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Heinzelmann A, Tewes M, Müller S, Sure U, Herrmann K, Schadendorf D, Warnecke E, Rausch R, Skoda EM, Salvador Comino MR. Determining the cut-off value for the Minimal Documentation System (MIDOS2) screening tool to initiate specialized palliative care based on patient's subjective need for palliative support and symptom burden in inpatients with advanced cancer. J Cancer Res Clin Oncol 2024; 150:360. [PMID: 39046592 PMCID: PMC11269497 DOI: 10.1007/s00432-024-05897-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Accepted: 07/15/2024] [Indexed: 07/25/2024]
Abstract
PURPOSE The Minimal Documentation System (MIDOS2) is recommended as a systematic screening tool for assessing symptom burden and patient needs in advanced cancer patients. Given the absence of an optimal weighting of individual symptoms and a corresponding cut-off value, this study aims to determine a threshold based on inpatient's subjective need for palliative support. Additionally, we investigate the correlation between symptom burden and subjective need for palliative support collected through a patient-reported outcome measure (PROM) with survival duration of less or more than one year. METHODS Inpatients diagnosed with advanced solid cancer completed an electronic PROM, which included the MIDOS2 questionnaire among other tools. Differences in symptom burden were analysed between patients expressing subjective need for palliative support and those with survival of less or more than one year using ANOVA, Mann-Whitney-U Test, logistic regression, Pearson and Spearman correlation tests. Cut-off analyses were performed using a ROC curve. Youden-Index, sensitivity, and specificity measures were used as well. RESULTS Between April 2020 and March 2021, 265 inpatients were included in the study. Using a ROC curve, the MIDOS2 analysis resulted in an Area under the curve (AUC) of 0.732, a corresponding cut-off value of eight points, a sensitivity of 76.36% and a specificity of 62.98% in assessing the subjective need for palliative support. The MIDOS2, with double weighting of the significant symptoms, showed a cut-off value of 14 points, achieving a sensitivity of 78.18% and a specificity of 72.38%. A total of 55 patients (20.8%) expressed a need for support from the palliative care team. This need was independent of the oncological tumour entity and increased among patients with a survival of less than one year. These patients reported significantly poorer physical (p < 0.001) or mental (p < 0.001) condition. Additionally, they reported higher intensities of pain (p = 0.002), depressive symptoms (p < 0.001), weakness (p < 0.001), anxiety (p < 0.001), and tiredness (p < 0.001). CONCLUSION Using the established MIDOS2 cut-off value with an adjusted double weighting in our study, a large proportion of inpatients may be accurately referred to SPC based on their subjective need for palliative support. Additionally, subjective reports of poor general, mental, and physical condition, as well as pain, depressive symptoms, weakness, anxiety, and tiredness, increase the subjective need for palliative support, particularly in patients with a survival prognosis of less than one year.
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Affiliation(s)
- Anna Heinzelmann
- Department of Palliative Medicine, University Hospital Essen (AöR), 45147, Essen, Germany
| | - Mitra Tewes
- Department of Palliative Medicine, University Hospital Essen (AöR), 45147, Essen, Germany
| | - Sandy Müller
- Department of Palliative Medicine, University Hospital Essen (AöR), 45147, Essen, Germany
| | - Ulrich Sure
- Department of Neurosurgery, University Hospital Essen (AöR), 45147, Essen, Germany
| | - Ken Herrmann
- Department of Nuclearmedicine, University Hospital Essen (AöR), 45147, Essen, Germany
| | - Dirk Schadendorf
- Department of Dermatology, University Hospital Essen (AöR), 45147, Essen, Germany
| | - Eva Warnecke
- Department of Palliative Medicine, University Hospital Essen (AöR), 45147, Essen, Germany
| | - Raya Rausch
- West German Cancer Center, University Hospital Essen (AöR), 45147, Essen, Germany
| | - Eva-Maria Skoda
- Department for Psychosomatic Medicine and Psychotherapy LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro-and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
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Leslie EA, Byrne J, Mesarwi P, Edmonds KP, Hirst JM, Atayee RS. Descriptive Analysis of Dexmedetomidine's Utility in a Palliative Care Unit at the End of Life. J Palliat Med 2024. [PMID: 38916782 DOI: 10.1089/jpm.2024.0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024] Open
Abstract
Context: Pain and symptom management at the end of life (EoL) can pose unique challenges, particularly when symptoms are refractory to conventional methods. Dexmedetomidine, originally approved for sedation in ventilated patients, has been demonstrated to be beneficial in pain management and palliative care settings by functioning as an alpha-2 agonist. Methods: A retrospective review of inpatient palliative care unit (IPU) records from January 2020 to December 2023 was conducted. Twenty-five adult patients receiving continuous dexmedetomidine for refractory pain at the EoL were identified. These patients were further evaluated for concurrent opioid, benzodiazepine, and chlorpromazine usage. Results: Patients experienced predominantly cancer-related pain, and had a median infusion duration of 5 days. Dexmedetomidine's initial dosing differed between the intensive care unit (ICU) and IPU settings. There was a trend toward a decreased opioid requirement 24 hours after initiation. Patients transferred from the ICU showed a progressive increase in opioid use. Conclusion: This study contributes to understanding dexmedetomidine's role in managing refractory symptoms at the EoL in the palliative care setting.
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Affiliation(s)
- Eric A Leslie
- UC San Diego & Scripps Health Joint Fellowship in Hospice & Palliative Medicine, Department of Family Medicine, UC San Diego Health Sciences, La Jolla, California, USA
- Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Jennifer Byrne
- Section of Palliative Care, Division of Geriatrics, Gerontology, & Palliative Care, Department of Medicine, UC San Diego Health Sciences, La Jolla, California, USA
- Palliative Care Program, UC San Diego Health, University of California San Diego, La Jolla, California, USA
| | - Paula Mesarwi
- Section of Palliative Care, Division of Geriatrics, Gerontology, & Palliative Care, Department of Medicine, UC San Diego Health Sciences, La Jolla, California, USA
- Palliative Care Program, UC San Diego Health, University of California San Diego, La Jolla, California, USA
| | - Kyle P Edmonds
- Section of Palliative Care, Division of Geriatrics, Gerontology, & Palliative Care, Department of Medicine, UC San Diego Health Sciences, La Jolla, California, USA
- Palliative Care Program, UC San Diego Health, University of California San Diego, La Jolla, California, USA
| | - Jeremy M Hirst
- Section of Palliative Care, Division of Geriatrics, Gerontology, & Palliative Care, Department of Medicine, UC San Diego Health Sciences, La Jolla, California, USA
- Palliative Care Program, UC San Diego Health, University of California San Diego, La Jolla, California, USA
| | - Rabia S Atayee
- Section of Palliative Care, Division of Geriatrics, Gerontology, & Palliative Care, Department of Medicine, UC San Diego Health Sciences, La Jolla, California, USA
- Palliative Care Program, UC San Diego Health, University of California San Diego, La Jolla, California, USA
- Department of Pharmacy, UC San Diego Health, San Diego, California, USA
- Skaggs School of Pharmacy & Pharmaceutical Sciences, UC San Diego Health, San Diego, California, USA
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Larson S, Laures E, Seo M, Cox M, Wagner M. Evidence-Based Pain Assessment in Nonverbal Palliative Care Patients. Pain Manag Nurs 2024; 25:152-159. [PMID: 38246815 DOI: 10.1016/j.pmn.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 11/09/2023] [Accepted: 12/19/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Central to palliative care is the early assessment and treatment of pain, whether physical, psychosocial, or spiritual. Nonverbal palliative care patients are at risk for inadequate pain assessment leading to prolonged suffering. AIMS The purpose of this project was to implement and evaluate an evidence-based pain assessment tool for nonverbal palliative care patients. DESIGN The Iowa Model Revised: Evidence-Based Practice to Promote Excellence in Healthcare and the Implementation Strategies for Evidence-Based Practice Guide provided the guiding frameworks. SETTINGS On a six-bed adult inpatient Palliative Care Unit (PCU). PARTICIPANTS/SUBJECTS Nonverbal palliative care patients. METHODS Evidence supported use of the Multidimensional Objective Pain Assessment Tool (MOPAT) for nonverbal patients receiving palliative care. During an eight-week pilot, nurses recorded pain assessments on a paper form and trended pain scores over a 24-hour period. Evaluation included knowledge, attitudes, and behaviors pre- and post-pilot and was subsequently used in a Precision Implementation Approach to promote adoption. RESULTS Nurses' attitudes toward palliative care pain assessment improved in all items on the evaluation tools. Pain was assessed using MOPAT for 74% of nonverbal palliative care patients and 88% of patients had linked pain interventions to MOPAT scores. CONCLUSIONS MOPAT is the only valid evidence-based pain assessment tool for nonverbal patients receiving palliative care. This project led to successful adoption of the MOPAT within the PCU.
