Randomized trial of postoperative patient-controlled analgesia vs intramuscular narcotics in frail elderly men

Article Abstract:

In elderly, frail patients, the use of narcotics injected into the muscle to relieve pain after an operation may be hazardous. Patient-controlled analgesia (PCA) is a new method of pain control in which the patient selects the amount of narcotic administered, within safe limits. PCA is thought to allow for better control over pain and to decrease the variability of blood levels of narcotics, compared with regular injections. The effectiveness of PCA has not been assessed in elderly or medically ill patients. The effectiveness of PCA with morphine sulfate was compared with that of intramuscular injections of morphine as needed to relieve pain in 83 elderly men after surgery. The patients had various medical diseases including: chronic lung disease in 57 percent; disease of the coronary arteries, the major blood vessels supplying the heart, in 43 percent; heart failure in 13 percent; and liver disease in 12 percent. Analgesia (relief of pain) was improved by PCA without an accompanying increase in sedation. Confusion after the surgery and severe lung complications developed more often in patients receiving intramuscular injections of morphine than in patients using PCA. Patients found that PCA was easier to use and provided more pain relief than intramuscular injections, and no problems developed with PCA use. In addition, the blood levels of morphine were less variable in patients using PCA. Thus, PCA was shown to be more effective than intramuscular injections for relieving pain in elderly men after surgery. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Pain, Narcotics, Analgesia

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The effect of prescribed daily dose frequency on patient medication compliance

Article Abstract:

Studies show that the inability of a patient to comply with, or adhere to, directions for taking medications interferes with the treatment of various illnesses. It was suggested that a decrease in the number of daily doses of medication may improve patient compliance. Consequently, medications that are effective when given only once or twice daily have been developed to improve patient compliance. The ability of such preparations to improve patient compliance has not been demonstrated. Hence the relationship between prescribed daily dose frequency for antihypertensive agents (drugs that lower blood pressure) and patient compliance was assessed. Compliance by the patients was measured using unique pill containers that electronically recorded the date and time of medication removal. In this group of 105 patients, compliance increased from 59.0 percent during a three-times-daily regimen to 83.6 percent with a once-a-day regimen. These findings show that compliance does improve with a decrease in the number of doses per day. Thus, to improve patient medication compliance, physicians may wish to select medications that need to be taken less frequently throughout the day rather than alternative medications that must be taken more often. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Drugs, Patient compliance, Drug administration and dosage

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Ethics consultations masking economic dilemmas in patient care

Article Abstract:

Three case studies are used to demonstrate how the ethical and economic aspects of treatment decisions are intertwined. A 49-year-old retarded man required short-term tube feeding. The family members of a 74- -year-old man with metastatic prostate cancer disagreed about whether or not he should have surgery. The health maintenance organization (HMO) of a patient with liver disease refused to pay for a liver transplant. It is suggested that ethics consultants can help to clarify these conflicts as they relate to financial limitations and financial conflicts of interest and that physicians must develop the ability to distinguish the economic issues in medical care.

Case studies, Ethical aspects, Medical care, Cost of, Health care costs, Medical ethics

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