Journal of pain & palliative care pharmacotherapy
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Oxycodone is among the most commonly used opioid analgesics for the relief of moderate-to-severe pain and is pharmacodynamically comparable to morphine. Oxycodone is available in the United States in oral dosage forms and controlled-release tablets. Studies have demonstrated marked interindividual variation in the pharmacokinetics of oxycodone. ⋯ A MEDLINE search was conducted to identify literature published between 1966 and May 2004 relevant to the pharmacokinetics of oxycodone. These publications were reviewed and the literature summarized regarding unique and clinically important elements of oxycodone disposition including its absorption profile (immediate release, controlled release, rectal administration, and intranasal administration), distribution, and its metabolism/excretion. Special populations, including children and those with liver/renal failure, have a unique oxycodone pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.
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J Pain Palliat Care Pharmacother · Jan 2004
ReviewA systematic review of oxygen and airflow effect on relief of dyspnea at rest in patients with advanced disease of any cause.
Oxygen is used frequently to relieve dyspnea in patients with advanced illness. The objective of this study was to critically appraise the scientific basis for oxygen therapy as a therapeutic intervention to manage dyspnea at rest in patients with advanced disease. A systematic search of all relevant databases was done using MeSH terms and appropriate key words. ⋯ This systematic review and critical appraisal found low-grade scientific evidence that oxygen and airflow improve dyspnea in some patients with advanced disease at rest. However, there is no evidence to identify which patients will benefit from airflow or supplemental oxygen or to determine when to use airflow versus supplemental oxygen. Further research is required to provide scientific evidence to evaluate oxygen and airflow effectiveness and determine the place of oxygen and airflow in the management of dyspnea at rest in patients with advanced disease.
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A notable and welcome increase in palliative care research has led to a multitude of ethical issues and concerns for researchers, clinicians, patients (subjects) and their family members (who also might be subjects), granting agencies, and professional journals. This edition of "Palliative Care Pearls" summarizes the recommendations from a work group that met at the National Institutes of Health in September, 2002. The primary purpose for that meeting was to explore the unique characteristics of this research population and the ethical concerns that might require tailoring of "standard" clinical research processes. ⋯ This 62 page long monograph was published as a supplement to the Journal of Pain and Symptom Management (April, 2003). It includes six "plenary" papers, each that focuses on a distinct ethical domain of palliative care research and concludes with a set of recommendations and research questions. These might best be viewed as hypotheses that need to be tested or further explored.
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J Pain Palliat Care Pharmacother · Jan 2004
Multicenter StudyKnowledge and attitudes in pain management: Hong Kong nurses' perspective.
Effective pain management requires accurate knowledge, attitudes and assessment skills. To determine the current knowledge level and attitudes of nurses in pain management, 1,604 registered nurses working in three different hospitals in Hong Kong were invited to participate in this study. The sample consisted of 601 registered nurses, 63 nursing officers, and 14 nursing specialists (N = 678). ⋯ There was statistical significant in educational preparation and clinical experiences with correct scores. The findings of our study support the concern of inadequate knowledge and attitudes in relation to pain management. Further intensive continuing education and staff development is highly indicated for nurses in Hong Kong.
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J Pain Palliat Care Pharmacother · Jan 2004
ReviewTreatment of terminal restlessness: a review of the evidence.
Terminal restlessness is an important issue in the management of symptoms at the end of life with between 25% and 88% of dying patients exhibiting this condition. (1-5) The purpose of this review was to examine the empiric evidence about the pharmacological treatment for terminal restlessness. All available literature, in all languages, from 1966-2002 including randomized trials, concurrent observations, retrospective chart reviews, single case studies, clinical practice guidelines, expert consensus, single expert opinion articles, and editorials were reviewed as "best available evidence." Of the 72 articles reviewed, 14 met the criteria and were chosen for analysis. ⋯ There is insufficient evidence to suggest that a single medication or class of medications is appropriate for terminal restlessness. There is a clear need for additional trials of neuroleptics, benzodiazepines, barbiturates, and combination protocols to determine which protocols are the most effective and have the least side effects.