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Biomedical subjects

B R Ferrell

Publications and source records attributed to B R Ferrell.

At least 73 records · Page 4Linked to original sources
PubMed1994

Cancer pain guidelines: now that we have them, what do we do?

Addressing the what, who, when, where, and how of implementing the AHCPR guidelines is an attempt to simplify what may be an overwhelming process. Use the suggestions presented in Figure 1 to formulate an action plan, and remember to assign a time frame and individual accountability. The commitment to moving the guidelines from the bookshelf to the bedside begins now. Using a process such as this will assist efforts to improve care of patients in pain. It is our hope that a year from now the copy of the AHCPR cancer pain guidelines on your shelf will not be covered with dust but rather will be a well-worn text translated to practice.

Clinical Protocols↗
PubMed1993

Development and implementation of a pain education program.

Pain is a significant problem for cancer patients and is of particular concern for the elderly. This article reports on the development and implementation of a pain management educational intervention for elderly cancer patients and their family caregivers. This patient education program was developed within a research study funded by the American Cancer Society. Subjects were stratified as either elderly (60-75 years) or oldest (greater than 75 years) and then were randomly assigned to an experimental group that received the three-part, structured pain education program or a control group that received usual care. Control group subjects were offered the intervention at the conclusion of data collection. The outcomes of the pain education were measured at two times after the intervention. Study variables included patient outcomes such as pain intensity, pain knowledge and attitudes, medication compliance, and quality of life as well as family caregiver outcomes. This pain education program was developed, implemented, and evaluated in 40 patients and family caregivers in the first year of a 2-year project. In this article, the investigators present the development and structure of the three-part education program, general principles of patient education regarding pain, methods of evaluating pain education, and initial results of the pain education. Pain education includes basic principles of pain relief, pharmacologic interventions, and nondrug interventions for relief of pain. This program has demonstrated that both cancer patients and their family caregivers benefit from a structured education program for relief of cancer pain.

Aged↗
PubMed1993

Circadian changes in cockroach ommatidial structure.

1. Morphological correlates of circadian changes in eye sensitivity to light measured electrophysiologically were sought in the cockroach, Leucophaea maderae. Cross sections of ommatidia removed at subjective midday and subjective midnight on 3 successive days from roaches held under constant darkness (DD) at 25 +/- 2 degrees C were examined using a transmission electron microscope for morphological differences related to sampling time. 2. The temporal difference in submicrovillar cisternae (SMC) area appeared to exhibit a circadian rhythm, however, the amplitude of this temporal difference measured under DD was less than that observed under LD 12:12 conditions. SMC areas characteristic at nighttime were achieved at subjective midnights but the area diminished only partially toward the daytime state on subjective middays. 3. Rhabdom area remained constant and the daily rhythm of screening pigment granules (SPG) arrangement about the rhabdom was not observed under conditions of constant darkness. 4. Results of this study indicate that a pacemaker(s) actively influences the change in the SMC toward the nighttime state, whereas, the change toward the daytime state results from a passive mechanism that possibly could be accelerated by light.

Animals↗
PubMed1993

The pain resource nurse training program: a unique approach to pain management.

Adequate pain management is a 24 hr a day responsibility for health-care professionals working with cancer patients. Because nurses spend more time with patients in pain than any other member of the health-care team, they play a central role in pain assessment and pain management. The City of Hope National Medical Center, a clinical cancer center, developed a pain management course for staff nurses entitled "The Pain Resource Nurse (PRN) Training Program." The purpose of this innovative course was to prepare staff nurses to assume an active role in pain management. Twenty-six registered nurses participated in the 40-hr didactic and clinical course. The curriculum included information on pain assessment, pharmacology, nondrug interventions, and cultural, ethical, and psychosocial issues related to pain. After completion of the course, program staff have remained available to the PRNs to provide current information on pain management, and to assist with role implementation and guidance on interfacing with staff. This paper reports on the development, implementation, and 3-mo evaluation of this unique program.

Education↗
PubMed1993

Extended follow-up in 212 long-term allogeneic bone marrow transplant survivors. Issues of quality of life.

