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Greenfield K, Schoth DE, Hain R, Bailey S, Mott C, Rajapakse D, Harrop E, Renton K, Anderson AK, Carter B, Johnson M, Liossi C. A rapid systematic review of breakthrough pain definitions and descriptions. Br J Pain 2024; 18:215-226. [PMID: 38751563 PMCID: PMC11092936 DOI: 10.1177/20494637231208093] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024] Open
Abstract
Background Breakthrough pain is common in life-limiting conditions and at end-of-life. Despite over 30 years of study, there is little consensus regarding the definition and characteristics of breakthrough pain. Objective This study aims to update and expand a 2010 systematic review by Haugen and colleagues to identify (1) all definitions of breakthrough pain and (2) all descriptions and classifications of breakthrough pain reported by patients, caregivers, clinicians, and experts. Design This rapid systematic review followed the Cochrane Rapid Review Methods Group guidelines. A protocol is published on PROSPERO (CRD42019155583). Data sources CINAHL, MEDLINE, PsycINFO, and the Web of Science were searched for breakthrough pain terms from the inception dates of each database to 26th August 2022. Results We identified 65 studies that included data on breakthrough pain definitions, descriptions, or classifications from patients (n = 30), clinicians (n = 6), and experts (n = 29), but none with data from caregivers. Most experts proposed that breakthrough pain was a sudden, severe, brief pain occurring in patients with adequately controlled mild-moderate background pain. However, definitions varied and there was no consensus. Pain characteristics were broadly similar across studies though temporal factors varied widely. Experts classified breakthrough pain into nociceptive, neuropathic, visceral, somatic, or mixed types. Patients with breakthrough pain commonly experienced depression, anxiety, and interference with daily life. Conclusions Despite ongoing efforts, there is still no consensus on the definition of breakthrough pain. A compromise is needed on breakthrough pain nomenclature to collect reliable incidence and prevalence data and to inform further refinement of the construct.
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Affiliation(s)
| | - Daniel E Schoth
- School of Psychology, University of Southampton, Highfield, UK
| | - Richard Hain
- Paediatric Palliative Medicine, Noah’s Ark Children’s Hospital for Wales, Cardiff, UK
| | - Simon Bailey
- Sir James Spence Institute,Royal Victoria Infirmary, Newcastle upon Tyne,UK
| | - Christine Mott
- Acorns Children’s Hospice, Birmingham,UK
- Birmingham Children’s Hospital, Birmingham,UK
| | - Dilini Rajapakse
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Emily Harrop
- Helen & Douglas House Hospices, Oxford, UK
- Oxford University Hospitals NHS Trust,John Radcliffe Hospital, Oxford, UK
| | - Kate Renton
- University Hospital Southampton NHS Trust, Southampton General Hospital, Southampton, UK
- Naomi House & Jacksplace, Winchester, UK
| | | | - Bernie Carter
- Faculty of Health, Social Care and Medicine,Edge Hill University, Ormskirk, UK
| | | | - Christina Liossi
- School of Psychology, University of Southampton, Highfield, UK
- Psychological Services Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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Chung HH, Wang CL, Wu JJ, Chien SP, Lee LC, Juang YH, Chu WM. Trend analysis of quality indicators in palliative home care among terminally ill cancer and non-cancer patients in Taiwan: a 6-year observational study. Support Care Cancer 2024; 32:75. [PMID: 38170324 DOI: 10.1007/s00520-023-08277-2] [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] [Received: 05/28/2023] [Accepted: 12/18/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE Palliative home care services (PHCS) have been emerging for years. However, limited data exist regarding quality indicators for pain control, unplanned hospital readmissions, and household deaths among terminal cancer and non-cancer patients receiving PHCS. METHODS We conducted a retrospective collection and recording of data from 1242 terminally ill cancer and non-cancer patients receiving PHCS. The data were obtained from the Hospice-Palliative Clinical Database (HPCD) of Taichung Veterans General Hospital (TCVGH) for the period from 2016 to 2021. T test and chi-square test were applied for characteristics and the quality indicators among cancer and non-cancer groups. Chi-square test was used for trend analysis of the number of patients receiving PHCS and the quality indicators among cancer and non-cancer groups throughout the study period. RESULTS A total of 1242 terminally ill cancer and non-cancer patients who had received PHCS were documented by TCVGH from the years 2016 to 2021, including 221 non-cancer patients and 1021 cancer patients having an average age of 70. The number of terminally ill cancer and non-cancer patients receiving PHCS has increased annually since 2016. Another finding was that age was a statistically significant factor impacting quality indicators. On the other hand, compared to non-cancer patients, cancer patients had a higher likelihood of receiving treatment with analgesics when needed. Their odds of needing analgesics more than three times within 4 days after PHCS enrollment were significantly elevated [OR 4.188, 95% CI (1.002, 17.51)]. CONCLUSION The results of this 6-year observational study indicate a substantial increase in the number of terminal cancer and non-cancer patients receiving PHCS over the past decade. Furthermore, aging plays an important role in life quality of terminal cancer and non-cancer patients.
