Articles: palliative-care.
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Arch. Dermatol. Res. · May 1996
Effect of topically applied menthol on thermal, pain and itch sensations and biophysical properties of the skin.
The effect of menthol and alcohol as its vehicle on thermal sensations, pain, experimental itch and irritation were studied in 18 subjects, using a computerized thermal sensory analyzer, laser Doppler flowmetry and an evaporimeter for transepidermal water loss (TEWL). Menthol had a subjective cooling effect lasting up to 70 min in 12/18 subjects; however, it did not affect cold and heat threshold, nor did it affect cold and heat pain threshold. Alcohol produced an immediate cold sensation lasting up to 5 min in 4/18 subjects and lowered the sensitivity of cold sensation threshold (P < 0.05). ⋯ Warm sensation and pain threshold in subjects receiving histamine injections, measured after menthol and alcohol application, did not differ from their baseline values with histamine alone. TEWL at the site treated with menthol was significantly higher (P < 0.05) than at the alcohol-treated and the control site (P < 0.01), suggesting that menthol has a higher skin irritating effect, or at least alters the stratum corneum water permeability. Our results suggest that menthol fulfills the definition of a counterirritant, but does not affect histamine-induced itch, nor does it affect pain sensation.
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Palliative care is received by a small number of patients with terminal illness, most of them with cancer. ⋯ Recognizing and overcoming the barriers to the provision of palliative care can bring about changes in education, health care practices, and administration to achieve the desired goals.
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Palliative medicine · Apr 1996
Randomized Controlled Trial Clinical TrialAn investigation of the ability of oral naloxone to correct opioid-related constipation in patients with advanced cancer.
A dose-ranging study of the use of oral naloxone in opioid-related constipation in patients with far-advanced cancer is reported. Naloxone doses were calculated as a percentage of the morphine dose each patient was receiving. Seventeen patients entered the first phase of the study, which had a randomised, double-blind design. ⋯ It is concluded that oral naloxone at a daily dose of 20% or more of the prevailing 24 h morphine dose is a potentially valuable therapy for opioid-related constipation. However, opioid withdrawal was observed and it is suggested that initial individual naloxone doses should not exceed 5 mg. Further research is needed into the oral absorption of naloxone, as well as further studies of clinical efficacy and dosing.
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Requirements for healthcare professionals in the United Kingdom to undertake continuing education are discussed. For nurses, midwives and many career-grade doctors, formal arrangements are in place; for other professionals, continuing education is recommended but not yet a formal requirement. In order to explore what is available, courses, conferences and seminars advertised in the Hospice Information Service's publication Choices for the academic year September 1994 to July 1995 are reviewed in terms of number, intended audience, participants and duration. ⋯ Issues of approval, quality assurance and evaluation are addressed. Suggestions are offered with regard to future financing of courses, and co-ordination of planning and provision. It is suggested that the National Council for Hospice and Specialist Palliative Care might encourage increasing co-operation between units in the provision of education.
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Am. J. Clin. Oncol. · Apr 1996
Strontium-89 chloride (Metastron) for palliative treatment of bony metastases. The University of Minnesota experience.
Strontium-89 chloride (Metastron) is an FDA-approved treatment for palliation of cancer pain. We evaluated blood count changes and pain relief in 28 patients with widespread painful bony metastasis treated with strontium-89 at the University of Minnesota Hospital and Clinics. Eighteen patients had prostate cancer (all hormone-refractory cancer), seven patients had breast cancer, and three patients had lung cancer, all previously treated with either radiation, chemotherapy, or a combination of the two. ⋯ Thirty-two percent of the treated patients required additional palliative external beam radiation to their bony lesions within the study period. Our results show that Metastron for palliation for bony metastases should be used with caution because of moderate to severe bone marrow toxicity, especially in platelets, associated with its use. Careful evaluation of patients given Metastron is needed to assess accurately its full benefit.