共查询到20条相似文献，搜索用时 15 毫秒
1.
Christopher C. Gruenberg Alan H. Breaud James H. Liu Patricia M. Mitchell James A. Feldman Kerrie P. Nelson Joseph H. Kahn 《The Journal of emergency medicine》2018,54(3):302-306
Background
Emergency department observation units (EDOUs) are used frequently for low-risk chest pain evaluations.Objective
The purpose of this study was to determine whether geriatric compared to non-geriatric patients evaluated in an EDOU for chest pain have differences in unscheduled 30-day re-presentation, length of stay (LOS), and use of stress testing.Methods
We conducted an exploratory, retrospective, cohort study at a single academic, urban ED of all adult patients placed in an EDOU chest pain protocol from June 1, 2014 to May 31, 2015. Our primary outcome was any unscheduled return visits within 30 days of discharge from the EDOU. Secondary outcomes included EDOU LOS and stress testing. We used Wilcoxon non-parametric and χ2 tests to compare geriatric to non-geriatric patients.Results
There were 959 unique EDOU placements of geriatric (n = 219) and non-geriatric (n = 740) patients. Geriatric compared to non-geriatric patients had: no significant difference in unscheduled 30-day return visits after discharge from the EDOU (15.5% vs. 18.5%; p = 0.31); significantly longer median EDOU LOS (22.1 vs. 20.6 h; p < 0.01) with a greater percentage staying longer than 24 h (42% vs. 29.1%; p < 0.01). Geriatric patients had significantly fewer stress tests (39.7% vs. 51.4%; p < 0.01), more of which were nuclear stress tests (78.2% vs. 39.5%; p < 0.01).Conclusions
In this exploratory retrospective study, geriatric EDOU chest pain patients did not have an increased rate of re-presentation to the hospital within 30 days compared to non-geriatric patients. Geriatric patients had a longer EDOU LOS than non-geriatric patients. Geriatric patients in the EDOU had fewer stress tests, but more of those were nuclear stress tests. 相似文献2.
Ahsan Azhar Sriram Yennurajalingam Aashraya Ramu Haibo Zhang Ali Haider Janet L. Williams Seyedeh S. Dibaj Diane D. Liu Eduardo Bruera 《Journal of pain and symptom management》2018,55(3):973-978
Context
Low-income patients face barriers to palliative care access, which might negatively influence symptom management and advanced care planning.Objective
Our aim was to compare time of referral and characteristics (level of symptom distress) among uninsured (indigent), low-insured (Medicaid), and insured patients presenting to our supportive care center (SCC).Methods
We conducted a retrospective review of randomly selected 100 indigent, 100 Medicaid, and 300 insured outpatients referred during the same five-year period. We reviewed demographic and clinical characteristics including date of diagnosis of advanced cancer and of first visit to SCC, symptom assessment (Edmonton Symptom Assessment System), type and dose of opioid medication, number of total outpatient visits, and date of last contact with palliative care team.Results
Among 482 evaluable patients, indigent, Medicaid, and insured patients, respectively, had mean (SD) ages of 48 (11), 50 (12), and 63 (13) years (P < 0.001); Edmonton Symptom Assessment System pain scores at first visit of 6.7 (2.5), 5.6 (3.2), and 4.9 (3.2) (P < 0.001); nonwhite race in 60%, 49%, and 25% of cases (P < 0.001); unmarried status in 68%, 64%, and 33% of cases (P < 0.001), while 63%, 87%, and 54% of patients (P < 0.001) were on opioids with median number of encounters per month of 0.6, 0.8, and 0.5 (P = 0.001). Median survival (95% CI) from first visit to last contact was 4.6 (2.8–6.2), 5.4 (3.5–7), and 5.6 (4.7–7.3) months (P = 0.036).Conclusion
Patients with limited or no insurance had significantly higher pain and were more frequently on opioids, younger, nonwhite, and not married. They required higher number of SCC follow-up visits. Insurance status did not affect timing of SCC referral or follow-ups at our cancer center. 相似文献3.
