The Edmonton Symptom Assessment System (ESAS): a simple method for the assessment of palliative care patients.

We describe a simple method for the assessment of symptoms twice a day in patients admitted to a palliative care unit. Eight visual analog scales (VAS) 0-100 mm are completed either by the patient alone, by the patient with nurse's assistance, or by the nurses or relatives at 10:00 and 18:00 hours, in order to indicate the levels of pain, activity, nausea, depression, anxiety, drowsiness, appetite, and sensation of well-being. The information is then transferred to a graph that contains the assessments of up to 21 days on each page.

Decreased local toxicity with subcutaneous diamorphine (heroin): a preliminary report.

We report the cases of 5 patients who developed severe local toxicity during the subcutaneous administration of morphine sulphate and hydromorphone hydrochloride. All patients required site changes more frequently than once every 24 h due to redness, swelling, or pain while receiving morphine or hydromorphone. All patients showed prolongation in the duration of sites of infusion once an equianalgesic dose of diamorphine hydrochloride (heroin) was started.

A controlled trial of megestrol acetate on appetite, caloric intake, nutritional status, and other symptoms in patients with advanced cancer.

This double-blind, cross-over trial was designed to assess the effects of megestrol acetate (MA) on cancer-induced cachexia. Forty consecutive malnourished patients with advanced non-hormone-responsive tumors receiving no antineoplastic treatment were randomized to receive MA 480 mg/day versus placebo for 7 days. During day 8, a cross-over was made until day 15.

A 3-month evaluation of the efficacy of nedocromil sodium in asthma: a randomized, double-blind, placebo-controlled trial of nedocromil sodium conducted by a Canadian multicenter study group.

Nedocromil sodium is a pyranoquinoline dicarboxylic acid derivative, formulated in a metered-dose inhaler. Because nedocromil sodium has in vitro and in vivo anti-inflammatory properties, it was evaluated in a group of steroid-dependent patients with asthma to observe how well it might be tolerated and for evidence of any beneficial effects. In a double-blind, group-comparative study, 127 patients received nedocromil sodium and 61 received placebo, administered as two puffs of 2 mg, four times per day, for 12 weeks.

Social and demographic characteristics of patients admitted to a palliative care unit.

In this retrospective study we reviewed the charts of 169 consecutive admissions to the Palliative Care Unit, Edmonton General Hospital. Demographic and social characteristics of patients were assessed in order to determine the likelihood that the patients could be managed at home according to currently available services. The mean age of the population was 65 +/- 12 years, 97 (57%) were women, they had a variety of cancers with major prevalence of the most frequent adult tumors, and 72% of patients were coming from acute care hospitals.

Non-cardiogenic pulmonary edema after narcotic treatment for cancer pain.

During recent years, better awareness of the problem of cancer pain has resulted in the use of increased doses of narcotics. We report the cases of 3 patients who presented non-cardiogenic pulmonary edema while receiving large doses of narcotics for cancer pain. In all cases, pulmonary edema occurred after patients required large increases in the dose of narcotic over a short period of time for rapidly progressing pain.

The cognitive effects of the administration of narcotic analgesics in patients with cancer pain.

Forty patients with cancer pain receiving intermittent narcotics were admitted to a prospective study designed to assess the cognitive effects of narcotics. Twenty patients had undergone no change in narcotic dose or type greater than or equal to 7 days (stable dose, SD, group), and 20 patients had undergone an increase of greater than or equal to 30% in dose less than or equal to 3 days before (increased dose, ID, group). Age, primary tumor, type, dose and route of narcotic were not different between the SD and ID group.

Continuing challenges in the management of cancer pain.

Four issues concerning the mechanisms of cancer pain are highlighted in this article. First is the need for a common language-a staging system-for assessing cancer pain. The author discusses the recently proposed Edmonton Staging System for Cancer Pain which classifies patients according to seven prognostic factors.

In vitro recovery of carbamazepine from ensure.

The in vitro recovery of three different dosage forms of carbamazepine (CBZ) when dispersed in gastric or intestinal fluids, in the presence or absence of Ensure was determined. An equivalent of 1 mg of pure CBZ from Tegretol 200 mg of conventional tablets, chewtablets of Tegretol 200-mg and Apo-carbamazepine (200-mg tablets) were dispersed in five dissolution mediums (0.5 ml of Ensure; 0.

Remodelling in slipped capital femoral epiphysis.

In-situ pinning of a slipped capital femoral epiphysis is the most common form of treatment for this problem. To find out if remodelling of the upper femur after pinning occurs often enough to justify this form of treatment and whether secondary osteotomies are required for residual deformity, 82 patients with slipped capital femoral epiphyses were reviewed. X-ray films were studied sequentially, noting remodelling changes in the femoral head and neck.