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Pain Management Ethics

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https://www.readbyqxmd.com/read/28641572/a-child-with-hypertension-and-ambiguous-genitalia-an-uncommon-variant-of-congenital-adrenal-hyperplasia-a-case-report
#1
Vivek Pant, Suman Baral, Bishal Shrestha, Arjun Tumbapo
BACKGROUND: Deficiency in 11β-hydroxylase as a cause of congenital adrenal hyperplasia is uncommon. It should be considered in the differential diagnosis of hypertension with virilization in any prepubescent child. CASE PRESENTATION: A 12-year-old Asian boy from eastern Nepal presented with pain in his abdomen and hypertension. He was raised as a male but had absent testicles since birth and had precocious puberty. Plasma testosterone, follicle-stimulating hormone, and luteinizing hormone were below baseline level...
June 23, 2017: Journal of Medical Case Reports
https://www.readbyqxmd.com/read/28635066/consensus-development-of-quality-indicators-for-end-of-life-care-for-elders-in-japan
#2
Harue Masaki, Nobuko Kawai, Keiko Matsumoto, Miyoko Kuwata, Sachiko Yoshioka, Midori Nishiyama, Ryoko Uchino, Hiroko Nagae, Megumi Teshima, Sayuri Sakai, Kazuko Endo
AIMS AND OBJECTIVES: Quality indicators for end-of-life care have been published; however, none have been developed specifically for nursing in the cultural and traditional context of Japan. This study aimed to develop and build a consensus of quality indicators for end-of-life care for elders in Japan from the perspective of nursing science. METHODS: To develop the quality indicators, we used a literature review, expert panel process, and the Delphi technique among clinical nurse specialists in geriatrics...
June 2017: International Journal of Nursing Practice
https://www.readbyqxmd.com/read/28631150/low-dose-subcutaneous-ketamine-for-postoperative-pain-management-in-rwanda-a-dose-finding-study
#3
Jon Tuchscherer, William P McKay, Theogene Twagirumugabe
PURPOSE: Good pain control is not a normal part of surgical care in sub-Saharan Africa due to lack of resources. The primary objective of this study was to determine an efficacious dose of subcutaneous ketamine for postoperative pain for use in a future randomized controlled trial. METHODS: Following research ethics board and local hospital approval for this research, we obtained informed consent from 31 patients undergoing major surgery for a random walk dose-finding study...
June 19, 2017: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
https://www.readbyqxmd.com/read/28616651/comparison-of-efficacy-of-transversus-abdominis-plane-block-and-iliohypogastric-ilioinguinal-nerve-block-for-postoperative-pain-management-in-patients-undergoing-inguinal-herniorrhaphy-with-spinal-anesthesia-a-prospective-randomized-controlled-open-label-study
#4
Onur Okur, Zeki Tuncel Tekgul, Nazif Erkan
PURPOSES: The purpose of this study was to compare the effects of lateral abdominal transversus abdominis plane block (TAP block) and iliohypogastric/ilioinguinal nerve block (IHINB) under ultrasound guidance for postoperative pain management of inguinal hernia repair. Secondary purposes were to compare the complication rates of the two techniques and to examine the effects of TAP block and IHINB on chronic postoperative pain. METHODS: This was a prospective randomized controlled open-label study...
June 14, 2017: Journal of Anesthesia
https://www.readbyqxmd.com/read/28580748/opioid-addiction-and-misuse-in-adult-and-adolescent-patients-with-cancer
#5
Ross Pinkerton, Janet R Hardy
In the context of a therapeutic opioid epidemic, particularly in the USA, where increasingly stringent screening for 'at risk' individuals and close monitoring of opioid prescription and use is strongly recommended, the issue of misuse within the cancer population must be addressed. Most patients with advanced cancer will have pain requiring opioid therapy at some stage during their disease course. In the majority, this will provide good pain relief with no short- or longer-term adverse sequelae. A subset will present with substance misuse issues that will influence management and prescribing practice...
