ottawa family physician Don Kilby is working hard to make it easier for ill patients to use the marijuana that alleviates their symptoms. A recent case in Toronto indicates that the courts are starting to share these views.
Comment In: CMAJ. 1998 May 19;158(10):1265-69614813