The Consultant pharmacist : the journal of the American Society of Consultant Pharmacists
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Evaluate the efficacy and safety of pharmacological pain management treatments to minimize adverse events and optimize pain relief. ⋯ Pain is a common problem among elderly long-term care residents and is vastly undertreated. Even when pain medication is prescribed, often residents do not receive the most appropriate drug, or prescribers fail to adjust the dose and frequency of administration to tailor therapy to the individual's compromised physiology and needs. This places elders at risk, for not only unnecessary suffering, but also for drug toxicity. Consultant pharmacists are in a key position to identify underuse and inappropriate use of analgesic drugs and assist prescribers with individualizing each resident's medication regimen to provide optimal therapeutic outcomes.
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Summarize practical strategies for recognizing and assessing pain in the long-term care population, particularly for cognitively impaired residents. ⋯ Pain that is under-recognized and undertreated can result in significant physical and social disability in the elderly long-term care population. Proper assessment of pain is needed to diagnose and determine an appropriate and individualized treatment plan for each resident. Consultant pharmacists play critical roles as medication experts and members of the long-term care interdisciplinary team that can assist other team members in the assessment, treatment, and management of pain in older adults.
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Outline the key points and list the criteria for compliance with the new Centers for Medicare & Medicaid Services (CMS) pain management at F-Tag 309. ⋯ In March 2009, CMS implemented revised guidelines for long-term care surveyors at F-Tag 309, Quality of Care, including a new general investigative protocol and pain-management guidance. While the regulations have remained the same, the way surveyors interpret pain management has changed. By understanding the criteria surveyors will use to determine F-Tag 309 deficiencies, consultant pharmacists can educate other interdisciplinary team members to improve pain management practices in long-term care.
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Review Comparative Study
The effect of sevelamer hydrochloride and calcium-based phosphate binders on mortality in hemodialysis patients: a need for more research.
To review phosphate-binder choice and mortality in hemodialysis patients. ⋯ Clinical trials relating the effect of phosphate-binder choice on cardiovascular disease and mortality in hemodialysis patients, judged to be pertinent by the authors, were selected for discussion. DATA SYNTHESIS/CONCLUSIONS: The Renagel in New Dialysis (RIND) extension study and the Dialysis Clinical Outcomes Revisted (DCOR) study were the first clinical trials to compare the effects of calcium-based phosphate binders and sevelamer hydrochloride on mortality in hemodialysis patients. Based on the results of these and other studies evaluated, it is still unclear if sevelamer hydrochloride has a survival benefit in hemodialysis patients over calcium-based phosphate binders.
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The purpose of this review is to provide an update of the neuropathic pain treatment algorithm previously published by Namaka et al. in 2004. This algorithm focuses on the strategic incorporation of the latest pain therapies while providing an update of any recent developments involving medications previously listed in the algorithm. ⋯ The updated algorithm provides a baseline framework from which clinicians can justify the medication they prescribe.