Prospective Cohort Study

Lincoln, Yvonna, and Egon Guba, "Postpositivism and the Naturalist Paradigm," pp. 14-46 in Yvonna Lincoln and Egon Guba, Naturalistic Inquiry . Beverly Hills, CA: Sage, 1985.*

Secret History: Return of the Black Death Channel 4, 7-8pm In 1348 the Black Death swept through London, killing people within days of the appearance of their first symptoms. Exactly how many died, and why, has long been a mystery. This Secret History documentary follows experts as they pick through the evidence and reveal why the plague killed on such a scale. And they ask, what might be coming next?

Medscape

1. Introduction and Overview. 2. Detecting Influential Observations and Outliers. 3. Detecting and Assessing Collinearity. 4. Applications and Remedies. 5. Research Issues and Directions for Extensions. Bibliography. Author Index. Subject Index.

Regression Diagnostics: Identifying Influential Data and Sources of Collinearity

https://www.commed.vcu.edu/Chronic_Disease/2012/cochranrvwrschbias.pdf

The Cochrane Collaboration's tool for assessing risk of bias in randomised trials

Goals of work Older patients experience a higher prevalence of pain, including cancer pain, than other age groups and tend to receive poorer pain management. The reasons for unnecessary suffering resulting from pain among older patients are not well understood. This study aimed to identify barriers to cancer pain management for older patients living at home and to compare these with a younger control group. Patients and methods Patients newly referred to community-based palliative care services were interviewed about their pain and related issues. Data included pain impact (BPI), mood (HAD), health (EuroQol), and barriers to reporting of pain and analgesic use (Barriers Questionnaire). Main results Fifty-eight patients aged 75 or over and 32 people aged 60 or under were interviewed. Both groups reported that beliefs about the use of analgesics was the greatest barrier to effective pain management. Older patients reported that beliefs about the use of analgesics and communicating with medical staff were significantly more important barriers to pain management than for younger patients. Overall, factors such as communication with medical staff and fatalism were ranked lower than barriers related to medication. Younger patients reported significantly greater sleep disturbance due to pain and greater anxiety. Conclusions Older age appears to influence attitudes towards pain and analgesia. Factors such as poorer knowledge about taking analgesia, reluctance to communicate with medical staff, poorer performance status, and being more likely to live alone suggest that older patients may require greater support in the management of their cancer pain than younger patients. Targeted interventions are needed to test this proposition.

Cancer pain management at home (II): does age influence attitudes towards pain and analgesia?

https://www.jpsmjournal.com/article/S0885-3924(07)00331-4/pdf

Managing the Symptoms of Neuropathic Pain: An Exploration of Patients' Experiences

Ten patients with primary fibromyalgia syndrome were treated with intravenous infusions of lignocaine on a daily basis for six days. This treatment produced a clinically useful improvement in pain relief and mood scores at the time of discharge on day seven and at follow-up on day thirty.

Intravenous lignocaine in the management of primary fibromyalgia syndrome.

Pain is common in advanced cancer but also in the late stages of other incurable non-malignant diseases, such as heart failure and neurological conditions.1 2 Almost half of patients with advanced cancer are undertreated for their pain, largely because clinicians are reluctant to use strong opioids for effective analgesia.3 4 Strong opioids such as morphine are indicated for moderate to severe pain and should be prescribed only after a full assessment of the analgesic needs of the patient.

This article summarises the most recent recommendations from the National Institute for Health and Clinical Excellence (NICE) on the care of people with advanced and progressive disease who require strong opioids for pain control.5 These patients are defined as those in moderate to severe pain who may never have used strong opioids, or those whose pain has been inadequately controlled by weak opioids such as codeine or tramadol. The guideline does not cover all aspects of pain management (including second line approaches) or pain control during the last days of life (for example, for patients who are being managed by the Liverpool care pathway, a care pathway that integrates the best aspects of care for dying patients that can be used in any clinical setting).

NICE recommendations are based on systematic reviews of the best available evidence. When minimal evidence is available, recommendations are based on the Guideline Development Group’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets.

### Communication and provision of information

When offering strong opioids as pain treatment to a patient with advanced and progressive disease:

https://www.bmj.com/content/bmj/344/bmj.e2806.full.pdf

Prescribing strong opioids for pain in adult palliative care: summary of NICE guidance.

https://www.jpsmjournal.com/article/S0885-3924(11)00067-4/pdf

Michael I. Bennett

Papers

Cancer pain management at home (II): does age influence attitudes towards pain and analgesia?

Managing the Symptoms of Neuropathic Pain: An Exploration of Patients' Experiences

Intravenous lignocaine in the management of primary fibromyalgia syndrome.

Prescribing strong opioids for pain in adult palliative care: summary of NICE guidance.

What influences patients' decisions on artificial hydration at the end of life? A Q-methodology study.