Yuhua Bao Renee C. Maciejewski Melissa M. Garrido Manish A. Shah Paul K. Maciejewski Holly G. Prigerson 《Journal of pain and symptom management》2018,55(4):1113-1121.e3
Context
For patients with metastatic cancer and limited life expectancy, potential benefits of chemotherapy must be balanced against harms to quality of life near death and increased out-of-pocket costs of care.Objectives
To evaluate the association between chemotherapy use by patients with Stage IV pancreatic cancer and health care use and Medicare and out-of-pocket costs in the last 30 days of life.Methods
We conducted a retrospective cohort study of 3825 patients aged 66 years or older when diagnosed with Stage IV pancreatic cancer in 2006–2011, using the linked Surveillance, Epidemiology, and End Results–Medicare data. Using a propensity score matched sample, we examined associations between initiation of chemotherapy shortly after the metastatic diagnosis (and secondarily, continued chemotherapy use in the last 30 days of life) and health care use and costs (both Medicare payment and patient out-of-pocket costs) in the last 30 days of life.Results
Chemotherapy use was associated with increased rates of hospital admissions (45.0% vs. 29.2%, P < 0.001), emergency department visits (41.3% vs. 27.2%, P < 0.001), and death in a hospital (14.2% vs. 9.1%, P < 0.001); fewer days in hospice care (11.5 days vs. 15.7 days, P < 0.001); and more than 50% increase in patient out-of-pocket costs for care ($1311.5 vs. $841.0, P < 0.001) in the last 30 days of life. Among patients who initiated chemotherapy, more stark differences in these outcomes were found by whether patients received chemotherapy in the last 30 days of life.Conclusion
Chemotherapy use among older patients diagnosed with metastatic pancreatic cancer was associated with substantially increased use of health care and higher patient out-of-pocket costs near death. 相似文献4.
Yoko Nakazawa Masashi Kato Mitsunori Miyashita Tatsuya Morita Yoshiyuki Kizawa 《Journal of pain and symptom management》2018,55(2):402-412
Context
The Cancer Control Act was passed in Japan in 2007, and various additional programs on palliative care have been implemented to improve quality of life and relieve pain and suffering in patients with cancer. However, how clinical settings have changed remains unclear.Objectives
The primary aim of the present study was to determine changes in nurses' palliative care knowledge, difficulties, and self-reported practices between 2008 and 2015.Methods
This study was an analysis of two nationwide observational studies from 2008 to 2015. We conducted two questionnaire surveys for representative samples of nurses in designated cancer hospitals, community hospitals, and district nurse services. The measurements used the Palliative Care Knowledge Test (PCKT, range 1–100), the Palliative Care Difficulties Scale (PCDS, range 1–5), and the Palliative Care Self-Reported Practice Scale (PCPS, range 1–5). Comparisons were made using the nonpaired Student t-test and a multivariate linear regression model using two cohorts.Results
We analyzed survey results for 2707 nurses in 2008 and 3649 nurses in 2015. Significant improvements were seen in PCKT, PCDS, and PCPS total scores for nurses in every work location over the seven-year study period, with PCKT total scores of 53 vs. 65 (P < 0.001; effect size = 0.60), 47 vs. 55 (P < 0.001; effect size = 0.40), and 52 vs. 55 (P = 0.118; effect size = 0.13), PCDS total scores of 3.0 vs. 2.5 (P < 0.001; effect size = 0.76), 3.4 vs. 2.8 (P < 0.001, effect size = 0.91), and 3.2 vs. 2.9 (P < 0.001; effect size = 0.53), and PCPS total scores of 3.7 vs. 4.0 (P < 0.001; effect size = 0.13), 3.5 vs. 3.8 (P < 0.001; effect size = 0.42), and 3.8 vs. 4.0 (P < 0.011; effect size = 0.21) in designated cancer hospitals, community hospitals, and district nurse services, respectively.Conclusion
Nurses' palliative care knowledge, difficulties, and self-reported practices improved over the seven-year study period, especially in terms of expert support in designated cancer hospitals and knowledge among nurses in designated cancer hospitals. 相似文献5.
