Journal of pain and symptom management
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J Pain Symptom Manage · Oct 2022
Multicenter StudySymptom control and survival for people severely ill with COVID: a multicentre cohort study (CovPall-Symptom).
Evidence of symptom control outcomes in severe COVID is scant. ⋯ Symptoms of COVID quickly improved during palliative care. Breathlessness, agitation and multimorbidity could be used as triggers for timelier referral, and symptom guidance for wider specialities should build on treatments identified in this study.
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J Pain Symptom Manage · Oct 2022
National End-of-Life-Treatment Preferences are stable over time: National Health and Aging Trends Study.
Advance Care Planning is a process of understanding and sharing preferences regarding future medical care. ⋯ We found that national trends in preferences for end-of-life treatment did not substantially change over time and may be stable within individual older adults.
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J Pain Symptom Manage · Oct 2022
Palliative Care Impact on COVID-19 Patients Requiring Extracorporeal Membrane Oxygenation.
Patients with severe respiratory failure from COVID-19 refractory to conventional therapies may be treated with extracorporeal membrane oxygenation (ECMO). ECMO requirement is associated with high mortality and prolonged hospital course. ECMO is a high-resource intervention with significant burdens placed on caregivers and families with limited data on the integration of palliative care consultation (PCC). ⋯ Among patients with COVID-19 receiving ECMO, PCC may be associated with a shift to DNAR status particularly with automatic PCC. There may be a further impact on length of stay, duration of time on ECMO and care plan at end of life.
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J Pain Symptom Manage · Oct 2022
Empowering Pediatric Palliative Homecare Patients and Caregivers with Symptom Management Plans.
Pediatric palliative home-based care has been shown to improve symptoms, quality of life, and coordination of care. Despite these successes, hospital utilization in our own palliative home-based care population remained high as some caregivers lacked confidence to manage symptoms at home and had difficulty in recalling or accessing "sick care plans." Our team developed the Symptom Management Plan (SMP), a multi-system "sick care plan," as a quality improvement project with the aim of improving caregiver confidence to manage symptoms at home. An Electronic Health Record-based SMP template was created for common symptoms: respiratory distress, seizures, feeding intolerance, and constipation with core subspecialists' input. ⋯ After the SMP was launched, the rate of ED visits decreased from 0.86 to 0.47 per 100 patient-days, and admissions decreased from 0.56 to 0.39 per 100 patient-days. These rates further decreased to 0.31 ED visits and 0.19 admissions per 100 patient-days within 4 and 6 months. Introducing the SMP for our home-based palliative care patients was associated with improved caregiver confidence in managing acute symptoms at home and a reduction in hospital utilization.
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J Pain Symptom Manage · Oct 2022
Review Meta AnalysisCan noninvasive brain stimulation improve pain and depressive symptoms in patients with neuropathic pain? A systematic review and meta-analysis.
Noninvasive brain stimulations (NIBS) have been increasingly applied to the patients with neuropathic pain (NP), while the effectiveness of NIBS in the management of NP is still conflicting. ⋯ This meta-analysis revealed the analgesic effect of NIBS on patients with NP, while no beneficial effect was observed on reducing concomitant depression symptoms. The findings recommended the clinical application of NIBS in patients with NP.