Journal of pain and symptom management
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J Pain Symptom Manage · Feb 2023
Anticholinergic Medications and Parent-Reported Anticholinergic Symptoms in Neurologically Impaired Children.
Children with severe neurological impairment and polypharmacy are exposed to anticholinergic (AC) medications that may have anticholinergic side effects, but this is understudied. Anticholinergic Cognitive Burden (ACB) scores measure total anticholinergic burden for a medication regimen, and scores ≥3 have been associated with increased morbidity and mortality in adults. ⋯ If replicated in larger populations, the association between elevated total ACB scores and anticholinergic side effects in children should prompt clinicians to consider deprescribing potentially unneeded anticholinergic medications.
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J Pain Symptom Manage · Feb 2023
ReviewDesign Considerations for Embedded Pragmatic Clinical Trials of Advance Care Planning Interventions for Persons Living With Dementia.
Advance care planning (ACP) is an important part of comprehensive care for persons living with dementia (PLWD). While many trials have established the efficacy of ACP in improving end-of-life communication and documentation of care preferences, there remains a gap in clinical usage. Embedded pragmatic clinical trials (ePCTs) may facilitate the uptake of evidence-based care into existing healthcare by deploying efficacious ACP interventions into real-world settings. ⋯ These considerations are weighed in further detail by describing the approaches from three published trials. Specifically, we consider how potential challenges were overcome by tradeoffs in study design. Finally, we offer directions for future growth to advance ePCTs for ACP among PLWD and catalyze future research.
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J Pain Symptom Manage · Feb 2023
Trends in Obesity Prevalence among US Older Adults in the Last Two Years of Life, 1998-2018.
The prevalence of obesity has grown in the US over the decades. The temporal trends of body mass index categories in the last two years of life are poorly understood. ⋯ Severe obesity has increased greatly while underweight has decreased. As obesity increases in the final years of life, it is critical to assess how the existing and future palliative services and end of life care system address body size and weight.
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J Pain Symptom Manage · Feb 2023
Patient-reported Quality Measures for Palliative Care: The time is now.
While progress has been made in the ability to measure the quality of hospice and specialty palliative care, there are notable gaps. A recent analysis conducted by Center for Medicare and Medicaid Services (CMS) revealed a paucity of patient-reported measures, particularly in palliative care domains such as symptom management and communication. ⋯ These measures highlight the key role of patient voices in palliative care and fill a much-needed gap for patient-reported experience measures in our field.
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J Pain Symptom Manage · Feb 2023
Patient reported outcomes and unscheduled health services use during oral anti-cancer treatment.
People on oral anti-cancer agents must self-manage their symptoms with less interaction with oncology providers compared to infusion treatments. Symptoms and physical function are key patient-reported outcomes (PROs) and may lead to unscheduled health services uses (urgent care and emergency department [ED] visits, hospitalizations), which in turn lead to increased health care costs. ⋯ Monitoring of PROs has the potential of reducing unscheduled health services use if supportive care interventions are deployed based on their levels.