Masanori Mori Maiko Fujimori Jun Hamano Akemi S. Naito Tatsuya Morita 《Journal of pain and symptom management》2018,55(2):189-197.e4
Context
Although the death of a loved one is a devastating family event, little is known about which behaviors positively affect families' perceptions on death pronouncements.Objectives
The objective of this study was to evaluate the effect of a compassionate death pronouncement on participant-perceived physician compassion, trust in physicians, and emotions.Methods
In this randomized, video-vignette study, 92 people (≥50 years) in Tokyo metropolitan area viewed two videos of death pronouncements by an on-call physician with or without compassion-enhanced behaviors, including five components: waiting until the families calm themselves down, explaining that the physician has received a sign-out about information of the patient's condition, performing examination respectfully, ascertaining the time of death with a wristwatch (vs. smartphone), and reassuring the families that the patient did not experience pain. Main outcomes were physician compassion score, trust in physician, and emotions.Results
After viewing the video with compassion-enhanced behaviors compared with the video without them, participants assigned significantly lower compassion scores (reflecting higher physician compassion) (mean 26.2 vs. 36.4, F = 33.1, P < 0.001); higher trust in physician (5.10 vs. 3.00, F = 39.7, P < 0.001); and lower scores for anger (2.49 vs. 3.78, F = 18.0, P < 0.001), sadness (3.42 vs. 3.85, F = 11.8, P = 0.001), fear (1.93 vs. 2.55, F = 15.8, P < 0.001), and disgust (2.45 vs. 3.71, F = 19.4, P < 0.001).Conclusion
To convey compassion on death pronouncement, we recommend that physicians initiate prompt examination, explain that the physician has received a sign-out, perform examination respectfully, ascertain the time of death with a wristwatch, and reassure the families that the patient did not experience pain. 相似文献6.
Pedro E. Perez-Cruz Omar Shamieh Carlos Eduardo Paiva Jung Hye Kwon Mary Ann Muckaden Eduardo Bruera David Hui 《Journal of pain and symptom management》2018,55(3):938-945
Context
Attrition is common in longitudinal observational studies in palliative care. Few studies have examined predictors of attrition.Objectives
To identify patient characteristics at enrollment associated with attrition in palliative oncology outpatient setting.Methods
In this longitudinal observational study, advanced cancer patients enrolled in an outpatient multicenter study were assessed at baseline and two to five weeks later. We compared baseline characteristics between patients who returned for follow-up and those who dropped out.Results
Seven hundred forty-four patients were enrolled from Jordan, Brazil, Chile, Korea, and India. Attrition rate was 33%, with variation among countries (22%–39%; P = 0.023). In univariate analysis, baseline predictors for attrition were cognitive failure (odds ratio [OR] 1.23 per point in Memorial Delirium Assessment Scale; P < 0.01), functional status (OR 1.55 per 10-point decrease in Karnofsky Performance Status; P < 0.01), Edmonton Symptom Assessment Scale [ESAS] physical score (OR 1.03 per point; P < 0.01), ESAS emotional score (OR 1.05 per point; P < 0.01), and shorter duration between cancer diagnosis and palliative care referral in months (OR 0.89 per log; P = 0.028). In multivariate analysis, cognitive failure (OR 1.12 per point; P = 0.007), ESAS physical score (OR 1.18 per point; P = 0.027), functional status (OR 1.35 per 10-point decrease; P < 0.001), and shorter duration from cancer diagnosis (OR 0.86 per log; P = 0.01) remained independent predictors of attrition.Conclusion
Advanced cancer patients with cognitive failure, increased physical symptoms, poorer performance status, and shorter duration from cancer diagnosis were more likely to dropout. These results have implications for research design, patient selection, and data interpretation in longitudinal observational studies. 相似文献7.