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Affiliation(s)
- Hao-Hsun Chung
- Department of Medical Education, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chun-Li Wang
- Department of Family Medicine, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, Taiwan, 40705
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Jia-Jyun Wu
- Department of Family Medicine, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, Taiwan, 40705
- Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Szu-Pei Chien
- College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Lung-Chun Lee
- Department of Family Medicine, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, Taiwan, 40705
| | - Ya-Huei Juang
- Department of Nursing, Taichung Veterans General Hospital, Taichung, Taiwan.
| | - Wei-Min Chu
- Department of Family Medicine, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, Taiwan, 40705.
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan.
- Geriatrics and Gerontology Research Center, College of Medicine, National Chung Hsing University, Taichung, Taiwan.
- Department of Epidemiology On Aging, National Center for Geriatrics and Gerontology, Aichi, Japan.
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Symptom prevalence and management in older adult patients in Lebanon. Palliat Support Care 2020; 17:464-471. [PMID: 30238866 DOI: 10.1017/s1478951518000676] [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: 11/12/2022]
Abstract
OBJECTIVE The purpose of this study is to explore symptoms and the effectiveness of their management in older adult palliative care candidates in Lebanon. The aims of this study were to: (1) determine symptom prevalence in Lebanese older adults who qualify for palliative care; (2) identify the severity and distress of symptoms; (3) identify the prevalence of symptom management and its efficacy; and (4) explore the relationship between overall symptom burden and its correlates. METHOD This study uses an observational cross-sectional design using convenience sampling (N = 203) to recruit older adults qualifying for palliative care from three major medical centers in Lebanon. RESULT The mean age of the sample was 78.61 years. The most prevalent symptoms were lack of energy (93.5%), worrying (83.2%), and pain (71.4%). Psychological symptoms had the highest mean scores, preceded only by the physical symptoms and lack of energy. The most treated symptoms were physical with pain having the highest treatment prevalence (91%). Although psychological symptoms were the most burdensome, they were poorly treated. Multiple regression analysis showed that symptom scores had significant positive associations with financial status, social functioning, and comorbidities; there was a negative association with age. SIGNIFICANCE OF RESULTS Lack of energy and psychological symptoms were the most prevalent, with the latter having the highest mean total symptom scores. Treatment was poor for psychological symptoms and effective for physical ones. Associations were found between age, comorbidity, financial problems, social functioning, and total physical and psychological mean symptom burden scores. More attention needs to be given to psychological symptoms and their management among older adults receiving palliative care.
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Klint Å, Bondesson E, Rasmussen BH, Fürst CJ, Schelin MEC. Dying With Unrelieved Pain-Prescription of Opioids Is Not Enough. J Pain Symptom Manage 2019; 58:784-791.e1. [PMID: 31319106 DOI: 10.1016/j.jpainsymman.2019.07.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 07/05/2019] [Accepted: 07/08/2019] [Indexed: 11/25/2022]
Abstract
CONTEXT Fear of pain resonates with most people, in particular, in relation to dying. Despite this, there are still people dying with unrelieved pain. OBJECTIVES We quantified the risk, and investigated risk factors, for dying with unrelieved pain in a nationwide observational cohort study. METHODS Using data from Swedish Register of Palliative Care, we analyzed 161,762 expected deaths during 2011-2015. The investigated risk factors included cause of death, place of death, absence of an end-of-life (EoL) conversation, and lack of contact with pain management expertise. Modified Poisson regression models were fitted to estimate risk ratios (RRs) and 95% confidence intervals (CIs) for dying with unrelieved pain. RESULTS Unrelieved pain during the final week of life was reported for 25% of the patients with pain, despite prescription of opioids PRN in 97% of cases. Unrelieved pain was common both among patients dying of cancer and of nonmalignant chronic diseases. Statistically significant risk factors for unrelieved pain included hospital death (RR = 1.84, 95% CI 1.79-1.88) compared with dying in specialist palliative care, absence of an EoL conversation (RR = 1.42, 95% CI 1.38-1.45), and dying of cancer in the bones (RR = 1.13, 95% CI 1.08-1.18) or lung (RR = 1.10, 95% CI 1.06-1.13) compared with nonmalignant causes. CONCLUSION Despite almost complete prescription of opioids PRN for patients with pain, patients die with unrelieved pain. Health care providers, hospitals in particular, need to focus more on pain in dying patients. An EoL conversation is one achievable intervention.