June 2017: Internal Medicine Journal
https://www.readbyqxmd.com/read/28554913/protocol-for-a-single-centre-parallel-arm-randomised-controlled-superiority-trial-evaluating-the-effects-of-transcatheter-arterial-embolisation-of-abnormal-knee-neovasculature-on-pain-function-and-quality-of-life-in-people-with-knee-osteoarthritis
#6
Steve Landers, Andrew Hely, Benjamin Harrison, Nick Maister, Rachael Hely, Stephen E Lane, Stephen D Gill, Richard S Page
INTRODUCTION: Symptomatic knee osteoarthritis (OA) is common. Advanced knee OA is successfully treated with joint replacement surgery, but effectively managing mild to moderate knee OA can be difficult. Angiogenesis increases with OA and might contribute to pain and structural damage. Modifying angiogenesis is a potential treatment pathway for OA. The aim of the current study is to determine whether transcatheter arterial embolisation of abnormal neovasculature arising from the genicular arterial branches improves knee pain, physical function and quality of life in people with mild to moderate symptomatic knee OA...
May 29, 2017: BMJ Open
https://www.readbyqxmd.com/read/28550589/carbon-dioxide-co2-angiography-as-an-option-for-endovascular-abdominal-aortic-aneurysm-repair-evar-in-patients-with-chronic-kidney-disease-ckd
#7
Chiara De Angelis, Francesco Sardanelli, Matteo Perego, Marco Alì, Francesco Casilli, Luigi Inglese, Giovanni Mauri
To assess feasibility, efficacy and safety of carbon dioxide (CO2) digital subtraction angiography (DSA) to guide endovascular aneurysm repair (EVAR) in a cohort of patients with chronic kidney disease (CKD). After Ethical Committee approval, the records of 13 patients (all male, mean age 74.6 ± 8.0 years) with CKD, who underwent EVAR to exclude an abdominal aortic aneurysm (AAA) under CO2 angiography guidance, were reviewed. The AAA to be excluded had a mean diameter of 52.0 ± 8.0 mm. CO2 angiography was performed by automatic (n = 7) or hand (n = 6) injection...
May 27, 2017: International Journal of Cardiovascular Imaging
https://www.readbyqxmd.com/read/28543418/reconciling-patient-safety-and-epistemic-humility-an-ethical-use-of-opioid-treatment-plans
#8
Anita Ho
In this issue of the Hastings Center Report, Joshua Rager and Peter Schwartz suggest using opioid treatment agreements as public health monitoring tools to inform patients about "the requirements entailed by undergoing opioid therapy," rather than as contractual agreements to alter patients' individual behavior or to benefit them directly. Because Rager and Schwartz's argument presents suspected OTA violations as a justification to stop providing opioids yet does not highlight the broader epistemic and systemic context within which clinicians prescribe these medications, their proposal may perpetuate a climate of distrust and stigmatization without correcting systemic factors that may have placed patients and others at risk in the first place...
May 2017: Hastings Center Report
https://www.readbyqxmd.com/read/28501812/integrating-culturally-informed-approaches-into-the-physiotherapy-assessment-and-treatment-of-chronic-pain-protocol-for-a-pilot-randomised-controlled-trial
#9
Bernadette Brady, Irena Veljanova, Siobhan Schabrun, Lucinda Chipchase
INTRODUCTION: There is strong evidence that biopsychosocial approaches are efficacious in the management of chronic pain. However, implementation of these approaches in clinical practice is known not to account for the beliefs and values of culturally and linguistically diverse (CALD) patients. This limitation in translation of research contributes to the disparities in outcomes for CALD patients with chronic pain adding to the socioeconomic burden of this prevalent condition. Cultural adaptation of chronic pain assessment and management is urgently required...