Kara E. Bischoff David L. O&#x;Riordan Kristyn Fazzalaro Anne Kinderman Steven Z. Pantilat 《Journal of pain and symptom management》2018,55(3):881-889
Context
Pain is a common and distressing symptom. Pain management is a core competency for palliative care (PC) teams.Objective
Identify characteristics associated with pain and pain improvement among inpatients referred to PC.Methods
Thirty-eight inpatient PC teams in the Palliative Care Quality Network entered data about patients seen between December 12, 2012 and March 15, 2016. We examined patient and care characteristics associated with pain and pain improvement.Results
Of patients who could self-report symptoms, 30.7% (4959 of 16,158) reported moderate-to-severe pain at first assessment. Over 40% of these patients had not been referred to PC for pain. Younger patients (P < 0.0001), women (P < 0.0001), patients with cancer (P < 0.0001), and patients in medical/surgical units (P < 0.0001) were more likely to report pain. Patients with pain had higher rates of anxiety (P < 0.0001), nausea (P < 0.0001), and dyspnea (P < 0.0001). Sixty-eight percent of patients with moderate-to-severe pain improved by the PC team's second assessment within 72 hours; 74.7% improved by final assessment. There was a significant variation in the rate of pain improvement between PC teams (P < 0.0001). Improvement in pain was associated with improvement in anxiety (OR = 2.9, P < 0.0001) and dyspnea (OR = 1.4, P = 0.03). Patients who reported an improvement in pain had shorter hospital length-of-stay by two days (P = 0.003).Conclusion
Pain is common among inpatients referred to PC. Three-quarters of patients with pain improve and improvement in pain is associated with other symptom improvement. Standardized, multisite data collection can identify PC patients likely to have marked and refractory pain, create benchmarks for the field, and identify best practices to inform quality improvement. 相似文献8.
Cameron J. Phillips Ross A. McKinnon Richard J. Woodman David L. Gordon 《Journal of infection and chemotherapy》2018,24(2):103-109
Introduction
Despite vancomycin being in use for over half-a-century, it is still not dosed or monitored appropriately in many centers around the world. The objective of this study was to determine the effectiveness of a multifaceted intervention to implement a vancomycin dosing and monitoring guideline across multiple medical and surgical units over time.Methods
This was an observational before-and-after interventional cohort study. The pre-intervention period was August to December 2010–2011 and the post-intervention period was September to November 2012–2014. The implementation strategy comprised: face-to-face education, online continuing medical education, dissemination of pocket guideline and email reminder. Outcome measures included: appropriate prescribing of loading and maintenance doses, therapeutic drug monitoring, time to attain target range and nephrotoxicity.Results
Post-implementation prescribing of loading doses increased (10.4%–43.6%, P=<0.001), guideline adherent first maintenance dose (44%–68.4% P = 0.04), correct dose adjustment from (53.1%–72.2%, P = 0.009). Beneficial effects pre and post-implementation were observed for adherent timing of initial concentration (43.2%–51.9%, P = 0.01), concentrations in target range (32.6%–44.1%, P = 0.001), time to target range (median 6–4 days, P=<0.001), potentially nephrotoxic concentrations (30.7%–20.9%, P=<0.001) and nephrotoxicity (10.4%–6.8%, P=<0.001).Conclusions
A multifaceted intervention to implement a vancomycin dosing and monitoring guideline significantly improved prescribing, monitoring, pharmacokinetic and safety outcomes for patients treated with vancomycin over an extended period. However, increased guideline adoption by clinicians is required to maximize and prolong the utility of this important agent. 相似文献9.
Context
Provision of home-based palliative care (PC) for seriously ill patients is important, yet few home-based PC services specifically or exclusively focus on end-stage heart failure (ESHF) patients.Objectives
This study aimed to examine the effect of a home-based palliative heart failure (HPHF) program on quality of life (QOL), symptoms burden, functional status, patient satisfaction, and caregiver burden among patients with ESHF.Methods
This study was a two-group randomized controlled trial undertaken in three hospitals. We recruited a total of 84 hospitalized ESHF patients who were referred to PC. They were randomized to the intervention or control group. The intervention group received a 12-week structured program with regular home visits/telephone calls provided by the nurse case managers. Data were collected at baseline (T1) and at four (T2) and 12 weeks (T3) after discharge.Results
A statistically significant between-group effect was found, with the HPHF group having significantly higher McGill QOL total score than the control group (P = 0.016) and there was significant group × time interaction effect (P = 0.032). There was no significant between-group effects detected for the measures of symptom distress or functional status at 12 weeks. The intervention group had higher satisfaction (P = 0.001) and lower caregiver burden (P = 0.024) than the control group at 12 weeks.Conclusion
The HPHF program is effective in enhancing the QOL of ESHF patients, satisfaction with care, and caregiver burden. The program has potential to reduce distress for some of the symptoms. 相似文献10.
