Journal of pain and symptom management最新文献

{"title":"Pediatric Palliative Care Simulation Improves Resident Learning Outcomes: An 11-Year Review","authors":"Cassandra D. Hirsh DO ,&nbsp;Gwendolyn Richner MPH ,&nbsp;Miraides Brown PhD ,&nbsp;Daniel H. Grossoehme DMin, MS ,&nbsp;Brian Harrell MA ,&nbsp;Sarah Friebert MD","doi":"10.1016/j.jpainsymman.2024.10.028","DOIUrl":"10.1016/j.jpainsymman.2024.10.028","url":null,"abstract":"<div><h3>Context</h3><div>Many general pediatrics residents lack sufficient opportunities to conduct difficult conversations with families, particularly about end-of-life care. Simulation learning is an effective means of practicing professional skills. A pediatric palliative care (PPC) physician is uniquely suited to mentor residents and fellows learning to lead difficult conversations through simulation. Co-facilitation of the simulated difficult conversation by a bereaved parent or family member enhances the learning experience.</div></div><div><h3>Objectives</h3><div>To report 11-years’ experience simulating difficult conversations with bereaved parent-actors.</div></div><div><h3>Methods</h3><div>PPC physicians developed two simulations to teach difficult conversations to clinical learners at a midwestern quaternary pediatric medical center. Bereaved parents and hospital chaplains co-facilitated the simulation. The first portrayed the death of an infant following emergency resuscitation, and the second, a goals-of-care conversation with the parent of a child with a degenerative condition. A <em>de-novo</em> evaluation rubric was prepared using the six Accreditation Council for Graduate Medical Education (ACGME) Core Competencies to evaluate the participant's performance in the simulation.</div></div><div><h3>Results</h3><div>For the first simulated scenario (<em>N</em> = 194 residents; <em>N</em> = 16 fellows), residents improved significantly on 16/21 ACGME-based criteria between encounters; for the second (<em>N</em> = 118 residents; <em>N</em> = 14 fellows), residents improved significantly on 10/21 criteria. Fellows’ performance did not improve significantly in either scenario, but they presented with high baseline scores.</div></div><div><h3>Conclusions</h3><div>Simulations with bereaved parent actors improved general pediatrics residents’ performance and comfort during difficult conversations and are transportable to diverse settings.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 2","pages":"Pages e178-e188"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Distress and Benefits of the Bereaved Family Survey: A Mortality Follow-Back Survey","authors":"Mai Hosokawa RN, PhD ,&nbsp;Yoko Nakazawa RN, PhD ,&nbsp;Mitsunori Miyashita RN, PhD ,&nbsp;Kento Masukawa RN, PhD ,&nbsp;Momoka Sato RN ,&nbsp;Tatsuya Morita MD ,&nbsp;Yasuyiki Okumura PhD ,&nbsp;Yoshiyuki Kizawa MD, PhD ,&nbsp;Shohei Kawagoe MD ,&nbsp;Hiroshi Yamamoto MD, PhD ,&nbsp;Emi Takeuchi PhD ,&nbsp;Risa Yamazaki MA ,&nbsp;Asao Ogawa MD, PhD","doi":"10.1016/j.jpainsymman.2024.10.029","DOIUrl":"10.1016/j.jpainsymman.2024.10.029","url":null,"abstract":"<div><h3>Context</h3><div>The Bereaved Family Survey is an important method for evaluating the quality of palliative care.</div></div><div><h3>Objectives</h3><div>To examine the distress and benefits of bereaved families of patients with or without cancer, who participated in a Bereaved Family Survey, and identify factors associated with distress and benefits.</div></div><div><h3>Methods</h3><div>We conducted a nationwide cross-sectional, self-reported questionnaire mail survey among the bereaved families of patients who died of cancer, heart disease, cerebrovascular disease, pneumonia, or kidney failure. Participants answered questions on a four-point Likert scale measuring the distress and benefit associated with participating in the Bereaved Family Survey. We conducted a qualitative analysis of responses to open-ended questions about the distress and benefits of participating in the survey to comprehensively examine the distress and benefits of participating in the survey.