scholarly journals Assessment tools for problematic opioid use in palliative care: A scoping review

2021 ◽  
pp. 026921632110155
Author(s):  
Jenny Lau ◽  
Paolo Mazzotta ◽  
Rouhi Fazelzad ◽  
Suzanne Ryan ◽  
Alissa Tedesco ◽  
...  
Keyword(s):  
Palliative Care ◽  
Scoping Review ◽  
Short Form ◽  
Grey Literature ◽  
Assessment Tools ◽  
Bibliographic Databases ◽  
Opioid Use ◽  
Urine Drug ◽  
Urine Drug Test ◽  
End Stage

Background: Screening for problematic opioid use is increasingly recommended in patients receiving palliative care. Aim: To identify tools used to assess for the presence or risk of problematic opioid use in palliative care. Design: Scoping review. Data sources: Bibliographic databases (inception to January 31, 2020), reference lists, and grey literature were searched to find primary studies reporting on adults receiving palliative care and prescription opioids to manage symptoms from advanced cancer, neurodegenerative diseases, or end-stage organ diseases; and included tools to assess for problematic opioid use. There were no restrictions based on study design, location, or language. Results: We identified 42 observational studies (total 14,431 participants) published between 2009 and 2020 that used questionnaires ( n = 32) and urine drug tests ( n = 21) to assess for problematic opioid use in palliative care, primarily in US ( n = 38) and outpatient palliative care settings ( n = 36). The questionnaires were Cut down, Annoyed, Guilty, and Eye-opener (CAGE, n = 8), CAGE-Adapted to Include Drugs (CAGE-AID, n = 6), Opioid Risk Tool ( n = 9), Screener and Opioid Assessment for Patients with Pain (SOAPP; n = 3), SOAPP-Revised ( n = 2), and SOAPP-Short Form ( n = 5). Only two studies’ primary objectives were to evaluate a questionnaire’s psychometric properties in patients receiving palliative care. There was wide variation in how urine drug tests were incorporated into palliative care; frequency of abnormal urine drug test results ranged from 8.6% to 70%. Conclusion: Given the dearth of studies using tools developed or validated specifically for patients receiving palliative care, further research is needed to inform clinical practice and policy regarding problematic opioid use in palliative care.

scholarly journals The roles, responsibilities and practices of healthcare assistants in out-of-hours community palliative care: A systematic scoping review

2020 ◽  
Vol 34 (8) ◽  
pp. 976-988
Author(s):  
Anne Fee ◽  
Deborah Muldrew ◽  
Paul Slater ◽  
Sheila Payne ◽  
Sonja McIlfatrick ◽  
...  
Keyword(s):  
Palliative Care ◽  
Scoping Review ◽  
Grey Literature ◽  
Bibliographic Databases ◽  
Future Research ◽  
Emotional Needs ◽  
Out Of Hours ◽  
Scoping Reviews ◽  
Role Responsibilities ◽  
Meta Analyses

Background: Access to community palliative care ‘out-of-hours’ – defined as care provided after the normal hours of work – is advocated globally. Healthcare assistants, who provide care under the direction of a qualified professional, are increasingly employed to help deliver such care, yet there is a little understanding regarding their role, responsibilities or contribution. Aim: The aim of this study was to identify the roles, responsibilities and contributions of healthcare assistants in out-of-hours community palliative care. Design: Scoping review Data sources: Five bibliographic databases (CINAHL, MEDLINE, EMBASE, PsycINFO and Scopus) and grey literature were searched using a predefined search strategy. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews statement. Results: The search yielded six papers using quantitative, qualitative and mixed methods. Results highlighted a lack of recognition of the role and contribution of healthcare assistants. A concurrent theme was that healthcare assistants continually monitored and responded to patient’s and family’s physical and emotional needs; there was also self-reported evidence indicating patient and family benefit, such as maintaining a sense of normality and support to remain at home. Discussion: This review highlighted a dearth of evidence relating to the healthcare assistant role in out-of-hours palliative care. Limited evidence suggests they play a role, but that it is hidden and undervalued. Such invisibility will have a significant impact on the planning and delivery of out-of-hours palliative care. Future research is needed on role development for the benefit of patients and caregivers.