Gabriel Lopez Alejandro Chaoul Catherine Powers-James Amy Spelman Qi Wei Rosalinda Engle Yousra Hashmi Eduardo Bruera Lorenzo Cohen 《Journal of pain and symptom management》2018,55(5):1321-1326.e1
Context
Complementary health approaches such as meditation may help improve cancer patient and caregiver symptoms, yet little research has examined the clinical application of these programs.Objectives
We explored the effects of a meditation group class, offered as part of an integrative medicine clinic at a comprehensive cancer center, on patient and caregiver self-reported symptoms.Methods
Participants (patients and caregivers) of any three meditation group classes offered—Power of Breath (PB), Sacred Sounds (SS), and Movement & Breath (MB)—were asked to complete the Edmonton Symptom Assessment Scale (ESAS; scale 0–10, 10 most severe) before and after participation. ESAS individual items and subscales were analyzed; distress subscales included global (global distress score 0–90), physical (physical distress score 0–60), and psychological (psychological distress score, 0–20). Data were analyzed examining premeditation/postmeditation scores using paired t-tests and between types of meditation using analyses of variance.Results
One hundred forty-two unique participants (76 patients and 66 caregivers) attended one or more meditation groups (mean 1.84) from May to December 2015 (265 total attendance: PB n = 92; SS n = 87; MB n = 86). For all participants, we observed clinically significant reduction/improvement in global distress scores (?5.17, SD 8; P < 0.0001) and in individual symptoms (ESAS decrease ≥ 1; means) of well-being (?1.36 SD 1.7; P < 0.0001), fatigue (?1.34 SD 1.9; P < 0.0001), anxiety (?1.26 SD 1.6; P < 0.001), and shortness of breath (?1.2 SD 2; P = 0.001). Comparing class length (60 vs. 90 minutes), class content (PB vs. SS vs. MB), and participants (caregivers vs. patients), there were no statistically significant differences in symptom score reduction.Conclusion
A single meditation group class offered as part of clinical care resulted in relief of multiple self-reported symptoms in both patients and caregivers. 相似文献11.
Heather A. Heaton David M. Nestler Derick D. Jones Rachelen S. Varghese Christine M. Lohse Eric S. Williamson Annie T. Sadosty 《The Journal of emergency medicine》2017,52(3):370-376
Background
Scribe use throughout health care is becoming more common. There is limited peer-reviewed literature supporting this emerging role in health care despite rapid uptake of the role.Objectives
Our study assesses impact of scribes on relative value units (RVUs) in adult and pediatric emergency departments (EDs).Methods
A prospective cohort study was developed in a tertiary academic ED. Charts were coded by an external billing and coding company, then returned and mapped by International Classification of Diseases, 9th revision diagnostic codes. After training by a staff member with significant experience in implementing scribe programs, scribes provided 1-to-1 support to a provider as staffing allowed. Comparisons were made between scribed and nonscribed visits.Results
There were 49,389 patient visits during the study period (39,926 adult [80.84%] and 9463 pediatric [19.16%] visits), of which 7865 (15.9%) were scribed. For adults, scribed visits produced 0.20 additional RVUs per patient (p < 0.001). Scribes generated additional RVUs in Emergency Severity Index (ESI) 2 (p < 0.001) and 3 (p < 0.001) patients. There were variable effects of scribes on RVUs by diagnostic codes. For pediatric patients, scribed encounters generated 0.08 fewer RVUs per patient (p = 0.007). ESI score had no effect on RVUs. The impact of scribes on pediatric diagnostic groupings was inconsistent.Conclusions
Scribes had a positive impact on RVUs in adult but not pediatric patients. Among adults, scribes led to higher RVUs in ESI 2 and 3 but not 4 and 5 patients, perhaps suggesting a limitation to improve revenue capture on lower-acuity patients. 相似文献12.
