Journal of pain and symptom management
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J Pain Symptom Manage · Nov 2015
Multicenter Study Observational StudyAn Observational Study on a Protocol for Withdrawal of Life-Sustaining Measures on Two Non-Academic Intensive Care Units in The Netherlands: Few Signs of Distress, No Suffering?
Because anticipation of death is common within the intensive care unit, attention must be paid to the prevention of distressing signs and symptoms, enabling the patient to die peacefully. In the relevant studies on this subject, there has been a lack of focus on measuring determinants of comfort in this population. ⋯ The end-of-life protocol seems effective in realizing adequate patient comfort. Most patients in whom life-sustaining measures are withdrawn are well sedated and show few signs of distress. Dosages of opioids and sedatives increase significantly during treatment withdrawal but do not contribute to time until death. Dying with a minimum of distressing signs is thus practically possible and ethically feasible.
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J Pain Symptom Manage · Oct 2015
Multicenter Study Comparative Study Observational StudyAccuracy of a Diagnostic Algorithm to Diagnose Breakthrough Cancer Pain as Compared with Clinical Assessment.
Breakthrough cancer pain (BTCP) is a heterogeneous condition, and there are no internationally agreed standardized criteria to diagnose it. There are published algorithms to assist with diagnosis, but these differ in content. There are no comparative data to support use. ⋯ The diagnostic breakthrough pain algorithm had a good positive predictive value but limited sensitivity using a cutoff score of "mild" to define controlled background pain. When the cutoff level was changed to moderate, the sensitivity increased, but specificity reduced. A comprehensive clinical assessment remains the preferred method to diagnose BTCP.
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J Pain Symptom Manage · Oct 2015
Multicenter StudyUse of the Preparedness for Caregiving Scale in Palliative Care: A Rasch Evaluation Study.
Studies have shown that family carers who feel more prepared for the caregiver role tend to have more favorable experiences. Valid and reliable methods are needed to identify family carers who may be less prepared for the role of supporting a person who needs palliative care. ⋯ The PCS is valid for use among family carers in palliative care. Data provide support for its use across age and gender groups as well as across the two language versions.
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J Pain Symptom Manage · Oct 2015
Multicenter StudyMedical Oncology Patients: Are They Offered Help and Does It Provide Relief?
Identifying modifiable gaps in the symptom management pathway, as perceived by patients, is the first step to relieving patient suffering. ⋯ Quality improvement initiatives must focus primarily on improving providers' awareness of their patients' symptoms and ensuring that patients are subsequently offered help.
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J Pain Symptom Manage · Oct 2015
Randomized Controlled Trial Multicenter Study Comparative StudyPractical Dyspnea Assessment: Relationship Between the 0-10 Numerical Rating Scale and the Four-Level Categorical Verbal Descriptor Scale of Dyspnea Intensity.
Measurement of dyspnea is important for clinical care and research. ⋯ There is strong correlation between VDS and NRS measures for dyspnea. Proposed practical cutpoints for the relationship between the dyspnea VDS and NRS are 0 for none, 1-4 for mild, 5-8 for moderate, and 9-10 for severe.