Journal of pain and symptom management
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J Pain Symptom Manage · Mar 2015
Limits and responsibilities of physicians addressing spiritual suffering in terminally ill patients.
Many patients experience spiritual suffering that complicates their physical suffering at the end of life. It remains unclear what physicians' perceived responsibilities are for responding to patients' spiritual suffering. ⋯ Most physicians believe that spiritual suffering tends to intensify physical pain and that physicians should seek to relieve such suffering. Physicians who believe they should address spiritual suffering just as much as physical pain report more success in relieving patient's suffering.
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J Pain Symptom Manage · Mar 2015
Comparative StudyWhat is different about patients with hematologic malignancies? A retrospective cohort study of cancer patients referred to a hospice research network.
Although much is known about solid tumor patients who use hospice, the hematologic malignancies hospice population is inadequately described. ⋯ Hospice patients with hematologic malignancies are more seriously ill at the time of admission, with worse functional status and shorter lengths of stay than other cancer patients. Differences in outcomes suggest the need for targeted interventions to optimize hospice services for the hematologic malignancies population, especially those with leukemia.
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J Pain Symptom Manage · Mar 2015
Fatigue is associated with serum interleukin-6 levels and symptoms of depression in patients on chronic hemodialysis.
Little is known about activated immune-inflammatory pathways and interleukin-6 (IL-6) in the development of fatigue and/or depression in patients with end-stage renal disease on chronic hemodialysis (HD). ⋯ Fatigue was significantly associated with symptoms of depression and serum IL-6 levels in patients receiving chronic HD.
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Thirst is a pervasive, intense, and distressing symptom in intensive care unit (ICU) patients. Although thirst may be avoided and/or treated, scant data are available to help providers identify patients most in need. ⋯ Thirst presence was predicted by selected medications (e.g., opioids). Thirst intensity and/or thirst distress were predicted by other treatments (e.g., mechanical ventilation) and medical diagnoses (e.g., GI). This is one of the first studies describing predictors of the multidimensional characteristics of thirst. Clinicians can use these data to target ICU patients whose thirst might warrant treatment.
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J Pain Symptom Manage · Mar 2015
ReviewWhich treatment is better? Ascertaining patient preferences with crossover randomized controlled trials.
The difference in patient-reported outcomes between study arms can often be difficult to ascertain in randomized controlled trials (RCTs) using a parallel design because of wide interindividual variations in baseline characteristics and how patients interpret the outcome measures. Furthermore, the minimal clinically significant difference is often not available for many outcomes, and even when available, not individualized for each patient. Crossover RCTs are designed for intraindividual comparisons, which can address these issues by asking patients to directly compare the interventions with regard to effectiveness, adverse effects, and ease of use and to provide an overall choice. ⋯ By facilitating intraindividual comparisons and eliciting patient preferences, crossover studies can provide unique information on the superior intervention. Crossover designs should be considered for selected palliative care studies.