Pain management nursing : official journal of the American Society of Pain Management Nurses
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Review
New approaches for evaluating the quality of cancer pain management in the outpatient setting.
Both retrospective and prospective methods can be used to evaluate the quality of cancer pain management in the outpatient setting. Retrospective evaluations of the quality of cancer pain management in the outpatient setting provide benchmark data that can be used to change clinical practice for groups of patients or for specific types of cancer pain problems. Prospective evaluations of the quality of cancer pain management with patient diaries in the outpatient/home care setting can help clinicians do "real-time" evaluations and modify the pain management plan for individual patients. This report provides practical suggestions for evaluating the quality of cancer pain management in the outpatient setting.
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Review Comparative Study
Cyclo-oxygenase 2 inhibitors: an important new drug classification.
The pharmacologic treatment of acute and chronic pain has evolved greatly over the last several decades. Notably, several new classifications of drugs have emerged to meet the growing demand of patients in pain and health care providers who attempt to assist them. This article describes 1 new classification, cyclo-oxygenase 2 inhibitors, and provides specifics about the 2 agents currently available via prescription.
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Randomized Controlled Trial Multicenter Study Clinical Trial
An educational implementation of a cancer pain algorithm for ambulatory care.
Algorithms are proposed as a means of operationalizing guidelines or standards for cancer pain management. Professional education is used as the means to translate knowledge into practice. Outcomes measurement is the gold standard for validating improvement. ⋯ There was a clear deterioration in the impact of the training over time. The most significant effect occurred within the first 140 days after the intervention and was followed by a gradual return to baseline practice. In conclusion, algorithmic interventions can be successfully transferred into community practice, but further work must be performed to develop methods for securing retention of knowledge and maintaining improved outcomes.
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The purpose of this study was to determine the self-report pain rating scale(s) that can be used to quantify pain in elderly persons across cognitive functioning levels. Randomly selected elderly subjects (N = 100) completed the Short Portable Mental Status Questionnaire to categorize their level of cognitive impairment: intact (n = 36), mild (n = 9), moderate (n = 15), and severe (n = 40). Pain was measured with the Memorial Pain Assessment Card verbal subscale, FACES, COOP pain subscale, a numeric rating scale, and the Present Pain Intensity subscale of the McGill Pain Questionnaire. ⋯ Of the severely impaired, 30% were able to complete 1 or more pain assessment tools. Intraclass correlations showed a high degree of consistency among all pairs of tools (intraclass correlation > 0.74). We conclude that most elderly, with normal to moderately impaired cognitive functioning, as well as some severely impaired elderly, are capable of using self-report tools to rate their pain.