Marymount University Hospital & Hospice
http://hdl.handle.net/10147/338477
2024-03-29T01:27:43Z
2024-03-29T01:27:43Z
Standards for the management of cancer-related pain across Europe-A position paper from the EFIC Task Force on Cancer Pain.
Bennett, Michael I
Eisenberg, Elon
Ahmedzai, Sam H
Bhaskar, Arun
O'Brien, Tony
Mercadante, Sebastiano
Krčevski Škvarč, Nevenka
Vissers, Kris
Wirz, Stefan
Wells, Chris
Morlion, Bart
http://hdl.handle.net/10147/627164
2020-02-11T02:03:38Z
2019-01-06T00:00:00Z
Standards for the management of cancer-related pain across Europe-A position paper from the EFIC Task Force on Cancer Pain.
Bennett, Michael I; Eisenberg, Elon; Ahmedzai, Sam H; Bhaskar, Arun; O'Brien, Tony; Mercadante, Sebastiano; Krčevski Škvarč, Nevenka; Vissers, Kris; Wirz, Stefan; Wells, Chris; Morlion, Bart
Background and objective: Pain is a common symptom in patients who survive cancer and in those who live with progressive advanced disease. Evidence from meta-analyses suggests that pain remains poorly controlled for a large proportion of patients; barriers to good management include poor assessment of pain, inadequate support for patient self-management and late or inadequate access to strong opioid analgesia in those with advanced disease.
Methods: The European Pain Federation (EFIC) established a Task Force in 2017 which convened a European group of experts, drawn from a diverse range of relevant clinical disciplines, to prepare a position paper on appropriate standards for the management of cancer-related pain. The expert panel reviewed the available literature and made recommendations using the GRADE system to combine quality of evidence with strength of recommendation. The panel took into account the desirable and undesirable effects of the management recommendation, including the cost and inconvenience of each when deciding the recommendation.
Results and conclusions: The 10 standards presented are aimed to improve cancer pain management and reduce variation in practice across Europe. The Task Force believes that adoption of these standards by all 37 countries will promote the quality of care of patients with cancer-related pain and reduce unnecessary suffering.
Significance: Pain affects up to 40% of cancer survivors and affects at least 66% of patients with advanced progressive disease, many of whom experience poor pain control. These 10 standards are aimed to improve cancer pain management, promote the quality of care of patients and reduce variation across Europe.
2019-01-06T00:00:00Z
European Pain Federation position paper on appropriate opioid use in chronic pain management.
O'Brien, T
Christrup, L L
Drewes, A M
Fallon, M T
Kress, H G
McQuay, H J
Mikus, G
Morlion, B J
Perez-Cajaraville, J
Pogatzki-Zahn, E
Varrassi, G
Wells, J C D
http://hdl.handle.net/10147/624814
2019-08-30T12:02:58Z
2017-01-01T00:00:00Z
European Pain Federation position paper on appropriate opioid use in chronic pain management.
O'Brien, T; Christrup, L L; Drewes, A M; Fallon, M T; Kress, H G; McQuay, H J; Mikus, G; Morlion, B J; Perez-Cajaraville, J; Pogatzki-Zahn, E; Varrassi, G; Wells, J C D
Poorly controlled pain is a global public health issue. The personal, familial and societal costs are immeasurable. Only a minority of European patients have access to a comprehensive specialist pain clinic. More commonly the responsibility for chronic pain management and initiating opioid therapy rests with the primary care physician and other non-specialist opioid prescribers. There is much confusing and conflicting information available to non-specialist prescribers regarding opioid therapy and a great deal of unjustified fear is generated. Opioid therapy should only be initiated by competent clinicians as part of a multi-faceted treatment programme in circumstances where more simple measures have failed. Throughout, all patients must be kept under close clinical surveillance. As with any other medical therapy, if the treatment fails to yield the desired results and/or the patient is additionally burdened by an unacceptable level of adverse effects, the overall management strategy must be reviewed and revised. No responsible clinician will wish to pursue a failed treatment strategy or persist with an ineffective and burdensome treatment. In a considered attempt to empower and inform non-specialist opioid prescribers, EFIC convened a European group of experts, drawn from a diverse range of basic science and relevant clinical disciplines, to prepare a position paper on appropriate opioid use in chronic pain. The expert panel reviewed the available literature and harnessed the experience of many years of clinical practice to produce these series of recommendations. Its success will be judged on the extent to which it contributes to an improved pain management experience for chronic pain patients across Europe.