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Affiliation(s)
- Åsa Klint
- Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden; Skåne University Hospital, Region Skåne, Lund, Sweden.
| | - Elisabeth Bondesson
- Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden; Department of Pain Rehabilitation, Skåne University Hospital, Lund, Sweden
| | - Birgit H Rasmussen
- Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden; Department for Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Carl Johan Fürst
- Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden; Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden
| | - Maria E C Schelin
- Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden; Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden
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Use of Electronic Health Records by Nurses for Symptom Management in Inpatient Settings. ACTA ACUST UNITED AC 2017; 35:465-472. [DOI: 10.1097/cin.0000000000000329] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Campbell CL, Kelly M, Rovnyak V. Pain management in home hospice patients: A retrospective descriptive study. Nurs Health Sci 2017; 19:381-387. [PMID: 28612352 DOI: 10.1111/nhs.12359] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Revised: 03/14/2017] [Accepted: 03/24/2017] [Indexed: 01/14/2023]
Abstract
The development and evaluation of evidence-based, safe, and effective home-based pain management models for caregivers implementation is receiving greater attention in the literature because of international initiatives intended to increase the number of people who receive end-of-life care in home-based settings. The purpose of this "retrospective descriptive design" study was to describe pharmacological pain management and outcomes for 40 cancer and non-cancer patients receiving hospice care at home. While the median pain score was higher at admission in the cancer group than in the hospice care at home group, the difference was not significant at or within 48 hour of admission. Overall, there was a significant decrease in pain from the first measurement to the second. Within the last seven days of life, the majority of participants were not able to provide a pain severity score when asked to evaluate the effectiveness of pain management, thus their caregiver provided a proxy evaluation. Pain management was effective in the home setting. More research is needed on the best methods to teach lay caregivers to assess pain and evaluate the effectiveness of pharmacological modalities to manage pain.
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Affiliation(s)
- Cathy L Campbell
- University of Virginia School of Nursing, Charlottesville, Virginia
| | - Meghan Kelly
- University of Virginia School of Nursing, Charlottesville, Virginia
| | - Virginia Rovnyak
- University of Virginia School of Nursing, Charlottesville, Virginia
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Deshields TL, Penalba V, Liu J, Avery J. Comparing the symptom experience of cancer patients and non-cancer patients. Support Care Cancer 2016; 25:1103-1109. [PMID: 27966024 DOI: 10.1007/s00520-016-3498-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 11/14/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE Symptom burden is an established concept in oncology encompassing the presence and severity of symptoms experienced by cancer patients. Few studies have examined differences in symptom burden between cancer patients and non-cancer patients. This study seeks to examine the differences in symptom burden between cancer patients (CP) and non-cancer patients (NCP) in order to better understand symptom burden in both populations. METHODS Two groups of patients completed the Memorial Symptom Assessment Scale: 301 patients from a general medical clinic and 558 cancer patients from a cancer tumor registry. Participants provided demographic information-age, race/ethnicity, and sex and completed the Memorial Symptom Assessment Scale. Medical comorbidity was also measured. RESULTS Most symptoms were more common in CP, except for pain, which was more prevalent in the NCP (45% of CP vs. 54% of NCP, p < .05). There was no difference in prevalence for the following symptoms: dry mouth, mouth sores, feeling nervous, worry, cough, and dizziness. The CP had greater mean MSAS Total scores (0.53 vs. 0.43, p < .01), number of symptoms (9.11 vs. 6.13, p < .01), and psychological subscale scores (0.77 vs. 0.64, p < .05). There was no difference by group in the physical nor the GDI subscale scores. CONCLUSION The results of this study support the perception that cancer patients have greater symptom burden. There were some unexpected results, particularly in terms of pain, which was more common in NCP and other symptoms that were experienced equally in both patient populations.
