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https://www.readbyqxmd.com/read/28486096/key-pharmacogenomic-considerations-for-sickle-cell-disease-patients
#1
Alexandra Kolliopoulou, Apostolos Stratopoulos, Stavroula Siamoglou, Argyro Sgourou, Adamantia Papachatzopoulou, Theodora Katsila, George P Patrinos
Sickle cell disease (SCD), although a monogenic disease, exhibits a complex clinical phenotype that hampers optimum patient stratification and disease management, especially on hydroxyurea treatment. Moreover, theranostics, the combination of diagnostics to individualize and optimize therapeutic interventions, has not been firmly on the forefront of SCD research and clinical management to date. We suggest that if tailor-made theranostics in SCD is envisaged, pharmacogenomics is anticipated to be the way forward...
May 9, 2017: Omics: a Journal of Integrative Biology
https://www.readbyqxmd.com/read/28459058/comorbidity-pain-utilization-and-psychosocial-outcomes-in-older-versus-younger-sickle-cell-adults-the-pisces-project
#2
Donna K McClish, Wally R Smith, James L Levenson, Imoigele P Aisiku, John D Roberts, Susan D Roseff, Viktor E Bovbjerg
Background. Patients with SCD now usually live well into adulthood. Whereas transitions into adulthood are now often studied, little is published about aging beyond the transition period. We therefore studied age-associated SCD differences in utilization, pain, and psychosocial variables. Methods. Subjects were 232 adults in the Pain in Sickle Cell Epidemiology Study (PiSCES). Data included demographics, comorbidity, and psychosocial measures. SCD-related pain and health care utilization were recorded in diaries...
2017: BioMed Research International
https://www.readbyqxmd.com/read/28375958/evidence-based-practice-standard-care-for-acute-pain-management-in-adults-with-sickle-cell-disease-in-an-urgent-care-center
#3
Sunghee Kim, Ron Brathwaite, Ook Kim
BACKGROUND: Vaso-occlusive episodes (VOEs) with sickle cell disease (SCD) require opioid treatment. Despite evidence to support rapid pain management within 30 minutes, care for these patients does not consistently meet this benchmark. This quality improvement study sought to decrease the first analgesic administration time, increase patient satisfaction, and expedite patient flow. METHODS: A prospective pre-/postevaluation design was used to evaluate outcomes with patients 18 years or older with VOEs in an urgent care (UC) center after implementation of evidence-based practice standard care (EBPSC)...
April 2017: Quality Management in Health Care
https://www.readbyqxmd.com/read/28361592/lactate-dehydrogenase-a-marker-of-the-severity-of-vaso-occlusive-crisis-in-children-with-sickle-cell-disease-presenting-at-the-emergency-department
#4
Marina García-Morin, Carolina López-Sangüos, Paula Vázquez, Teresa Alvárez, Rafael Marañón, Jorge Huerta, Elena Cela
The aim of this study was to describe the characteristics of vaso-occlusive crises (VOC) in children with sickle cell disease and to identify factors associated with greater severity. We performed a prospective observational study from August 2012 to January 2014. The study population comprised patients with sickle cell disease who consulted at the emergency department (ED) for VOC. We recorded demographic variables, history of complications related to the disease, and data on usual treatment. We also assessed pain, analgesia at home, need for admission, length of stay, and analgesia during admission...
November 2016: Hemoglobin
https://www.readbyqxmd.com/read/28334590/a-prospective-emergency-department-quality-improvement-project-to-improve-the-treatment-of-vaso-occlusive-crisis-in-sickle-cell-disease-lessons-learned
#5
Paula Tanabe, Caroline E Freiermuth, David M Cline, Susan Silva
BACKGROUND: Guidelines recommend rapid, aggressive management of vaso-occlusive crisis (VOC) for patients with sickle cell disease (SCD). A large prospective research and quality improvement (QI) project was conducted to measure changes in clinical outcomes in two EDs-academic medical centers with emergency medicine residency programs and Level 1 trauma centers-during a 2.5-year time period (October 2011-March 2014). METHODS: A QI team used a Plan-Do-Study-Act approach to modify and implement changes to opioid analgesic protocols for the emergency department (ED) treatment of VOC...