</div></div><div><h3>Results</h3><div>Questionnaires were distributed to 115,816 eligible bereaved family members between February 2019 and February 2020; 62,576 (54.0%) family members returned valid responses. Distress and benefits accounted for 51.4% and 49.3%, respectively. The results of the binomial logistic analysis for distress were significantly higher among cancer patients (<em>P</em> &lt; 0.001–0.003), 20–39-year-old patients (<em>P</em> &lt; 0.001), female bereaved family members (<em>P</em> &lt; 0.001), and bereaved family members with poor mental health statuses (<em>P</em> &lt; 0.001). Factors related to “benefit” were significantly higher among over-80-year-old bereaved family members (<em>P</em> &lt; 0.001), higher care evaluation scale (CES) scores (<em>P</em> &lt; 0.001), and higher good death inventory (GDI) scores (<em>P</em> &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>Bereaved family members experience both distress and benefits. There is need to devise ways to reduce distress and increase its benefits to continue assessing the quality of palliative care.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 2","pages":"Pages 152-164"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142590649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sights and Sounds of Respiratory Changes During Hospice Death Vigils: Hospice Caregivers Experience","authors":"Debra Parker Oliver MSW, PhD ,&nbsp;Masako Mayahara PhD, RN ,&nbsp;Allison Donehower MS ,&nbsp;Jacquelyn J. Benson PhD ,&nbsp;Daniel Paget MD ,&nbsp;Keisha White Makinde MD, MPH ,&nbsp;Justin Daniels MD ,&nbsp;Patrick White MD, PhD","doi":"10.1016/j.jpainsymman.2024.10.035","DOIUrl":"10.1016/j.jpainsymman.2024.10.035","url":null,"abstract":"<div><h3>Context</h3><div>Research has documented common respiratory changes at the end of life for hospice patients. Some studies have noted these symptoms as distressing and challenging for families, and as a potential reason for emergency room visits and hospice benefit revocation. However, the experiences and emotions of family members regarding these respiratory changes in the final days, particularly when they are alone in a home setting, are not well documented. A recent study found 51% caregivers identified abnormal breathing as a challenge during their vigil experience.</div></div><div><h3>Objectives</h3><div>The study aimed to answer three research questions: 1) How do family members describe the sights and sounds of the respiratory changes experienced during the final days of life? 2) What are the emotions caregivers experience as a result of witnessing the sights and sounds of respiratory changes? 3) What interventions are caregivers using to manage respiratory changes?</div></div><div><h3>Methods</h3><div>A secondary analysis of 22 hospice caregiver interviews from a larger study of family interviews focused analyzing in depth narratives related to respiratory changes during the vigil period.</div></div><div><h3>Results</h3><div>Caregiver narratives distressful sights and sounds related to respiratory symptoms during the final days were described by 27% and 77% of family narratives, respectively. Negative emotional reactions were reported by more than a third of those interviewed. Caregivers expressed frustration at not understanding the reasons behind respiratory changes, with 27% noting they wished for more information on what to expect and how to intervene. There were inconsistencies in the interventions provided by hospice teams in managing respiratory symptoms.</div></div><div><h3>Conclusions</h3><div>Opportunities exist for hospice agencies to better address the caregiver distress caused by witnessing noisy breathing (death rattle), Cheyne-Stokes breathing, and agonal breathing. Further research is needed to identify standard definitions for these respiratory changes, their prevalence in the home hospice setting, and to develop practice standards and effective interventions to relieve caregiver distress.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 2","pages":"Pages 190-195"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-pharmacological Therapies for Depression in Women With Breast Cancer at Different Treatment Phases: A Systematic Review and Network Meta-Analysis","authors":"Deqi Zhang MD ,&nbsp;Wenxin Zhao MD ,&nbsp;Lin Yuan MD ,&nbsp;Qiling Xu MD ,&nbsp;Hongyan Bi MD","doi":"10.1016/j.jpainsymman.2024.10.022","DOIUrl":"10.1016/j.jpainsymman.2024.10.022","url":null,"abstract":"<div><h3>Context</h3><div>Various non-pharmacological therapies (NPTs) have been found to be helpful for depression in women with breast cancer (BC). However, the relative efficacy of different NPTs in women with BC during different treatment phases is unclear.