Journal of pain and symptom management
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J Pain Symptom Manage · Oct 2018
Randomized Controlled TrialExtended-Release Morphine for Chronic Breathlessness in Pulmonary Arterial Hypertension-A Randomized, Double-Blind, Placebo-Controlled, Crossover Study.
Pulmonary arterial hypertension (PAH) affects people of all ages and is associated with poor prognosis. Chronic breathlessness affects almost all people with PAH. ⋯ This study does not support a Phase III study of ER morphine for people with PAH-associated chronic breathlessness. Recruiting to the target sample size was difficult, the direction of effect in every measure of breathlessness favored placebo and morphine generated more harms.
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J Pain Symptom Manage · Oct 2018
Randomized Controlled Trial Comparative StudyImproving a Full Range of Advance Care Planning Behavior Change and Action Domains: The PREPARE Randomized Trial.
Advance care planning (ACP) engagement includes a wide range of behaviors and actions related to discussions and documentation, yet few ACP intervention studies measure the full process. ⋯ Both PREPARE plus an easy-to-read AD and an AD-only markedly increased ACP engagement in a full range of ACP behaviors, including discussions and documentation, and engagement was nearly 100% with PREPARE + AD. Future ACP studies should examine a full range of ACP behaviors beyond ADs and the impact of PREPARE and easy-to-read AD implementation on health care systems.
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J Pain Symptom Manage · Oct 2018
VALIDATION OF TWO PAIN ASSESSMENT TOOLS UTILIZING A STANDARDIZED NOCICEPTIVE STIMULATION IN CRITICALLY ILL ADULTS.
The Behavioral Pain Scale (BPS) or the Critical-Care Pain Observation Tool (CPOT) are recommended in practice guidelines for pain assessment in critically ill adults unable to self-report. However, their use in another language requires cultural adaptation and validation testing. ⋯ The use of the Brazilian CPOT and BPS versions showed good reliability and validity in critically ill adults unable to self-report. A standardized procedure, the SNSPA, was used for the first time in the validation process of these tools and helped us improve the validation process.
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J Pain Symptom Manage · Oct 2018
ReviewCultural Factors Influencing Advance Care Planning in Progressive, Incurable Disease: A Systematic Review With Narrative Synthesis.
Advance care planning (ACP) can improve end-of-life outcomes, but low uptake indicates it is less acceptable to patients of some cultural backgrounds. ⋯ Many interconnected cultural factors influence the acceptability of ACP in progressive, incurable disease, although specific mechanisms remain unclear. A communication-focused approach to ACP may better meet the needs of culturally diverse populations.
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J Pain Symptom Manage · Oct 2018
Drugs used for euthanasia: a repeated population-based mortality follow-back study in Flanders, Belgium, 1998 - 2013.
According to guideline recommendations, barbiturates and neuromuscular relaxants are the recommended drugs for euthanasia. ⋯ Physicians in Flanders are increasingly using the recommended drugs for euthanasia. This suggests that guidelines and training regarding the conduct and pharmacological aspects of euthanasia may have had important effects on the practice of euthanasia. However, the declining but persisting use of nonrecommended drugs requires further attention.