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Affiliation(s)
- Sara Larson
- University of Iowa Hospitals and Clinics, Iowa City, Iowa; St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
| | - Elyse Laures
- University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Minjeong Seo
- University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Margo Cox
- University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Michele Wagner
- University of Iowa Hospitals and Clinics, Iowa City, Iowa
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Gulsoy Z, Ozdemir Kol I. The Effect of Endotracheal Suctioning on Pain in Conscious Adult Patients in Intensive Care Unit. Dimens Crit Care Nurs 2024; 43:72-79. [PMID: 38271311 DOI: 10.1097/dcc.0000000000000624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND AND PURPOSE Pain assessment and management are an important issue to ensure the comfort of patients in the intensive care unit, and reducing pain is an important nursing intervention. Therefore, it is important to evaluate pain correctly. For correct pain management, it is necessary to correctly determine the presence and severity of pain. The study was conducted to determine whether endotracheal suctioning was painless and whether the Behavioral Pain Scale (BPS) was an accurate assessment tool to assess pain during endotracheal suctioning. METHODS This study is a prospective clinical study. Thirty-two patients were endotracheal suctioned using the same technique by the same person, and their before-procedure BPS and visual analog scale (VAS) scores were recorded. The study was conducted in the anesthesia and reanimation intensive care unit of a university hospital between December 12, 2020, and April 14, 2021. RESULTS The before-procedure BPS and VAS scores indicated no pain. There was an increase in the procedure BPS score, whereas the VAS score did not change. CONCLUSIONS Endotracheal suctioning did not cause pain in conscious patients when the procedure was performed with the correct catheter in accordance with the guideline. In addition, it can be said that BPS is not sufficient to evaluate pain, but the reason for its high level is because endotracheal suctioning is an uncomfortable procedure. Of course, more studies and further studies are needed for a clear result.It is important for health care professionals to relieve or reduce the pain of patients during the endotracheal aspiration procedure. In addition, the presence and severity of pain associated with the endotracheal aspiration procedure should be accurately measured. This study is registered in ClinicalTrials.gov with the IDNCT04634474.The data that support the findings of this study are available from the corresponding author upon reasonable request.
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Kawji Y, Almoaswes H, Bise C, Kawji L, Murphy A, Reed TD, Klapper RJ, Ahmadzadeh S, Shekoohi S, Cornett EM, Kaye AD. Electronic Health Record Recording of Patient Pain: Challenges and Discrepancies. Curr Pain Headache Rep 2023; 27:737-745. [PMID: 37740879 DOI: 10.1007/s11916-023-01170-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2023] [Indexed: 09/25/2023]
Abstract
PURPOSE OF REVIEW In the present review, various categories of pain, clinician-observed pain scales, and patient-reported pain scales are evaluated to better understand factors that impact patient pain perceptions. Additionally, the expansion of areas that require further research to determine the optimal way to evaluate pain scale data for treatment and management are discussed. RECENT FINDINGS Electronic health record (EHR) data provides a starting point for evaluating whether patient predictors influence postoperative pain. There are several ways to assess pain and choosing the most effective form of pain treatment. Identifying individuals at high risk for severe postoperative pain enables more effective pain treatment. However, there are discrepancies in patient pain reporting dependent on instruments used to measure pain and their storage in the EHR. Additionally, whether administered by a physician or another healthcare practitioner, differences in patient pain perception occur. While each scale has distinct advantages and limitations, pain scale data is a valuable therapeutic tool for assisting clinicians in providing patients with optimal pain control. Accurate assessment of patient pain perceptions by data extraction from electronic health records provides a potential for pain alleviation improvement. Predicting high-risk postoperative pain syndromes is a difficult clinical challenge. Numerous studies have been conducted on factors that impact pain prediction. Postoperative pain is significantly predicted by the kind of operation, the existence of prior discomfort, patient anxiety, and age.
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Affiliation(s)
- Yasmeen Kawji
- School of Medicine, Louisiana State University Health Sciences Center New Orleans, 433 Bolivar Street, New Orleans, LA, 70112, USA
| | - Hanna Almoaswes
- School of Medicine, Louisiana State University Health Sciences Center New Orleans, 433 Bolivar Street, New Orleans, LA, 70112, USA
| | - Claire Bise
- School of Medicine, Louisiana State University Health Sciences Center New Orleans, 433 Bolivar Street, New Orleans, LA, 70112, USA
| | - Lena Kawji
- Department of Internal Medicine, School of Medicine, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
| | - Adrienne Murphy
- School of Medicine, Louisiana State University Health Sciences Center New Orleans, 433 Bolivar Street, New Orleans, LA, 70112, USA
| | - Tanner D Reed
- School of Medicine, Louisiana State University Health Sciences Center New Orleans, 433 Bolivar Street, New Orleans, LA, 70112, USA
| | - Rachel J Klapper
- Department of Radiology, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
| | - Shahab Ahmadzadeh
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
| | - Sahar Shekoohi
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA.
| | - Elyse M Cornett
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
- Departments of Anesthesiology and Pharmacology, Toxicology, and Neurosciences, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
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Ueareekul S, Changratanakorn C, Tianwibool P, Meelarp N, Wongtanasarasin W. Accuracy of Pain Scales in Predicting Critical Diagnoses in Non-Traumatic Abdominal Pain Cases; a Cross-sectional Study. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE 2023; 11:e68. [PMID: 38028934 PMCID: PMC10646955 DOI: 10.22037/aaem.v11i1.2131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
Introduction Accurate assessment and management of abdominal pain in the emergency department (ED) is crucial, as it can indicate potentially life-threatening conditions requiring timely treatment. This study aimed to evaluate the ability of pain scales to predict critical diagnoses in patients with non-traumatic abdominal pain. Methods This cross-sectional study was conducted at a tertiary university hospital and involved individuals aged 15 years and above who presented to the ED with non-traumatic abdominal pain. Pain severity was evaluated using subjective pain scales, including the Numerical Rating Scale (NRS) and the Face Pain Scale (FPS), as well as objective pain scales, including the Critical Care Pain Observation Tool (CPOT) and the Non-verbal Pain Score (NVPS). The area under the receiver operating characteristic curve (AuROC) was employed to determine the discriminative ability of each pain scale to predict critical diagnosis. Results 264 cases with the mean age of 47.2±19.4 years were studied (53.0% male). The most common location of abdominal pain was epigastric pain (43.9%). Most patients presented with dull-aching pain, and those with critical diagnoses had more of this characteristic than those with non-critical diagnoses. (52.5% vs. 28.3%, p = 0.01). The overall median NRS, FPS, CPOT, and NVPS of included participants were 8 (interquartile range (IQR) 7-10), 8 (IQR 6-8), 3 (IQR 1-4), and 3 (IQR 2-4), respectively. Patients with critical diagnoses had a higher NVPS score than patients with non-critical diagnoses (median score of 4 vs. 3, p = 0.02). The AuROC of NRS, FPS, CPOT, and NVPS were 0.53 (95% CI: 0.45-0.62), 0.55 (95% CI: 0.46-0.63), 0.59 (95% CI: 0.50-0.68), and 0.62 (95% CI: 0.53-0.71), respectively. The correlation coefficients among these scales were considered moderately correlated or higher. Conclusion In evaluating patients with non-traumatic abdominal pain, the NVPS demonstrated the highest accuracy in predicting critical diagnoses. However, all pain scales, whether subjective or objective, exhibited suboptimal performance in predicting critical diagnoses.