Tapentadol is the least common opioid found in admission urine drug-test results at an intensive outpatient opioid-use disorder treatment program in Ohio: A brief report

2021 ◽  
Vol 17 (1) ◽  
pp. 13-17
Author(s):  
Adam Rzetelny, PhD ◽  
Diana Meske, PhD ◽  
Parag Patel, MD, FACOG, FASAM ◽  
Steven Passik, PhD
Keyword(s):  
Treatment Program ◽  
Opioid Use Disorder ◽  
Common Finding ◽  
Prescription Opioid ◽  
Test Results ◽  
Opioid Use ◽  
Drug Test ◽  
Urine Drug ◽  
Urine Drug Test ◽  
Dispensing Data

Background: Previous data suggest that tapentadol, an atypical opioid with a putative dual mechanism of action, has relatively low rates of abuse. A better understanding of the rates of abuse among different prescription opioids may help clinicians when considering their potential risks and benefits. The results of urine drug tests (UDTs) may provide a unique opportunity to help answer this question.Method: To investigate different rates of prescription-opioid abuse in this retrospective study, we examined urine drug test results from patients seeking treatment at four facilities of an opioid-use-disorder (OUD) treatment program in Ohio. Urine specimens were collected on admission, one from each patient, in the regular course of care. The opioids reviewed in the present study were tapentadol, hydrocodone, oxycodone, hydromorphone, oxymorphone, and tramadol. Drug dispensing data, including morphine-milligram equivalents (MME) dispensed, were examined to adjust for the relative prevalence of each opioid being examined.Results: Data from 4,162 patients were examined. Tapentadol was the least common finding in UDT results in this cohort and remained so after adjusting for drug availability. The percentage of specimens positive for a given opioid ranged from 0.12 percent (tapentadol) to 7.04 percent (oxycodone). The availability and MME adjustments resulted in a change of rank order, with tapentadol remaining the lowest but tramadol replacing oxycodone as the prescription opioid with the highest rate of abuse.Conclusions: In this sample of UDT results from patients seeking treatment at an OUD program in Ohio, tapentadol was the least frequent finding among the opioids examined, and this remained true when adjusting for dispensing data. Factors potentially contributing to this difference may include pharmacological properties unique to tapentadol. Several important limitations notwithstanding, these findings are consistent with previous real-world evidence and warrant an ongoing line of inquiry. 

Reduced urinary opioid levels from pain management patients associated with marijuana use

2019 ◽  
Vol 9 (5) ◽  
pp. 441-447
Author(s):  
Melissa M Goggin ◽  
Breane J Shahriar ◽  
Andy Stead ◽  
Gregory C Janis
Keyword(s):  
Pain Management ◽  
Drug Testing ◽  
Marijuana Use ◽  
Potential Interaction ◽  
Test Results ◽  
Opioid Use ◽  
Target Drug ◽  
Urine Drug ◽  
Urine Drug Test ◽  
Lower Urinary

Aim: Marijuana use has been postulated to modulate opioid use, dependence and withdrawal. Broad target drug testing results provide a unique perspective to identify any potential interaction between marijuana use and opioid use. Materials & methods: Using a dataset of approximately 800,000 urine drug test results collected from pain management patients of a time from of multiple years, creatinine corrected opioid levels were evaluated to determine if the presence of the primary marijuana marker 11-nor-carboxy-tetrahydrocannabinol (THC-COOH) was associated with statistical differences in excreted opioid concentrations. Results & conclusion: For each of the opioids investigated (codeine, morphine, hydrocodone, hydromorphone, oxycodone, oxymorphone, fentanyl and buprenorphine), marijuana use was associated with statistically significant lower urinary opiate levels than in samples without indicators of marijuana use.

