Journal of pain and symptom management
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J Pain Symptom Manage · Mar 2013
Multicenter StudyDo patients with advanced cognitive impairment admitted to hospitals with higher rates of feeding tube insertion have improved survival?
Research is conflicting on whether receiving medical care at a hospital with more aggressive treatment patterns improves survival. ⋯ Hospitals with more aggressive patterns of feeding tube insertion did not have improved survival for hospitalized nursing home residents with advanced cognitive impairment.
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Clinicians prescribe and administer oxygen in response to reports of dyspnea, in the face of dropping oxygen saturation, as a "routine" comfort intervention, or to support anxious family members. Oxygen may produce nasal irritation and increase the cost of care. ⋯ The routine application of oxygen to patients who are near death is not supported. The n-of-1 trial of oxygen in clinical practice is appropriate in the face of hypoxemic respiratory distress.
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J Pain Symptom Manage · Mar 2013
Controlled Clinical TrialFrequency and predictors of patient deviation from prescribed opioids and barriers to opioid pain management in patients with advanced cancer.
Approximately 80% of patients with advanced cancer report pain and receive opioids. Information is limited about deviations from prescribed opioid doses and barriers to pain control, but poor opioid adherence has been reported in 49%-70% of patients. ⋯ Very few patients reported dose deviations, which were mostly toward lower dose. More research is necessary to better characterize the frequency and predictors of opioid deviation in this population.
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J Pain Symptom Manage · Mar 2013
Randomized Controlled TrialDelivery strategies to optimize resource utilization and performance status for patients with advanced life-limiting illness: results from the "palliative care trial" [ISRCTN 81117481].
Evidence-based approaches are needed to improve the delivery of specialized palliative care. ⋯ A single case conference added to current specialized community-based palliative care reduced hospitalizations and better maintained performance status. Comparatively, patient/caregiver education was less effective; GP education was not effective.