84 research outputs found
Evaluation and comparison of two prognostic scores and the physiciansâ estimate of survival in terminally ill patients
Day-to-day variations during clinical drug monitoring of morphine, morphine-3-glucuronide and morphine-6-glucuronide serum concentrations in cancer patients. A prospective observational study
BACKGROUND: The feasibility of drug monitoring of serum concentrations of morphine, morphine-6-glucuronide (M6G) and morphine-3-glucuronide (M3G) during chronic morphine therapy is not established. One important factor relevant to drug monitoring is to what extent morphine, M6G and M3G serum concentrations fluctuate during stable morphine treatment. METHODS: We included twenty-nine patients admitted to a palliative care unit receiving oral morphine (n = 19) or continuous subcutaneous (sc) morphine infusions (n = 10). Serum concentrations of morphine, M6G and M3G were obtained at the same time on four consecutive days. If readmitted, the patients were followed for another trial period. Day-to-day variations in serum concentrations and ratios were determined by estimating the percent coefficient of variation (CV = (mean/SD) Ă100). RESULTS: The patients' median morphine doses were 90 (range; 20â1460) mg/24 h and 135 (range; 30â440) mg/24 h during oral and sc administration, respectively. Intraindividual fluctuations of serum concentrations estimated by median coefficients of day-to-day variation were in the oral group for morphine 46%, for M6G 25% and for M3G 18%. The median coefficients of variation were lower in patients receiving continuous sc morphine infusions (morphine 10%, M6G 13%, M3G 9%). CONCLUSION: These findings indicate that serum concentrations of morphine and morphine metabolites fluctuate. The fluctuations found in our study are not explained by changes in morphine doses, administration of other drugs or by time for collection of blood samples. As expected the day-to-day variation was lower in patients receiving continuous sc morphine infusions compared with patients receiving oral morphine
Evidence for the use of Levomepromazine for symptom control in the palliative care setting: a systematic review
The characteristics of patients who discontinue their dying process â an observational study at a single university hospital centre
Design of, and enrollment in, the palliative care communication research initiative: a direct-observation cohort study
Peritoneal carcinomatosis, unilateral malignant pleural effusion with bilateral hydronephrosis post-radical gastrectomy in a signet-ring gastric cancer patient: a case report
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