Journal of pain and symptom management
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J Pain Symptom Manage · Mar 2010
Review Meta AnalysisFactors associated with congruence between preferred and actual place of death.
Congruence between preferred and actual place of death may be an essential component in terminal care. Most patients prefer a home death, but many patients do not die in their preferred location. Specialized (physician, hospice, and palliative) home care visits may increase home deaths, but factors associated with congruence have not been systematically reviewed. ⋯ Of the remaining three studies without specialized home care for all patients, two reported 43%-46% congruence among hospital inpatients, and one elicited patient preference "if everything were possible," with 30% congruence. Physician support, hospice enrollment, and family support improved congruence in multiple studies. Research in this important area must consider potential sources of bias, the method of eliciting patient preference, and the absence of a single ideal place of death.
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J Pain Symptom Manage · Feb 2010
Review Meta AnalysisA systematic review of oxymorphone in the management of chronic pain.
Opioids are recommended for control of moderate-to-severe, chronic, malignant, and nonmalignant pain. A controlled-release formulation of the opioid oxymorphone has recently been launched. The aim of this review was to assess the effectiveness of oxymorphone as an analgesic in chronic pain. ⋯ No significant differences between oxymorphone and oxycodone at equipotent doses were found. In conclusion, oxymorphone is superior to placebo. There is no evidence that the efficacy of oxymorphone differs from other opioids.
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Although fatigue is a common complaint after stroke, relatively little is known about how poststroke fatigue is experienced and what its related factors are. An in-depth understanding is necessary to develop effective and patient-centered poststroke rehabilitation programs. This review was undertaken to provide a comprehensive synthesis of knowledge from the literature concerning the description, definition, and measurement of fatigue and its relationship to sociodemographic and clinical factors. ⋯ There is an indication that prestroke and poststroke fatigue are related. Possible antecedent components identified are personal factors, biomarkers, stroke characteristics, prestroke fatigue, and comorbidity. As knowledge regarding poststroke fatigue remains limited, there is a need to continue empirical research with various theoretical orientations.
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J Pain Symptom Manage · Dec 2009
Review Meta AnalysisManagement of terminal hemorrhage in patients with advanced cancer: a systematic literature review.
Although terminal hemorrhage is an infrequent occurrence in advanced cancer patients, it is extremely distressing for patients, their families, and health care professionals when it does occur. By definition, there is a very short time period to support and comfort the patient, and it is vital that the management approach follows the best available evidence base. A systematic literature search was carried out to retrieve relevant publications relating to the management of terminal hemorrhage in patients with advanced cancer in whom invasive or interventional procedures are no longer appropriate. ⋯ Drugs recommended included diazepam, midazolam, diamorphine, and ketamine at varying doses and routes of administration. Current guidelines are based completely on isolated case reports and expert opinion. Clinical research is needed in this area but is difficult because of practical and ethical limitations.
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J Pain Symptom Manage · Apr 2009
Review Meta AnalysisAcupuncture: what does the most reliable evidence tell us?
Many trials of acupuncture and numerous systematic reviews have recently become available. Their conclusions are far from uniform. In an attempt to find the most reliable type of evidence, this article provides an overview of Cochrane reviews of acupuncture. ⋯ Five reviews arrived at positive or tentatively positive conclusions and two were inconclusive. The conditions that are most solidly backed up by evidence are chemotherapy-induced nausea/vomiting, postoperative nausea/vomiting, and idiopathic headache. It is concluded that Cochrane reviews of acupuncture do not suggest that this treatment is effective for a wide range of conditions.