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Affiliation(s)
- Supapilai Ueareekul
- Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Chanon Changratanakorn
- Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Parinya Tianwibool
- Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Nattikarn Meelarp
- Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Wachira Wongtanasarasin
- Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Department of Emergency Medicine, University of California Davis School of Medicine, Sacramento, California 95817, United States of America
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Pouzot-Nevoret C, Junot S, Goffette L, Bonnet-Garin JM, Allaouchiche B, Magnin M. Use of pupillometry for the evaluation of analgesia in dogs hospitalized in intensive care: A prospective study. Res Vet Sci 2023; 158:96-105. [PMID: 36965258 DOI: 10.1016/j.rvsc.2023.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 03/01/2023] [Accepted: 03/16/2023] [Indexed: 03/27/2023]
Abstract
A prospective study was performed on hospitalized conscious dogs. The objectives were: 1) to evaluate the feasibility and reliability of portable infrared pupillometry using a measure of photo light reflexes, 2) to identify parameters influencing measures, and 3) to compare parameters before and after the administration of analgesia. Twenty-nine dogs were included. Pupillometry was feasible by a single person. There was an excellent reliability for the evaluation of pupil diameter. There was poor to good reliability for the other parameters. There was an association between weight and mean pupil diameter (estimate = 0.1 mm, CI95 = [0.0; 0.1], P = 0.02), mean diameter variation (estimate = 0.2%, CI95 = [0.0; 0.4], P = 0.01), and mean velocity (estimate = 0.08 ms, CI95 = [0.03; 0.13], P = 0.002). Male dogs had a significantly larger mean pupil diameter than females (estimate = 1.3 mm, CI95 = [0.1; 2.5], P = 0.03). Independently of weight and sex, there was an association between mean pupil diameter and pain score: the higher the pain score, the lower the mean pupil diameter. There was a correlation between mean pupil diameter and morphine dose (ρ = -0.78, P = 0.0004). There was no significant difference in pupil diameter, velocity, and latency before and after analgesic administration. In conclusion, results do not support the use of PLR measurement by pupillometry as a pain assessment technique in hospitalized conscious dogs.
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Affiliation(s)
- Céline Pouzot-Nevoret
- Université de Lyon, UR APCSe Agressions Pulmonaires et Circulatoires dans le Sepsis, UP 2021.A101, VetAgro Sup, 1 Avenue Bourgelat F-69280 Marcy L'Etoile, France; Université de Lyon, VetAgro Sup, Soins Intensifs Anesthésie et Médecine d'Urgence (SIAMU), 1 avenue Bourgelat F-69280 Marcy l'Etoile, France.
| | - Stéphane Junot
- Université de Lyon, UR APCSe Agressions Pulmonaires et Circulatoires dans le Sepsis, UP 2021.A101, VetAgro Sup, 1 Avenue Bourgelat F-69280 Marcy L'Etoile, France; Université de Lyon, VetAgro Sup, Anesthésiologie, 1 avenue Bourgelat F-69280 Marcy l'Etoile, France.
| | - Léa Goffette
- Université de Lyon, UR APCSe Agressions Pulmonaires et Circulatoires dans le Sepsis, UP 2021.A101, VetAgro Sup, 1 Avenue Bourgelat F-69280 Marcy L'Etoile, France.
| | - Jeanne-Marie Bonnet-Garin
- Université de Lyon, UR APCSe Agressions Pulmonaires et Circulatoires dans le Sepsis, UP 2021.A101, VetAgro Sup, 1 Avenue Bourgelat F-69280 Marcy L'Etoile, France; Université de Lyon, VetAgro Sup, Unité de Physiologie, Pharmacodynamie et Thérapeutique, 1 avenue Bourgelat F-69280 Marcy l'Etoile, France.
| | - Bernard Allaouchiche
- Université de Lyon, UR APCSe Agressions Pulmonaires et Circulatoires dans le Sepsis, UP 2021.A101, VetAgro Sup, 1 Avenue Bourgelat F-69280 Marcy L'Etoile, France; Université de Lyon, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Réanimation Médicale, 165 Chemin du Grand Revoyet F-69310 Pierre-Bénite, France
| | - Mathieu Magnin
- Université de Lyon, UR APCSe Agressions Pulmonaires et Circulatoires dans le Sepsis, UP 2021.A101, VetAgro Sup, 1 Avenue Bourgelat F-69280 Marcy L'Etoile, France; Université de Lyon, VetAgro Sup, Unité de Physiologie, Pharmacodynamie et Thérapeutique, 1 avenue Bourgelat F-69280 Marcy l'Etoile, France.
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Mari T, Asgard O, Henderson J, Hewitt D, Brown C, Stancak A, Fallon N. External validation of binary machine learning models for pain intensity perception classification from EEG in healthy individuals. Sci Rep 2023; 13:242. [PMID: 36604453 PMCID: PMC9816165 DOI: 10.1038/s41598-022-27298-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 12/29/2022] [Indexed: 01/07/2023] Open
Abstract
Discrimination of pain intensity using machine learning (ML) and electroencephalography (EEG) has significant potential for clinical applications, especially in scenarios where self-report is unsuitable. However, existing research is limited due to a lack of external validation (assessing performance using novel data). We aimed for the first external validation study for pain intensity classification with EEG. Pneumatic pressure stimuli were delivered to the fingernail bed at high and low pain intensities during two independent EEG experiments with healthy participants. Study one (n = 25) was utilised for training and cross-validation. Study two (n = 15) was used for external validation one (identical stimulation parameters to study one) and external validation two (new stimulation parameters). Time-frequency features of peri-stimulus EEG were computed on a single-trial basis for all electrodes. ML training and analysis were performed on a subset of features, identified through feature selection, which were distributed across scalp electrodes and included frontal, central, and parietal regions. Results demonstrated that ML models outperformed chance. The Random Forest (RF) achieved the greatest accuracies of 73.18, 68.32 and 60.42% for cross-validation, external validation one and two, respectively. Importantly, this research is the first to externally validate ML and EEG for the classification of intensity during experimental pain, demonstrating promising performance which generalises to novel samples and paradigms. These findings offer the most rigorous estimates of ML's clinical potential for pain classification.
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Affiliation(s)
- Tyler Mari
- Department of Psychology, Institute of Population Health, University of Liverpool, 2.21 Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK.
| | - Oda Asgard
- grid.10025.360000 0004 1936 8470Department of Psychology, Institute of Population Health, University of Liverpool, 2.21 Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA UK
| | - Jessica Henderson
- grid.10025.360000 0004 1936 8470Department of Psychology, Institute of Population Health, University of Liverpool, 2.21 Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA UK
| | - Danielle Hewitt
- grid.10025.360000 0004 1936 8470Department of Psychology, Institute of Population Health, University of Liverpool, 2.21 Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA UK
| | - Christopher Brown
- grid.10025.360000 0004 1936 8470Department of Psychology, Institute of Population Health, University of Liverpool, 2.21 Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA UK
| | - Andrej Stancak
- grid.10025.360000 0004 1936 8470Department of Psychology, Institute of Population Health, University of Liverpool, 2.21 Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA UK
| | - Nicholas Fallon
- grid.10025.360000 0004 1936 8470Department of Psychology, Institute of Population Health, University of Liverpool, 2.21 Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA UK
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Ijaopo EO, Zaw KM, Ijaopo RO, Khawand-Azoulai M. A Review of Clinical Signs and Symptoms of Imminent End-of-Life in Individuals With Advanced Illness. Gerontol Geriatr Med 2023; 9:23337214231183243. [PMID: 37426771 PMCID: PMC10327414 DOI: 10.1177/23337214231183243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 05/23/2023] [Accepted: 05/31/2023] [Indexed: 07/11/2023] Open
Abstract
Background: World population is not only aging but suffering from serious chronic illnesses, requiring an increasing need for end-of-life care. However, studies show that many healthcare providers involved in the care of dying patients sometimes express challenges in knowing when to stop non-beneficial investigations and futile treatments that tend to prolong undue suffering for the dying person. Objective: To evaluate the clinical signs and symptoms that show end-of-life is imminent in individuals with advanced illness. Design: Narrative review. Methods: Computerized databases, including PubMed, Embase, Medline,CINAHL, PsycInfo, and Google Scholar were searched from 1992 to 2022 for relevant original papers written in or translated into English language that investigated clinical signs and symptoms of imminent death in individuals with advanced illness. Results: 185 articles identified were carefully reviewed and only those that met the inclusion criteria were included for review. Conclusion: While it is often difficult to predict the timing of death, the ability of healthcare providers to recognize the clinical signs and symptoms of imminent death in terminally-ill individuals may lead to earlier anticipation of care needs and better planning to provide care that is tailored to individual's needs, and ultimately results in better end-of-life care, as well as a better bereavement adjustment experience for the families.