May 12, 2017: BMJ Open
https://www.readbyqxmd.com/read/28494906/the-effect-of-morphine-added-to-bupivacaine-in-ultrasound-guided-transversus-abdominis-plane-tap-block-for-postoperative-analgesia-following-lower-abdominal-cancer-surgery-a-randomized-controlled-study
#10
Fatma Adel El Sherif, Sahar Abdel-Baky Mohamed, Shereen Mamdouh Kamal
OBJECTIVES: Transversus abdominis plane (TAP) block used for management of surgical abdominal pain by injecting local anesthetics into the plane between the internal oblique and transversus abdominis muscles. We aimed to explore the effect of adding morphine to bupivacaine in ultrasound guided TAP-block in patients undergoing lower abdominal cancer surgery. STUDY DESIGN: Randomized, double-blind, prospective study. Clinical trial identifier: NCT02566096. SETTING: Academic medical center...
June 2017: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/28486096/key-pharmacogenomic-considerations-for-sickle-cell-disease-patients
#11
Alexandra Kolliopoulou, Apostolos Stratopoulos, Stavroula Siamoglou, Argyro Sgourou, Bassam R Ali, 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...
June 2017: Omics: a Journal of Integrative Biology
https://www.readbyqxmd.com/read/28473517/what-is-the-best-analgesic-option-for-patients-presenting-with-renal-colic-to-the-emergency-department-protocol-for-a-systematic-review-and-meta-analysis
#12
Sameer A Pathan, Biswadev Mitra, Lorena Romero, Peter A Cameron
INTRODUCTION: Patients with renal colic present to the emergency department in excruciating pain. There is variability in practice regarding the choice of initial analgesic to be used in renal colic. The aim of this article is to outline the protocol for review of the efficacy and safety of non-steroidal anti-inflammatory drugs (NSAIDs), opioids and paracetamol use in renal colic pain management. METHODS AND ANALYSIS: This is the protocol for a systematic review, comparing efficacy of NSAIDs, opioids and paracetamol in renal colic studied under randomised controlled trial (RCT) design...
May 4, 2017: BMJ Open
https://www.readbyqxmd.com/read/28462897/radiation-oncology-resident-palliative-education
#13
Monica Krishnan, Margarita Racsa, Joshua Jones, Eva Chittenden, Kristen G Schaefer, Alex Spektor, Andrea Enzinger, Randy Wei, Tracy Balboni
PURPOSE: Although palliative care is recognized as integral to oncology care, limited data exist regarding the extent to which palliative care training is incorporated into radiation oncology residency training in the United States. We aim to characterize US radiation oncology residents' perceived palliative care educational needs and experience to guide future palliative oncology educational interventions. METHODS AND MATERIALS: An 8-person expert panel developed a survey to assess resident perceptions of generalist palliative care education within radiation oncology residency...
March 14, 2017: Practical Radiation Oncology
https://www.readbyqxmd.com/read/28460701/effective-management-of-pain-and-anxiety-for-the-pediatric-patient-in-the-emergency-department
#14
REVIEW
Virginia B Young
Inadequate treatment of pain for children in the emergency department is a persistent problem. Health care professionals are bound by ethical principles to provide adequate pain management; in children, this may be challenging owing to cognitive and developmental differences, lack of knowledge regarding best practices, and other barriers. Studies have concluded that immediate assessment, treatment, and reassessment of pain after an intervention are essential. Self-report and behavioral scales are available...
June 2017: Critical Care Nursing Clinics of North America
https://www.readbyqxmd.com/read/28445263/acupuncture-for-enhancing-early-recovery-of-bowel-function-in-cancer-protocol-for-a-systematic-review
#15
REVIEW
Yi-Hua Liu, Yang Ye, Jia-Bin Zheng, Xue-Qian Wang, Ying Zhang, Hong-Sheng Lin
BACKGROUND: Cancer patients undergoing surgical procedure often suffer from bowel dysfunction and postoperative ileus (POI). Cancer management for early recovery of bowel function is still a challenging topic. Acupuncture has been commonly used in a variety of gastrointestinal diseases. The aim of this study is to evaluate the effects of acupuncture therapy to reduce the duration of POI and enhance bowel function in cancer patients. METHODS: We will systematically screen all randomized controlled trials (RCTs) published through electronically and hand searching...
