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Biomedical subjects

R Payne

Publications and source records attributed to R Payne.

At least 37 records · Page 2Linked to original sources
PubMed2001

Current management of opioid-related side effects.

The optimal management of opioid-related side effects is hampered by a lack of comparative studies of management strategies. The prevalence of such side effects is influenced by the extent of disease, the patient's age, the presence of coexistent renal and hepatic disease, pulmonary disease, and cognitive dysfunction, a prior opioid history, use of polypharmacy, dose of opioid drug being administered, and the route of administration. The most common opioid-related side effects are constipation, sedation, nausea, vomiting, and cognitive disturbance. Less frequent side effects include urinary retention, perceptual distortion, respiratory depression, and myoclonus. In an era emphasizing quality of life in cancer care, clinicians need to be aware of (1) factors that influence the prevalence of opioid-related side effects, (2) effective management strategies, and (3) how to recognize when symptoms are opioid related as opposed to caused by other etiologies, such as the patient's disease process or treatment approaches. The use of validated instruments and repeated assessment enhances such an evaluation and subsequent treatment. This article delineates the current optimal management of opioid-related nausea and vomiting, constipation, cognitive side effects, myoclonus, and respiratory depression.

Analgesics, Opioid↗
PubMed2000

Outcome of cancer pain consultations.

BACKGROUND: All major cancer centers in the United States are equipped with pain management consultation services. We report on the outcome of such consultations within 24 hours from the intervention. METHODS: All consecutive patients referred to the pain management service of a tertiary care cancer center were assessed before and 14-24 hours after the intervention. RESULTS: A total of 45 patients completed the study. The mean current pain intensity score was 5.2 on the Visual Analogue Scale before the consultation and 2.7 after the consultation (P < 0.05). The pain was described as excruciating on the Categorical Scale by three patients before the consultation and by no patients after the consultation. CONCLUSIONS: In hospitalized cancer patients with difficult to control pain, cancer pain consultations result in a measurable effect within 24 hours of the pharmacologic intervention. To avoid unnecessary suffering, timeliness is of the utmost importance when requesting and delivering cancer pain consultations.

Adult↗
PubMed2000

Herpes zoster.

Explore the source record for details and available documents.

Acetates↗
PubMed2000

Minority cancer patients and their providers: pain management attitudes and practice.

BACKGROUND: The goals of the current studies were: 1) to determine the pain treatment needs of socioeconomically disadvantaged African-American and Hispanic patients with recurrent or metastatic cancer and 2) to assess the attitudes of health care professionals who treat them. METHODS: In the first study 108 African-American and Hispanic patients with metastatic or recurrent cancer and pain completed a survey about their pain intensity, pain interference, and attitudes toward analgesic medications. Physicians also rated their patients' pain and the adequacy of the patients' current analgesic prescriptions was assessed. In the second study 55 physicians and nurses who treat these patients completed a questionnaire regarding cancer pain and its management in their practice settings. RESULTS: Approximately 28% of the Hispanic and 31% of the African-American patients received analgesics of insufficient strength to manage their pain. Although the majority of patients received appropriate analgesics, 65% reported severe pain. Physicians underestimated pain severity for 64% of the Hispanic and 74% of the African-American patients. Physicians were more likely to underestimate the pain severity of female patients than male patients. Inadequate pain assessment, patient reluctance to report pain, and lack of staff time were perceived as barriers to pain management. CONCLUSIONS: Although the data suggest recent improvements in analgesic prescribing practices for African-American and Hispanic cancer patients, the majority of patients reported high levels of pain and limited pain relief from analgesic medications. Inadequate pain assessment remains a major barrier to optimal cancer pain treatment.

Adult↗
PubMed2000

Axial and total-body bone densitometry using a narrow-angle fan-beam.