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Affiliation(s)
| | - Khin Maung Zaw
- University of Miami Miller School of Medicine, FL, USA
- Miami VA Medical Center, FL, USA
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Beaudry JS. Death as "benefit" in the context of non-voluntary euthanasia. THEORETICAL MEDICINE AND BIOETHICS 2022; 43:329-354. [PMID: 36227395 DOI: 10.1007/s11017-022-09597-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/24/2022] [Indexed: 06/16/2023]
Abstract
I offer a principled objection to arguments in favour of legalizing non-voluntary euthanasia on the basis of the principle of beneficence. The objection is that the status of death as a benefit to people who cannot formulate a desire to die is more problematic than pain management care. I ground this objection on epistemic and political arguments. Namely, I argue that death is relatively more unknowable, and the benefits it confers more subjectively debatable, than pain management. I am not primarily referring to the claim that it is difficult to make comparisons between live and post-mortem states, but rather to the fact that it is epistemically and metaphysically problematic to impute a "life-worse-than-death" or a state of "suffering-calling-for-death" to people who cannot subjectively wish to die, as though this kind of suffering were a medically observable fact rather than a belief- and value-laden notion. On the contrary, people enduring similar causes of pain may have different experiences of suffering and views on how it affects the worthwhileness of their existence or the desirability of death or of continuing their lives. The projection of a "suffering-calling-for-death" onto infants or people with severe intellectual disabilities may not be indefensible, but it is more controversial than judging that pain management will improve their well-being from the perspective of beneficence. My argument also relies on our society's liberal endeavour to avoid endorsing unverifiable beliefs about life and death or controversial conceptions of the good life. My goal is not to suggest we should not attend the suffering of cognitively disabled people. On the contrary, I only cast doubt on too quick an assumption that ending their lives is the best way of caring for them, when robust palliative treatments are available. Moreover, I express the concern that a lack of attention to distinctions between "pain-calling-for-relief" and "suffering-calling-for-death" may be based on ableist projections and assumptions. I conclude that it is imperative to continue research into the nature of pain and suffering experienced by individuals with mental or cognitive impairments preventing them from expressing autonomous wishes about the kind of treatment that would most benefit them.
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Affiliation(s)
- Jonas-Sébastien Beaudry
- Faculty of Law and School of Population and Global Health, McGill University, Montreal, QC, Canada.
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11
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Ooi K, Aihara M, Matsumura H, Matsuda S, Watanabe Y, Yuasa H, Matsuka Y. Therapy outcome measures in temporomandibular disorder: a scoping review. BMJ Open 2022; 12:e061387. [PMID: 35985779 PMCID: PMC9396127 DOI: 10.1136/bmjopen-2022-061387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Therapy outcome measures (TOMs) in temporomandibular disorders (TMDs) have not been systematically evaluated. We systematically explored the main TOM assessment methods for TMD TOMs used in previous studies. DESIGN Scoping review. DATA SOURCES According to Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Review reporting guidelines, we systematically searched five key databases (MEDLINE/PubMed, Web of Science, Embase, Epistemonikos and ClinicalTrials) and thoroughly scanned relevant grey literature using Medical Subject Headings, Emtree and index terms. ELIGIBILITY CRITERIA We considered primary research papers published from January 2010 to December 2020 that included patients with TMD aged ≥18 years, diagnosed according to the Diagnostic Criteria for Temporomandibular Disorders. DATA EXTRACTION AND SYNTHESIS Four reviewers extracted general information and information on study design and setting, target, interventions, and outcome type. RESULTS One hundred and seventy-two of the 3726 screened articles (3704 by search engines and 22 manually) were included. The TOMs analysed included pain (n=161 articles), maximal mouth opening (MMO) (91), jaw function (32), jaw movement (26), joint sound (16), quality of life (QOL) (15), depression/anxiety (14), oral QOL (10) or others (30). Evaluation periods were <4 weeks (111), <8 weeks (62), <12 weeks (59), >12 weeks (75) or 'not mentioned' (12). Pain outcomes (229) included general pain (115), tenderness (45), pain during functioning (44), resting pain (16) and others (8). Pain outcome evaluation methods included Visual Analogue Scale (VAS; 121), Numerical Rating Scale (21) and other methods (21). Pain outcome indicators were binary (10) or continuous (158); only five studies reported the least significant difference in treatment efficacy. MMO evaluation using painless methods (19) and jaw function evaluation using methods assessing mandibular movement range (23) were the most frequent. CONCLUSIONS TMD TOMs are diverse; the major outcomes were pain, MMO, jaw function and jaw movement. Most pain outcomes are evaluated by VAS Score changes.
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Affiliation(s)
- Kazuhiro Ooi
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | | | - Hidehisa Matsumura
- Matsumura Dental Clinic, Fukuoka, Japan
- Faculty of Dental Science, Division of Oral Rehabilitation, Section of Implant and Rehabilitative Dentistry, Kyushu University, Fukuoka, Japan
| | - Shinpei Matsuda
- Department of Dentistry and Oral Surgery, Unit of Sensory and Locomotor Medicine, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Yuki Watanabe
- Division of Temporomandibular Disorders and Orofacial Pain, Department of Special Needs Dentistry, Showa University Graduate School of Dentistry, Tokyo, Japan
| | - Hidemichi Yuasa
- Oral and Maxillofacial Surgery, Toyohashi Medical Center, Toyohashi, Japan
| | - Yoshizo Matsuka
- Department of Stomatognathic Function and Occlusal Reconstruction, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
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12
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Davoudi A, Shickel B, Tighe PJ, Bihorac A, Rashidi P. Potentials and Challenges of Pervasive Sensing in the Intensive Care Unit. Front Digit Health 2022; 4:773387. [PMID: 35656333 PMCID: PMC9152012 DOI: 10.3389/fdgth.2022.773387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 04/08/2022] [Indexed: 11/13/2022] Open
Abstract
Patients in critical care settings often require continuous and multifaceted monitoring. However, current clinical monitoring practices fail to capture important functional and behavioral indices such as mobility or agitation. Recent advances in non-invasive sensing technology, high throughput computing, and deep learning techniques are expected to transform the existing patient monitoring paradigm by enabling and streamlining granular and continuous monitoring of these crucial critical care measures. In this review, we highlight current approaches to pervasive sensing in critical care and identify limitations, future challenges, and opportunities in this emerging field.
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Affiliation(s)
- Anis Davoudi
- Department of Biomedical Engineering, University of Florida, Gainesville, FL, United States,*Correspondence: Anis Davoudi
| | - Benjamin Shickel
- Department of Medicine, University of Florida, Gainesville, FL, United States
| | - Patrick James Tighe
- Department of Anesthesiology, University of Florida, Gainesville, FL, United States
| | - Azra Bihorac
- Department of Medicine, University of Florida, Gainesville, FL, United States
| | - Parisa Rashidi
- Department of Biomedical Engineering, University of Florida, Gainesville, FL, United States
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13
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Biomarcadores salivares na avaliação da dor: revisão integrativa. ACTA PAUL ENFERM 2022. [DOI: 10.37689/acta-ape/2022ar03203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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14
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The conscious state of the dying patient: An integrative review. Palliat Support Care 2021; 20:731-743. [PMID: 34615571 DOI: 10.1017/s1478951521001541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The cognitive state of the dying in the last days of life may deteriorate, resulting in a reduced ability to communicate their care needs. Distressing symptoms, physical and existential, may go unrecognized and untreated. The objectives of this integrative review were to systematically interrogate the literature to determine the changing conscious state of dying adults and to identify changes in their care needs. METHODS An integrative review protocol was registered with PROSPERO (CRD42020160475). The World Health Organization definition of palliative care informed the review. CINAHL, MEDLINE (OVID), Scopus, PsycINFO, Cochrane Library, and PubMed were searched from inception to October 2019 using search strategies for each database. Inclusion and exclusion criteria were applied. Methodological quality was appraised using the Joanna Briggs Institute Checklist for the Case Series appraisal tool. Extracted data were synthesized using a narrative approach. RESULTS Of 5,136 papers identified, 11 quantitative case series studies were included. Six themes were identified: conscious state and change over time, awareness, pain, absence of holistic care, the voiceless patient, and signs and symptoms of dying. SIGNIFICANCE OF RESULTS In the last days of life, the physical and conscious state of the dying patient declines, resulting in an inability to express their care needs. Dignity in dying and freedom from pain and suffering are both an imperative and a human right; and unvoiced care needs can result in unnecessary suffering and distress. This review revealed that little is known about how healthcare professionals assess holistic care needs at this vulnerable time. Although much has been written about palliative and end-of-life care, the assessment of care needs when patients are no longer able to voice their own needs has largely been ignored, with little attention from clinical, educational, or research perspectives. This gap in evidence has important implications for the dying and their families.
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15
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Kaasalainen S, Mccleary L, Vellani S, Pereira J. Improving End-of-Life Care for People with Dementia in LTC Homes During the COVID-19 Pandemic and Beyond. Can Geriatr J 2021; 24:164-169. [PMID: 34484498 PMCID: PMC8390320 DOI: 10.5770/cgj.24.493] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
COVID-19 pandemic has resulted in a significant increase in deaths in long-term care homes (LTCH). People with dementia living in LTCHs represent one of the most frail and marginalized populations in Canada. The surge of COVID-19 cases in LTCHs and rationing of health-care resources during the pandemic have amplified the pre-existing need for improvements in palliative and end-of-life care in LTCHs. This position statement, created by a task force commissioned by the Alzheimer Society of Canada, provides recommendations for a multipronged coordinated approach to improving palliative and end-of-life care of people with dementia living in LTCHs during the COVID-19 pandemic and beyond.
