Journal of pain and symptom management
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J Pain Symptom Manage · Apr 2001
Dyspnea, anxiety, body consciousness, and quality of life in patients with lung cancer.
Dyspnea is a common symptom of lung cancer that can impact patient physical, social, and psychological well-being. Study goals were to evaluate quality of life (QOL) and dyspnea in patients with lung cancer and the relationships between QOL, dyspnea, trait anxiety, and body consciousness. Sociodemographic and cancer-related variables (stage, cell type, performance status) were evaluated. ⋯ Pain and anxiety scores were higher in patients with high dyspnea (P = 0.02, P = 0.03). Dyspnea was more severe in patients taking opioid analgesics when compared to non-opioids or no pain medications (P = 0.03). No significant association was found between dyspnea, anxiety, and private body consciousness.
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J Pain Symptom Manage · Apr 2001
Cancer pain management skills among medical students: the development of a Cancer Pain Objective Structured Clinical Examination.
Recent surveys suggest that most physicians have inadequate knowledge to assess and manage cancer pain; however, the important domain of clinical performance has not yet been clearly evaluated. The Objective Structured Clinical Examination (OSCE) has become a widely- used and accepted method to evaluate the clinical abilities of medical students. The purpose of this study was to develop and test a Cancer Pain OSCE for medical students evaluating their clinical competence in the area of cancer pain management. ⋯ We conclude that the Cancer Pain OSCE is a useful performance-based tool to test individual skills in the essential components of cancer pain assessment and management. Of the four components of the Cancer Pain OSCE, medical students performed best on the cancer pain history and performed poorly on the cancer pain physical examination. Information gained from this study will provide a foundation on which future small-group medical student structured teaching will be based.
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J Pain Symptom Manage · Apr 2001
ReviewOpioid poorly-responsive cancer pain. Part 3. Clinical strategies to improve opioid responsiveness.
Some pain syndromes may be difficult to treat due to a poor response to opioids. This situation demands a range of alternative measures, including the use of adjuvant drugs with independent effects, such as antidepressants, sodium channel-blocking agents, steroids and anti-inflammatory drugs (NSAIDs); drugs that reduce opioid side effects; and drugs that enhance analgesia produced by opioids, such as N-methyl-D-aspartate (NMDA) antagonists, calcium channel antagonists, and clonidine. Other approaches, including opioid trials, neural blockade when necessary, and psychological interventions, also may be useful.
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J Pain Symptom Manage · Apr 2001
Minority representation, prevalence of symptoms, and utilization of services in a large metropolitan hospice.
Minority access to and utilization of hospice services is gaining increasing attention in the field of health care delivery systems. This case study describes the 1997 ethnic and racial make-up of a large metropolitan hospice facility located in Arlington, Virginia and compares its composition with the regional community. ⋯ When hospice deaths were compared with regional deaths, the hospice provided service to 30% of Caucasians decedents, 20% of Asian decedents, 19% of Hispanic decedents, and 18% of African-American decedents. By using mortality data rather than census data, the discrepancy between minority and Caucasian populations is not as large as has been reported in previous research.
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J Pain Symptom Manage · Apr 2001
Effects of high dose opioids and sedatives on survival in terminally ill cancer patients.
Concerns that high dose opioids and sedatives might shorten patient survival could contribute to insufficient symptom alleviation for terminally ill cancer patients. To examine the effects of opioids and sedatives prescribed in the final 48 hours on patient survival, a re-analysis of the prospectively collected data was performed on 209 hospice inpatients. Patient characteristics and clinical symptoms were prospectively recorded, and information about the use of opioids and sedatives in the last two days was collected by a chart review. ⋯ Furthermore, an addition of use of opioids and sedatives in the final 48 hours into the multiple regression model for survival prediction achieved no significant increase in predictability. In conclusion, opioids and sedatives used for symptom control in the last days are not associated with patient survival. They are safe and useful medications to palliate severe distress in the terminal stage of cancer when administered with a low initial dosage and adequate titration.