</div></div><div><h3>Objectives</h3><div>To conduct a systematic review and network meta-analysis (NMA) to compare the relative efficacy of various NPTs for improving depression in women with BC during the inter-/post-treatment periods.</div></div><div><h3>Methods</h3><div>We searched eight databases (Embase, PubMed, PsycINFO, The Cochrane Library, Chinese Biomedical Database, China National Knowledge Infrastructure, Chinese Scientific Journal Database, and WanFang Database) to identify relevant randomized controlled trials published in English and Chinese from their inception to 31 January 2024. We assessed the methodological quality of the included studies using the Cochrane Collaboration Risk of Bias Tool. NMA was conducted using a frequentist approach. The surface under the cumulative ranking (SUCRA) probabilities were used to rank the NPTs.</div></div><div><h3>Results</h3><div>A total of 41 articles involving 5408 participants studied 18 NPTs. Based on NMA, in the intertreatment phase, mindfulness-based cognitive therapy (MBCT), psychological education, virtual reality (VR) and yoga significantly improved depression in women with BC. MBCT, psychological education, and VR were the three most effective NPTs in this period. In the post-treatment phase, mindfulness-based stress reduction significantly improved depression in women with BC, which was the most effective NPTs in this period. Based on the GRADE framework, most results were rated as “high” to “very low” for the confidence of evidence.</div></div><div><h3>Conclusions</h3><div>Our study confirmed the efficacy of several NPTs for depression in women with BC during inter-/post-treatment phases. These results should inform future clinical decisions and guidelines for depression in women with BC.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 2","pages":"Pages e113-e130"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Electronic Health Record Serious Illness Conversation Dashboards: An Implementation Case Series","authors":"Yasmina Hachem MD ,&nbsp;Joshua Lakin MD ,&nbsp;Winifred Teuteberg MD ,&nbsp;Amelia Cullinan MD ,&nbsp;Matthew J. Gonzales MD, FAAHPM ,&nbsp;Charlotta Lindvall MD, PhD ,&nbsp;Pallavi Kumar MD ,&nbsp;Laura Dingfield MD ,&nbsp;Laurel Kilpatrick MD ,&nbsp;Jeff Greenwald MD ,&nbsp;Angela Miller MA ,&nbsp;Tamra Keeney PT, PhD, DPT, CCS ,&nbsp;Erik K. Fromme MD, MCR, FAAHPM ,&nbsp;Joanna Paladino MD","doi":"10.1016/j.jpainsymman.2024.10.032","DOIUrl":"10.1016/j.jpainsymman.2024.10.032","url":null,"abstract":"<div><h3>Introduction</h3><div>Dashboards are used to track and visualize quality indicators within health systems to improve clinical performance. Structured serious illness conversation (SIC) documentation templates within electronic health records (EHR) have enabled the development of SIC dashboards for quality improvement. Little is known about the successes and challenges of SIC dashboards.</div></div><div><h3>Methods</h3><div>This implementation case series describes findings from semi-structured interviews and surveys with nine palliative care leaders in eight health systems that implemented SIC dashboards. Interviews and case information were analyzed to identify themes.</div></div><div><h3>Results</h3><div>Five themes were identified. First, dashboards focus on process metrics. By creating transparent and efficient access to data on EHR-documented SICs, dashboards facilitated monitoring of the results of clinician training and quality improvement efforts. Second, palliative care leaders used dashboard data on documented SICs to implement clinician practice change strategies (e.g. data feedback; quality incentives), but clinicians had mixed reactions to data. Third, dashboards facilitated leadership investment in SIC efforts and required financial and technical resources to build and maintain. Fourth, while dashboards streamlined data collection for implementation teams, participants noted challenges with data reliability, including inadequate clinician use of structured SIC documentation templates (which most dashboards rely on for measurement). Fifth, needs and tensions arose with integrating patient-centered outcome measures as part of dashboards.