SIGNIFICANCE:
This position paper provides expert recommendations for primary care physicians and other non- specialist healthcare professionals in Europe, particularly those who do not have ready access to specialists in pain medicine, on the safe and appropriate use of opioid medications as part of a multi-faceted approach to pain management, in properly selected and supervised patients.
2017-01-01T00:00:00Z
Residents' perceptions of relocating from one long-term setting to another.
Murphy, Lynda
McCarthy, Geraldine
Cornally, Nicola
http://hdl.handle.net/10147/348561
2019-08-30T12:53:50Z
2013-02-01T00:00:00Z
Residents' perceptions of relocating from one long-term setting to another.
Murphy, Lynda; McCarthy, Geraldine; Cornally, Nicola
To investigate older people's perceptions of a planned relocation from one long-term care facility in an older building to another modern setting almost 10km away.; A qualitative descriptive design was used. Semi-structured interviews were conducted with eight residents. Manifest content analysis was used to analyse the data.; Three major themes were identified: information required, desirability and continuity. Emerging subthemes were also described and these included aspects of knowing and relationship issues.; By understanding residents' perspectives a more person-centred approach can be taken to reduce the negative impact of the transition from one care setting to another.
BACKGROUND: To investigate older people's perceptions of a planned relocation from one long-term care facility in an older building to another modern setting almost 10km away.
METHOD:
A qualitative descriptive design was used. Semi-structured interviews were conducted with eight residents. Manifest content analysis was used to analyse the data.
FINDINGS:
Three major themes were identified: information required, desirability and continuity. Emerging subthemes were also described and these included aspects of knowing and relationship issues.
CONCLUSION:
By understanding residents' perspectives a more person-centred approach can be taken to reduce the negative impact of the transition from one care setting to another.
2013-02-01T00:00:00Z
Cancer pain and opioid use--a global issue.
O'Brien, Tony
http://hdl.handle.net/10147/348548
2019-08-30T12:39:51Z
2013-07-01T00:00:00Z
Cancer pain and opioid use--a global issue.
O'Brien, Tony
2013-07-01T00:00:00Z
Place of care: from referral to specialist palliative care until death.
O'Leary, Mary Jane
O'Brien, Alison C
Murphy, Marie
Crowley, Claire M
Leahy, Helen M
McCarthy, Jill M
Collins, Joan C
O'Brien, Tony
http://hdl.handle.net/10147/348560
2019-08-30T12:53:50Z
2014-12-08T00:00:00Z
Place of care: from referral to specialist palliative care until death.
O'Leary, Mary Jane; O'Brien, Alison C; Murphy, Marie; Crowley, Claire M; Leahy, Helen M; McCarthy, Jill M; Collins, Joan C; O'Brien, Tony
While there are many poorly standardised studies focusing on place of death, there are limited data on place(s) of care during the final stages of disease.; This study aims to identify where patients are cared for in the interval from referral to specialist palliative care until death.; All patients who died while under the care of a specialist palliative care service over a 6-month period were considered.; Of the 507 patients included, 255 (50.3%) were men and 428 (84.4%) had a malignant diagnosis. The mean referral-to-death interval was 70 days (SD 113, Range 1-838). The majority (n=281, 55.4%) received care in a single care setting-hospital (28.4%), home (21.5%), nursing home/community hospital (4.1%), hospice (1.4%)-and had a shorter mean referral-to-death interval. Most patients with more than one care setting spent three-quarters of their time in their normal place of residence. A total of 199 (39.3%) died in hospital, 131 (25.8%) in hospice, 131 (25.8%) at home (25.8%) and 46 (9.1%) in a nursing home/community hospital. Patients referred by a general practitioner (n=80 patients, 15.8%) were more likely to be cared for at home (p<0.001), and die at home (p<0.001).; A significant number of patients received specialist palliative care across multiple care settings. Late referral is associated with a single domain of care. General practitioner involvement supports patient care and death at home. Place of care and ease of transfer between care settings may be better indicators of the quality of care we provide.
Background: While there are many poorly standardised studies focusing on place of death, there are limited data on place(s) of care during the final stages of disease.
AIM:
This study aims to identify where patients are cared for in the interval from referral to specialist palliative care until death.
METHODS:
All patients who died while under the care of a specialist palliative care service over a 6-month period were considered.
