Articles: palliative-care.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Randomized trial of single dose versus fractionated palliative radiotherapy of bone metastases.
Data in the literature suggest that for painful bone metastases a single dose is as effective as fractionated radiotherapy. In the present multicentre prospective trial, the effects of 8 Gy x1 and 5 Gy x4 were compared. ⋯ The present randomized study showed that a single fraction of 8 Gy was as effective as 5 Gy x4 in relieving pain from bone metastasis.
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Burn injuries produce severe wound care pain that is ideally controlled on intensive burn care units with high-dosage intravenous opioid medications. We report a case illustrating the use of hypnosis for pain management when one opioid medication was ineffective. ⋯ This case illustrates that hypnosis can not only be used easily and quite appropriately in a busy medical intensive care unit environment, but that sometimes this treatment may be a very useful alternative when opioid pain medication proves to be dangerous and ineffective. This case also illustrates possible clinical implications both pain relief and side-effect profiles for opioid receptor specificity. Although this report does not provide data regarding hypnotic mechanisms, it is clear that with some patients nonopioid inhibitory mechanisms can be activated in a highly effective manner, that clinical context may be important for the activation of those pathways, and that those mechanisms may be accessed more easily than opioid mechanisms.
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Comparative Study
Palliative terminal cancer care in community hospitals and a hospice: a comparative study.
Despite palliative care being an accepted role of community hospitals, there is little quantitative evidence of the type of care provided. ⋯ This study confirms the role of community hospitals in palliative terminal cancer care. Differences in care between community hospitals and a hospice have been demonstrated that may reflect either different admission populations to each setting or differences in the way care was delivered.
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Ninety per cent of the last year of life of cancer patients is spent at home. Some studies have suggested that care in this setting is often suboptimal. Information on the standard of palliative care delivered at home by general practitioners (GPs) and their teams is limited, and clarification of the problems faced is needed. ⋯ Levels of reporting of poor symptom control by professionals was much lower than levels reported by relatives in other studies, but there was no difference between the reporting of GPs and nurses. However, a number of areas were identified where care could be enhanced by improved teamwork and further education and training in symptom control, as well as in communication, use of services, and information provision.
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Social science & medicine · Jun 1998
To supplant, supplement or support? Organisational issues for hospices.
This paper provides an analysis of organisational issues in palliative care. Palliative care services have spread to many parts of the world and in the process have adapted to the context in which they are situated. This analysis draws on data from a small study of 18 hospices in the North Island of New Zealand. ⋯ Four main types of hospice were identified; (1) in-patient units with medical staff, (2) nurse led services, (3) volunteer led services which employed no health professionals and (4) hospital based palliative care teams. This paper proposes a conceptual analysis of the role of hospices in health care around three major issues: to supplant, supplement or support. Comparisons are drawn between the development and organisation of British and New Zealand hospices.