</div></div><div><h3>Conclusion</h3><div>Dashboards can be powerful tools for identifying gaps in SIC and driving interventions for clinician practice change. However, challenges related to clinician adoption of structured templates for SIC documentation and mixed clinician receptivity to data feedback may limit their reliability and use.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 2","pages":"Pages e139-e146"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genomic Study in Opioid-Treated Cancer Patients Identifies Variants Associated With Nausea-Vomiting","authors":"Francesca Minnai MSc ,&nbsp;Morena Shkodra MD, PhD ,&nbsp;Sara Noci PhD ,&nbsp;Cinzia Brunelli PhD ,&nbsp;Alessandra Pigni MD ,&nbsp;Ernesto Zecca MD ,&nbsp;Frank Skorpen PhD ,&nbsp;Pål Klepstad MD, PhD ,&nbsp;Stein Kaasa MD ,&nbsp;Oscar Corli MD ,&nbsp;Maria Caterina Pallotti MD, PhD ,&nbsp;Marco Cesare Maltoni MD ,&nbsp;Augusto Tommaso Caraceni MD ,&nbsp;Francesca Colombo PhD","doi":"10.1016/j.jpainsymman.2024.10.033","DOIUrl":"10.1016/j.jpainsymman.2024.10.033","url":null,"abstract":"<div><h3>Context</h3><div>Opioids are the mainstay therapy for patients affected by cancer pain. However, about 10%–20% of patients do not benefit from the received analgesic treatment or experience side effects. Genetic variability might account for the variation in individual responses to opioids, both in terms of efficacy and toxicity.</div></div><div><h3>Objectives</h3><div>The aim of this genome-wide association study (GWAS) was to identify genetic markers of opioid toxicity, in terms of nausea-vomiting.</div></div><div><h3>Methods</h3><div>Cancer patients receiving morphine, oxycodone, buprenorphine, and fentanyl were recruited from different European countries. Data about toxicity (nausea-vomiting score, NVS) and other relevant clinical information were collected, as well as genotyping data. Regression analysis between genotypes of 2052 patients and NVS was performed, using appropriate covariates, with REGENIE software.</div></div><div><h3>Results</h3><div>We found 65 variants associated with NVS (<em>P</em>-value &lt; 1.0×10⁻⁵). Of note, 14 intronic variants on chromosome 2 were in <em>NPAS2</em> gene, encoding a circadian transcription factor reported to play a role in another opioid side effect, the alteration of sleep. Some of these variants were previously identified as splicing quantitative trait loci of the <em>NPAS2</em> gene.</div></div><div><h3>Conclusions</h3><div>This is the first GWAS, performed in more than two thousand individually genotyped patients treated with opioids for cancer pain, that investigated the genetic bases of opioid-induced nausea-vomiting. Although further studies are needed to confirm our findings and to characterize the functional role of the identified variants, our results emphasize the importance of performing large pharmacogenomic studies to identify germline variants associated with opioid response, with the ultimate goal of tailoring cancer pain therapies.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 2","pages":"Pages 175-182.e5"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Are Muscle and Fat Loss Predictive of Clinical Events in Pancreatic Cancer? The Importance of Precision Metrics","authors":"Mellar P Davis MD ,&nbsp;Nada Bader BS ,&nbsp;James Basting BS ,&nbsp;Erin Vanenkevort Ph.D ,&nbsp;Nicole Koppenhaver BS ,&nbsp;Aalpen Patel MD ,&nbsp;Mudit Gupta MBA ,&nbsp;Braxton Lagerman BS ,&nbsp;Mark Wojtowicz MS","doi":"10.1016/j.jpainsymman.2024.10.004","DOIUrl":"10.1016/j.jpainsymman.2024.10.004","url":null,"abstract":"<div><h3>Context</h3><div>Muscle and fat loss from cancer may have prognostic significance. Skeletal muscle and fat areas measured at L3 on a CT scan correlate with body muscle and fat mass. We wished to know if reduced skeletal muscle area or fat on diagnostic CT scans or changes from initial CT scans in patients with pancreatic cancer who died in 2018 and 2019 predicted mortality.