The corner stone of palliative care is pain management (WHO, 2009). This is because pain is very severe and distressing in cancer patients and can lead to physical disability, emotional maladjustment, social detachment, psychological depression and distress, sleep disturbances, loss of appetite etc…
Round the clock administration of oral morphine for acute and chronic pain in patients with terminal and preterminal cancer is a widely accepted procedure. However, the need to administer the drug frequently and the increased risk of analgesic efficacy poses a problem in the management of pain in cancer patients. Several studies have reported other means of administration of opioid without altering the analgesic efficacy and without cumbersome dosing schedules. A couple of such important strategies are controlled-release morphine tablets and fentanyl-transdermal therapeutic system. To ascertain as to which is a better strategy for pain relief in cancer patients review of literature is essential. Making clinical decisions based on appropriate evidence is known as evidence-based practice. According to McKibbon (1998), "Evidence-based practice (EBP) is an approach to health care wherein health professionals use the best evidence possible, i.e. the most appropriate information available, to make clinical decisions for individual patients. EBP values, enhances and builds on clinical expertise, knowledge of disease mechanisms, and pathophysiology. It involves complex and conscientious decision-making based not only on the available evidence but also on patient characteristics, situations, and preferences." Literature review is the most critical exercise for EBP. Literature search for EBP can be done effectively by creating appropriate question in PICO format. In this assignment, literature review for an evidence-based answer of a clinical question will be discussed after deciphering the question in PICO format. The literature search will be performed in a systematic manner through electronic databases. Clinical Question "In patients with terminal and preterminal cancer, which is the most appropriate strategy for pain relief? Oral sustained release morphine or transdermal fentanyl?" PICO Population: Patients with cancer in preterminal or terminal stages with acute or chronic pain Intervention: Orals sustained release morphine Comparison: Intradermal fentanyl Outcome: Relief from pain Search Process The commencement of search in electronic databases was based on the inclusion/exclusion criteria and knowledge of the hierarchies of evidence. Hierarchy provides a confidence measure to the end-user (Evans, 2003). According to Evans (2003), random control trials can be considered of good standard and they are in fact labeled as the gold standard of research for providing optimal research designs to answer pertinent questions. However, systemic reviews and meta-analysis have topped the hierarchy list. The databases used for search were PUBMED, Google Scholar and CINAHL. The MESH terms used in PUBMED were cancer pain (AND), morphine (AND), fentanyl (AND), & pain (AND). The limits used were adults and ...
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(Patients With Terminal and Preterminal Cancer- Evidence Based Practice Assignment)
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Other databases are unused due to non-relevance to the topic.
You will already have completed the Search Planning Form and identified your research question and key concepts. This section will help you to identify and expand the range of
Various models, concepts, and theories were employed in obtaining a better research design. Such models included stress process model where the stressors of caregivers are mainly patient’s signs, symptoms, and the distress symptoms. Stress process
This theory assumes that an initial few people are ready to accept new ideas or practices and implement them. However, after a certain time, the idea or practice is diffused amongst the population to a point known as
The setting and access of these subjects would be schools for those between the ages of 13 and 19 or colleges for those between the ages of 16 and 19 years of age. Therefore, schools and colleges will be the
It is estimated that in every 37 seconds, one person dies in America because of a cardiovascular disease (May, Kuklina & Yoon, 2012). The kind of lifestyle that teenagers live today exposes them to heart diseases such as high blood pressure
This document looks at the clinical guidelines that are set out for the care providers, the challenges they face in meeting them, and their reactions to the new guidelines.
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2. Farris M, Anderson C, Doty S, Myers C, Johnson K, and Prasad S. Non-OR procedural safety. Health care protocol. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2012 Sep. 38 p. [4 references]
ICSI (Institute for Clinical Systems
This research aims to evaluate and present a report of the history of the actual search of the clinical question in CINHAL and a report of the history of the actual search of the clinical question in Joanna Briggs Institute. The researcher searched on the PICOT elements by typing it in the search field and then he clicked search.
The guidelines and grading rubric for this assignment may be found in Doc Sharing.
Cherlin, E. J., Curry, L. A., Thompson, J. W., Greysen, S. R., Spatz, E., Krumholz, H. M., & Bradley, E. H. (2013). Features of high quality discharge planning
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