Articles: palliative-care.
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Clin Oncol (R Coll Radiol) · Jan 2000
Comparative StudyPalliative care activity in a medical oncology unit: the implications for oncology training.
There has been a nationwide reorganization of cancer services since publication of the Calman-Hine report, which encourages the integration of high-quality palliative care into all areas of cancer provision. Details of the daily clinical care activity for medical oncology inpatients are not collected routinely. ⋯ Palliative care activity accounted for 34% (169 bed-days) of daily activity, compared with 32% (163 bed-days) for the administration of chemotherapy. A high proportion of patients receive palliative care on medical oncology wards, consideration therefore needs to be given to the place of formal training in palliative medicine for oncology trainees.
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Am J Hosp Palliat Care · Jan 2000
Developing a physicians' palliative care pain hotline in Maryland.
Physicians have had relatively little formal training in pain management and palliative care. For this reason, a telephone consultation service was offered, the physicians' palliative care pain hotline, that would allow physicians to call a toll-free number and, within 15 minutes, speak to a board-certified physician in hospice and palliative medicine. ⋯ This article describes the process involved in creating such a pain hotline and reports on some data collected on its use in the first 10 months. This report should help others who have an interest in establishing a similar program.
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Radiotherapy is used commonly to provide pain relief for painful bone metastases, and there is a perception that of the three-quarters of patients who achieve pain relief, half of these stay free from pain. However, the precise contribution from radiotherapy may be unclear because of difficulties in assessing the numbers of people achieving relief, the extent of relief and its duration, and the influence of other contemporaneous interventions, such as analgesics. ⋯ Radiotherapy is clearly effective at reducing pain from painful bone metastases. There was no evidence of any difference in efficacy between different fractionation schedules, nor indeed of a dose-response with total dose of radiation. For treatment of generalised bone pain both hemibody irradiation and radioisotopes can reduce the number of painful new sites.
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Tramadol is an option for the treatment of rheumatological pain. Its mode of action and safety profile distinguishes it from other opioids. Tramadol differs from other opioids by combining a weak opioid and a monoaminergic mode of action. ⋯ Tramadol should be avoided or used with caution in epileptics, or in individuals who are receiving seizure-threshold lowering drugs. Finally, tramadol has a low risk of abuse because it has only a weak opioid effect and its monoaminergic action could inhibit the development of dependence. The low abuse potential of tramadol has been demonstrated by postmarketing surveillance data.