RESULTS:
Of the 507 patients included, 255 (50.3%) were men and 428 (84.4%) had a malignant diagnosis. The mean referral-to-death interval was 70 days (SD 113, Range 1-838). The majority (n=281, 55.4%) received care in a single care setting-hospital (28.4%), home (21.5%), nursing home/community hospital (4.1%), hospice (1.4%)-and had a shorter mean referral-to-death interval. Most patients with more than one care setting spent three-quarters of their time in their normal place of residence. A total of 199 (39.3%) died in hospital, 131 (25.8%) in hospice, 131 (25.8%) at home (25.8%) and 46 (9.1%) in a nursing home/community hospital. Patients referred by a general practitioner (n=80 patients, 15.8%) were more likely to be cared for at home (p<0.001), and die at home (p<0.001).
CONCLUSIONS:
A significant number of patients received specialist palliative care across multiple care settings. Late referral is associated with a single domain of care. General practitioner involvement supports patient care and death at home. Place of care and ease of transfer between care settings may be better indicators of the quality of care we provide.
Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
2014-12-08T00:00:00Z
The Attractiveness of Opposites: Agonists and Antagonists.
O'Brien, Tony
http://hdl.handle.net/10147/348559
2019-08-30T12:38:52Z
2015-02-02T00:00:00Z
The Attractiveness of Opposites: Agonists and Antagonists.
O'Brien, Tony
ABSTRACT Opioid-induced bowel dysfunction, of which constipation is the most common aspect, is a major limiting factor in the use of opioids for pain management. The availability of an oral, long-acting formulation of oxycodone and naloxone represents a highly significant development in pain management. The combination of an opioid analgesic with an opioid antagonist offers reliable pain control with a significant reduction in the burden of opioid-induced constipation. This report is adapted from paineurope 2014; Issue 3, ©Haymarket Medical Publications Ltd, and is presented with permission. paineurope is provided as a service to pain management by Mundipharma International, LTD and is distributed free of charge to healthcare professionals in Europe. Archival issues can be accessed via the website: http://www.paineurope.com at which European health professionals can register online to receive copies of the quarterly publication.
Opioid-induced bowel dysfunction, of which constipation is the most common aspect, is a major limiting factor in the use of opioids for pain management. The availability of an oral, long-acting formulation of oxycodone and naloxone represents a highly significant development in pain management. The combination of an opioid analgesic with an opioid antagonist offers reliable pain control with a significant reduction in the burden of opioid-induced constipation. This report is adapted from paineurope 2014; Issue 3, ©Haymarket Medical Publications Ltd, and is presented with permission. paineurope is provided as a service to pain management by Mundipharma International, LTD and is distributed free of charge to healthcare professionals in Europe. Archival issues can be accessed via the website: http://www.paineurope.com at which European health professionals can register online to receive copies of the quarterly publication.
2015-02-02T00:00:00Z
Information transfer to out-of-hours co-operatives: a survey of general practitioners' views in relation to palliative patients.
Kiely, Fiona
Murphy, Marie
O'Brien, Tony
http://hdl.handle.net/10147/348547
2019-08-30T12:53:50Z
2013-12-01T00:00:00Z
Information transfer to out-of-hours co-operatives: a survey of general practitioners' views in relation to palliative patients.
Kiely, Fiona; Murphy, Marie; O'Brien, Tony
In Ireland, weekend and night medical cover for community based patients is largely provided by general practice co-operatives. Doctors working in this service do not have direct access to patients' medical records which challenges continuity of care.; This study investigates the opinion of general practitioners (GPs) on the potential value of a formalised method of information transfer regarding their palliative patients to out-of-hours GP co-operatives. The survey was designed to identify the information that is necessary to offer appropriate anticipated end-of-life care.; A questionnaire was sent to all 414 GPs registered in the Irish Medical Directory in the southwest of Ireland. Data were analysed with Microsoft Excel and SPSS V.12.0.; 52% response rate with exclusion of incomplete questionnaires allowed analysis of 212 data sets. Currently, 82% of GPs do not routinely transfer information pertaining to end-of-life issues to the out-of-hours service. Despite this, 96% would value a standardised way of transferring information. 67% felt they sometimes refer unnecessarily to hospital emergency departments due to lack of information. The most important items of information identified by study participants are as follows: ▸ Diagnosis (97%) ▸ Medications (94%) ▸ Patient insight (91%) ▸ Patient wishes regarding end-of-life care (90%) ▸ Anticipated problems and suggested management(90%).; A structured format for information transfer regarding end-of-life care is deemed important by GPs when working on-call at night and weekends. Diagnosis, patient preference and management plans are valued.
BACKGROUND: In Ireland, weekend and night medical cover for community based patients is largely provided by general practice co-operatives. Doctors working in this service do not have direct access to patients' medical records which challenges continuity of care.
OBJECTIVES:
This study investigates the opinion of general practitioners (GPs) on the potential value of a formalised method of information transfer regarding their palliative patients to out-of-hours GP co-operatives. The survey was designed to identify the information that is necessary to offer appropriate anticipated end-of-life care.
