Journal of pain and symptom management
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J Pain Symptom Manage · Feb 2018
Meta AnalysisDrugs for treating opioid-induced constipation: A mixed treatment comparison network meta-analysis of randomized controlled clinical trials.
Opioid-induced constipation is a common problem associated with chronic use of opioid analgesics. ⋯ Subcutaneous methyl naltrexone was found to perform better than other interventions for managing opioid-induced constipation.
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J Pain Symptom Manage · Feb 2018
Determining Palliative Care Penetration Rates in the Acute Care Setting.
Intermountain Healthcare, in collaboration with Cerner Corporation, developed a hospital-based electronic palliative care algorithm. ⋯ This study successfully optimized an electronic palliative care identification algorithm with a PPV of 80.1% and indicates appropriate palliative care penetration rates may be as high as 26.4% of the total inpatient population.
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J Pain Symptom Manage · Feb 2018
Multiple Symptoms in Family Caregivers of Intensive Care Unit Patients.
Intensive care unit (ICU) patients experience physical and psychological challenges related to ICU admission in the acute and recovery phases after a critical illness. Involvement of family caregivers (FCs) is essential in the patients' struggle to survive critical illness. FCs report a high symptom burden related to ICU admission. Previous research has investigated mainly single symptoms. Little is known about multiple symptom burden related to FC experiences in an ICU. ⋯ FCs of ICU patients experience multiple symptoms, among which, psychological symptoms are most occurring. Age, relationship to the patient, and comorbidities were significantly associated with the number of symptoms reported by FCs. Comprehensive symptom assessment may identify FCs who are at risk of developing a high symptom burden when the patient is admitted to the ICU.
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J Pain Symptom Manage · Feb 2018
Development and Field-Test of an Audit Tool and Tracer Methodology for Clinician Assessment of Quality in End-of-Life Care.
Quality improvement in end-of-life care generally acquires data from charts or caregivers. "Tracer" methodology, which assesses real-time information from multiple sources, may provide complementary information. ⋯ The Tracer EoLC v1 can be used with tracer methodology to guide the assessment and rate the quality of end-of-life care.
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J Pain Symptom Manage · Feb 2018
Beyond Idiopathic Pulmonary Fibrosis diagnosis: Multidisciplinary care with an early integrated palliative approach is associated with a decrease in acute care utilization and hospital deaths.
Idiopathic pulmonary fibrosis (IPF) is a progressive, incurable interstitial lung disease with heavy symptom burden and poor quality of life. The last year of life is characterized by increased acute care utilization and hospital deaths. Clinical guidelines recommend early integration of palliative care but are rarely implemented. In 2012, we reorganized our clinic into a multidisciplinary team comprising two pulmonologists (expertise in interstitial lung disease and palliative respiratory care, respectively), nurse, respiratory therapist, physiotherapist, and a dietitian. We adopted an early integrated palliative approach with a focus on early symptom management and advance care planning starting at the first clinic visit. We designed a Multidisciplinary collaborative (MDC) care model with emphasis on community-based care to manage patients in their homes and support caregivers. ⋯ MDC care model for IPF was associated with reduced health care use in the last year of life and more home deaths.