April 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28431539/pain-intervention-for-people-with-dementia-in-nursing-homes-pid-study-protocol-for-a-quasi-experimental-nurse-intervention
#16
Andrea Koppitz, Georg Bosshard, Geneviève Blanc, Hannele Hediger, Sheila Payne, Thomas Volken
BACKGROUND: It is estimated that 19 to 83% of people with dementia suffer from pain that is inadequately treated in the last months of life. A large number of healthcare workers who care for these people in nursing homes lack appropriate expertise and may therefore not always recognise, assess and treat pain in those with dementia who have complex problems on time, properly and efficiently. The aim of this intervention trial is to identify care needs of people with dementia suffering from pain living in a nursing home...
April 21, 2017: BMC Palliative Care
https://www.readbyqxmd.com/read/28429143/how-to-treat-lumbar-disc-herniation-in-pregnancy-a-systematic-review-on-current-standards
#17
REVIEW
Alberto Di Martino, Fabrizio Russo, Luca Denaro, Vincenzo Denaro
PURPOSE: In this systematic review, we aim to illustrate the current and safe concepts in the assessment, diagnosis and management of herniated lumbar disc (HLD) during pregnancy. METHODS: A systematic review and reporting on the diagnosis, treatment and clinical results of HLD during pregnancy is performed. RESULTS: The MRI represents the first level and safest diagnostic tool for pregnant women affected by spinal problems allowing for a noninvasive and detailed radiological examination of the spine...
April 20, 2017: European Spine Journal
https://www.readbyqxmd.com/read/28409480/genetic-testing-for-opioid-pain-management-a-primer
#18
Deepti Agarwal, Mercy A Udoji, Andrea Trescot
Patients see their primary care physicians (PCPs) for a variety of medical conditions, chronic pain being one of the most common. An increased use of prescription medications (especially opioids) has led to an increase in adverse drug reactions and has heightened our awareness of the variability in response to medications. Opioids and other pain adjuvants are widely used, and drug-drug interactions involving these analgesics can be problematic and potentially lethal. Pharmacogenetics has improved our understanding of drug efficacy and response, opened doors to individual tailoring of medical management, and created a series of ethical and economic considerations...
June 2017: Pain and Therapy
https://www.readbyqxmd.com/read/28383311/musculoskeletal-pain-profile-of-obese-individuals-attending-a-multidisciplinary-weight-management-service
#19
Grace A MacLellan, Colin Dunlevy, Emer OʼMalley, Catherine Blake, Cathy Breen, Karen Gaynor, Natalie Wallace, Ruth Yoder, Domhnall Casey, John Mehegan, Donal OʼShea, Brona M Fullen
Obesity is associated with numerous chronic diseases, including musculoskeletal (MSK) pain, which affects on quality of life (QoL). There is, however, limited research providing a comprehensive MSK pain profile of an obese cohort. This retrospective study used a patient database at a national weight management service. After ethical approval, anonymized patient data were statistically analyzed to develop a pain profile, investigate relationships between pain, sleep, and function, and explore variables associated with having low back pain (LBP) and knee pain...
July 2017: Pain
https://www.readbyqxmd.com/read/28351829/innovations-in-the-management-of-musculoskeletal-pain-with-alpha-lipoic-acid-impala-trial-study-protocol-for-a-double-blind-randomized-placebo-controlled-crossover-trial-of-alpha-lipoic-acid-for-the-treatment-of-fibromyalgia-pain
#20
Ian Gilron, Dongsheng Tu, Ronald Holden, Tanveer Towheed, Dan Ziegler, Louie Wang, Roumen Milev, Christopher Gray
BACKGROUND: Fibromyalgia is a common disorder characterized by chronic widespread pain, sleep disturbance, fatigue, depression, and cognitive dysfunction, resulting in substantial disability. As current analgesics provide incomplete relief and disabling side effects that aggravate fatigue and cognitive dysfunction, there is a need for new pain treatments with better efficacy and tolerability. Alpha-lipoic acid (ALA) is an antioxidant proven effective in painful diabetic neuropathy with minimal side effects...
March 28, 2017: JMIR Research Protocols
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