</div></div><div><h3>Method</h3><div>Electronic records of 112 patients with locally advanced or metastatic pancreatic cancer were used to extract stage, age, gender, comorbidities, weight, and height at the time of the first CT scan. Survival (in days) was defined from the first CT scan to the death date. Patients had at least one CT scan of the abdomen. I. Two trained medical students read scans independently using TeraRecon software (Durham, NC). Results were averaged, and the differences determined precision. Interclass correlation coefficient (ICC), coefficient of variation, and least significant change determined the precision between readers. Independent prognostic modeling included age and BMI.</div></div><div><h3>Results</h3><div>An evaluable sample of 104 with an average age of 67, 56 were male. Nearly half had a TNM Stage of IV (45%). The average Charlson Comorbidity index is 7.2. In those undergoing repeat scans, most were in the timeframe of 60–120 days. Changes in visceral fat in men in the unadjusted Cox proportional hazard model and reduced skeletal muscle area in the age-adjusted model of men predicted mortality. In contrast, myosteatosis in women marginally predicted improved survival. ICC's precision between readers was adequate but by least significant change would have missed subtle, clinically important changes.</div></div><div><h3>Discussion</h3><div>Muscle loss during chemotherapy in men predicted mortality in men but not women. Precision is an important metric when measuring body composition.</div></div><div><h3>Conclusion</h3><div>Muscle loss in men during chemotherapy of pancreatic cancer predicts mortality.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 2","pages":"Pages 141-151"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation and Evaluation of a Pediatric Palliative Care Curriculum for Adult-Track HPM Fellows","authors":"Emilee Flynn MD, MPH ,&nbsp;Camille Murray MPH, CHES® ,&nbsp;Cynthia B. Sinha PhD ,&nbsp;Ulemu Luhanga PhD, MEd, MSc","doi":"10.1016/j.jpainsymman.2024.10.027","DOIUrl":"10.1016/j.jpainsymman.2024.10.027","url":null,"abstract":"<div><h3>Introduction</h3><div>Hospice and Palliative Medicine (HPM) fellowship training provides education on caring for patients from early childhood through adulthood. Yet, there are few guidelines about how to teach these key components, and more specifically the components of Pediatric Palliative Care (PPC), to fellows who have a variety of backgrounds prior to entering HPM fellowship.</div></div><div><h3>Methods</h3><div>We created a curriculum in PPC that could be used with adult-track HPM fellows. We developed an outline for material to cover during each of the three weeks of PPC clinical rotations. We also created a longitudinal lecture series encompassing several foundational topics and concepts in PPC. We conducted “Just-in-Time” evaluation of the clinical rotation curriculum utilizing a critical reflection model as well as focus groups with fellows and faculty members to further explore the knowledge, attitudes, and perceptions of the entire PPC curriculum. Transcripts were coded Nvivo and template analysis was used to understand code distribution between and within focus groups.</div></div><div><h3>Results</h3><div>Eight overarching codes emerged from the focus groups: “Staffing Issues,” “Learning Structure,” “Useful Material,” “Topics Attending Contingent,” “Time Management,” “Teachable Moment,” “Not Useful Material,” and \"Adherence to Teaching Materials.”</div></div><div><h3>Conclusion</h3><div>The study revealed some limitations in the current curriculum design, such as its lack of consistency. However, it also highlighted several strengths, including the importance of flexibility and personal responsibility for learning. The results provide valuable insights into the experiences among fellows and educators at a single institution with a PPC Curriculum for adult-track HPM fellows.