scholarly journals Quality of patient, family, caregiver and public engagement in decision-making in healthcare systems: a scoping review protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e032788
Author(s):  
Clayon Hamilton ◽  
M Elizabeth Snow ◽  
Nancy Clark ◽  
Shannon Gibson ◽  
Maryam Dehnadi ◽  
...  
Keyword(s):  
Decision Making ◽  
Scoping Review ◽  
Family Caregiver ◽  
Research Question ◽  
Grey Literature ◽  
Healthcare Systems ◽  
Evaluation Framework ◽  
Bibliographic Databases ◽  
Scientific Article

IntroductionTo advance person- and family-centred healthcare, government initiatives have supported the engagement of patients and family caregivers in decision-making in healthcare systems. There is, however, no consensus on how to define success for such initiatives. This scoping review aims to identify the key elements for defining the quality of patient and family caregiver engagement in decision-making across the engagement domains (individual, community/organisation, system) of British Columbia’s healthcare system. We will use those elements to develop a conceptual evaluation framework.Methods and analysisThis scoping review follows Arskey and O’Malley’s methodology. (1) The research question was identified through team discussions. (2) Articles for data source will be identified using a librarian-informed search strategy for seven bibliographic databases as well as grey literature sources. (3) Selected articles will be relevant to the evaluation of patient and family caregiver engagement in healthcare systems. (4) Two researchers will independently extract data into predefined and emerging categories. (5) The researchers will reconcile and organise the identified elements. The research team’s collective perspective will then refine the elements, and select, interpret and summarise the results. (6) Persons from key stakeholder groups will be consulted to refine the emergent conceptual framework.Ethics and disseminationWe will seek ethics approval for the stakeholder consultation. This study follows an integrated knowledge translation approach. The results will inform evaluation of the Patients as Partners Initiative of the British Columbia Ministry of Health, and will be disseminated as a scientific article, a research brief, and presentations at conferences and stakeholder meetings.

scholarly journals Substance use disorders among African, Caribbean and Black (ACB) people in Canada: a scoping review protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e028985
Author(s):  
Joseph D Nguemo ◽  
Ngozi Iroanyah ◽  
Winston Husbands ◽  
LaRon E Nelson ◽  
Geoffrey Maina ◽  
...  
Keyword(s):  
Substance Use ◽  
Substance Use Disorders ◽  
Scoping Review ◽  
Meta Analysis ◽  
Grey Literature ◽  
Bibliographic Databases ◽  
Scoping Reviews ◽  
African Caribbean ◽  
Scientific Meetings ◽  
English Articles

IntroductionPrevious research demonstrated that substance use continues to be one of the most complex and prevalent problems among African, Caribbean and Black (ACB) people. A number of studies were conducted to characterise substance use patterns in this population. To our knowledge, this is the first known review in Canada characterising substance use disorders on ACB people.This scoping review seeks to answer the following research questions: What characterises substance use disorders among ACB people in Canada? What are the different types and prevalence of substance use among ACB people in Canada? Do ACB people in Canada use more than one substance? What factors are associated with substance use among ACB people in Canada? What are the health and social impacts of substance use in ACB people in Canada?Methods and analysesThis study will use the methodological framework for scoping reviews developed by Arksey and O’Malley. We will search electronic bibliographic databases including Ovid MEDLINE, PsycINFO and CINAHL. We will limit our search to English articles published between 2000and2019. In addition, we will conduct a grey literature search. Two investigators will independently screen citations and full-text articles. Our findings will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis for scoping reviews guidelines. We will provide a descriptive summary of the studies and summarise the findings with respect to the outcomes and report any gaps that might require further investigation.Ethics and disseminationOur proposed study does not involve human participants; therefore, research ethics approval is not required. This study will provide evidence that will inform the development of strategies for appropriate interventions, as well as policy and further research. The results will be disseminated through publications in open access peer-reviewed journals, presentations at scientific meetings and to the lay public.

