Journal of pain and symptom management
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J Pain Symptom Manage · Aug 2014
ReviewDelirium diagnostic and classification challenges in palliative care: subsyndromal delirium, comorbid delirium-dementia, and psychomotor subtypes.
Delirium often presents difficult diagnostic and classification challenges in palliative care settings. ⋯ Challenges in the diagnosis and classification of delirium in people with advanced disease are compounded by the generalized disturbance of central nervous system function that occurs in the seriously ill, often with comorbid illness, including dementia. Further research is needed to delineate the pathophysiological and clinical associations of these presentations and thus inform therapeutic strategies. The expanding aged population and growing focus on dementia care in palliative care highlight the need to conduct this research.
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J Pain Symptom Manage · Aug 2014
ReviewClinical practice guidelines for delirium management: potential application in palliative care.
Delirium occurs in patients across a wide array of health care settings. The extent to which formal management guidelines exist or are adaptable to palliative care is unclear. ⋯ Delirium clinical guidelines are available but the level of evidence is limited. More robust evidence is required for future guideline development.
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J Pain Symptom Manage · Aug 2014
Multicenter Study Comparative StudyComparative effectiveness of senna to prevent problematic constipation in pediatric oncology patients receiving opioids: a multicenter study of clinically detailed administrative data.
Pediatric oncology patients often receive prolonged courses of opioids, which can result in constipation. ⋯ Initiating senna therapy, compared with other oral bowel medications, diminishes the subsequent risk of surrogate markers of problematic constipation in this population.
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J Pain Symptom Manage · Aug 2014
ReviewEnd-of-life delirium: issues regarding recognition, optimal management, and the role of sedation in the dying phase.
In end-of-life care, delirium is often not recognized and poses unique management challenges, especially in the case of refractory delirium in the terminal phase. ⋯ Further research on the effectiveness of delirium management strategies in the terminal phase for patients and their families is required. Further validation of assessment tools for diagnostic screening and severity measurement is needed in this patient population.
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Delirium is a common, distressing neuropsychiatric complication for patients in palliative care settings, where the need to minimize burden yet accurately assess delirium is hugely challenging. ⋯ Given the unique characteristics of patients in palliative care settings, further contextually sensitive studies of delirium assessment are required in this population.