Journal of pain and symptom management
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J Pain Symptom Manage · Jul 2014
The impact of body mass index dynamics on survival of patients with advanced pancreatic cancer receiving chemotherapy.
High body mass index (BMI) is linked to an increased risk of developing pancreatic cancer (PC). However, in patients with advanced PC (APC), especially those receiving palliative chemotherapy, the impact of BMI on survival has not been investigated fully. ⋯ In patients with APC undergoing palliative chemotherapy, decreases in BMI at APC diagnosis and during chemotherapy are more hazardous for OS than precancer BMI or baseline BMI (at diagnosis) as absolute values. Further studies are needed to validate this finding and investigate strategies to maintain BMI during chemotherapy in this setting.
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J Pain Symptom Manage · Jul 2014
Comparative StudySymptoms and problem clusters in cancer and non-cancer patients in specialized palliative care-is there a difference?
In clinical practice, some symptoms and problems frequently occur in combination, which may have consequences for symptom management. ⋯ As symptom clusters do not significantly differ between cancer and non-cancer patients, specific frequent symptoms in non-cancer patients should be assessed. Identification of symptom clusters may help to target therapies and focus the use of medications to improve patients' quality of life.
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J Pain Symptom Manage · Jul 2014
Comparative StudyA single institution's effort to translate codeine knowledge into specific clinical practice.
Codeine is an unpredictable analgesic because of its variable pharmacokinetic, pharmacodynamic, and pharmacogenetic properties. This variability may lead to ineffective analgesia in some and respiratory depression in others. Despite this, codeine is still widely used. At a pediatric tertiary medical institution, codeine was prescribed despite efforts to inform prescribers of the potentially unpredictable analgesia and serious side effects. ⋯ This quality improvement initiative was successful in eliminating codeine from the hospital formulary. Although education decreased codeine orders, understanding and addressing the barriers to change and directly changing the ordersets were the most effective and efficient for knowledge translation.
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J Pain Symptom Manage · Jul 2014
Comparative StudyPatterns of hospice care among military veterans and non-veterans.
Historically, hospice use by veterans has lagged behind that of non-veterans. Little is known about hospice use by veterans at a population level. ⋯ Although veteran and non-veteran hospice users were similar on most demographic measures, important differences in hospice referral patterns and utilization exist.
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J Pain Symptom Manage · Jul 2014
Primary thromboprophylaxis in hospices: the association between risk of venous thromboembolism and development of symptoms.
Venous thromboembolism (VTE) risk assessment for adults admitted to hospital is commonplace, but the utility of assessment tools in patients admitted to hospices or palliative care units and prediction of symptomatic VTE is unknown. ⋯ Hospice inpatients are at risk for VTE. TER alone is simpler to use and may be more useful in this population than the THRIFT but still has limitations regarding ability to predict symptoms.