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Affiliation(s)
| | - Lynn Mccleary
- Faculty of Applied Health Sciences, Nursing, Brock University, St. Catharines, ON
| | - Shirin Vellani
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON
| | - Jose Pereira
- Division of Palliative Care, Department of Family Medicine, McMaster University, Hamilton, ON.,Pallium Canada, Ottawa, ON
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16
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Cook H, Kaiser KS, Walker KA, McPherson ML. Interprofessional Healthcare Students' Attitudes, Skills, and Knowledge After Comprehensive Pain Assessment Training in Verbal and Nonverbal Patients. J Hosp Palliat Nurs 2021; 23:386-395. [PMID: 33990515 DOI: 10.1097/njh.0000000000000771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A comprehensive pain assessment is the first step in safe, effective pain management. Few studies have explored variations of strategies and measures for multidimensional pain assessment education in both verbal and nonverbal patients. In this retrospective cohort study, interprofessional health care students enrolled in a palliative care curriculum completed a pain assessment training, which taught the PQRSTA ("palliating factors, precipitating factors, previous treatments, quality, region, radiation, severity, temporal factors and associated symptoms") mnemonic as a strategy for assessing pain in verbal patients and the Pain Assessment in Advance Dementia and Checklist of Nonverbal Pain Indicators measures for nonverbal patients. The purpose of this study was to compare the change in attitudes, self-perceived skills, and knowledge regarding pain assessment before and after the training. Attitudes and self-perceived skills were assessed in the pretraining and posttraining survey, which was analyzed using χ2 test or Fisher exact test. Students' knowledge responses were analyzed using Wilcoxon signed rank test to assess accuracy of responses compared with the expert defined score. One hundred eighty-two students were included. Results showed a statistically significant improvement in attitudes related to applicability of pain measures and self-perceived skills. Overall, data did not support an increase in knowledge using the PQRSTA mnemonic, or Pain Assessment in Advance Dementia and Checklist of Nonverbal Pain Indicators measures. Future pain trainings should consider training on only 1 nonverbal pain measure, incorporating bedside assessments, and integrating real-time feedback.
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17
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Goto H, Yamauchi T, Okumura K, Matsuoka K, Toritsuka M, Yasuno F, Uemura H, Kuki K, Makinodan M, Kishimoto T. A retrospective study of factors associated with persistent delirium. Psychogeriatrics 2021; 21:193-200. [PMID: 33429465 DOI: 10.1111/psyg.12655] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/26/2020] [Accepted: 12/24/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND It has been reported that delirium causes various problems. Many researchers have reported the risk factors associated with the onset of delirium; however, there are few reports focused on persistent delirium. This study aimed to identify the risk factors associated with persistent delirium. METHODS A total of 573 patients hospitalised in Nara Prefecture General Medical Centre from October 2014 through September 2017 who were referred to the psychiatry consultation service were included in this study. Persistent delirium was defined as delirium lasting for 14 days or more. A retrospective study was carried out based on the patients' records. The relationship between various background factors and persistent delirium was statistically analysed. RESULTS Of the 573 hospitalised patients, 295 were diagnosed as having delirium. Forty-six patients with persistent delirium and 181 patients with nonpersistent delirium were included in this study. Multivariable logistic regression analyses revealed that male gender, opioid analgesics use, non-opioid analgesics use, and low serum sodium were significantly and independently associated with persistent delirium. Ramelteon or trazodone was used significantly more in persistent delirium, although each use was not significant. CONCLUSION This is the first study to reveal that male gender and use of analgesics were associated with persistent delirium in general hospital. However, as this is a case-control study and may contain bias, future cohort studies and intervention studies are needed. It is also necessary to investigate the relevance of the 'degree of pain' behind the use of analgesics.
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Affiliation(s)
- Harue Goto
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan.,Department of Psychiatry, Nara Prefecture General Medical Centre, Nara, Japan
| | - Takahira Yamauchi
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan.,Department of Psychiatry, Nara Prefecture General Medical Centre, Nara, Japan
| | - Kazuki Okumura
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan
| | - Kiwamu Matsuoka
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan
| | - Michihiro Toritsuka
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan
| | - Fumihiko Yasuno
- Department of Psychiatry, National Centre for Geriatrics and Gerontology, Obu, Japan
| | - Hideki Uemura
- Department of Psychiatry, Nara Prefecture General Medical Centre, Nara, Japan
| | - Kazutaka Kuki
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan
| | - Manabu Makinodan
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan
| | - Toshifumi Kishimoto
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan
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18
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Rababa M, Al-Rawashdeh S. Critical care nurses' critical thinking and decision making related to pain management. Intensive Crit Care Nurs 2020; 63:103000. [PMID: 33376039 DOI: 10.1016/j.iccn.2020.103000] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/18/2020] [Accepted: 12/05/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The current study aimed to examine nurses' critical thinking and decision-making skills related to pain management and their association with nurses' characteristics. RESEARCH METHODOLOGY/DESIGN This descriptive correlational study used a convenience sample of 115 critical care nurses working in a university hospital in Jordan. Data were collected using a pain-related vignette and validated questionnaires. MAIN OUTCOME MEASURES The Critical Thinking Self-Assessment Scale and the Nursing Decision-Making Instrument were used to measure the nurses' critical thinking and decision-making skills, respectively. As a secondary outcome measure, data regarding the sociodemographic/professional characteristics of the participants, including gender, marital status, experience, education and work environment, were collected. RESULT The participating nurses reported poor critical thinking and intuitive decision-making skills related to pain management. Nurses with more clinical experience and higher levels of education reported significantly better critical thinking and intuitive decision-making skills than less experienced and less educated nurses. Nurses with intuitive decision-making modes reported significantly better levels of critical thinking than nurses with analytical or flexible analytical-intuitive decision-making modes. CONCLUSION Critical care nurses were found to have ineffective critical thinking and intuitive decision-making skills related to pain management, which may lead to poor patient outcomes. Gaining more in-depth understanding of nurses' critical thinking and decision-making skills and their associated factors is crucial for achieving effective pain management in critical care settings.
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Affiliation(s)
- Mohammad Rababa
- Department of Adult Health Nursing, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan.
| | - Sami Al-Rawashdeh
- Department of Community and Mental Health Nursing, Faculty of Nursing, The Hashemite University, P.O. Box 330127, Zarqa 13133, Jordan
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19
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Management of Severe Pain in Terminally Ill Patients at Home: An Evidence-Based Strategy. Home Healthc Now 2020; 38:8-15. [PMID: 31895892 DOI: 10.1097/nhh.0000000000000826] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The purpose of this article is to describe current evidence-based strategies to manage severe pain in patients living with terminal illnesses. A comprehensive pain assessment is a critical step in the initial development of a pain management plan and for ongoing evaluation of patients' pain. Although we have many effective clinical tools available for pain assessment, they are not always used consistently, which can negatively affect the pain management plan. Home care and hospice nurses need to be consistent in using the tools and documenting the patient's pain level and response to the pain management plan. Patients and caregivers have concerns and fears surrounding medication use, particularly with narcotic analgesics. It is vital that nurses provide thorough patient-centered teaching about medications to help address these concerns. Research has found that nurses who also provided validation to patients and families regarding their concerns, followed by education, were the most effective.
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20
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Davoudi A, Ozrazgat-Baslanti T, Tighe PJ, Bihorac A, Rashidi P. Pain and Physical Activity Association in Critically Ill Patients .. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:5696-5699. [PMID: 33019268 DOI: 10.1109/embc44109.2020.9176227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Critical care patients experience varying levels of pain during their stay in the intensive care unit, often requiring administration of analgesics and sedation. Such medications generally exacerbate the already sedentary physical activity profiles of critical care patients, contributing to delayed recovery. Thus, it is important not only to minimize pain levels, but also to optimize analgesic strategies in order to maximize mobility and activity of ICU patients. Currently, we lack an understanding of the relation between pain and physical activity on a granular level. In this study, we examined the relationship between nurse assessed pain scores and physical activity as measured using a wearable accelerometer device. We found that average, standard deviation, and maximum physical activity counts are significantly higher before high pain reports compared to before low pain reports during both daytime and nighttime, while percentage of time spent immobile was not significantly different between the two pain report groups. Clusters detected among patients using extracted physical activity features were significant in adjusted logistic regression analysis for prediction of pain report group.
