The Experts below are selected from a list of 124326 Experts worldwide ranked by ideXlab platform
Andrew Davies - One of the best experts on this subject based on the ideXlab platform.
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disparities between clinician and patient perception of Breakthrough pain control
Journal of Pain and Symptom Management, 2016Co-Authors: Katherine Webber, Andrew Davies, Martin R CowieAbstract:Abstract Context There are disparities in the level of symptom severity as perceived by patients and health professionals. There is limited information about patients' and clinicians' global assessment of Breakthrough pain control, the need to change analgesics, and change in Breakthrough pain over time. Objectives To establish whether patients and clinicians independently agree on adequacy of Breakthrough pain control, management strategy, and impression of change over time. Methods One hundred patients with Breakthrough cancer pain were assessed and followed up one week later by a palliative medicine specialist. The patient and clinician independently answered the same questions about the adequacy of the patient's Breakthrough pain control and Breakthrough pain management. The results were compared with items on the Breakthrough Pain Assessment Tool (BAT). Results At initial consultation, 35% of patients rated their Breakthrough cancer pain as inadequately controlled compared with 72% of clinicians. Breakthrough pain analgesics were changed in 68% of cases. At one-week follow-up consultation, 62% of patients considered their Breakthrough cancer pain to be better, and in 57% of cases, the clinicians also categorized the pain this way. Conclusion There are significant differences in global impressions of Breakthrough pain between patients and pain clinicians that become less disparate as a therapeutic relationship evolves. Therapeutic decisions were based on clinical rather than patient perceptions.
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Breakthrough cancer pain a comparison of surveys with european and canadian patients
Supportive Care in Cancer, 2015Co-Authors: Gillian Bedard, Andrew Davies, Philippa Hawley, Edward Chow, Alison Buchanan, Rachel Mcdonald, Marko Popovic, Erin WongAbstract:Breakthrough cancer pain is defined as a transient exacerbation of pain that occurs spontaneously or in response to a trigger, despite stable and controlled background pain. Breakthrough pain often causes significant functional impairments for patients and can decrease quality of life. The objective of the study was to determine differences between Breakthrough cancer pain incidence and management in Canada and Europe. Data collected from previous studies of Breakthrough cancer pain in Canada and Europe was compared. A standard survey with identical inclusion/exclusion criteria was utilized for both patient populations. Both groups of patients had a similar number and duration of Breakthrough pain episodes, and similar pain intensity and pain interference with their daily activities. European patients reported better analgesic efficacy and satisfaction with management, and a greater percentage of European patients were prescribed a transmucosal fentanyl formulation (19.1 vs 2.9 %). More European patients (55 %) than Canadian patients (32.5 %) took their rescue medication every time they had a Breakthrough pain episode. Breakthrough cancer pain in both Canadian and European patients greatly impacts their daily living, and both groups of patients had similar experiences with Breakthrough cancer pain. Currently, this pain is not adequately managed for many patients. The role for new analgesic treatments in management of Breakthrough cancer pain needs further study.
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development and validation of the Breakthrough pain assessment tool bat in cancer patients
Journal of Pain and Symptom Management, 2014Co-Authors: Andrew Davies, Giovambattista Zeppetella, Katherine Webber, Martin R CowieAbstract:Abstract Context The successful management of Breakthrough pain depends on a combination of adequate assessment, appropriate (individualized) treatment, and adequate re-assessment. Currently, there is no fully validated clinical assessment tool for Breakthrough pain in cancer patients. Objectives The aim of this project was to develop and validate a Breakthrough pain assessment tool (the BAT) for use in the clinical setting. Methods The content of the BAT was determined by reviewing the medical literature, conducting a Delphi process with experts in Breakthrough pain and/or pain assessment and conducting semi-structured interviews with cancer patients with Breakthrough pain. The tool was then subjected to a series of standard psychometric tests to assess its factor structure, validity (i.e., content validity, construct validity), reliability (i.e., internal consistency, test-retest reliability), and responsiveness to change. Results The BAT comprised two pages with 14 questions. Factor analysis confirmed the presence of two underlying factors. Psychometric testing confirmed that the tool is valid, reliable, and responsive to change. Conclusion This study provides initial evidence for the validity and reliability of the Breakthrough pain assessment tool which may be used to facilitate the management of patients with Breakthrough cancer pain in the clinical setting.