March 2017: Joint Commission Journal on Quality and Patient Safety
https://www.readbyqxmd.com/read/28221266/body-mass-index-and-the-association-with-vaso-occlusive-crises-in-pediatric-sickle-cell-disease
#6
Andrea Zivot, Nataly Apollonsky, Edward Gracely, Deepti Raybagkar
BACKGROUND: Children with sickle cell disease (SCD) historically have been underweight and have poor overall growth. Recent studies have demonstrated a trend toward obesity in pediatric SCD populations. MATERIALS AND METHODS: Through retrospective chart review of patients with SCD followed at our center, we collected patient's data, including body mass index (BMI), weight percentiles, sickle cell genotype, baseline hemoglobin, medical and psychiatric comorbidities, 25-hydroxy vitamin D level, treatment with hydroxyurea, and chronic transfusions...
May 2017: Journal of Pediatric Hematology/oncology
https://www.readbyqxmd.com/read/28192225/a-randomized-trial-of-yoga-for-children-hospitalized-with-sickle-cell-vaso-occlusive-crisis
#7
Karen Moody, Bess Abrahams, Rebecca Baker, Ruth Santizo, Deepa Manwani, Veronica Carullo, Doris Eugenio, Aaron Carroll
CONTEXT: Sickle cell disease (SCD) vaso-occlusive crisis (VOC) remains an important cause of acute pain in pediatrics and the most common SCD complication. Pain management recommendations in SCD include nonpharmacological interventions. Yoga is one nonpharmacological intervention that has been shown to reduce pain in some populations, however, evidence is lacking in children with VOC. OBJECTIVES: The primary objective of this study was to compare the effect of yoga versus an attention control on pain in children with VOC...
February 9, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/27902670/ketamine-infusion-for-pain-control-in-acute-pediatric-sickle-cell-painful-crises
#8
Jonathan M Hagedorn, Evelyn C Monico
OBJECTIVES: Sickle cell disease is the most common hemoglobin variant in the world and can present with recurrent vaso-occlusive painful crises. Pain control in these patients is often difficult and requires a multimodal approach. In patients with uncontrolled pain after traditional pain control methods, ketamine infusions have proven beneficial. Unfortunately, no source alone had described ketamine infusions for pediatric sickle cell patients. Our objective was to provide a thorough definitive reference for health care providers regarding the use of ketamine infusion for pain control in pediatric sickle cell painful crises...
November 29, 2016: Pediatric Emergency Care
https://www.readbyqxmd.com/read/27880985/daily-pain-in-adults-with-sickle-cell-disease-a-different-perspective
#9
Charlotte F J van Tuijn, Joep W R Sins, Karin Fijnvandraat, Bart J Biemond
Previous reports demonstrated that patients with sickle cell disease (SCD) experience pain on more than half of the observed days. Yet, these high incidences do not seem to match observations in our population. In this prospective cohort study, we aimed to assess the frequency and characteristics of daily, self-reported pain among adult SCD patients in the Netherlands. Consecutive patients were enrolled during routine outpatient visits and followed up to 6 months. A total of 55 patients completed 5,982 diary observation days...
February 2017: American Journal of Hematology
https://www.readbyqxmd.com/read/27803072/factors-associated-with-the-prophylactic-prescription-of-a-bowel-regimen-to-prevent-opioid-induced-constipation
#10
Nancy Y Chen, Eugene Nguyen, Sheree M Schrager, Christopher J Russell
OBJECTIVE: Identify factors associated with the prophylactic prescription of a bowel regimen with an inpatient opioid prescription. METHODS: This was a retrospective cohort study from June 1, 2013, to October 31, 2014 of pediatric inpatients prescribed an oral or intravenous opioid on the general medical/surgical floors. We identified patients with or without a prophylactic prescription of a bowel regimen. We obtained patient demographics, prescriber training level and service and used multivariate logistic regression to analyze the factors associated with prophylactic bowel regimen and opioid prescription...
