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

Objectives

Uncontrolled pain in advanced cancer is a common problem and has significant impact on individuals’ quality of life and use of healthcare resources. Interventions to help manage pain at the end of life are available, but there is limited economic evidence to support their wider implementation. We conducted a case study economic evaluation of two pain self-management interventions (PainCheck and Tackling Cancer Pain Toolkit [TCPT]) compared with usual care.



Methods

We generated a decision-analytic model to facilitate the evaluation. This modelled the survival of individuals at the end of life as they moved through pain severity categories. Intervention effectiveness was based on published meta-analyses results. The evaluation was conducted from the perspective of the U.K. health service provider and reported cost per quality-adjusted life-year (QALY).



Results

PainCheck and TCPT were cheaper (respective incremental costs -GBP148 [-EUR168.53] and -GBP474 [-EUR539.74]) and more effective (respective incremental QALYs of 0.010 and 0.013) than usual care. There was a 65 percent and 99.5 percent chance of cost-effectiveness for PainCheck and TCPT, respectively. Results were relatively robust to sensitivity analyses. The most important driver of cost-effectiveness was level of pain reduction (intervention effectiveness). Although cost savings were modest per patient, these were considerable when accounting for the number of potential intervention beneficiaries.



Conclusions

Educational and monitoring/feedback interventions have the potential to be cost-effective. Economic evaluations based on estimates of effectiveness from published meta-analyses and using a decision modeling approach can support commissioning decisions and implementation of pain management strategies.

/pdf/cost-effectiveness-of-pain-management-strategies-in-advanced-2r0pff68x7.pdf

Cost-Effectiveness of Pain Management Strategies in Advanced Cancer.

Dear Editor:

Chronic pain is a significant problem ⇓ that is often poorly managed ⇓. Electronic tools could be used to facilitate routine collection of various patient reported symptoms including pain ⇓. Data collected electronically has the potential to improve supportive care ⇓ and influence treatment management decisions ⇓.

Traditionally electronic pain monitoring has been collected using personal computers (PCs) or laptops. With advances in technology, other methods of collecting this data have become more common ⇓. A limitation of existing pain monitoring tools is that assessments are designed to be completed using only one electronic device or mode of data collection. A literature search identified no studies exploring the capabilities of a single system that could be used on multiple devices interchangeably.

We evaluated an early prototype of a pain reporting system that could be completed using various modes of technology interchangeably. The study aimed to determine feasibility of collecting pain data using a system accessed through different modes of technology, to explore …

/pdf/the-feasibility-of-collecting-patient-reported-pain-data-1iklhfmcim.pdf

The Feasibility of Collecting Patient Reported Pain Data Using a System Delivered Across Four Modes of Technology

Earlier this year, a working party representing theAssociation for Palliative Medicine (APM) and The PainSociety produced a position statement setting out theviews of both societies in relation to the use of drugsbeyond their product licence in clinical practice. Theworking party included clinical, managerial, legal, andpatient representatives. The position statement is animportant first step in clarifying the legal position andrecognizing ± and dealing with ± the potential risks thatthis practice poses to all involved. The statement isintended to make clear that this practice is necessaryand legal, but at the same time stresses that effortsshould be made to reduce any risks associated with thispractice.The Medicines Control Agency in the UK grants alicence (or marketing authorization) for a product forwhich therapeutic claims are made. The purpose of thelicence is to regulate the activity of the pharmaceuticalcompany when marketing the drug. The licence does notrestrict the prescription of the drug by properly qualifiedmedical practitioners. Licensed drugs can be usedlegally in clinical situations that fall outside the remitof the licence (referred to as `off-label’), e.g., a differentage group, a different indication, a different dose, orroute, or method of administration. Use of unlicenseddrugs refers to those products that have no licence forany clinical situation or may be in the process ofevaluation leading to such a licence.Off-label prescribing is common in palliative care, butuse of unlicensed drugs is rare. A recent audit found thataround a third of prescriptions affecting around 66% ofpatients in one specialist palliative care unit was off-label.

The use of drugs beyond licence in palliative care and pain management.

The Principles of Pain Management

Reason for withdrawal from publication


This protocol is out of date and did not progress to full review stage within the expected timeframe. A new protocol is currently being prepared by a new team of authors. To view the published versions of this article, please click the 'Other versions' tab.

Michael I. Bennett

Papers

Cost-Effectiveness of Pain Management Strategies in Advanced Cancer.

The Feasibility of Collecting Patient Reported Pain Data Using a System Delivered Across Four Modes of Technology

The use of drugs beyond licence in palliative care and pain management.

The Principles of Pain Management

Transcutaneous electrical nerve stimulation (TENS) for neuropathic pain in adults