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21
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Morrison RA, Jesdale BM, Dubé CE, Nunes AP, Bova CA, Liu SH, Lapane KL. Differences in Staff-Assessed Pain Behaviors among Newly Admitted Nursing Home Residents by Level of Cognitive Impairment. Dement Geriatr Cogn Disord 2020; 49:243-251. [PMID: 32610321 PMCID: PMC7704920 DOI: 10.1159/000508096] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 04/22/2020] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE Pain is common among nursing home residents with cognitive impairment and dementia. Pain is often underdiagnosed and undertreated, which may lead to adverse health outcomes. Nonverbal behaviors are valid indicators of pain, but the extent to which these behavioral expressions vary across levels of cognitive impairment is unknown. This study sought to examine differences in the prevalence of pain behaviors among nursing home residents with varying levels of cognitive impairment. METHODS The Minimum Data Set, version 3.0, was used to identify newly admitted nursing home residents with staff-assessed pain (2010-2016, n = 1,036,806). Staff-assessed pain behaviors included nonverbal sounds, vocal complaints, facial expressions, and protective body movements or postures over a 5-day look-back period for residents unable or unwilling to self-report pain. The Cognitive Function Scale was used to categorize residents as having no/mild, moderate, or severe cognitive impairment. Modified Poisson models provided adjusted prevalence ratios (aPR) and 95% CIs. RESULTS Compared to residents with no/mild cognitive impairments (any pain: 48.1%), residents with moderate cognitive impairment (any pain: 42.4%; aPR: 0.94 [95% CI 0.93-0.95]) and severe cognitive impairment (any pain: 38.4%; aPR: 0.86 [95% CI 0.85-0.88]) were less likely to have any pain behavior documented. Vocal pain behaviors were common (43.5% in residents with no/mild cognitive impairment), but less so in those with severe cognitive impairment (20.1%). Documentation of facial expressions and nonverbal pain behaviors was more frequent for residents with moderate and severe cognitive impairment than those with no/mild cognitive impairment. CONCLUSIONS The prevalence of behaviors indicative of pain differs by level of cognitive impairment. Pain evaluation and management plays an important role in treatment and care outcomes. Future work should examine how practitioners' perceptions of pain behaviors influence their ratings of pain intensity and treatment choices.
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Affiliation(s)
- Reynolds A Morrison
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Bill M Jesdale
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Catherine E Dubé
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Anthony P Nunes
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Carol A Bova
- School of Nursing, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Shao-Hsien Liu
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Kate L Lapane
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA,
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22
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Khosravani H, Steinberg L, Incardona N, Quail P, Perri GA. Symptom management and end-of-life care of residents with COVID-19 in long-term care homes. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2020; 66:404-406. [PMID: 32532719 PMCID: PMC7292525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Houman Khosravani
- Clinician in quality and innovation and Assistant Professor of Medicine in the Division of Neurology at the University of Toronto in Ontario
| | - Leah Steinberg
- Palliative care clinician in the Temmy Latner Centre for Palliative Care in Toronto
| | - Nadia Incardona
- Emergency physician and Assistant Professor and Rural Northern Initiative Coordinator in the Department of Family and Community Medicine at the University of Toronto, and a clinical advisor for Hospice Palliative Care Ontario
| | - Patrick Quail
- Medical Lead for Supportive Living Alberta Health Services Calgary Zone; Medical Director for the Intercare Corporate Group Inc, Retirement Concepts, Millrise Place, and AgeCare Walden Heights; and a family physician and Clinical Assistant Professor in the Department of Family Medicine University of Calgary
| | - Giulia-Anna Perri
- Palliative care physician and Medical Director for Palliative Care at Baycrest Health Sciences Centre in Toronto and Assistant Professor in the Division of Palliative Care in the Department of Family Medicine and Community Medicine at the University of Toronto.
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Fedele S, Strasser S, Roulin MJ. Validation of the Critical Care Pain Observational Tool in Palliative Care. Pain Manag Nurs 2020; 21:360-364. [PMID: 32113802 DOI: 10.1016/j.pmn.2019.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 11/18/2019] [Accepted: 12/31/2019] [Indexed: 01/23/2023]
Abstract
PURPOSE Pain assessment at the end of life remains a problem for patients who are unable to self-report their pain when transitioning across care settings. This study therefore tested the internal consistency and discriminant, concurrent, and convergent validity of the Critical-Care Pain Observational Tool (French version) when used with end-of-life patients in a palliative care setting. DESIGN This was a descriptive correlational study that used a repeated-measures within-subjects prospective design. METHODS The pain of 13 patients was assessed when at rest and during turning. RESULTS The internal consistency reliability coefficient alphas were .64 at rest and .70 during turning. Discriminant validity was shown by a decrease in the total Critical-Care Pain Observation Tool score. Concurrent validity was demonstrated by the association between the patients' self-report of pain and the Critical-Care Pain Observation Tool score at rest (0.65, p < .016) and during turning (0.77, p = .002). Finally, the convergent validity between the Critical-Care Pain Observation Tool score and the Algoplus scale score was demonstrated with a Spearman's correlation coefficient of 0.76 at rest and 0.84 during turning. CONCLUSIONS The results suggest that the Critical-Care Pain Observation Tool can be used with end-of-life patients in French-speaking countries.
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Mitra S, Jain K, Singh J, Saxena P, Nyima T, Selvam SR, Walia MC. Clinical Utility of the Behavioral Pain Assessment Tool in Patients Admitted in the Intensive Care Unit. Indian J Crit Care Med 2020; 24:695-700. [PMID: 33024377 PMCID: PMC7519617 DOI: 10.5005/jp-journals-10071-23521] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Introduction Unnoticed and unrelieved pain is one of the main sources of psychological and physiological stress for intensive care unit (ICU) patients. The eight-item behavior pain assessment tool (BPAT) is a multicountry validated tool to assess pain in ICU patients. However, its feasibility and clinical utility for ICU patients in India need further research. Aims and objectives The Aims and objectives of the study were to assess pain using BPAT and its clinical utility in pain assessment and management in ICU patients. Materials and methods Following ethical approval, 400 consecutive adult patients admitted in the ICUs in a tertiary care teaching hospital were assessed for pain severity using BPAT at intake, baseline pain and procedural pain. Patients <18 years and in deep coma on the Glasgow coma scale were excluded from the study. The patients with BPAT score ≥4 were given opioid analgesic, and their pain was reassessed after 2-3 hours. A feedback regarding feasibility and clinical utility was filled by the doctors. Results High interrater agreement for BPAT was observed with excellent kappa coefficients (>0.85) for each item. The BPAT significantly guided the pain management (p < 0.0001). More than 90% of doctors found BPAT easy to understand and use. In most of the cases (95.5%), doctors agreed that BPAT can improve the clinical management of ICU patients. Conclusion The BPAT is a reliable, brief, and an easy-to-use pain assessment tool, which clinicians can use for guiding pain assessment and management in the ICU setting on a routine basis. Clinical significance We recommend implementing BPAT in the clinical practice for better pain assessment and control in ICU patients. How to cite this article Mitra S, Jain K, Singh J, Saxena P, Nyima T, Selvam SR, et al. Clinical Utility of the Behavioral Pain Assessment Tool in Patients Admitted in the Intensive Care Unit. Indian J Crit Care Med 2020;24(8):695-700.
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Affiliation(s)
- Sukanya Mitra
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Kompal Jain
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Jasveer Singh
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Puja Saxena
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Tenzin Nyima
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Selwin R Selvam
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Mansi C Walia
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
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25
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Kaiser KS, McGuire DB, Keay TJ, Haisfield-Wolfe ME. Methodological challenges in conducting instrumentation research in non-communicative palliative care patients. Appl Nurs Res 2019; 51:151199. [PMID: 31759841 DOI: 10.1016/j.apnr.2019.151199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/30/2019] [Accepted: 10/18/2019] [Indexed: 01/09/2023]
Abstract
Well-designed, rigorously implemented instrumentation studies are essential to develop valid, reliable pain assessment tools in non-communicative (non-self-reporting) palliative care patients. When conducting a pain instrumentation study, a research team identified methodologic challenges surrounding informed consent, eligibility criteria, acute pain operational definitions, patient recruitment, missing data, and study-related training during a run-in phase at the beginning of the project and during the conduct of the study. The team dealt with these challenges through identifying root causes, implementing remedial measures, and collecting data to demonstrate improvement or resolution. Effective strategies included obtaining Institutional Review Board (IRB) approval for a waiver of informed consent, modifying eligibility criteria, ensuring that operational definitions and study procedures were consistent with clinical practice, decreasing time from screening to data collection to improve recruitment, increasing study nurse staffing by re-budgeting grant funds, focusing time and resources on high accruing clinical units, revising processes to minimize missing data, and developing detailed training for users of the instrument. With these multi-pronged solutions, the team exceeded the patient accrual target by 25% within the funding period and reduced missing data. While pain instrumentation studies in non-communicative patients have similar challenges to other palliative care studies, some of the solutions may be unique and several are applicable to other palliative care studies, particularly instrumentation research. The team's experience may also be useful for funders and IRBs.
