Journal of pain and symptom management
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J Pain Symptom Manage · Jun 2019
Identifying Older Adults With Serious Illness: Transitioning From ICD-9 to ICD-10.
Identifying the seriously ill population is integral to improving the value of health care. Efforts to identify this population using existing data are anchored to a list of severe medical conditions (SMCs) using diagnostic codes. Published approaches have used International Classification of Diseases, Ninth Revision (ICD-9) codes, which has since been replaced by ICD-10. ⋯ Identifying the seriously ill population using currently available data requires using ICD-10 to define SMCs. Routine measurement of function, quality of life, and caregiver strain will further enhance the identification process and efficiently target palliative care services and appropriate quality measures.
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J Pain Symptom Manage · Jun 2019
Association of persistent intense thirst with delirium among critically ill patients: A cross-sectional study.
Thirst is a prevalent distressing symptom often reported by patients in the intensive care unit (ICU). Little is known about the association of thirst with delirium. ⋯ Intense thirst persisting for more than 24 hours was associated with increased risk for delirium.
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J Pain Symptom Manage · Jun 2019
Preferences for continence care experienced at end of life: a qualitative study.
Functional dependence at end of life often leaves individuals requiring help for personal care, including maintaining continence. Current continence guidelines offer little direction for end of life continence care, and little is known of the perspectives of people receiving palliative care. ⋯ As patients approached end of life they were willing to give up dignity if it was required to address symptoms causing them more distress, like pain. Health care professionals and family have an important role in social interactions around continence care. Health care professionals should incorporate patient preferences as best they can and explain the options when treating incontinence at end of life.
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J Pain Symptom Manage · Jun 2019
Delays in palliative care referral among surgical patients: perspectives of surgical residents across the state of Michigan.
Palliative care services (PCS) are underutilized and frequently delayed among surgical patients. Surgical residents often serve at the forefront for patient issues, including conducting conversations regarding prognosis and goals of care. ⋯ Among resident trainees, unpredictable patient outcomes led to uncertainty in the timing and appropriateness of palliative care referral and further complicated communicating plans of care. Residents perceived and relied on the attending surgeon as the ultimate decision maker, wherein the surgeon's sense of responsibility to the patient was identified as a significant barrier to PCS referral. Further studies are needed to test surgeon-specific interventions to improve access to and delivery of PCS.
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J Pain Symptom Manage · Jun 2019
The Weight of Pain: What Does a 10 on the Pain Scale Mean? An Innovative Use of Art in Medical Education to Enhance Pain Management.
Art and museum spaces offer a novel educational platform for exploring the subjective elements inherent to the understanding and treatment of pain. Physicians and museum educators collaborated on an educational model using art to explore the metacognitive dimensions of pain management. ⋯ Facilitated, reflective experiences with works of art have the capacity to challenge clinicians to become aware of their implicit biases, thought processes, and communication with potential importance for improving pain management and providing more compassionate care.