Optimal treatment of opioid induced constipation in daily clinical practice - an observational study.

Background: Opioids are prescribed in over 40% of patients with advanced cancer, but side effects occur frequently. In this study we evaluated the development and treatment of opioid induced constipation (OIC), and OIC resolving effect of methylnaltrexone for different opioid subtypes in daily clinical practice.

Methods: Patients with cancer using opioids were included in a retrospective chart analysis.

[Palliative sedation in the acute setting].

If a patient receiving palliative care suffers from an acute complication of an underlying disease and death is expected within minutes to hours, acute sedation may be necessary to alleviate intolerable refractory symptoms. Current guidelines do not provide sufficient information regarding the management of acute palliative sedation. Here, we describe the cases of three patients to stress the importance of anticipation for palliative sedation in the acute setting, a stepwise treatment approach and intensive counselling.

The use of opioids at the end of life: the knowledge level of Dutch physicians as a potential barrier to effective pain management.

Background: Pain is still one of the most frequently occurring symptoms at the end of life, although it can be treated satisfactorily in most cases if the physician has adequate knowledge. In the Netherlands, almost 60% of the patients with non-acute illnesses die at home where end of life care is coordinated by the general practitioner (GP); about 30% die in hospitals (cared for by clinical specialists), and about 10% in nursing homes (cared for by elderly care physicians).The research question of this study is: what is the level of knowledge of Dutch physicians concerning pain management and the use of opioids at the end of life?

Methods: A written questionnaire was sent to a random sample of physicians of specialties most often involved in end of life care in the Netherlands.

The use of opioids at the end of life: knowledge level of pharmacists and cooperation with physicians.

Purpose: What is the level of knowledge of pharmacists concerning pain management and the use of opioids at the end of life, and how do they cooperate with physicians?

Methods: A written questionnaire was sent to a sample of community and hospital pharmacists in the Netherlands. The questionnaire was completed by 182 pharmacists (response rate 45%).

Results: Pharmacists were aware of the most basic knowledge about opioids.