Journal of pain and symptom management
-
J Pain Symptom Manage · Apr 2020
Review Meta AnalysisThe effects of opioids on cognition in older adults with cancer and chronic non-cancer pain: A systematic review.
Opioids are prescribed to manage moderate-to-severe pain and can be used with older adults; however, they may lead to several adverse effects, including cognitive impairment. ⋯ Both improvements and impairments to cognition were observed in studies with higher mean opioid doses. In clinical practice, a brief screening tool assessing attention, language, orientation, psychomotor function, and verbal working/delayed episodic memory may be beneficial to detect worsening cognition in older adults with chronic pain using opioids.
-
J Pain Symptom Manage · Apr 2020
ReviewConceptualizing and Counting Discretionary Utilization in the Final 100 Days of Life: A Scoping Review.
There has been surprisingly little attention to conceptual and methodological issues that influence the measurement of discretionary utilization at the end of life (DIAL), an indicator of quality care. ⋯ Unwarranted variation in DIAL assessments raises difficult questions concerning how DIALs are defined, by whom, and why. We recommend several strategies for improving DIAL assessments. Improved metrics could be used by the public, patients, caregivers, clinicians, researchers, hospitals, health systems, payers, governments, and others to evaluate and improve end-of-life care.
-
J Pain Symptom Manage · Apr 2020
Clinical consumption of opioid analgesics in China: a retrospective analysis of the national and regional data 2006-2016.
The annual consumption of opioid analgesics in the U.S. was more than 10 times the world average, whereas that in China was at a moderate level within Asia but much lower than the worldwide average. The opposite situations of opioid use in the U.S. and China revealed totally different problems in the developed versus developing world, that is, overuse versus underuse of opioids. ⋯ The clinical consumption of opioid analgesics for the treatment of moderate-to-severe pain in mainland China was far below the international level. The annual per capita of clinical consumption was lower, and the adequacy of cancer pain treatment was poorer in less developed areas. All these findings call for actions to strengthen pain management.
-
J Pain Symptom Manage · Apr 2020
Randomized Controlled Trial Multicenter StudyImpact of a nurse-led advance care planning intervention on satisfaction, health related quality of life and health care utilization among patients with severe respiratory disease: A randomized patient preference trial.
Previous work has found that facilitated advance care planning (ACP) interventions are effective in increasing ACP uptake among patients with severe respiratory disease. ⋯ A facilitated ACP intervention among patients with severe respiratory disease did not have an impact on satisfaction, health-related quality of life, or 12-month mortality rate. Facilitated ACP may be associated with a different type of health care utilization during the end-of-life period.
-
J Pain Symptom Manage · Apr 2020
ReviewPulmonary arterial hypertension: A palliative medicine review of the disease, its therapies and drug interactions.
Pulmonary arterial hypertension (PAH) is often a progressive and ultimately fatal disease. It is characterized by an elevated mean pulmonary arterial pressure because of disease of the small pulmonary arterioles. PAH leads to a constellation of symptoms, including dyspnea, fatigue, syncope, chest discomfort, and peripheral edema. ⋯ This review describes disease-targeted therapies and their effects on symptoms, physical functioning, and health-related quality of life. We also review the unique physiology of PAH and its implication for palliative interventions. Pharmacological interactions with, and precautions related to commonly used palliative care medications, are discussed.