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Biomedical subjects

C Miaskowski

Publications and source records attributed to C Miaskowski.

At least 19 recordsLinked to original sources
PubMed2001

Lack of adherence with the analgesic regimen: a significant barrier to effective cancer pain management.

PURPOSE: To evaluate oncology outpatients' level of adherence to their analgesic regimen during a 5-week period. PATIENTS AND METHODS: A random sample of 65 adult oncology outpatients with a Karnofsky performance status score of >or= 50, an average pain intensity score of >or= 2.5, and radiographic evidence of bone metastasis were recruited for this longitudinal study from seven outpatient settings. On a daily basis, patients rated their level of pain intensity and recorded pain medication intake. Adherence rates for opioid analgesics prescribed on an around-the-clock (ATC) and on an as-needed (PRN) basis were calculated on a weekly basis. RESULTS: Overall adherence rates for ATC opioid analgesics ranged from 84.5% to 90.8% and, for PRN analgesics, from 22.2% to 26.6%. No significant differences over time were found in either of these adherence rates. CONCLUSION: One factor that seems to contribute to ineffective cancer pain management is poor adherence to the analgesic regimen.

Analgesics↗
PubMed2001

A comparison of the affective state and quality of life of chemotherapy patients who do and do not develop chemotherapy-induced oral mucositis.

The purpose of this longitudinal study was to compare the quality of life and affective state of patients receiving chemotherapy who developed oral mucositis to patients who did not. Outpatients had their mouths assessed at the beginning of their chemotherapy, completed the Multidimensional Quality of Life scale, Cancer version (MQOLS-CA) and the Profile of Mood States (POMS). Patients again completed the MQOLS-CA and POMS if they developed mucositis during their three cycles (monthly), or if they did not and were exiting the study. Seventy-seven outpatients completed the study; 28 patients developed mucositis and 49 did not. The MQOLS-CA total scores for the entire sample decreased significantly over time (F(1,75) = 25.44, P < 0.001), but there was no group by time interaction, i.e., the change in MQOLS-CA total scores did not depend on mucositis status. While the POMS Total Mood Disturbance scores for the entire sample increased significantly over time (F(1,75) = 19.55, P < 0.001), there was a significant group by time interaction (F(1,75)= 4.85, P = 0.03). Patients who developed mucositis had a significant increase in mood disturbance compared to patients who did not. Further, the POMS subscales of depression and anger showed the same pattern of significant increases. In conclusion, the development of mucositis adversely affected the outpatients' affective states, but not their QOL.

Adult↗
PubMed2001

Advancing the science of symptom management.

UNLABELLED: Since the publication of the original Symptom Management Model (Larson et al. 1994), faculty and students at the University of California, San Francisco (UCSF) School of Nursing Centre for System Management have tested this model in research studies and expanded the model through collegial discussions and seminars. AIM: In this paper, we describe the evidence-based revised conceptual model, the three dimensions of the model, and the areas where further research is needed. BACKGROUND/RATIONALE: The experience of symptoms, minor to severe, prompts millions of patients to visit their healthcare providers each year. Symptoms not only create distress, but also disrupt social functioning. The management of symptoms and their resulting outcomes often become the responsibility of the patient and his or her family members. Healthcare providers have difficulty developing symptom management strategies that can be applied across acute and home-care settings because few models of symptom management have been tested empirically. To date, the majority of research on symptoms was directed toward studying a single symptom, such as pain or fatigue, or toward evaluating associated symptoms, such as depression and sleep disturbance. While this approach has advanced our understanding of some symptoms, we offer a generic symptom management model to provide direction for selecting clinical interventions, informing research, and bridging an array of symptoms associated with a variety of diseases and conditions. Finally, a broadly-based symptom management model allows the integration of science from other fields.

Holistic Nursing↗
PubMed2001

New approaches for evaluating the quality of cancer pain management in the outpatient setting.

Both retrospective and prospective methods can be used to evaluate the quality of cancer pain management in the outpatient setting. Retrospective evaluations of the quality of cancer pain management in the outpatient setting provide benchmark data that can be used to change clinical practice for groups of patients or for specific types of cancer pain problems. Prospective evaluations of the quality of cancer pain management with patient diaries in the outpatient/home care setting can help clinicians do "real-time" evaluations and modify the pain management plan for individual patients. This report provides practical suggestions for evaluating the quality of cancer pain management in the outpatient setting.

Ambulatory Care↗
PubMed2001

Definition of and mechanism for opioid-induced sedation.

Although sedation is acknowledged to be one of the most common side effects of opioid analgesics, the mechanisms and characteristics of this phenomenon remain elusive, and research in this area is extremely limited. This report integrates research findings on the mechanism of action of opioids with research findings on the phenomenon of consciousness to develop a model of how opioids may act in the central nervous system to produce sedation. Based on this integration, a definition of opioid-induced sedation is proposed to encourage dialogue and research on this perplexing and clinically significant phenomenon.

Analgesics, Opioid↗
PubMed2001

Measurement of opioid-induced sedation.

One of the major side effects of opioid analgesics is sedation. Despite the fact that neither a universal definition nor a gold standard for the measurement of opioid-induced sedation exists, various neurophysiologic and psychomotor measures are used to quantify the sedative effects of opioids. This report reviews the strengths and weaknesses of various approaches that are used to measure opioid-induced sedation. The first section summarizes various neurophysiologic measures (i.e., electroencephalogram, autonomic reflexes, and evoked responses), and the second section reviews psychomotor measures (i.e., visual analog scales, observer assessments, motor performance tests, tests of perceptual processes, tests of information processing, tests of memory, and composite tests) that are used to evaluate the sedative effects of opioids. Implications for future research on opioid-induced sedation are discussed.

