Journal of pain and symptom management
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J Pain Symptom Manage · Sep 2007
Randomized Controlled Trial Multicenter Study Comparative StudyA comparison of the analgesic efficacy of Tramadol Contramid OAD versus placebo in patients with pain due to osteoarthritis.
One thousand twenty-eight (1,028) patients with pain due to osteoarthritis (OA) of the knee were enrolled in this multicenter, randomized, double-blind, parallel study designed to assess the analgesic efficacy and safety of Tramadol Contramid OAD compared to placebo. An open-label phase was followed by a double-blind phase, in which a total of 646 patients were randomized to double-blind treatment with placebo or Tramadol Contramid OAD. Patients were titrated to their optimal dose (200mg or 300 mg), which was maintained for 12 weeks. ⋯ Both the 200mg and 300 mg doses contributed to the overall superiority of Tramadol Contramid OAD. The most frequent adverse events were consistent with the known side effects of tramadol and were generally mild to moderate in intensity. These results confirm that Tramadol Contramid OAD given once daily is an efficacious and safe treatment for pain due to OA.
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J Pain Symptom Manage · Sep 2007
Time course and characteristics of symptom distress and quality of life at the end of life.
This study sought to describe the characteristics and correlates of symptom distress and quality of life (QOL) among persons receiving hospice/palliative care. English-speaking adults (n=86), their nurses (n=86), and family caregivers (n=49) from 11 hospice/palliative care organizations completed the Memorial Symptom Assessment Scale (MSAS) and McGill Quality of Life Questionnaire (MQOL) at hospice/palliative care enrollment, at one week, two weeks, then monthly until death or discharge. Mixed effects modeling using proxy reports to impute missing patient-reported data were used to describe predictors of symptom distress and QOL. ⋯ There were no significant associations between patient characteristics and distress due to pain. While greater psychological symptom distress had a negative association with QOL, neither pain nor other physical symptom distress was associated with QOL. The persistence of significant symptom distress, particularly due to pain, argues for the need for enhanced evidence to guide care provided in the last days and weeks of life.
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J Pain Symptom Manage · Sep 2007
Racial differences in the growth of noncancer diagnoses among hospice enrollees.
Patients with noncancer life-limiting illnesses now represent over half of all hospice enrollees, compared to only one-quarter of enrollees in 1992. Whether this growth in enrollees with noncancer diagnoses has been similar for Caucasians and African Americans, a group historically underrepresented in hospice, has not been described. The purpose of this study was to compare rates of noncancer diagnoses among African American and Caucasian hospice enrollees. ⋯ However, in multivariate analysis (adjusted for age, gender, admission level of care, payment source, Health Maintenance Organization (HMO) use, discharge year, and hospice program characteristics-size, location, presence of an inpatient unit), African Americans had 32% lower odds of having a noncancer (vs. cancer) diagnosis than Caucasians (odds ratio [OR] 0.68 [0.66, 0.77]). While numerous studies document lower rates of hospice use among African Americans than Caucasians, these findings suggest disease-specific differences in patterns of hospice use, with greater disparities in hospice use among African Americans with noncancer diagnoses than those with cancer diagnoses. Targeted efforts to increase hospice use among African Americans with noncancer diagnoses may be important in reducing racial disparities in overall hospice use and improving the quality of care for dying African Americans.
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J Pain Symptom Manage · Sep 2007
Forgoing artificial nutrition or hydration in patients nearing death in six European countries.
Whether or not artificial nutrition or hydration (ANH) may be forgone in terminally ill patients has been the subject of medical and ethical discussions. Information about the frequency and background characteristics of making decisions to forgo ANH is generally limited to specific clinical settings. The aim of this study was to compare the practice of forgoing ANH in six European countries: Belgium, Denmark, Italy, The Netherlands, Sweden, and Switzerland. ⋯ Patients in whom ANH was forgone did not receive more potentially life-shortening drugs to relieve symptoms than other patients for whom other end-of-life decisions had been made. Decisions to forgo ANH are made in a substantial percentage of terminally ill patients. Providing all patients who are in the terminal stage of a lethal disease with ANH does not seem to be a widely accepted standard among physicians in Western Europe.
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Complete Center for Disease Control death certificate records and Centers for Medicare and Medicaid Services 100% Standard Analytic File for hospice claims for 2002 were used to describe the whole population of hospice users and nonusers in the United States. The overall hospice utilization rate for persons 65 years and older was 28.6%. Hospice utilization varied by cause of death, and was highest for individuals with malignancies (65%), kidney disease and nephritis (55%), and Alzheimer's disease (41%). ⋯ Considerable geographic differences in hospice utilization existed, with hospice use higher in the South and the Southwest and lower in the Midwest and the Northeast. State-specific usage rates ranged from 8% in Alaska to 49% in Arizona. Our findings highlight opportunities for the hospice industry to provide more care, opportunities defined by diagnostic and geographic axes.