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Affiliation(s)
- Karen Snow Kaiser
- Corporate Education, University of Maryland Capital Region Health, 3001 Hospital Drive, Cheverly, MD 20785-1189, United States of America.
| | - Deborah B McGuire
- Professor Emeritus, Virginia Commonwealth University School of Nursing, 1100 East Leigh St., Richmond, VA 23298-0567, United States of America
| | - Timothy J Keay
- Formerly: Department of Family and Community Medicine, Palliative Care, University of Maryland School of Medicine Baltimore, MD 21201, United States of America
| | - Mary Ellen Haisfield-Wolfe
- Formerly: University of Maryland Baltimore School of Nursing, Baltimore, MD 21201, United States of America
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26
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Herr K, Coyne PJ, Ely E, Gélinas C, Manworren RCB. Pain Assessment in the Patient Unable to Self-Report: Clinical Practice Recommendations in Support of the ASPMN 2019 Position Statement. Pain Manag Nurs 2019; 20:404-417. [PMID: 31610992 DOI: 10.1016/j.pmn.2019.07.005] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 06/25/2019] [Accepted: 07/21/2019] [Indexed: 11/18/2022]
Abstract
Pain is a subjective experience, unfortunately, some patients cannot provide a self-report of pain verbally, in writing, or by other means. In patients who are unable to self-report pain, other strategies must be used to infer pain and evaluate interventions. In support of the ASPMN position statement "Pain Assessment in the Patient Unable to Self-Report", this paper provides clinical practice recommendations for five populations in which difficulty communicating pain often exists: neonates, toddlers and young children, persons with intellectual disabilities, critically ill/unconscious patients, older adults with advanced dementia, and patients at the end of life. Nurses are integral to ensuring assessment and treatment of these vulnerable populations.
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Affiliation(s)
- Keela Herr
- College of Nursing, University of Iowa, Iowa City, Iowa.
| | - Patrick J Coyne
- Palliative Care Department, Medical University of South Carolina, Charleston, South Carolina
| | - Elizabeth Ely
- Department of Nursing Research, University of Chicago Hospitals, Chicago, Illinois
| | - Céline Gélinas
- Ingram School of Nursing, McGill University, Montréal, Québec, Canada; Centre for Nursing Research and Lady Davis Institute, Jewish General Hospital - CIUSSS, Centre-West-Montréal, Montréal, Québec, Canada
| | - Renee C B Manworren
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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27
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Taylor BL, O'Riordan DL, Pantilat SZ, Creutzfeldt CJ. Inpatients with neurologic disease referred for palliative care consultation. Neurology 2019; 92:e1975-e1981. [PMID: 30918095 DOI: 10.1212/wnl.0000000000007364] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Accepted: 01/03/2019] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES To compare characteristics and needs of inpatients with neurologic disease to those with cancer referred for palliative care (PC) consultation. METHODS This prospective cohort study used data collected by the Palliative Care Quality Network from January 2013 until December 2016. We compared demographics, reasons for consultation, discharge disposition, Palliative Performance Scale (PPS) score, and outcomes of care among patients with a primary diagnosis of neurologic disease vs cancer. RESULTS The most common reason for PC consultation in all patients was assistance with goals of care and advanced care planning. PC consultation was less often requested for pain and symptom management in patients with neurologic disease compared to patients with cancer (13.7% vs 43%, odds ratio 0.3) and more often for assistance with transition to comfort measures only and withdrawal of life-sustaining treatment (19.1% vs 7.1%, odds ratio 1.3). Patients with cancer had higher PPS scores (42.1% vs 23.4%) and were more likely to be discharged home from the hospital, while patients with neurologic disease were more likely to die in hospital. CONCLUSIONS Patients with neurologic disease as a reason for PC consultation are more in need of end-of-life care planning and more likely to die in the hospital than those with cancer, suggesting that targeted approaches may best address the needs of each patient population. Our results can direct further research and education in neuropalliative care.
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Affiliation(s)
- Breana L Taylor
- From the Department of Neurology (B.L.T., C.J.C.), University of Washington, Seattle; and Department of Medicine (D.L.O., S.Z.P.), Division of Palliative Medicine, University of California San Francisco.
| | - David L O'Riordan
- From the Department of Neurology (B.L.T., C.J.C.), University of Washington, Seattle; and Department of Medicine (D.L.O., S.Z.P.), Division of Palliative Medicine, University of California San Francisco
| | - Steven Z Pantilat
- From the Department of Neurology (B.L.T., C.J.C.), University of Washington, Seattle; and Department of Medicine (D.L.O., S.Z.P.), Division of Palliative Medicine, University of California San Francisco
| | - Claire J Creutzfeldt
- From the Department of Neurology (B.L.T., C.J.C.), University of Washington, Seattle; and Department of Medicine (D.L.O., S.Z.P.), Division of Palliative Medicine, University of California San Francisco
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28
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Tapp D, Chenacher S, Gérard NPA, Bérubé-Mercier P, Gelinas C, Douville F, Desbiens JF. Observational Pain Assessment Instruments for Use With Nonverbal Patients at the End-of-life: A Systematic Review. J Palliat Care 2019; 34:255-266. [DOI: 10.1177/0825859718816073] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: To review studies pertaining to the reliability and validity of observational pain assessment tools for use with nonverbal patients at the end-of-life, a field of research not documented by previous systematic reviews. Methods: Databases (PubMed, Embase, Epistemonikos, the Cochrane Library, and CINAHL) were systematically searched for studies from study inception to February 21, 2016 (update in May 9, 2018). Two independent reviewers screened study titles, abstracts, and full texts according to inclusion and exclusion criteria. Disagreements were resolved through consensus. Reviewers also extracted the psychometrics properties of studies of observational pain assessment instruments dedicated to a noncommunicative population in palliative care or at the end-of-life. A comprehensive quality assessment was conducted using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) to derive poor, fair, good or excellent ratings for the psychometric tests reported in each study. Results: Four studies linked to 4 different tools met the inclusion criteria. Study populations included dementia, palliative care and severe illness in the context of intensive care. All the studies included in this review obtained poor COSMIN ratings overall. Conclusions: At this point, it is impossible to recommend any of the tools evaluated given the low number and quality of the studies. Other analyses and studies need to be conducted to develop, adapt, or further validate observational pain instruments for the end-of-life population, regardless of the disease.
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Affiliation(s)
- Diane Tapp
- Faculty of Nursing, Université Laval, Quebec City, Quebec, Canada
- Quebec Heart and Lung Institute Research Center, Quebec City, Quebec, Canada
| | - Sara Chenacher
- Faculty of Pharmacy, Université Laval, Québec City, Quebec, Canada
| | | | - Philippe Bérubé-Mercier
- Faculty of Nursing, Université Laval, Quebec City, Quebec, Canada
- Quebec Heart and Lung Institute Research Center, Quebec City, Quebec, Canada
| | - Celine Gelinas
- Ingram School of Nursing, McGill University, Montreal, Quebec, Canada
| | - Frédéric Douville
- Faculty of Nursing, Université Laval, Quebec City, Quebec, Canada
- Quebec Heart and Lung Institute Research Center, Quebec City, Quebec, Canada
| | - Jean-François Desbiens
- Faculty of Nursing, Université Laval, Quebec City, Quebec, Canada
- Centre de recherche du centre hospitalier universitaire de Québec-Université Laval, Quebec City, Quebec, Canada
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29
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Gomarverdi S, Sedighie L, Seifrabiei MA, Nikooseresht M. Comparison of Two Pain Scales: Behavioral Pain Scale and Critical-care Pain Observation Tool During Invasive and Noninvasive Procedures in Intensive Care Unit-admitted Patients. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2019; 24:151-155. [PMID: 30820228 PMCID: PMC6390431 DOI: 10.4103/ijnmr.ijnmr_47_18] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background: Critically ill patients admitted to intensive care units (ICUs) frequently experience pain, but the severity of pain in this group of patients is underestimated by the treatment team due to barriers to verbal communication. The aim of the present study was comparing the severity of pain measured by two scales: behavioral pain scale (BPS) and critical-care pain observation tool (CPOT) in ICU-admitted patients during routine daily procedures. Materials and Methods: Ninety patients were enrolled in the study. The severity of pain was measured during resting, invasive (suctioning) and noninvasive (mouthwash and body position change) procedures, and respiratory physiotherapy with two scales: BPS and CPOT. Wilcoxon and Friedman statistical tests were used to compare the score of pain in different situations, and Spearman correlation coefficient was also used to measure the correlation of pain score measured by two scales. Results: Patients experienced no pain during resting, mild pain during changing position, and respiratory physiotherapy, mild-to-moderate pain during mouthwash and moderate pain during secretion suctioning. Wilcoxon test used for pairwise comparisons between pain score in different situations showed a significant difference in both scales (p < 0.05). There were positive and strong correlations (r > 0.80, p < 0.05) between the pain score measured by BPS and CPOT from ICU-admitted patients in all procedures. Conclusions: Critically ill patients in ICU experience a different range of pain in routine daily care. BPS and CPOT scales could be used successfully for monitoring of pain in this group of patients.