Assessment tools for palliative care.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 66-66
Author(s):  
Sarina Isenberg ◽  
Rebecca Aslakson ◽  
Sydney Morss Dy ◽  
Renee Wilson ◽  
Julie Waldfogel ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Clinical Practice ◽  
Quality Indicators ◽  
Systematic Reviews ◽  
Grey Literature ◽  
Care Quality ◽  
Assessment Tools ◽  
Patient Reported

66 Background: Recent reviews have not comprehensively addressed palliative care (PC) assessment tools. This project summarizes the extent of evidence about PC assessment tools for patients and families, and how tools have been used for clinical care, quality indicators, and evaluation of interventions. Methods: We searched MEDLINE, CINAHL, and Cochrane Database of Systematic Reviews for systematic reviews of assessment tools for PC, from January 2007 to March 2016. We searched the grey literature for domains without systematic reviews, and for domains with systematic reviews > three years old. Paired investigators independently screened search results and grey literature to determine eligibility, and assessed risk of bias of systematic reviews. The team selected the most recent and highest-quality systematic reviews for each domain. One investigator abstracted information, and a second investigator checked the information. Results: Using the National Consensus Project Palliative Care Guidelines domains, we included nine systematic reviews with 167 tools, and six tools from grey literature. Most tools were in physical, psychological, psychiatric, and social aspects of care, care at the end of life, and tools that cross domains (quality of life and caregiver-reported experience). Only two tools directly addressed spiritual aspects and none addressed cultural or patient-reported experience. Internal consistency reliability was evaluated for almost all tools; most reported construct validity; and few reported responsiveness (sensitivity to change). Few studies evaluated the use of assessment tools in quality indicators or clinical practice. A systematic review of 38 PC interventions and the assessment tools used found that at least 25 interventions included physical, psychosocial and psychiatric, and quality of life tools, but the tools varied extensively, and only nine included patient experience tools. Conclusions: Although assessment tools exist in many PC domains, tools are needed to assess spiritual and cultural aspects of care, and patient-reported experience. Research is needed concerning: tools in clinical practice and quality of care; comparison of existing tools; and evaluation and dissemination tools with evidence of responsiveness.

scholarly journals Use of telehealth in the provision of after-hours palliative care services in rural and remote Australia: A scoping review protocol

PLoS ONE ◽  
2022 ◽  
Vol 17 (1) ◽  
pp. e0261962
Author(s):  
Pathmavathy Namasivayam ◽  
Dung T. Bui ◽  
Christine Low ◽  
Tony Barnett ◽  
Heather Bridgman ◽  
...  
Keyword(s):  
Palliative Care ◽  
Systematic Reviews ◽  
Scoping Review ◽  
Grey Literature ◽  
Rural And Remote ◽  
Remote Communities ◽  
Care Services ◽  
Scoping Reviews ◽  
Palliative Care Services ◽  
After Hours

Introduction After-hours services are essential in ensuring patients with life limiting illness and their caregivers are supported to enable continuity of care. Telehealth is a valuable approach to meeting after-hours support needs of people living with life-limiting illness, their families, and caregivers in rural and remote communities. It is important to explore the provision of after-hours palliative care services using telehealth to understand the reach of these services in rural and remote Australia. A preliminary search of databases failed to reveal any scoping or systematic reviews of telehealth in after-hours palliative care services in rural or remote Australia. Aim To review and map the available evidence about the use of telehealth in providing after-hours palliative care services in Australian rural and remote communities. Methods The proposed scoping review will be conducted using the Arksey and O’Malley methodological framework and in accordance with the Joanna Briggs Institute methodology for scoping reviews. The reporting of the scoping review will be guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). This review will consider research and evaluation of after-hours services using telehealth for palliative care stakeholders in rural and remote Australia. Peer reviewed studies and grey literature published in English from 2000 to May 2021 will be included. Scopus, Web of Science, CINAHL Complete, Embase via Ovid, PsycINFO via Ovid, Emcare via Ovid, Medline via Ovid, and grey literature will be searched for relevant articles. Titles and abstracts will be screened by two independent reviewers for assessment against the inclusion criteria. Data will be extracted and analysed by two reviewers using an adapted data extraction tool and thematic analysis techniques. Diagrams, tables, and summary narratives will be used to map, summarise and thematically group the characteristics of palliative care telehealth services in rural and remote Australia, including stakeholders’ perceptions and benefits and challenges of the services.