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cancer related Breakthrough pain
2012Co-Authors: Andrew DaviesAbstract:Breakthrough pain is a common problem in patients with cancer, and is associated with significant morbidity among this group of patients. This review examines the different types of Breakthrough pain, and the various options for the management of Breakthrough pain.
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Breakthrough pain a qualitative study involving patients with advanced cancer
Supportive Care in Cancer, 2011Co-Authors: Katherine Webber, Andrew Davies, Martin R CowieAbstract:Breakthrough cancer pain is associated with a high burden of physical, psychological and social problems in quantitative studies. Individual experiences of living with Breakthrough pain have not been studied. This study aims to explore the individual experience of living with Breakthrough cancer pain using a qualitative methodology. In depth semi-structured interviews were conducted in ten patients with Breakthrough cancer pain, and a qualitative content analysis was performed. The overarching themes that emerged were daily living, communication with health care professionals and management of Breakthrough pain. Recognising the impact of Breakthrough pain and the issues expressed by patients regarding communication and medication gives the clinician a framework for assessment and intervention.
Katherine Webber - One of the best experts on this subject based on the ideXlab platform.
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disparities between clinician and patient perception of Breakthrough pain control
Journal of Pain and Symptom Management, 2016Co-Authors: Katherine Webber, Andrew Davies, Martin R CowieAbstract:Abstract Context There are disparities in the level of symptom severity as perceived by patients and health professionals. There is limited information about patients' and clinicians' global assessment of Breakthrough pain control, the need to change analgesics, and change in Breakthrough pain over time. Objectives To establish whether patients and clinicians independently agree on adequacy of Breakthrough pain control, management strategy, and impression of change over time. Methods One hundred patients with Breakthrough cancer pain were assessed and followed up one week later by a palliative medicine specialist. The patient and clinician independently answered the same questions about the adequacy of the patient's Breakthrough pain control and Breakthrough pain management. The results were compared with items on the Breakthrough Pain Assessment Tool (BAT). Results At initial consultation, 35% of patients rated their Breakthrough cancer pain as inadequately controlled compared with 72% of clinicians. Breakthrough pain analgesics were changed in 68% of cases. At one-week follow-up consultation, 62% of patients considered their Breakthrough cancer pain to be better, and in 57% of cases, the clinicians also categorized the pain this way. Conclusion There are significant differences in global impressions of Breakthrough pain between patients and pain clinicians that become less disparate as a therapeutic relationship evolves. Therapeutic decisions were based on clinical rather than patient perceptions.
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development and validation of the Breakthrough pain assessment tool bat in cancer patients
Journal of Pain and Symptom Management, 2014Co-Authors: Andrew Davies, Giovambattista Zeppetella, Katherine Webber, Martin R CowieAbstract:Abstract Context The successful management of Breakthrough pain depends on a combination of adequate assessment, appropriate (individualized) treatment, and adequate re-assessment. Currently, there is no fully validated clinical assessment tool for Breakthrough pain in cancer patients. Objectives The aim of this project was to develop and validate a Breakthrough pain assessment tool (the BAT) for use in the clinical setting. Methods The content of the BAT was determined by reviewing the medical literature, conducting a Delphi process with experts in Breakthrough pain and/or pain assessment and conducting semi-structured interviews with cancer patients with Breakthrough pain. The tool was then subjected to a series of standard psychometric tests to assess its factor structure, validity (i.e., content validity, construct validity), reliability (i.e., internal consistency, test-retest reliability), and responsiveness to change. Results The BAT comprised two pages with 14 questions. Factor analysis confirmed the presence of two underlying factors. Psychometric testing confirmed that the tool is valid, reliable, and responsive to change. Conclusion This study provides initial evidence for the validity and reliability of the Breakthrough pain assessment tool which may be used to facilitate the management of patients with Breakthrough cancer pain in the clinical setting.
