Articles: palliative-care.
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J Pain Symptom Manage · Feb 1999
ReviewFor every numerator, you need a denominator: a simple statement but key to measuring the quality of care of the "dying".
A mathematical rate is composed of a numerator, denominator, and time period of observation. Deciding who is in the denominator is a key, yet difficult task given the blurred boundaries of chronic illness, in examining the quality of care for dying patients. ⋯ Second, retrospective interviews could be used with family members or other loved ones about their perceptions of the quality of care in the last weeks of life. Improving the quality of care for dying patients and their families requires attention to this matter.
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In 1992 a home care technology project was started in which infusion therapy in the home setting was made available for patients with end-stage cancer. Beside aspects of feasibility and quality of life the resource utilization and costs of this transition was studied. ⋯ Our data suggest that significant savings can be obtained by implementing programs transferring palliative care technology to the home setting.
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Comparative Study
Relative efficacy of 32P and 89Sr in palliation in skeletal metastases.
32p and 89Sr have been shown to produce significant pain relief in patients with skeletal metastases from advanced cancer. Clinically significant pancytopenia has not been reported in doses up to 12 mCi (444 MBq) of either radionuclide. To date, no reports comparing the relative efficacy and toxicity of the two radionuclides in comparable patient populations have been available. Although a cure has not been reported, both treatments have achieved substantial pain relief. However, several studies have used semiquantitative measures such as "slight," "fair," "partial" and "dramatic" responses, which lend themselves to subjective bias. This report examines the responses to treatment with 32P or 89Sr by attempting a quantification of pain relief and quality of life using the patients as their own controls and compares toxicity in terms of hematological parameters. ⋯ No justification has been found in this study for the recommendation of 89Sr over the considerably less expensive oral 32P for the palliation of skeletal pain from metastases of advanced cancer.