A group of 235 allogeneic marrow recipients were contacted at least one year following their BMT to obtain information on their quality of life; 212 (90%) agreed to participate in this survey. A total of 162 adults and 50 pediatric survivors were interviewed during clinic visits (5%) or over the telephone (95%). Changes in productive activity and marital status at the time of interview were studied, as well as the presence of physical symptoms and perception of a general sense of well-being. Older transplant recipients were observed to have a significantly higher incidence of chronic graft-versus-host disease, common colds, and skin changes when compared with pediatric transplant recipients (P < 0.01). Older subjects were also more likely to require any type of regular medication. Younger survivors were rated with a higher Karnofsky performance status and global subjective score. There were no significant differences between patients who received TBI as part of the conditioning regimen and those who did not, with the exception of increased cataract development in pediatric patients receiving TBI (P < 0.008). We conclude that most allogeneic marrow transplant survivors, especially those individuals of younger age at the time of their transplants, are doing well in the domains tested.

Adolescent↗
PubMed1993

Pain management at home. Struggle, comfort, and mission.

This article presents findings from an exploratory, descriptive study that investigated the experiences of pain in the home from the perspective of the patient, the primary family caregiver, and the home care nurse. The following research questions are addressed: What are the special problems associated with pain management at home as identified by patients, caregivers, and nurses? What are the similarities and differences among patients, caregivers, and nurses regarding issues of managing pain at home? Qualitative techniques were used to collect and analyze data. The sample included 10 cancer patients with pain and their respective caregivers and nurses. After the in-depth interviews were transcribed, a multidisciplinary research team performed content analysis on the data. Overall, the findings suggest that patients approach pain management with a struggle for control, whereas self-denying caregivers seek to provide comfort, and nurses attempt to fulfill an urgent mission to eradicate pain.

Adult↗
PubMed1993

Managing cancer pain at home: the decisions and ethical conflicts of patients, family caregivers, and homecare nurses.

The purpose of this paper is to present findings from an exploratory, descriptive study that investigated the experience of managing pain in the home from the perspectives of the patient, the primary family caregiver, and the homecare nurse. In particular, the decisions and ethical conflicts encountered by members of 10 patient-caregiver-nurse triads were studied. Data were collected through in-depth semistructured interviews, and the transcribed interviews were content-analyzed by a multidisciplinary research team. Subjects reported that the use of medications prompted the majority of the decisions and provoked most of the conflicts; however, decisions related to assessment, the future, and how to live with pain were identified as well. Subjects also identified other areas that created conflict, such as spiritual/theological issues, when to tell the truth, and interpersonal relationships. Findings illustrate the importance of understanding the beliefs and values that influence individuals' decisions and conflicts, because discrepant perceptions of the pain experience among patients, caregivers, and nurses can interfere with satisfactory management of pain.

Adaptation, Psychological↗
PubMed1992

Pain and addiction: an urgent need for change in nursing education.

Lack of education of health care professionals, including nurses, is frequently cited as a major reason for undertreatment of patients with pain. A reason for undertreatment of pain with opioid analgesics is the irrational fear of creating opioid addiction. To characterize the information nurses receive in their basic education that could contribute to misinformation about this issue, the authors reviewed 14 nursing textbooks, published since 1985, including 8 pharmacology texts and 6 medical surgical texts. An analysis of content revealed that only one textbook correctly stated the definition of opioid addiction and its likelihood following use of opioid analgesics for pain control. Almost all of the texts used confusing terminology, and some erroneously promoted the fear of addiction when opioids are used for pain relief. A simple solution to this problem is to encourage nursing educators to use the American Pain Society publication "Guidelines for Analgesic Use" until textbooks have the opportunity to incorporate correct information.

Attitude of Health Personnel↗
PubMed1992

The role of patient-controlled analgesia in the management of cancer pain.

The technology of patient-controlled analgesia (PCA) has gained wide acceptance for use in cancer pain management. Assessment of technological innovations is necessary in order to evaluate the most appropriate use from the perspective of the individual patient and broader health policy perspective. This paper reviews the literature related to PCA use in chronic cancer pain, appropriate and inappropriate uses of PCA, as well as several professional issues and directions for future PCA use. Professional dialogue regarding the standard of PCA care is necessary for optimum use of this technology for relief of chronic pain.

Analgesia, Patient-Controlled↗
PubMed1992

Home care: maintaining quality of life for patient and family.

Cancer affects the family as well as the patient. The home is a primary site of care, which often must be intensive and complex. Attention to home care of the cancer patient is therefore a major concern in maintaining quality of life for both patient and family. The authors explore the major burdens of home care that affect both patient and family and describe four specific interventions that the health care team can initiate to optimize quality of life in these difficult situations.

Aged↗