Biomedical subjects
Karen Forbes
Publications and source records attributed to Karen Forbes.
Pain assessment tools: is the content appropriate for use in palliative care?
Inadequate pain assessment prevents optimal treatment in palliative care. The content of pain assessment tools might limit their usefulness for proper pain assessment, but data on the content validity of the tools are scarce. The objective of this study was to examine the content of the existing pain assessment tools, and to evaluate the appropriateness of different dimensions and items for pain assessment in palliative care. A systematic search was performed to find pain assessment tools for patients with advanced cancer who were receiving palliative care. An ad hoc search with broader search criteria supplemented the systematic search. The items of the identified tools were allocated to appropriate dimensions. This was reviewed by an international panel of experts, who also evaluated the relevance of the different dimensions for pain assessment in palliative care. The systematic literature search generated 16 assessment tools while the ad hoc search generated 64. Ten pain dimensions containing 1,011 pain items were identified by the experts. The experts ranked intensity, temporal pattern, treatment and exacerbating/relieving factors, location, and interference with health-related quality of life as the most important dimensions. None of the assessment tools covered these dimensions satisfactorily. Most items were related to interference (231) and intensity (138). Temporal pattern (which includes breakthrough pain), ranked as the second most important dimension, was covered by 29 items only. Many tools include dimensions and items of limited relevance for patients with advanced cancer. This might reduce compliance and threaten the validity of the assessment. New tools should reflect the clinical relevance of different dimensions and be user-friendly.
Clarifying the data on double effect.
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Opioids: beliefs and myths.
Commonly held beliefs and myths about opioids within Europe are described. These include sedation, cognitive impairment, addiction, pseudoaddiction, tolerance, efficacy, cancer pain, and end-of-life care. Key learning points for refuting untrue beliefs are presented.
Re: Use of strong opioids in advanced cancer pain.
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If it doesn't work, stop it: don't just stand there, hold my hand.
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The euthanasia debate and a new position paper from a Task Force of the EAPC: a helpful reappraisal or a retreat into obfuscation?
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The experiences of donor families in the hospice.
OBJECTIVES: This study explored the experiences, attitudes and feelings of relatives who consented to donation of corneas of a loved one who had died of cancer. DESIGN: Semi-structured interviews were conducted by a single researcher and qualitatively analysed for systematic identification of themes. SETTING AND PARTICIPANTS: Two specialist palliative care units in Southern England participated. The names of donor families were obtained via transplant coordinators, the local eye bank and hospice records. Ten donor families were interviewed, four to 12 months after their relative's death. RESULTS: The majority of interviewees had thought the deceased was ineligible for donation due to cancer or old age. Approaches regarding donation were generally made by nurses and described as sensitive by relatives. Very few family members would otherwise have considered or raised the subject. Almost all were glad they had agreed to donation although few felt it directly affected their bereavement. A range of motivations for consent was encountered but decisions were very much easier if the deceased's wishes were already known. Most favoured an opt-out system or the right of the family to decide if the deceased's wishes were not known. CONCLUSIONS: Corneal donation is possible for patients dying from cancer. This study indicates that it is generally regarded positively by donor family members. Education of the public and health professionals is necessary to highlight both the eligibility criteria and the need for donation. Families should be encouraged to discuss donation to facilitate respecting individuals' wishes. In the absence of a known decision from the deceased, health professionals should be aware of their responsibility to discuss the issue with the family.
Morbidity on youth expeditions to developing countries.
OBJECTIVE: To document the frequency of illness and injury on youth expeditions and to compare this information with published data concerning other travelers. METHODS: During July and August 1996, 945 young people aged 15 to 20 years traveled to the developing world with a single expedition company, World Challenge Expeditions Ltd. All groups were supervised by adult leaders. Leaders recorded all episodes of illness or injury occurring on the expedition on medical cards. We report a retrospective analysis of these medical cards. RESULTS: There were no deaths or emergency repatriations for the entire group of 65 expeditions. A complete set of medical cards was received from 47 of 65 expeditions (72%). Data were available for 644 individuals (309 male and 335 female). Local medical advice was sought on 17 occasions (1% of all episodes); 2 expeditioners required admission to a hospital. Four hundred eighty individuals (75%) experienced 1646 recorded health problems during their expedition. The most common problems were headache (18% of individuals), diarrhea (33%), nausea and/or vomiting (20%), and respiratory tract symptoms (14%). CONCLUSIONS: This study suggests supervised travel to the developing world is safe for young people. The incidence of gastrointestinal and respiratory symptoms was similar to that in travelers of other age groups, and trauma or serious injury was much less common in this group than is reported in other travelers. Headache was more common than in older travelers and indicates that preexpedition briefing should focus on the assessment and potential significance of this symptom in the younger age group, particularly at high altitude (above 2500 m).