scholarly journals Use of behavioural activation to manage pain: a scoping review protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e041036
Author(s):  
Sandra Walsh ◽  
Martin Jones ◽  
Richard John Gray ◽  
Marianne Gillam ◽  
Kate M Gunn ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Scoping Review ◽  
Data Extraction ◽  
Grey Literature ◽  
Empirical Support ◽  
Bibliographic Databases ◽  
Behavioural Activation ◽  
Clinician Training ◽  
Psychological Therapies ◽  
Clinical Trial Registries

IntroductionChronic pain is a distressing condition and often poorly treated and managed. Psychological therapies are considered first-line intervention for people with chronic pain. Common psychological therapies require extensive clinician training and specialist qualifications. One approach that does not need lengthy training nor specialist qualification, but has empirical support in other health domains, is behavioural activation (BA). BA seeks to increase engagement in behaviours that are valued by the person and progress through behaviours that can increase mood and develop skills that build satisfying routines. BA can help people to manage their condition through scheduling behaviours, promoting routine and mastery over their condition. The extent to which BA has been used to support people living with chronic pain is not clear.Methods and analysisThis scoping review aims to identify published studies describing the application of BA to support people living with chronic pain. To map the evidence regarding BA and chronic pain, including the study type and the associated evidence, a scoping review was adopted. The search will be conducted in bibliographic databases, clinical trial registries and grey literature. No date limits will be applied to the search strategy. Screening of titles and abstracts, and full-text screening, will be independently undertaken by two investigators using Covidence software. Any disagreement between investigators will be resolved by a third investigator. Data from included publications will be extracted using a customised data extraction tool.Ethics and disseminationThe scoping review is an analysis of existing data and therefore ethics approval is not required. The findings of this scoping review will further our understanding of how BA has been used to support people living with chronic pain and inform future training and education programmes in this area.

scholarly journals Meta-analysis of interventions to reduce door to needle times in acute ischaemic stroke patients

2020 ◽  
Vol 9 (3) ◽  
pp. e000915
Author(s):  
Michael Siarkowski ◽  
Katie Lin ◽  
Shari S Li ◽  
Abdulaziz Al Sultan ◽  
Heather Ganshorn ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Meta Analysis ◽  
Grey Literature ◽  
Assessment Tools ◽  
Bibliographic Databases ◽  
Standard Mean Difference ◽  
Reduction Strategies ◽  
Randomised Control Trials ◽  
Health Quality

BackgroundDoor-to-needle time (DTN) has an important impact on thrombolysis and reperfusion outcomes in the treatment of acute ischaemic stroke. This systematic review is a critical synthesis of studies evaluating DTN reduction strategies.MethodOvid MEDLINE, PubMed, Cochrane Database of Systematic Reviews, CINAHL, ProQuest dissertations and LILACS were used as bibliographic databases for primary literature. CIHI, Health Quality Council of Alberta, Health Quality Ontario and websites of heart and stroke associations in Canada, USA, UK, Australia and New Zealand were used as sources of grey literature. Searched reports were screened by title and abstract, and full texts were located for review. Articles quality was evaluated using National Institute of Health’s Study Quality Assessment tools. Methods for improving DTN were categorised under 13 DTN reduction strategies, primarily adapted from the Target: Stroke Phase II recommendations, and including two additional categories: Strategies not encompassed by any Target: Stroke recommendation, and Combinations of Interventions.Results96 studies (4 randomised control trials, 1 review, 91 observational pre/post studies) were included in the review. All strategies and interventions resulted in a reduction of DTN. Approaches using combinations of interventions were the most effective at reducing DTN (33.77% DTN reduction, standard mean difference=1.857, 95% CI=1.510–2.205), and were more effective than approaches using only a single strategy (p=0.040). DTN reduction was associated with the duration of the DTN reduction programme at each facility (p=0.006).InterpretationThe greatest reductions in DTN were observed when implementing combinations of DTN reduction strategies, although there was no significant advantage to implementing more than two strategies simultaneously.PROSPERO registration number42016036215.

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