Articles: palliative-care.
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Although pain is always intense and unpleasant, the capacity to experience this sensation is, under normal circumstances, fundamental to the preservation of bodily integrity. Clinically, however, after injury to peripheral tissue or directly to the nervous system, spontaneous and evoked pain manifest that serve no physiologic function, are crippling to patients, and are difficult to treat. ⋯ This spinal neuronal plasticity is shown to be a key contributor to pathologic pain hypersensitivity. The potential for the molecular mechanisms responsible for the spinal plasticity in revealing new targets for future treatment is also discussed.
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Palliative radiotherapy constitutes nearly 50% of the workload in radiotherapy. Surveys on the patterns of practice in radiotherapy have been published from North America and Europe. Our objective was to determine the current pattern of practice of radiation oncologists in Canada for the palliation of bone metastases. ⋯ Local field external radiotherapy remains the mainstay of therapy, and the most common fractionation for bone metastases in Canada is 20 Gy in five fractions compared with 30 Gy in ten fractions in the US. Despite randomized trials showing similar results for single compared with fractionated radiotherapy, the majority of us still advocate five fractions. The frequency of employing a single fractionation has not changed since the last national survey in 1992. Nearly 70% use a standard dose fractionation to palliate localized painful metastasis by radiotherapy, independent of the site of involvement or tumor type. The pattern of practice of palliative radiotherapy for bone metastases in Canada is different to that reported previously from the US. The reasons why the results of randomized studies on bone metastases have no impact on the patterns of practice are worth exploring.
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Am J Hosp Palliat Care · Sep 2000
Comparative StudyUse of continuous ambulatory infusions of concentrated subcutaneous (s.q.) hydromorphone versus intravenous (i.v.) morphine: cost implications for palliative care.
Health care practitioners are increasingly under pressure to curtail spending while trying to deliver excellent patient care. These issues are also affecting palliative care, particularly now that palliative care programs are expanding. A comparison of cost-effectiveness and feasibility of using continuous subcutaneous (s.q.) ambulatory infusion of hydromorphone versus intravenous (i.v.) ambulatory morphine is illustrated in this study. ⋯ Cost comparisons of supplies and associated costs with subcutaneous versus intravenous solutions were obtained. Hydromorphone was found to be stable for 28 days in both dilutants. Cost analysis of a hydromorphone 28-day supply resulted in substantial savings over the equivalent costs of morphine infusions.
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Nuklearmed Nucl Med · Sep 2000
Comparative Study Clinical Trial Controlled Clinical Trial[Comparison of rhenium-188, rhenium-186-HEDP and strontium-89 in palliation of painful bone metastases].
Several radiopharmaceuticals were compared previously with regard to the efficiency in pain palliation of bone metastases. Furthermore, first results were reported on the suitability for such kind of therapy of the generator produced radionuclide rhenium-188. ⋯ All tried radiopharmaceuticals were effective in pain palliation. The various radionuclides had no significant difference in the pain relief or the bone marrow impairment. If only the Karnofsky-Index after Re-188 HEDP seems to be a little more increase.
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With the sponsorship of the Spanish Society of Palliative Care (SECPAL), two nation-wide studies from the University of Valladolid were carried out in 1996 and 1998 into the state of palliative care teams in Spain. This report is based on those studies and is the first overall analysis of the current situation of palliative care in Spain. A total of 143 programmes were identified and data were collected from 128 teams (89%): 53 were programmes with hospitalised patients, 75 for home-based patients and 15 were mixed programmes. ⋯ Of the patients who die from cancer each year in our country, 21.2% receive palliative care during the final weeks of life. More than 10 years have passed since the first teams in Spain started their work. The time has now come to recognize the reality of palliative care in our society and to adopt a national policy for terminally ill patients, in line with World Health Organization recommendations formulated in 1989.