We assessed a new dual-energy bone densitometer, the PRODIGY, that uses a narrow-angle fan-beam (4.5 degrees) oriented parallel to the longitudinal axis of the body (i.e., perpendicular to the usual orientation). High-resolution scans across the body can be stepped at 17 mm intervals. The energy-sensitive array detector uses cadmium zinc telluride, which allowed rapid photon counting. Spine and femur scans required 30 s, and total-body scans required 4-5 min; the dose was only 3.7 mrem and 0.04 mrem respectively, or about 5 to 10 times lower than conventional fan-beam densitometry. We found only a small influence of soft-tissue thickness on bone mineral density (BMD) results. There was also a small (+/- 1%) influence of height above the tabletop on BMD results. A software correction for object height allowed a first-order correction for the large magnification effects of position on bone mineral content (BMC) and area. Consequently, the results for BMC and area, as well as BMD, with PRODIGY corresponded closely to those obtained using the predecessor DPX densitometer, both in vitro and in vivo; there was a generally high correlation (r = 0.98-0.99) for BMD values. Spine and femur values for BMC, area and BMD averaged within 0.5% in vivo (n = 122), as did total-body BMC and BMD (n = 46). PRODIGY values for total-body lean tissue and fat also corresponded within 1% to DPX values. Regional and total-body BMD were measured with 0.5% precision in vitro and 1% precision in vivo. The new PRODIGY densitometer appears to combine the low dose and high accuracy of pencil-beam densitometry with the speed of fan-beam densitometers.

Absorptiometry, Photon↗
PubMed2000

Multidisciplinary care of the terminally ill patient.

This article discusses sedation, the assessment and management of physical symptoms, and symptom-assessment scales for the terminally ill patient. The evaluation of the ability of the family or community to care for a terminally ill patient in pain also is discussed.

Procedural Sedation↗
PubMed2000

Chronic pain: challenges in the assessment and management of cancer pain.

Assessing and managing pain while caring for the whole patient is a challenge for physicians. Barriers to pain management include clinician-, patient-, and health system-related issues. The traditional model of care is focused on disease-specific treatments. If these treatments fail, the focus shifts to palliation. A new model of care integrates disease-specific treatments with palliative care and rehabilitation. This model includes prevention and treatment of suffering. An essential element of this model is evaluation of the patient's concerns about the future and fear. Treating patient pain with quality pain management and palliative care involves a holistic pain assessment and management strategy.

Chronic Disease↗
PubMed2000

World-wide genetic differentiation of Eubalaena: questioning the number of right whale species.

Few studies have examined systematic relationships of right whales (Eubalaena spp.) since the original species descriptions, even though they are one of the most endangered large whales. Little morphological evidence exists to support the current species designations for Eubalaena glacialis in the northern hemisphere and E. australis in the southern hemisphere. Differences in migratory behaviour or antitropical distribution between right whales in each hemisphere are considered a barrier to gene flow and maintain the current species distinctions and geographical populations. However, these distinctions between populations have remained controversial and no study has included an analysis of all right whales from the three major ocean basins. To address issues of genetic differentiation and relationships among right whales, we have compiled a database of mitochondrial DNA control region sequences from right whales representing populations in all three ocean basins that consist of: western North Atlantic E. glacialis, multiple geographically distributed populations of E. australis and the first molecular analysis of historical and recent samples of E. glacialis from the western and eastern North Pacific Ocean. Diagnostic characters, as well as phylogenetic and phylogeographic analyses, support the possibility that three distinct maternal lineages exist in right whales, with North Pacific E. glacialis being more closely related to E. australis than to North Atlantic E. glacialis. Our genetic results provide unequivocal character support for the two usually recognized species and a third distinct genetic lineage in the North Pacific under the Phylogenetic Species Concept, as well as levels of genetic diversity among right whales world-wide.

Animals↗
PubMed2000

Sumatriptan for headache caused by head and neck cancer.

The use of sumatriptan for the treatment of migraine and cluster headache is well established. Sumatriptan has also been reported to be effective for the treatment of postdural puncture headache, postictal headache, and headache related to intravenous immunoglobulin infusion. We report two patients with headache caused by locally invasive head and neck cancer relieved by oral sumatriptan.

Adult↗
PubMed2000

Limitations of NSAIDs for pain management: toxicity or lack of efficacy?

