Journal of pain and symptom management
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J Pain Symptom Manage · Dec 2013
ReviewRegional anesthesia approaches to pain management in pediatric palliative care: a review of current knowledge.
Although systemic analgesic therapies are the mainstay of pain treatment in pediatric palliative care, there are cases where they fail to adequately relieve symptoms or produce side effects that undermine effectiveness. Regional anesthesia may be considered as a potential therapy for these patients. ⋯ The present medical literature on regional anesthesia techniques in children receiving palliative care is limited to case reports and case series. Based on this evidence, recommendations must be provisional. Careful thought and discussion with pain management specialists are encouraged when pain symptoms are inadequately managed or the treatments produce deleterious side effects.
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J Pain Symptom Manage · Dec 2013
Capturing the patient's experience: using qualitative methods to develop a measure of patient-reported symptom burden: an example from ovarian cancer.
Experts in patient-reported outcome (PRO) measurement emphasize the importance of including patient input in the development of PRO measures. Although best methods for acquiring this input are not yet identified, patient input early in instrument development ensures that instrument content captures information most important and relevant to patients in understandable terms. ⋯ The qualitative interviewing process, used to develop the test MDASI-OC, systematically captures common symptoms important to patients with OC. This methodology incorporates the patient experience recommended by experts in PRO instrument development.
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J Pain Symptom Manage · Dec 2013
Consensus building on access to controlled medicines: a four-stage Delphi consensus procedure.
In 2011, the World Health Organization (WHO) published the policy guidelines Ensuring Balance in National Controlled Substances Policies-Guidance for Availability and Accessibility of Controlled Medicines, presenting a revised version of the previous guidelines from 2000. ⋯ The four-stage multimethod consensus process resulted in a substantial revision to the WHO guidelines. This takes into account the increase in knowledge about opioid medication since the first edition of the guidelines. Disagreement emerging from the process underlines the complexity of preparing guidance because of the delicate balance between need and control.
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J Pain Symptom Manage · Dec 2013
Creating computable algorithms for symptom management in an outpatient thoracic oncology setting.
Adequate symptom management is essential to ensure quality cancer care, but symptom management is not always evidence based. Adapting and automating national guidelines for use at the point of care may enhance use by clinicians. ⋯ A modified ADAPTE process and nominal group technique enabled the development and approval of locally adapted computable algorithms for individualized symptom management in patients with lung cancer. The process was more complex and required more time and resources than initially anticipated, but it resulted in computable algorithms that represented the consensus of many experts.
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J Pain Symptom Manage · Dec 2013
Controlled Clinical TrialClinical trial of a supportive care team for patients with advanced cancer.
Encouraging use of hospice and minimizing the use of cure-oriented aggressive interventions that detract from quality of life in the last month of life are specific targets for improvement in cancer care. ⋯ Individually tailored supportive services from an interdisciplinary team are associated with improved HRQOL in some patients. This has implications for the potential benefits that can be accrued from providing intensive support to all patients, even those who may appear to be at less risk for distress. There also are important methodological considerations in using aggressiveness of care indices as a measure of quality of care.