Analgesics, Opioid↗
PubMed2001

Biology of mucosal pain.

Pain is experienced when injury to mucosal tissues occurs. Although the neurobiology of mucosal pain has not been fully elucidated, research has demonstrated that the oral mucosa contains primary afferent nociceptors that respond to thermal, mechanical, and chemical stimuli. Inflammation occurs during the initial phase of mucosal injury caused by stomatotoxic chemotherapy or radiation therapy. This article reviews the mechanisms that underlie acute pain in inflamed cutaneous tissue and summarizes the major mediators that activate and sensitize primary afferent nociceptors. Recommendations for future research to elucidate the neurobiology of mucosal pain throughout the gastrointestinal tract are presented.

Animals↗
PubMed2001

Symptom clusters and their effect on the functional status of patients with cancer.

PURPOSE/OBJECTIVES: To determine the effect of the symptom cluster of pain, fatigue, and sleep insufficiency on functional status during three cycles of chemotherapy. DESIGN: Prospective, longitudinal. SETTING: 23 outpatient offices and clinics. SAMPLE: 93 patients with cancer. The typical participant was female (72%), married/partnered (65%), white (87%), and middle-aged (55.4 years), with an average of 14.8 years of education. METHODS: The Quality of Life-Cancer (QOL-CA) version instrument and the Karnofsky Performance Scale (KPS) were completed by 93 outpatients receiving chemotherapy at baseline (Time 1) and at the end of the third cycle (Time 2). Three items (pain, tires easily, sleeps enough to meet needs) from the QOL-CA questionnaire were used to measure the symptom cluster. MAIN RESEARCH VARIABLES: Symptom cluster, outcome, functional status, chemotherapy. FINDINGS: A hierarchical multiple regression model explained 48.4% of the variance in functional status. The KPS at Time 1 explained 30.8% of the variance in KPS at Time 2 (p < 0.001). After KPS at Time 1 was partialled out from KPS at Time 2, the four independent variables entered in the next step were considered predictors of the change in functional status between Time 1 and Time 2. Age explained 11.8% of the change (p = 0.001), pain explained 10.7% of the change (p = 0.002), and fatigue explained 7.3% of the change (p = 0.011). Sleep insufficiency statistically was not significant, only explaining 1% of the change (p = 0.344). CONCLUSION: This study provides beginning insights into the effect of a symptom cluster on patients' functional status. IMPLICATIONS FOR NURSING PRACTICE: Healthcare professionals need to be aware of the presence of symptom clusters and their possible synergistic adverse effect on patients' future morbidity.

Antineoplastic Agents↗
PubMed2001

Monitoring and improving pain management practices. A quality improvement approach.

The development of a multidisciplinary pain management committee is a critical step in monitoring and improving pain management practices. The systematic evaluation of the quality of pain management using the principles of QI establishes a process that can lead to improvements in the care that patients receive. Clinicians need to develop a 1- to 2-year plan to improve the quality of pain management. Changes in clinicians' behaviors occur slowly; thus, members of pain management committees should not become discouraged but continue to move forward one step at a time.

Guidelines as Topic↗
PubMed2000

The symptom experience of angina in women.

Angina is the symptom of myocardial ischemia and the most common presentation of women with coronary artery disease. Women have delayed responses to angina and postpone seeking care more than men. Myocardial ischemia is life threatening and timeliness of treatment is critical. Understanding the symptom experience is important to patients and health care providers alike to reduce morbidity and mortality rates. This article reviews current knowledge of the symptom experience to identify gaps in knowledge and provide a basis for future research and interventions. The symptom experience component of the Symptom Management Model is used as an organizing framework. In terms of chest pain perception, biopsychosocially oriented studies are inconsistent. Data suggest that women use different pain descriptors than men and that diabetes, somatic awareness, and hormonal status probably play a role in attenuating or altering anginal pain. In evaluating symptoms, findings suggest that if anginal symptoms were experienced as expected and/or were evaluated as cardiac in origin, response was more appropriate. Even when it is known that the symptoms are related to cardiac disease, women's responses are still delayed because of a need to self-treat to maintain control. If a patient recognizes symptoms to be cardiac in origin, an appropriate evaluation of the urgency of the situation was made more often, and a rapid response was more likely. Therefore, the larger problem may be the accurate perception of the symptom and the recognition that the symptom is cardiac in origin. This article has implications for future research dealing with improved responses.

Angina Pectoris↗
PubMed2000

The impact of age on a patient's perception of pain and ways it can be managed.

The elderly population is one of the fastest growing groups in the United States. Pain is a significant problem for community-dwelling elders and for elderly persons in residential facilities. Numerous barriers exist to effective pain management in the elderly. Clinicians, however, can overcome many of these barriers through careful assessments of pain that accommodate many of the physiologic changes that occur with aging. Effective pain management of elderly individuals requires knowledge of the pharmacokinetic and pharmacodynamic changes that occur with aging. Both pharmacologic and nonpharmacologic approaches should be used to manage pain in the elderly.

Age Factors↗
PubMed2000

The PRO-SELF Program: a self-care intervention program for patients receiving cancer treatment.

OBJECTIVES: To describe the development, testing, and refinement of the PRO-SELF Program as used in randomized clinical trials. DATA SOURCES: Research studies and articles. CONCLUSIONS: The PRO-SELF Program has made an important contribution in enhancing patients' self-care and reducing morbidity. It has the potential to contribute to self-care abilities of children and adolescents who have cancer. IMPLICATIONS FOR NURSING PRACTICE: It is imperative that patients and their families have the essential information, skills, and support to carry out effective self-care symptom management.

Adolescent↗