Britta Grünke Rebecca Philipp Sigrun Vehling Katharina Scheffold Martin Härter Karin Oechsle Frank Schulz-Kindermann Anja Mehnert Christopher Lo 《Journal of pain and symptom management》2018,55(3):985-991.e1
Context
Quality of life (QoL) is a central focus of care in advanced cancer. Specialized instruments, such as the Quality of Life at the End of Life-Cancer (QUAL-EC), may be useful to assess psychosocial issues associated with QoL unique to this population.Objectives
To evaluate the measurement of the psychosocial dimensions of QoL using the German translation of the QUAL-EC-Psychosocial (QUAL-EC-P) questionnaire, including factor structure and psychometrics.Methods
About 183 patients with advanced cancer from the University Medical Center Hamburg-Eppendorf and University Medical Center Leipzig completed the QUAL-EC-P questionnaire. We conducted exploratory factor analysis as well as item and reliability analysis. We examined convergent validity with correlations between the scale and relevant psychological constructs.Results
The sample was 60% female with mean age of 57.7 (SD = 11.7). We extracted three factors accounting for 44% of the variance aligning with the structure of the instrument. The QUAL-EC-P questionnaire showed good to acceptable internal consistency for the QoL-psychosocial total score (α = 0.77), the Life completion subscale (α = 0.77), and the Relationship with health care provider subscale (α = 0.81). The Preparation for end of life subscale had adequate albeit low internal consistency (α = 0.64) because concerns about family were less associated with financial worry and fear of death than expected. The psychosocial dimensions of QoL correlated negatively with depression (r = ?0.27, P ≤ 0.001), anxiety (r = ?0.32, P ≤ 0.001), demoralization (r = ?0.63, P ≤ 0.001), and attachment insecurity (r = ?0.51, P ≤ 0.001) and positively with spiritual well-being (r = 0.63, P ≤ 0.001).Conclusion
The QUAL-EC-P questionnaire may be used to assess the psychosocial aspects of QoL and promote their clinical discussion in patients with advanced cancer. 相似文献13.
14.
Yuki Sumazaki Watanabe Tomofumi Miura Ayumi Okizaki Keita Tagami Yoshihisa Matsumoto Maiko Fujimori Tatsuya Morita Hiroya Kinoshita 《Journal of pain and symptom management》2018,55(4):1159-1164
Context
The achievement of a personalized pain goal (PPG) is advocated as an individualized pain relief indicator.Objectives
Pain relief indicators, including PPG, pain intensity (PI), and interference with daily activities (interference), were compared herein.Methods
This was a single-center cross-sectional study. Adult patients with cancer on opioid medications who visited the outpatient clinic at the National Cancer Center Hospital East between March and September 2015 were consecutively enrolled. Patients conducted a self-report questionnaire, including reports of average PI, interference, PPG, and the need for further analgesic treatment. We compared the proportion of patients achieving PPG (PI ≤ PPG) and other pain relief indicators including PI ≤3 or interference ≤3 and the percentage of patients who did not need further analgesic treatment among those who fulfilled each pain relief indicator.Results
A total of 347 patients (median age 64; 38% females) were analyzed. Median (interquartile range [IQR]) of PPG, PI, and interference was 2 (IQR 1–3), 2 (IQR 1–4), and 2 (IQR 0–5), respectively. The proportion of patients achieving PPG was 45.3% and significantly lower than those with PI ≤3 (69.0%; P < 0.001) and interference ≤3 (70.2%; P < 0.001). Eighty percent of patients achieving PPG did not need further analgesic treatment, whereas 70.8% of patients with PI ≤3 (P < 0.001) and 73.3% with interference ≤3 did need further analgesic treatment (P < 0.001).Conclusion
The achievement of PPG was a stricter pain relief indicator than PI and interference and may reflect a real need for pain control. 相似文献15.