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Affiliation(s)
- Shiva Gomarverdi
- Department of Medical-Surgical Nursing, School of Nursing, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ladan Sedighie
- Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohamad Ali Seifrabiei
- Department of Community Medicine, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mahshid Nikooseresht
- Department of Anesthesiology and Intensive Care Medicine, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
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Cluxton C. The Challenge of Cancer Pain Assessment. THE ULSTER MEDICAL JOURNAL 2019; 88:43-46. [PMID: 30675079 PMCID: PMC6342038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 11/22/2018] [Indexed: 11/20/2022]
Affiliation(s)
- Christopher Cluxton
- ,Correspondence to: Christopher Cluxton, 4th-year QUB medical student, E-mail:
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31
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Baillie J, Anagnostou D, Sivell S, Van Godwin J, Byrne A, Nelson A. Symptom management, nutrition and hydration at end-of-life: a qualitative exploration of patients', carers' and health professionals' experiences and further research questions. BMC Palliat Care 2018; 17:60. [PMID: 29656713 PMCID: PMC5901670 DOI: 10.1186/s12904-018-0314-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 03/23/2018] [Indexed: 11/10/2022] Open
Abstract
Background Symptom management is an essential aspect of palliative and end-of-life care, but evidence suggests that patients’ symptoms may not always be relieved, causing significant harm to patients and magnifying their relatives’ distress. A growing body of evidence focuses on symptom management at the end-of-life, but research funding for palliative care remains disproportionately low. It is therefore crucial that research funding is targeted at areas of importance to patients and relatives. The Palliative and end-of-life care Priority Setting Partnership (PeolcPSP) undertook a UK-wide free-text survey to establish research priorities within palliative and end-of-life care and disseminated its results in 2015. Much of the data were related more broadly to personal perceptions and experiences rather than specific research questions. The aim of this article is to report on a supplementary analysis exploring the experiences and questions of PeolcPSP survey respondents regarding symptoms, hydration and nutrition. Methods The PeolcPSP data (n = 1403) were coded by a team of qualitative researchers in a supplementary analysis. There were 190 responses that related to symptoms, nutrition and hydration. The data were analysed thematically using Braun and Clarke’s approach. Results Five themes were identified: pain, breathlessness, agitation, nutrition and hydration. The majority of responses related to symptoms that were sub-optimally managed, in particular pain. Nutrition and hydration were of significant concern, particularly for carers. Overall, respondents consistently asked about the most effective, evidence-based methods for managing symptoms and suggested areas where further research is necessary. Conclusions This study highlights the perceptions and experiences of patients, families and professionals within palliative care, highlighting the need for improved care, communication and further research to establish which treatments are most effective within a palliative care population. This is essential to reduce harm and distress for patients and families. Electronic supplementary material The online version of this article (10.1186/s12904-018-0314-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jessica Baillie
- School of Healthcare Sciences, Cardiff University, Cardiff, UK.
| | - Despina Anagnostou
- Marie Curie Palliative Care Research Centre, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Stephanie Sivell
- Marie Curie Palliative Care Research Centre, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Jordan Van Godwin
- DECIPHer, School of Social Sciences, Cardiff University, Cardiff, UK
| | - Anthony Byrne
- Marie Curie Palliative Care Research Centre, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Annmarie Nelson
- Marie Curie Palliative Care Research Centre, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
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32
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Sharifi H. Letters to the Editor. AACN Adv Crit Care 2018; 28:134. [PMID: 28592471 DOI: 10.4037/aacnacc2017299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Wiegand DL, Wilson T, Pannullo D, Russo MM, Kaiser KS, Soeken K, McGuire DB. Measuring Acute Pain Over Time in the Critically Ill Using the Multidimensional Objective Pain Assessment Tool (MOPAT). Pain Manag Nurs 2018; 19:277-287. [PMID: 29398346 DOI: 10.1016/j.pmn.2017.10.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 10/07/2017] [Accepted: 10/11/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND A valid and reliable instrument is needed to assess acute pain in critically ill patients unable to self-report and who may be transitioning between critical care and other settings. AIM To examine the reliability, validity, and clinical utility of the Multidimensional Objective Pain Assessment Tool (MOPAT) when used over time by critical care nurses to assess acute pain in non-communicative critically ill patients. METHODS Twenty-seven patients had pain assessed at two time points (T1 and T2) surrounding a painful event for up to 3 days. Twenty-one ICU nurses participated in pain assessments and completed the Clinical Utility Questionnaire. RESULTS Internal consistency reliability coefficient alphas for the MOPAT were .68 at T1 and .72 at T2. Inter-rater agreement during painful procedures or turning was 68% for the behavioral dimension and 80% for the physiologic dimension. Validity was evidenced by decreases (p < .001) in the MOPAT total and behavioral and physiologic dimension scores when comparing T1 and T2. Nurses found the tool clinically useful. CONCLUSION The MOPAT can be used in the critical care setting as a helpful tool to assess pain in non-communicative patients. The MOPAT is unique in that the instrument can be used over time and across settings.
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Affiliation(s)
- Debra L Wiegand
- University of Maryland School of Nursing, Baltimore, Maryland.
| | - Tracey Wilson
- Medical Intensive Care Unit, University of Maryland Medical Center, Baltimore, Maryland
| | - Diane Pannullo
- Surgical Intensive Care Unit, University of Maryland Medical Center, Baltimore, Maryland
| | - Marguerite M Russo
- Palliative Care, University of Maryland Medical Center, Baltimore, Maryland; University of Maryland Baltimore Graduate School, Baltimore, Maryland
| | | | - Karen Soeken
- University of Maryland School of Nursing, Baltimore, Maryland
| | - Deborah B McGuire
- Virginia Commonwealth University School of Nursing, Richmond, Virginia
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Paez K, Gregg M, Massion CT, Macy B. Promoting Excellence in Symptom Management Case Series: Case Study: A New Intervention for Rapid End-of-Life Symptom Control in the Home Setting. J Hosp Palliat Nurs 2016; 18:498-504. [PMID: 29238269 PMCID: PMC5708715 DOI: 10.1097/njh.0000000000000298] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The oral route is compromised for nearly all patients at the end of life (EOL). This article reviews the benefits and burdens of the usual alternative routes of medication delivery when the oral route fails and presents a case study on the use of a new innovation for the rectal delivery of medication to control EOL symptoms. A 62-year-old male hospice patient with end-stage metastatic prostate cancer presented with severe symptoms (Face, Legs, Activity, Cry and Consolability scale score, 9/10) that were uncontrollable with medications given via oral or sublingual routes. The patient goals were to remain at home with optimal symptom management. Rapid relief of symptoms was accomplished by the administration of medications already present in the home delivered with a new rectal catheter that provides discreet access for ongoing medication administration. Significant relief was noted within 20 minutes of dosing. The patient died peacefully 18 hours later, meeting his EOL goals, and the family was empowered to provide effective care for the patient at home. The family found the intervention easy to use. This case demonstrates how this new innovation can be used to ensure rapid symptom management and decreased burden of care by facilitating immediate and easy use of medications already present in the home.
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Affiliation(s)
- Kathryn Paez
- is case manager, Hospice of Santa Cruz County, Scotts Valley, CA
| | - Meegan Gregg
- is case manager, Hospice of Santa Cruz County, Scotts Valley, CA
| | | | - Brad Macy
- is case manager, Hospice of Santa Cruz County, Scotts Valley, CA
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