Journal of pain and symptom management
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J Pain Symptom Manage · Jan 2024
ReviewEthical and practical considerations of perimortem gamete procurement for palliative care providers.
Requests for perimortem gamete procurement (PGP) typically arise by a surrogate decision maker after the unexpected death or incapacitation of a reproductive-aged individual. Palliative care clinicians should have a working knowledge of the medical, ethical, and practical considerations pertaining to such requests. ⋯ We review the technologies associated with PGP and posthumous assisted reproduction (PAR) and discuss the ethical and legal issues involved in such cases, including recent position statements from national and international reproductive health groups. Finally, we provider readers with a stepwise approach for considering requests for PGP.
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J Pain Symptom Manage · Jan 2024
ReviewBarriers for adult patients to access palliative care in hospitals: A mixed methods systematic review.
Access to palliative care services is variable, and many inpatients do not receive palliative care. An overview of potential barriers could facilitate the development of strategies to overcome factors that impede access for patients with palliative care needs. ⋯ Hospital inpatients face multiple barriers to accessing palliative care. Strategies to address these barriers need to take into account their multidimensionality and long-standing persistence.
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J Pain Symptom Manage · Jan 2024
Comparative StudyComparison of the effects of OPRM1 A118G polymorphism using different opioids: A prospective study.
μ-opioid receptor gene (OPRM1) A118G polymorphism (rs1799971) causes loss of N-glycosylation sites at the extracellular domain of μ-opioid receptors. G-allele carriers show a limited response to morphine; however, studies investigating the impact of A118G polymorphism on the efficacy of opioids other than morphine are limited. ⋯ Tapentadol and methadone may be more suitable than hydromorphone, oxycodone, and fentanyl for G-allele carriers due to their dual mechanism of action and low susceptibility to OPRM1 A118G polymorphism.
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J Pain Symptom Manage · Jan 2024
Randomized Controlled TrialImpact of Dosing and Duration of Dexamethasone on Serious Corticosteroid-Related Adverse Events.
Corticosteroids are commonly prescribed in oncology, but few studies have examined its adverse events (AEs) compared to placebo control. ⋯ Greater dexamethasone exposure, even at moderate doses, was associated with more serious AEs. Prescribers should cautiously weigh the risks and benefits of dexamethasone use, especially when considering for palliation of symptoms.
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J Pain Symptom Manage · Jan 2024
RELIGIOUS, CULTURAL AND SEX INFLUENCES ON ADVANCE CARE DIRECTIVES IN PATIENTS ADMITTED TO A TERTIARY CARE CENTER IN KENYA.
Advance care directives (AD) are instructions from patients regarding the care they would prefer if they could not make medical decisions in the future. It is widely recognized that racial and ethnic as well as sex differences, particularly in the West, can influence AD. However, to the best of our knowledge, there is limited understanding of how these factors impact AD in sub-Saharan Africa. ⋯ This study indicated a lower awareness and knowledge of AD among the participants. Hindus and Asians exhibited higher levels of awareness regarding AD. Considering the diverse religious and cultural backgrounds in our setting, there is a pressing need for strategies to increase awareness surrounding AD.