METHODS:
A questionnaire was sent to all 414 GPs registered in the Irish Medical Directory in the southwest of Ireland. Data were analysed with Microsoft Excel and SPSS V.12.0.
RESULTS:
52% response rate with exclusion of incomplete questionnaires allowed analysis of 212 data sets. Currently, 82% of GPs do not routinely transfer information pertaining to end-of-life issues to the out-of-hours service. Despite this, 96% would value a standardised way of transferring information. 67% felt they sometimes refer unnecessarily to hospital emergency departments due to lack of information. The most important items of information identified by study participants are as follows: ▸ Diagnosis (97%) ▸ Medications (94%) ▸ Patient insight (91%) ▸ Patient wishes regarding end-of-life care (90%) ▸ Anticipated problems and suggested management(90%).
CONCLUSIONS:
A structured format for information transfer regarding end-of-life care is deemed important by GPs when working on-call at night and weekends. Diagnosis, patient preference and management plans are valued
2013-12-01T00:00:00Z
The landscape of blogging in palliative care.
Lowney, A C
O'Brien, T
http://hdl.handle.net/10147/264498
2019-08-30T12:38:52Z
2012-09-01T00:00:00Z
The landscape of blogging in palliative care.
Lowney, A C; O'Brien, T
We present the case of a 30-year-old patient with pontine glioblastoma multiforme, World Health Organisation grade IV (WHO IV). This case is of particular interest in terms of the patient's use of social media as a medium of expression. This popular form of communication raises important clinical, ethical and social issues relating to confidentiality and the nature of the physician-patient relationship in a unique context.
2012-09-01T00:00:00Z
Neuropathic pain management in children.
Hyde, Catherine
Price, Jayne
Nicholl, Honor
http://hdl.handle.net/10147/264376
2019-08-30T12:57:47Z
2012-10-01T00:00:00Z
Neuropathic pain management in children.
Hyde, Catherine; Price, Jayne; Nicholl, Honor
There are difficulties in assessing, managing, and evaluating neuropathic pain in dying children, particularly those with neurological impairment. Neuropathic pain in children often presents differently to how it presents in the adult population. Comprehensive assessment as well as pharmacological and non-pharmacological interventions are crucial to its successful management and frequently require input from an interdisciplinary team. Notwithstanding the need for further research, this paper brings together research papers, reviews, and clinical guidelines to present an exploration of existing evidence regarding care for children with neuropathic pain and their families.
2012-10-01T00:00:00Z
Person-centred care in nursing documentation.
Broderick, Margaret C
Coffey, Alice
http://hdl.handle.net/10147/264354
2019-08-30T12:38:52Z
2012-12-07T00:00:00Z
Person-centred care in nursing documentation.
Broderick, Margaret C; Coffey, Alice
BACKGROUND: Documentation is an essential part of nursing. It provides evidence that care has been carried out and contains important information to enhance the quality and continuity of care. Person-centred care (PCC) is an approach to care that is underpinned by mutual respect and the development of a therapeutic relationship between the patient and nurse. It is a core principle in standards for residential care settings for older people and is beneficial for both patients and staff (International Practice Development in Nursing and Healthcare, Chichester, Blackwell, 2008 and The Implementation of a Model of Person-Centred Practice in Older Person Settings, Dublin, Health Service Executive, 2010a). However, the literature suggests a lack of person-centredness within nursing documentation (International Journal of Older People Nursing 2, 2007, 263 and The Implementation of a Model of Person-Centred Practice in Older Person Settings, Dublin, Health Service Executive, 2010a). AIMS AND OBJECTIVES: To explore nursing documentation in long-term care, to determine whether it reflected a person-centred approach to care and to describe aspects of PCC as they appeared in nursing records. METHOD: A qualitative descriptive study using the PCN framework (Person-centred Nursing; Theory and Practice, Oxford, Wiley-Blackwell, 2010) as the context through which nursing assessments and care plans were explored. RESULTS: Findings indicated that many nursing records were incomplete, and information regarding psychosocial aspects of care was infrequent. There was evidence that nurses engaged with residents and worked with their beliefs and values. However, nursing documentation was not completed in consultation with the patient, and there was little to suggest that patients were involved in decisions relating to their care. IMPLICATIONS FOR PRACTICE: The structure of nursing documentation can be a major obstacle to the recording of PCC and appropriate care planning. Documentation that is focused on the 'person' will contribute to a more meaningful relationship between nurses and residents.
2012-12-07T00:00:00Z