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

Transcutaneous electrical nerve stimulation (TENS) is a treatment option for cancer pain, but the evidence is inconclusive. We aimed to evaluate the efficacy and safety of TENS. A blinded, randomized, sham-controlled pilot cross-over trial (NCT02655289) was conducted on an inpatient specialist palliative care ward. We included adult inpatients with cancer pain ≥ 3 on an 11-point numerical rating scale (NRS). Intensity-modulated high TENS (IMT) was compared with placebo TENS (PBT). Patients used both modes according to their preferred application scheme during 24 h with a 24-h washout phase. The primary outcome was change in average pain intensity on the NRS during the preceding 24 h. Responders were patients with at least a “slight improvement.” Of 632 patients screened, 25 were randomized (sequence IMT-PBT = 13 and PBT-IMT = 12). Finally, 11 patients in IMT-PBT and 9 in PBT-IMT completed the study (N = 20). The primary outcome did not differ between groups (IMT minus PBT: − 0.2, 95% confidence interval − 0.9 to 0.6). However, responder rates were higher in IMT (17/20 [85%] vs. 10/20 [50%], p = 0.0428). Two patients experienced an uncomfortable feeling caused by the current, one after IMT and one after PBT. Seven patients (35%) desired a TENS prescription. Women and patients with incident pain were most likely to benefit from TENS. TENS was safe, but IMT was unlikely to offer more analgesic effects than PBT. Even though many patients desired a TENS prescription, 50% still reported at least “slight pain relief” from PBT. Differences for gender and incident pain aspects demand future trials.

/pdf/transcutaneous-electrical-nerve-stimulation-for-advanced-3vhjxu0l1z.pdf

Transcutaneous electrical nerve stimulation for advanced cancer pain inpatients in specialist palliative care—a blinded, randomized, sham-controlled pilot cross-over trial

Developing palliative care services in the community (which is sometimes now called Primary Palliative Care) is important to reach and serve the whole population, and to provide care where many people wish.1 Such services can moreover provide supportive care in primary care from diagnosis of a life-threatening illness (as recommended by the World Health Organisation), and to people with non-malignant conditions and older persons who have comparable concerns to and in some cases even greater and more prolonged unmet needs than people with cancer.2,3 Primary care clinicians have the potential to provide end-of-life care for most patients, given adequate training and support from specialist palliative care services.4 Primary care professionals share common values with palliative care specialists – holistic, patient centred care, delivered in the context of families and friends – and are thus well placed to provide palliative and supportive care to all in need from an early stage. The increased emergence and reliance on the hospice movement, especially for example in urban Australia, has possibly disempowered some primary care providers and led to a belief that only specialist palliative care can provide ‘proper palliative care’. Although it is acknowledged that some patients do require the expertise that specialist palliative care can and does provide, it must be remembered and acknowledged that the vast majority of palliative care is carried out within primary care multidisciplinary teams, who are also very well placed to provide support to those families that require it after the death of the patient. Some important initiatives are gaining momentum internationally within primary care, such as the Gold Standards Framework in the United Kingdom,5 case conferencing in Australia,6 and in the United States evolving models of chronic care delivery and reimbursement can facilitate the delivery of primary palliative services.7 However, the academic base to guide palliative care delivery in the community is underdeveloped. There is thus an urgent need for rigorous research to guide clinical services and to ensure that primary palliative care remains on the political and research agenda.

https://journals.sagepub.com/doi/pdf/10.1177/0269216308093578

Editorial: Palliative care research in the community: it is time to progress this emerging field:

Clinical Question Is oxycodone associated with greater efficacy and fewer adverse events compared with alternative analgesics for cancer pain? Bottom Line Oxycodone was not associated with superior cancer pain relief or fewer adverse effects compared with other strong opioids, such as morphine or oxymorphone. However, the quality of the evidence was low.

/pdf/oxycodone-for-cancer-pain-in-adult-patients-2qu7nq6lxe.pdf

Oxycodone for Cancer Pain in Adult Patients

Gabapentin significantly improves analgesia in people receiving opioids for neuropathic cancer pain

Patient access to medicines at home during the last year of life is critical for symptom control, but is thought to be problematic. Little is known about healthcare professionals’ practices in supporting timely medicines access and what influences their effectiveness. The purpose of the study was to evaluate health professionals’ medicines access practices, perceived effectiveness and influencing factors. On-line questionnaire survey of health care professionals (General Practitioners, Community Pharmacists, community-based Clinical Nurse Specialists and Community Nurses) delivering end-of-life care in primary and community care settings in England. Quantitative data were analysed using descriptive statistics. One thousand three hundred twenty-seven responses were received. All health professional groups are engaged in supporting access to prescriptions, using a number of different methods. GPs remain a predominant route for patients to access new prescriptions in working hours. However, nurses and, increasingly, primary care-based pharmacists are also actively contributing. However, only 42% (160) of Clinical Nurse Specialists and 27% (27) of Community Nurses were trained as prescribers. The majority (58% 142) of prescribing nurses and pharmacists did not have access to an electronic prescribing system. Satisfaction with access to shared patient records to facilitate medicines access was low: 39% (507) were either Not At All or only Slightly satisfied. Out-of-hours specialist cover was reported by less than half (49%; 656) and many General Practitioners and pharmacists lacked confidence advising about out-of-hours services. Respondents perceived there would be a significant improvement in pain control if access to medicines was greater. Those with shared records access reported significantly lower pain estimates for their caseload patients. Action is required to support a greater number of nurses and pharmacists to prescribe end-of-life medicines. Solutions are also required to enable shared access to patient records across health professional groups. Coverage and awareness of out-of-hours services to access medicines needs to be improved.

/pdf/supporting-patient-access-to-medicines-in-community-3vo9jjelke.pdf

Supporting patient access to medicines in community palliative care: on-line survey of health professionals’ practice, perceived effectiveness and influencing factors

Michael I. Bennett

Papers

Transcutaneous electrical nerve stimulation for advanced cancer pain inpatients in specialist palliative care—a blinded, randomized, sham-controlled pilot cross-over trial

Editorial: Palliative care research in the community: it is time to progress this emerging field:

Oxycodone for Cancer Pain in Adult Patients

Gabapentin significantly improves analgesia in people receiving opioids for neuropathic cancer pain

Supporting patient access to medicines in community palliative care: on-line survey of health professionals’ practice, perceived effectiveness and influencing factors