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Affiliation(s)
- Teresa L Deshields
- Siteman Cancer, Barnes-Jewish Hospital, Washington University School of Medicine, 4921 Parkview Place, MS: 90-35-703, St. Louis, MO, 63110, USA.
| | - Valentina Penalba
- Siteman Cancer, Barnes-Jewish Hospital, Washington University School of Medicine, 4921 Parkview Place, MS: 90-35-703, St. Louis, MO, 63110, USA
| | - Jingxa Liu
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - James Avery
- Department of Medicine, Washington University School of Medicine, Saint Louis, MO, USA
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Romem A, Tom SE, Beauchene M, Babington L, Scharf SM, Romem A. Pain management at the end of life: A comparative study of cancer, dementia, and chronic obstructive pulmonary disease patients. Palliat Med 2015; 29:464-9. [PMID: 25680377 DOI: 10.1177/0269216315570411] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Limited data exist concerning the unique pain characteristics of patients with non-cancer terminal diseases referred for inpatient hospice care. AIMS To define the unique pain characteristics of patients admitted to an acute inpatient hospice setting with end-stage dementia or chronic obstructive lung disease (or chronic obstructive pulmonary disease) and to compare them to patients with end-stage cancer. DESIGN Retrospective patient chart review. Demographic, physiological, pain parameters, and medication utilization data were extracted. Associations between pain characteristics, medication utilization, and admission diagnoses were assessed. Analyses included descriptive statistics. SETTING/PARTICIPANTS In total, 146 patients admitted to an acute inpatient hospice between 1 April 2011 and 31 March 2012 with an underlying primary diagnosis of chronic obstructive pulmonary disease (n = 51), dementia (n = 48), or cancer (n = 47). RESULTS Pain was highly prevalent in all diagnostic groups, with cancer patients experiencing more severe pain on admission. Cancer patients received a significantly higher cumulative opioid dose compared with dementia and chronic obstructive pulmonary disease patients. Pain control within 24 h of pain onset was achieved in less than half of all patient groups with chronic obstructive pulmonary disease patients the least likely to achieve pain control. CONCLUSIONS Despite the fact that pain is the most common complaint at the end of life, pain management may be suboptimal for some primary diagnoses. Admission diagnosis is the strongest predictor of pain control. Patient with cancer achieve the best pain control, and chronic obstructive pulmonary disease patients are the least likely to have their pain adequately treated.
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Affiliation(s)
- Anat Romem
- School of Nursing Sciences, The Academic College of Tel-Aviv, Yaffo, Israel
| | - Sarah E Tom
- Pharmaceutical Health Services Research Department, University of Maryland, Baltimore, MD, USA
| | - Michelle Beauchene
- School of Nursing, Bouve College of Health Sciences, Northeastern University, Boston, MA, USA
| | - Lynn Babington
- School of Nursing, Fairfield University, Fairfield, CT, USA
| | - Steven M Scharf
- Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ayal Romem
- Pulmonary Institute, Shaare Zedek Medical Center, Jerusalem, Israel
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Washington KT, Pike KC, Demiris G, Oliver DP. Unique characteristics of informal hospice cancer caregiving. Support Care Cancer 2014; 23:2121-8. [PMID: 25547480 DOI: 10.1007/s00520-014-2570-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 12/15/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this study was to describe the unique characteristics of informal hospice cancer caregiving. METHODS Researchers conducted a secondary analysis of data drawn from a randomized clinical trial of an informal hospice caregiving intervention (N = 348). Demographic characteristics and measures of the informal caregiving experience of hospice patients and their informal caregivers were compared based on the patient's diagnosis using chi-square tests for association of categorical variables and t tests for continuous variables. RESULTS Informal caregivers of cancer patients differed from their non-cancer counterparts in a number of respects including patient age, caregiver age, patient residence, relationship between patient and caregiver, amount and duration of care provided, likelihood to incur out-of-pocket expenses related to patient care, caregiver problem-solving style, and impact on caregiver daily schedule. There were no statistically significant differences between cancer and non-cancer caregivers in terms of gender, race, employment status, anxiety, and quality of life. CONCLUSIONS While cancer and non-cancer caregivers are similar in many respects, a number of unique features characterize the informal hospice cancer caregiving experience. Attention to these unique features will allow hospice providers to tailor supportive care interventions to better address cancer caregivers' needs.