The effects of selective Pilates versus extension-based exercises on rehabilitation of low back pain
Vahid Mazloum Mansour Sahebozamani Amirhossein Barati Nouzar Nakhaee Pouya Rabiei 《Journal of bodywork and movement therapies》2018,22(4):999-1003
Introduction
Chronic non-specific low back pain (LBP) may lead to functional impairment and physical disability. The aim of this study was to compare the effects of selective Pilates (SP) and extension-based (EB) exercises on pain, lumbar spine curvature, lumbar forward flexion range of motion (ROM), and physical disability in such individuals.Materials and methods
In this randomized clinical trial, Forty-seven patients with chronic non-specific LBP (Mean of age: 39.7 years) were randomly allocated into either SP (N = 16), EB (N = 15), or control (N = 16) groups. The measurements included pain intensity, physical disability, lumbar forward bending ROM, and lumbar spine curvature at the baseline, after receiving the 6-week interventions, and also following one month of cessation of the exercises The analysis of co-variance (ANCOVA) and Post-hoc Bonferroni tests were administered to compare the three groups after the interventions and one month later (P < 0.05).Results
More significant improvement was observed in SP group compared to the subjects receiving EB exercises in terms of pain, ROM, and physical disability (P < 0.001), however, there was no significant difference between the two experimental groups for lumbar curvature (P > 0.05). Furthermore; in follow-up, the patients in SP group significantly achieved a higher level of pain intensity improvement and lumbar flexion ROM than the EB exercises (P < 0.001).Conclusions
It is estimated that core muscles activation and improving lumbopelvic rhythm in SP training may play a role in decreasing pain and physical disability in chronic LBP patients. Further high-quality studies are required to investigate the details of this mechanism. 相似文献16.
Sriram Yennurajalingam Duck-Hee Kang Wen-Jen Hwu Nikhil S. Padhye Charles Masino Seyedeh S. Dibaj Diane D. Liu Janet L. Williams Zhanni Lu Eduardo Bruera 《Journal of pain and symptom management》2018,55(2):198-206
Context
Cranial electrotherapy stimulation (CES) is a safe modulation of brain activity for treating depression, anxiety, insomnia, and pain. However, there are no published studies in patients with advanced cancer (ACPs).Objectives
The aim of the study was to determine the feasibility and preliminary efficacy of a four-week CES intervention on depression, anxiety, sleep disturbance, and pain scores. Concurrent salivary biomarker studies were conducted.Methods
In this one group open label pre- and post-intervention study with a four-week CES intervention, ACPs with one or more of four moderate intensity (≥3/10) Edmonton Symptom Assessment Scale (ESAS) symptoms (depression, anxiety, sleep disturbance, and pain) were eligible. Adherence (0%–100%), satisfaction rates (0–10), and safety were assessed. ESAS, Hospital Anxiety and Depression Scale (HADS), Pittsburgh Sleep Quality Index, Brief Pain Inventory, and salivary levels (cortisol, alpha amylase, C-reactive protein, and interleukin-1β, and interleukin-6) were assessed from baseline to Week 4.Results
Thirty-three of 36 patients (92%) completed the CES. Median (interquartile range) adherence CES use and satisfaction scores were 93% (89–100) and 10% (9–10), respectively, and the adherence criteria was met in the study. CES use was safe (no Grade 3 or higher adverse events). HADS anxiety (P < 0.001), HADS depression (P = 0.024), ESAS anxiety (P = 0.001), ESAS depression (P = 0.025), Brief Pain Inventory pain (P = 0.013), Pittsburgh Sleep Quality Index daytime dysfunction (P = 0.002), and medication use (P = 0.006) scores improved after four-week CES treatment.Conclusion
In this preliminary study, we found that the use of CES was safe and feasible in ACP. The use of CES was associated with significant improvement of depression, anxiety, pain, and sleep scores. These findings support further studies of CES in ACP for symptom control. 相似文献17.
Peter May Melissa M. Garrido Egidio Del Fabbro Danielle Noreika Charles Normand Nevena Skoro J. Brian Cassel 《Journal of pain and symptom management》2018,55(3):766-774.e4
Context
Inpatient palliative care (PC) is associated with reduced costs, but the optimal model for providing inpatient PC is unknown.Objectives
To estimate the effect of palliative care consultations (PCCs) and care in a palliative care unit (PCU) on cost of care, in comparison with usual care (UC) only and in comparison with each other.Methods
Retrospective cohort study, using multinomial propensity scoring to control for observed confounding between treatment groups. Participants were adults admitted as inpatients between 2009 and 2015, with at least one of seven life-limiting conditions who died within a year of admission (N = 6761).Results
PC within 10 days of admission is estimated to reduce costs compared with UC in the case of both PCU (?$6333; 95% CI: ?7871 to ?4795; P < 0.001) and PCC (?$3559; 95% CI: ?5732 to ?1387; P < 0.001). PCU is estimated to reduce costs compared with PCC (?$2774; 95% CI: ?5107 to ?441; P = 0.02) and length of stay compared with UC (?1.5 days; ?2.2 to ?0.9; P < 0.001). The comparatively larger effect of PCU over PCC is not observable when the treatment groups are restricted to those who received PC early in their admission (within six days).Conclusion
Both PCU and PCC are associated with lower hospital costs than UC. PCU is associated with a greater cost-avoidance effect than PCC, except where both interventions are provided early in the hospitalization. Both timely provision of PC for appropriate patients and creation of more PCUs may decrease hospital costs. 相似文献18.
