Journal of pain and symptom management
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J Pain Symptom Manage · Nov 2013
ReviewFrom sedation to continuous sedation until death: how has the conceptual basis of sedation in end-of-life care changed over time?
Numerous attempts have been made to describe and define sedation in end-of-life care over time. However, confusion and inconsistency in the use of terms and definitions persevere in the literature, making interpretation, comparison, and extrapolation of many studies and case analyses problematic. ⋯ There is a pressing need to resolve the conceptual confusion that currently exists in the literature to bring clarity to the dialogue and build a base of commonality on which to design research and enhance the practice of sedation in end-of-life care.
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J Pain Symptom Manage · Nov 2013
Multicenter Study Observational StudyBreakthrough cancer pain: an observational study of 1000 European oncology patients.
Breakthrough pain is common in patients with cancer and is a significant cause of morbidity in this group of patients. ⋯ Breakthrough cancer pain is an extremely heterogeneous condition.
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J Pain Symptom Manage · Nov 2013
Fatigue in Parkinson's disease: measurement properties of a generic and a condition-specific rating scale.
High-quality fatigue rating scales are needed to advance the understanding of fatigue and determine the efficacy of interventions. Several fatigue scales are used in Parkinson's disease, but few have been tested using modern psychometric methodology (Rasch analysis). ⋯ We found general support for the measurement properties of both scales. However, polytomous PFS-16 scores exhibited advantages compared with dichotomous PFS-16 and FACIT-F scores. Dichotomization of item responses compromises measurement precision and the ability to separate people, and should be avoided.
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J Pain Symptom Manage · Nov 2013
Placebo and nocebo effects in randomized controlled trials: the implications for research and practice.
Placebo and nocebo effects are known to contribute significantly to the response to symptom control, including analgesia. Clinical trial methodologies using placebo controls are designed to identify the magnitude of these effects in the research context. An adequately powered, randomized, double-blind, placebo-controlled trial of ketamine in cancer pain has recently been reported, which demonstrated no net clinical benefit for ketamine over and above that of placebo. ⋯ The findings of the ketamine study are analyzed in the context of a methodological discussion of placebo and nocebo effects, what is known about the biological and psychological bases for each of these, and their implications for a clinical trial design in the palliative care setting. Along with reviewing the use of ketamine after this negative trial, clinicians need to remain aware of the strength and significance of both placebo and nocebo responses in their own practices and the biopsychosocial complexity of why and how patients actually respond to pain management strategies. The results of this study strongly reinforce the importance of the therapeutic relationship and the context of care.
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J Pain Symptom Manage · Nov 2013
Race and residence: intercounty variation in black-white differences in hospice use.
Although blacks use hospice at lower rates than whites in the U.S., racial differences in hospice use vary by geographic area. ⋯ In most counties, the rates of hospice use were similar for blacks and whites. In counties with a racial disparity, there were more resources to deliver aggressive care (i.e., hospital beds and specialists). Because of a greater preference for life-sustaining therapies, blacks may be more likely to use acute care services at the end of life when resources for the delivery of these services are readily available.