November 2016: Hospital Pediatrics
https://www.readbyqxmd.com/read/27800652/opioid-prescription-practices-at-discharge-and-30-day-returns-in-children-with-sickle-cell-disease-and-pain
#11
Leslie M Okorji, Devin S Muntz, Robert I Liem
BACKGROUND: Acute pain episodes in children with sickle cell disease (SCD) represent a leading cause of readmissions. We examined prescription practices at the time of discharge in children with SCD presenting with acute pain to determine their impact on 30-day emergency department (ED) revisits and readmissions. METHODS: In this single-institution, 5-year retrospective study, we reviewed 290 encounters of patients with SCD aged 7-21 years hospitalized or discharged from the ED with acute pain...
May 2017: Pediatric Blood & Cancer
https://www.readbyqxmd.com/read/27797344/objective-basis-for-chronic-pain-in-patients-with-adult-sickle-cell-disease
#12
Samip Master, Abhishek Patel, Glenn Mills, Richard Mansour
Sickle Cell Disease (SCD) affects approximately 100,000 Americans and due to lack of an organized treatment approach, patients with SCD pose a high economic burden on medical services. The patients with SCD have chronic bone damage from bone marrow infraction and vaso-occulsive events. These bone damages lead to chronic pain in patients with SCD. The inadwquate treatment of chronic pain in adult patients with SCD can lead to pseudo-addictive behavior and also affect their psycho-social life. There are certain barriers to adequate pain management in adult patients with SCD, namely, limited knowledge among the clinicians, inadequate assessment, concerns about addiction, and biases against opioid use...
September 2016: Journal of the Louisiana State Medical Society: Official Organ of the Louisiana State Medical Society
https://www.readbyqxmd.com/read/27687125/electroacupuncture-in-conscious-free-moving-mice-reduces-pain-by-ameliorating-peripheral-and-central-nociceptive-mechanisms
#13
Ying Wang, Jianxun Lei, Mihir Gupta, Fei Peng, Sarah Lam, Ritu Jha, Ellis Raduenz, Al J Beitz, Kalpna Gupta
Integrative approaches such as electroacupuncture, devoid of drug effects are gaining prominence for treating pain. Understanding the mechanisms of electroacupuncture induced analgesia would benefit chronic pain conditions such as sickle cell disease (SCD), for which patients may require opioid analgesics throughout life. Mouse models are instructive in developing a mechanistic understanding of pain, but the anesthesia/restraint required to administer electroacupuncture may alter the underlying mechanisms. To overcome these limitations, we developed a method to perform electroacupuncture in conscious, freely moving, unrestrained mice...
September 30, 2016: Scientific Reports
https://www.readbyqxmd.com/read/27636225/an-expert-review-of-pharmacogenomics-of-sickle-cell-disease-therapeutics-not-yet-ready-for-global-precision-medicine
#14
Khuthala Mnika, Gift D Pule, Collet Dandara, Ambroise Wonkam
Sickle cell disease (SCD) is a blood disease caused by a single nucleotide substitution (T > A) in the beta globin gene on chromosome 11. The single point mutation (Glu6Val) promotes polymerization of hemoglobin S (HbS) and causes sickling of erythrocytes. Vaso-occlusive painful crises are associated with recurrent and long-term use of analgesics/opioids and hydroxyurea (HU) by people living with SCD. The present analysis offers a state-of-the-art expert review of the effectiveness of pharmacogenomics/genetics of pain management in SCD, with specific focus on HU and opioids...
October 2016: Omics: a Journal of Integrative Biology
https://www.readbyqxmd.com/read/27598369/examination-of-the-patient-and-hospitalization-characteristics-of-30-day-scd-readmissions
#15
C Patrick Carroll, Carlton Haywood, Sophie M Lanzkron
OBJECTIVES: Sickle cell disease (SCD) is associated with a high level of emergency department and hospital utilization, as well as a high rate of hospital readmissions. At Johns Hopkins Hospital, as at other institutions, SCD accounts for a large proportion of readmissions. Our study examined patient and hospitalization factors involved in readmissions at Johns Hopkins Hospital. METHODS: Patients at the Johns Hopkins Sickle Cell Center for Adults with a readmission in fiscal year 2011 were compared with an age- and sex-matched sample of clinic patients for comorbidities, complications, and prior utilization...