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Affiliation(s)
- Karla T Washington
- Department of Family and Community Medicine, School of Medicine, University of Missouri, MA306 Medical Sciences Building, DC032.00, Columbia, MO, 65212, USA,
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Steindal SA, Bredal IS, Ranhoff AH, Sørbye LW, Lerdal A. The last three days of life: a comparison of pain management in the young old and the oldest old hospitalised patients using the Resident Assessment Instrument for Palliative Care. Int J Older People Nurs 2014; 10:263-72. [PMID: 25418556 DOI: 10.1111/opn.12076] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 09/29/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pain is a common symptom in older patients at the end of life. Little research has evaluated pain management among the oldest hospitalised dying patients. AIMS AND OBJECTIVES To compare the pain characteristics documented by healthcare workers for the young old and the oldest old hospitalised patients and the types of analgesics administered in the last three days of life. DESIGN A retrospective cross-sectional comparative study. METHODS The study included 190 patients from a Norwegian general hospital: 101 young old patients (aged 65-84 years) and 89 oldest old patients (aged 85-100 years). Data were extracted from electronic patient records (EPRs) using the Resident Assessment Instrument for Palliative Care. RESULTS No significant differences were found between the young old and the oldest old patients with regard to pain characteristics. Pain intensity was poorly recorded in the EPRs. Most of the patients received adequate pain control. Morphine was the most frequently administered analgesic for dying patients. Compared to the oldest old patients, a greater proportion of the young old patients received paracetamol combined with codeine (OR = 3.25, 95% CI 1.02-10.40). CONCLUSIONS There appeared to be no differences in healthcare workers' documentation of pain characteristics in young old and oldest old patients, but young old patients were more likely to receive paracetamol in combination with codeine. IMPLICATIONS FOR PRACTICE A limitation of the study is the retrospective design and that data were collected from a single hospital. Therefore, caution should be taken for interpretation of the results. The use of systematic patient-reported assessments in combination with feasible validated tools could contribute to more comprehensive documentation of pain intensity and improved pain control.
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Affiliation(s)
- Simen Alexander Steindal
- Institute of Nursing and Health, Diakonhjemmet University College, Oslo, Norway.,Palliative Care Unit, Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Inger Schou Bredal
- Surgery and Transplantation Department, Faculty of Medicine, University of Oslo and Cancer, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Anette Hylen Ranhoff
- Medical Department, Diakonhjemmet Hospital, Oslo, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | | | - Anners Lerdal
- Department of Research, Lovisenberg Diakonale Hospital, Oslo, Norway.,Deptartment of Nursing Science, Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
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Steindal S, Sørbye L. Treatments during the last three days of life: a comparison of hospitalised cancer and non-cancer patients using the resident assessment instrument for palliative care. J Geriatr Oncol 2013. [DOI: 10.1016/j.jgo.2013.09.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
This paper is the thirty-fourth consecutive installment of the annual review of research concerning the endogenous opioid system. It summarizes papers published during 2011 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides, opioid receptors, opioid agonists and opioid antagonists. The particular topics that continue to be covered include the molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors related to behavior (Section 2), and the roles of these opioid peptides and receptors in pain and analgesia (Section 3); stress and social status (Section 4); tolerance and dependence (Section 5); learning and memory (Section 6); eating and drinking (Section 7); alcohol and drugs of abuse (Section 8); sexual activity and hormones, pregnancy, development and endocrinology (Section 9); mental illness and mood (Section 10); seizures and neurologic disorders (Section 11); electrical-related activity and neurophysiology (Section 12); general activity and locomotion (Section 13); gastrointestinal, renal and hepatic functions (Section 14); cardiovascular responses (Section 15); respiration (Section 16); and immunological responses (Section 17).
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Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Neuropsychology Doctoral Sub-Program, Queens College, City University of New York, Flushing, NY 11367, United States.
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Steindal SA, Ranhoff AH, Bredal IS, Sørbye LW, Lerdal A. Last three days of life in the hospital: a comparison of symptoms, signs and treatments in the young old and the oldest old patients using the Resident assessment instrument for palliative care. Int J Older People Nurs 2012; 8:199-206. [PMID: 22329702 DOI: 10.1111/j.1748-3743.2012.00313.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Knowledge concerning the provision of end of life care to the oldest old hospitalised patients is deficient. AIMS AND OBJECTIVES To analyse whether there were differences in registered nurses' documentation of the young old vs. the oldest old patients according to symptoms, clinical signs and treatment in the last 3 days of life. DESIGN Data were collected retrospectively in a cross-sectional comparative study at a hospital between autumn 2007 and spring 2009. Methods. The study included 190 patients: 101 (65-84 years) and 89 (85+). Data were extracted from the patients' electronic records using the Resident Assessment Instrument for Palliative Care (RAI-PC). RESULTS Falls (OR = 4.01, 95% CI 1.47-10.90) and peripheral oedema (OR = 2.74, 95% CI 1.06-7.11) were significantly more frequent documented in the oldest old patients compared with the young old patients. Delirium was recorded in 15.3% of all patients. CONCLUSION With the exception of more falls and peripheral oedema in the oldest old patients, this study showed no differences in symptoms and treatment between the young old and the oldest old patients. Delirium was poorly documented compared to other studies. Implications for practice. The oldest old patients have a higher risk of falls in the final phase of life, and fall prevention should be considered.
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Affiliation(s)
- Simen A Steindal
- Diakonhjemmet University College, Institute of Nursing and Health, Oslo, Norway.
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