The American journal of hospice & palliative care
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Am J Hosp Palliat Care · Nov 2005
Controlled Clinical TrialSystemic radionuclide therapy in pain palliation.
Several radiopharmaceuticals were investigated to determine their efficacy and toxicity in the palliation of painful bone metastases. Data on the influence of rhenium-188 hydroxyethylidene diphosphonate (188Re-HEDP), rhenium-186 hydroxyethylidene diphosphonate (186Re-HEDP), and strontium-89 (89Sr) on pain symptoms, quality of life, and bone-marrow function were obtained in 64 patients with breast and prostate cancer. Thirty-one patients were treated with 188Re-HEDP (3194 +/- 387 MBq), 15 patients with 186Re-HEDP (1358 +/- 158 MBq), and 18 patients with 89Sr (152 +/- 19 MBq). ⋯ There were no significant differences in bone marrow toxicity (p = 0.123-0.421). Results of this study indicate that all evaluated radiopharmaceuticals were effective in pain palliation without induction of severe side effects. The increase in KPS after 188Re-HEDP was the only statistically significant finding (p = 0.001).
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Am J Hosp Palliat Care · Nov 2005
Hospice and palliative care: an educational intervention for healthcare professionals in a rural community.
The purpose of the study was to increase the awareness and availability of hospice care in rural communities. In Taos, New Mexico, a community of about 30,000 people, we developed an educational intervention that introduced the topic of end-of-life care and hospice to their healthcare professionals. We targeted nurses, physicians, and other related healthcare professionals. ⋯ However, it did not affect the length of stay or increase enrollment for people with a non-cancer diagnosis. The educational intervention was inexpensive, locally run, and very effective as demonstrated by the increase in hospice referrals. Exporting the model to other rural sites appears to be feasible.
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Ziconotide (PRIALT) is a new nonopioid treatment for chronic pain. It is a peptide that is the synthetic analog of the omega-conotoxin, derived from the marine snail, Conus magus. The therapeutic benefit of ziconotide derives from its potent and selective blockade of neuronal N-type voltage-sensitive calcium channels. ⋯ A recent clinical trial demonstrated that ziconotide has a significant analgesic effect compared to placebo in patients considered intolerant or refractory to other treatment such as systemic analgesics, adjunctive therapies, or intrathecal (IT) morphine. Thus, ziconotide is the first of a new class of agents--N-type calcium channel blockers, or NCCBs. Ziconotide may represent another option for patients with refractory pain.