September 2016: Southern Medical Journal
https://www.readbyqxmd.com/read/27572136/pharmacokinetics-and-analgesic-effects-of-methadone-in-children-and-adults-with-sickle-cell-disease
#16
Jennifer Horst, Melissa Frei-Jones, Elena Deych, William Shannon, Evan D Kharasch
BACKGROUND: Vaso-occlusive episodes (VOEs) are a significant source of morbidity among children and adults with sickle cell disease (SCD). There is little information on methadone use for SCD pain. This investigation evaluated methadone pharmacokinetics in children and adults with SCD, with a secondary aim to assess pain relief and opioid consumption. PROCEDURE: Participants included children (<18 years) and adults with a VOE requiring hospitalization. Patients were randomly assigned to receive standard care (opioid patient-controlled analgesia; control group) or one dose of intravenous methadone (0...
December 2016: Pediatric Blood & Cancer
https://www.readbyqxmd.com/read/27548045/characterizing-the-pain-score-trajectories-of-hospitalized-adult-medical-and-surgical-patients-a-retrospective-cohort-study
#17
Thomas Kannampallil, William L Galanter, Suzanne Falck, Michael J Gaunt, Robert D Gibbons, Robert McNutt, Richard Odwazny, Gordon Schiff, Allen J Vaida, Diana J Wilkie, Bruce L Lambert
Pain care for hospitalized patients is often suboptimal. Representing pain scores as a graphical trajectory may provide insights into the understanding and treatment of pain. We describe a 1-year, retrospective, observational study to characterize pain trajectories of hospitalized adults during the first 48 hours after admission at an urban academic medical center. Using a subgroup of patients who presented with significant pain (pain score >4; n = 7762 encounters), we characterized pain trajectories and measured area under the curve, slope of the trajectory for the first 2 hours after admission, and pain intensity at plateau...
December 2016: Pain
https://www.readbyqxmd.com/read/27517842/impact-of-emergency-department-care-on-outcomes-of-acute-pain-events-in-children-with-sickle-cell-disease
#18
Amanda M Brandow, Mark Nimmer, Timothy Simmons, T Charles Casper, Lawrence J Cook, Corrie E Chumpitazi, J Paul Scott, Julie A Panepinto, David C Brousseau
The impact of emergency department (ED) treatment on outcomes of sickle cell disease (SCD) acute pain hospitalizations is not well described. We investigated whether length of stay (LOS) and change in health-related quality of life (HRQL) are affected by initial opioid dose and time to administration. We conducted secondary analyses of data from the randomized-controlled Magnesium for children in Crisis (MAGiC) trial. The primary outcome was LOS. Secondary outcome was change in HRQL, assessed using PedsQL SCD Pain and Hurt and Pain Impact Domains measured in ED and at discharge...
December 2016: American Journal of Hematology
https://www.readbyqxmd.com/read/27466799/patterns-of-opioid-use-in-sickle-cell-disease
#19
Jin Han, Santosh L Saraf, Xu Zhang, Michel Gowhari, Robert E Molokie, Joharah Hassan, Chaher Alhandalous, Shivi Jain, Jewel Younge, Taimur Abbasi, Roberto F Machado, Victor R Gordeuk
Pain, the hallmark complication of sickle cell disease (SCD), is largely managed with opioid analgesics in the United States, but comprehensive data regarding the long-term use of opioids in this patient population is lacking. The pain medication prescription records from a cohort of 203 SCD patients were analyzed. Twenty-five percent were not prescribed opioid medications while 47% took only short-acting opioids, 1% took only long-acting opioids, and 27% took a combination of short-acting and long-acting opioids...
November 2016: American Journal of Hematology
https://www.readbyqxmd.com/read/27445606/patient-controlled-analgesia-for-adults-with-sickle-cell-disease-awaiting-admission-from-the-emergency-department
#20
Josue Santos, Sasia Jones, Daniel Wakefield, James Grady, Biree Andemariam
Background. A treatment algorithm for sickle cell disease (SCD) pain in adults presenting to a single emergency department (ED) was developed prioritizing initiation of patient controlled analgesia (PCA) for patients awaiting hospitalization. Objectives. Evaluate the proportion of ED visits in which PCA was started in the ED. Methods. A two-year retrospective chart review of consecutive SCD pain ED visits was undertaken. Data abstracted included PCA initiation, low versus high utilizer status, pain scores, bolus opioid number, treatment times, and length of hospitalization...
2016: Pain Research & Management: the Journal of the Canadian Pain Society
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