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used in the management of arthritis and acute and chronic pain of many etiologies, including cancer-related pain. These drugs are indicated for use as single agents in mild to moderate pain and in combination with opioid analgesics or adjuvant analgesic drugs in severe pain. NSAIDs, which nonselectively inhibit the cyclooxygenase enzymes (isoenzymes 1 and 2), pose a potentially serious risk of gastrointestinal toxicity with acute and chronic use, hematologic toxicity with acute use, and nephrotoxicity with chronic use. Patients experiencing acute and chronic pain associated with serious and even life-threatening medical illness such as cancer and human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) fall into a high-risk group with respect to the use of NSAIDs. This is so because the occurrence of gastrointestinal bleeding and the masking of opportunistic infections related to the antipyretic effects of NSAIDs pose particular risk and might even cause lethal complications in patients who are neutropenic, thrombocytopenic, or otherwise immuno-compromised.

Journal Article↗
PubMed2000

Timing of Ca(2+) release from intracellular stores and the electrical response of Limulus ventral photoreceptors to dim flashes.

Light-induced release of Ca(2+) from stores in Limulus ventral photoreceptors was studied using confocal fluorescence microscopy and the Ca(2+) indicator dyes, Oregon green-5N and fluo-4. Fluorescence was collected from a spot within 4 microm of the microvillar membrane. A dual-flash protocol was used to reconstruct transient elevations of intracellular free calcium ion concentration (Ca(i)) after flashes delivering between 10 and 5 x 10(5) effective photons. Peak Ca(i) increased with flash intensity to 138 +/- 76 microM after flashes delivering approximately 10(4) effective photons, while the latent period of the elevation of Ca(i) fell from approximately 140 to 21 ms. The onset of the light-induced elevation of Ca(i) was always highly correlated with that of the receptor potential. The time for Ca(i) to exceed 2 microM was approximately equal to that for the receptor potential to exceed 8 mV (mean difference; 2.2 +/- 6.4 ms). Ca(i) was also measured during steps of light delivering approximately 10(5) effective photons/s to photoreceptors that had been bleached with hydroxylamine so as to reduce their quantum efficiency. Elevations of Ca(i) were detected at the earliest times of the electrical response to the steps of light, when a significant receptor potential had yet to develop. Successive responses exhibited stochastic variation in their latency of up to 20 ms, but the elevation of Ca(i) and the receptor potential still rose at approximately the same time, indicating a shared process generating the latent period. Light-induced elevations of Ca(i) resulted from Ca(2+) release from intracellular stores, being abolished by cyclopiazonic acid (CPA), an inhibitor of endoplasmic reticulum Ca(2+) pumps, but not by removal of extracellular Ca(2+) ions. CPA also greatly diminished and slowed the receptor potential elicited by dim flashes. The results demonstrate a rapid release of Ca(2+) ions that appears necessary for a highly amplified electrical response to dim flashes.

Animals↗
PubMed2000

An alternative algorithm for dosing transdermal fentanyl for cancer-related pain.

Many cancer patients are undermedicated and inappropriately managed for pain, leading to a diminished quality of life. Patients with moderate to severe pain often require opioid analgesics. Recently published guidelines emphasize individualization of opioid treatment to provide the drug and route of administration that meet the needs of the particular patient. Intolerable side effects, ineffective pain relief, or a change in the patient's clinical status can dictate the need for a new pain management regimen. Physicians must be able to readily quantify relative analgesic potency when converting from one opioid to another or from one route of administration to another. Transdermal fentanyl (Duragesic) is an opioid agonist that has been shown to be safe and effective for the treatment of cancer pain. However, clinicians should realize that the manufacturer's recommendations for equianalgesic dosing of transdermal fentanyl may result in initial doses that are too low in some patients, and in a titration period that is too long. Under these circumstances, the patient is likely to experience unrelieved pain. An alternative dosing algorithm that considers both a review of the literature and our combined clinical experience with transdermal fentanyl should help clinicians individualize the treatment of pain.

Administration, Cutaneous↗