Yuan-yuan Song Ru-jun Hu Yong-shu Diao Lin Chen Xiao-lian Jiang 《Journal of pain and symptom management》2018,55(4):1184-1195
Context
Hemodialysis (HD) patients experience a heavy symptom burden that leads to a decreased quality of life. Pharmacological treatment is effective but costly and has adverse effects. Exercise is a promising approach for symptom management, but the effect of exercise on restless legs syndrome (RLS), depression, sleep quality, and fatigue in HD patients is still uncertain.Objectives
This meta-analysis was conducted to identify whether exercise training is beneficial in the treatment of the symptoms of RLS, depression, poor sleep quality, and fatigue in patients receiving HD.Methods
A systematic search of PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Cochrane Central Register of Controlled Trials, and Web of Science was conducted to identify randomized controlled trials (RCTs) comparing exercise training with routine care on RLS, depression, sleep quality, and fatigue among HD patients. Quality assessment was conducted using the Cochrane risk of bias tool, and RevMan 5.3 was used to analyze the data.Results
Fifteen RCTs that met our inclusion criteria were included. The pooled effect size showed that exercise training was effective on RLS (P < 0.001), depression (P < 0.001), and fatigue (P < 0.001). However, effect size combinations for sleep quality were not performed owing to the sensitivity analysis results.Conclusion
Exercise training may help HD patients to reduce the severity of RLS, depression, and fatigue. More high-quality RCTs with larger samples and comparative RCTs focused on different exercise regimens are needed. 相似文献19.
Erica C. Kaye Jonathan Jerkins Courtney A. Gushue Samantha DeMarsh April Sykes Zhaohua Lu Jennifer M. Snaman Lindsay Blazin Liza-Marie Johnson Deena R. Levine R. Ray Morrison Justin N. Baker 《Journal of pain and symptom management》2018,55(6):1550-1556
Context
Early integration of palliative care (PC) in the management of children with high-risk cancer is widely endorsed by patients, families, clinicians, and national organizations. However, optimal timing for PC consultation is not standardized, and variables that influence timing of PC integration for children with cancer remain unknown.Objectives
To investigate associations between demographic, disease, treatment, and end-of-life attributes and timing of PC consultation for children with high-risk cancer enrolled on a PC service.Methods
A comprehensive standardized tool was used to abstract data from the medical records of 321 patients treated at a large academic pediatric cancer center, who died between 2011 and 2015.Results
Gender, race, ethnicity, enrollment on a Phase I protocol, number of high-acuity hospitalizations, and receipt of cardiopulmonary resuscitation were not associated with timing of PC involvement. Patients with hematologic malignancy, those who received cancer-directed therapy during the last month of life, and those with advance directives documented one week or less before death had higher odds of late PC referral (malignancy: odds ratio [OR] 3.24, P = 0.001; therapy: OR 4.65, P < 0.001; directive: OR 4.81, P < 0.0001). Patients who received hospice services had lower odds of late PC referral <30 days before death (OR 0.31, P < 0.001).Conclusion
Hematologic malignancy, cancer-directed therapy at the end of life, and delayed documentation of advance directives are associated with late PC involvement in children who died of cancer. Identification of these variables affords opportunities to study targeted interventions to enhance access to earlier PC resources and services for children with high-risk cancer and their families. 相似文献20.
Nancy Dudley Christine S. Ritchie Margaret I. Wallhagen Kenneth E. Covinsky Bruce A. Cooper Kanan Patel Irena Stijacic Cenzer Susan A. Chapman 《Journal of pain and symptom management》2018,55(2):217-225