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 2","pages":"Pages e150-e177"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142568398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"NLP for Analyzing Electronic Health Records and Clinical Notes in Cancer Research: A Review.","authors":"Muhammad Bilal, Ameer Hamza, Nadia Malik","doi":"10.1016/j.jpainsymman.2025.01.019","DOIUrl":"10.1016/j.jpainsymman.2025.01.019","url":null,"abstract":"<p><p>This review examines the application of natural language processing (NLP) techniques in cancer research using electronic health records (EHRs) and clinical notes. It addresses gaps in existing literature by providing a broader perspective than previous studies focused on specific cancer types or applications. A comprehensive literature search in the Scopus database identified 94 relevant studies published between 2019 and 2024. The analysis revealed a growing trend in NLP applications for cancer research, with information extraction (47 studies) and text classification (40 studies) emerging as predominant NLP tasks, followed by named entity recognition (7 studies). Among cancer types, breast, lung, and colorectal cancers were found to be the most studied. A significant shift from rule-based and traditional machine learning approaches to advanced deep learning techniques and transformer-based models was observed. It was found that dataset sizes used in existing studies varied widely, ranging from small, manually annotated datasets to large-scale EHRs. The review highlighted key challenges, including the limited generalizability of proposed solutions and the need for improved integration into clinical workflows. While NLP techniques show significant potential in analyzing EHRs and clinical notes for cancer research, future work should focus on improving model generalizability, enhancing robustness in handling complex clinical language, and expanding applications to understudied cancer types. The integration of NLP tools into palliative medicine and addressing ethical considerations remain crucial for utilizing the full potential of NLP in enhancing cancer diagnosis, treatment, and patient outcomes. This review provides valuable insights into the current state and future directions of NLP applications in cancer research.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute Care Use and Prognosis in Older Adults Presenting to the Emergency Department.","authors":"Oluwaseun Adeyemi, Jacob Hill, Nina Siman, Keith S Goldfeld, Allison M Cuthel, Corita R Grudzen","doi":"10.1016/j.jpainsymman.2025.01.006","DOIUrl":"10.1016/j.jpainsymman.2025.01.006","url":null,"abstract":"<p><strong>Context: </strong>Understanding how prognosis influences acute care use among older adults at risk of short-term mortality is essential for providing care consistent with patients' wishes.</p><p><strong>Objectives: </strong>This study assesses whether prognosis is associated with acute care and Intensive Care Unit (ICU) transfer in older adults presenting to the Emergency Department (ED) at high and low risk of short-term mortality.</p><p><strong>Methods: </strong>For this cross-sectional analysis, we pooled the Medicare claims for older adults 66 years and older from 2015 to 2019 who visited at least one of the 29 EDs participating in the Primary Palliative Care for Emergency Medicine study. Our outcome measures were defined as an acute care admission and ICU transfer resulting from an ED visit, both measured as binary variables. The predictor variables were age, sex, race/ethnicity, and Gagne score. We stratified the analysis into those with low (≤6) and high risk (>6) short-term mortality using the Gagne scores. To assess the odds of an acute care or ICU transfer, we used multivariable logistic regression via generalized estimating equation models and computed the adjusted odds ratios (AOR) among the general population and among those at high risk of short-term mortality.</p><p><strong>Results: </strong>Of the 301,083 older adults who visited one of the 29 EDs, 13% were at high risk for short-term mortality. Among this high-risk group, 64% had an acute care admission, and 15% of those admitted had an ICU transfer, as compared to 43% and 12% of those at low risk of short-term mortality. Among those at high risk for short-term mortality, prognosis was associated with 6% (AOR 1.06; 95% CI, 1.04-1.09) and 8% (AOR 1.08; 95% CI, 1.06-1.09) increased adjusted odds of inpatient admission and ICU transfer, respectively.</p><p><strong>Conclusion: </strong>The prognosis of older adults, especially those at high risk of short-term mortality, predicts both inpatient admissions and ICU transfers.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}