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Breakthrough pain a qualitative study involving patients with advanced cancer
Supportive Care in Cancer, 2011Co-Authors: Katherine Webber, Andrew Davies, Martin R CowieAbstract:Breakthrough cancer pain is associated with a high burden of physical, psychological and social problems in quantitative studies. Individual experiences of living with Breakthrough pain have not been studied. This study aims to explore the individual experience of living with Breakthrough cancer pain using a qualitative methodology. In depth semi-structured interviews were conducted in ten patients with Breakthrough cancer pain, and a qualitative content analysis was performed. The overarching themes that emerged were daily living, communication with health care professionals and management of Breakthrough pain. Recognising the impact of Breakthrough pain and the issues expressed by patients regarding communication and medication gives the clinician a framework for assessment and intervention.
Edward Chow - One of the best experts on this subject based on the ideXlab platform.
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Breakthrough cancer pain a comparison of surveys with european and canadian patients
Supportive Care in Cancer, 2015Co-Authors: Gillian Bedard, Andrew Davies, Philippa Hawley, Edward Chow, Alison Buchanan, Rachel Mcdonald, Marko Popovic, Erin WongAbstract:Breakthrough cancer pain is defined as a transient exacerbation of pain that occurs spontaneously or in response to a trigger, despite stable and controlled background pain. Breakthrough pain often causes significant functional impairments for patients and can decrease quality of life. The objective of the study was to determine differences between Breakthrough cancer pain incidence and management in Canada and Europe. Data collected from previous studies of Breakthrough cancer pain in Canada and Europe was compared. A standard survey with identical inclusion/exclusion criteria was utilized for both patient populations. Both groups of patients had a similar number and duration of Breakthrough pain episodes, and similar pain intensity and pain interference with their daily activities. European patients reported better analgesic efficacy and satisfaction with management, and a greater percentage of European patients were prescribed a transmucosal fentanyl formulation (19.1 vs 2.9 %). More European patients (55 %) than Canadian patients (32.5 %) took their rescue medication every time they had a Breakthrough pain episode. Breakthrough cancer pain in both Canadian and European patients greatly impacts their daily living, and both groups of patients had similar experiences with Breakthrough cancer pain. Currently, this pain is not adequately managed for many patients. The role for new analgesic treatments in management of Breakthrough cancer pain needs further study.
Craig S Henriquez - One of the best experts on this subject based on the ideXlab platform.
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a microstructural model of reentry arising from focal Breakthrough at sites of source load mismatch in a central region of slow conduction
American Journal of Physiology-heart and Circulatory Physiology, 2014Co-Authors: Marjorie Letitia Hubbard, Craig S HenriquezAbstract:Regions of cardiac tissue that have a combination of focal activity and poor, heterogeneous gap junction coupling are often considered to be arrhythmogenic; however, the relationship between the properties of the cardiac microstructure and patterns of abnormal propagation is not well understood. The objective of this study was to investigate the effect of microstructure on the initiation of reentry from focal stimulation inside a poorly coupled region embedded in more well-coupled tissue. Two-dimensional discrete computer models of ventricular monolayers (1 × 1 cm) were randomly generated to represent heterogeneity in the cardiac microstructure. A small, central poorly coupled patch (0.40 × 0.40 cm) was introduced to represent the site of focal activity. Simulated unipolar electrogram recordings were computed at various points in the tissue. As the gap conductance of the patch decreased, conduction slowed and became increasingly complex, marked by fractionated electrograms with reduced amplitude. Near the limit of conduction block, isolated Breakthrough sites occurred at single cells along the patch boundary and were marked by long cell-to-cell delays and negative deflections on electrogram recordings. The strongest determinant of the site of wavefront Breakthrough was the connectivity of the brick wall architecture, which enabled current flow through small regions of overlapping cells to drive propagation into the well-coupled zone. In conclusion, Breakthroughs at the size scale of a single cell can occur at the boundary of source-load mismatch allowing focal activations from slow conducting regions to produce reentry. These Breakthrough regions, identifiable by distinct asymmetric, reduced amplitude electrograms, are sensitive to tissue architecture and may be targets for ablation.
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microscopic variations in interstitial and intracellular structure modulate the distribution of conduction delays and block in cardiac tissue with source load mismatch
Europace, 2012Co-Authors: Marjorie Letitia Hubbard, Craig S HenriquezAbstract:Aims Reentrant activity in the heart is often correlated with heterogeneity in both the intracellular structure and the interstitial structure surrounding cells; however, the combined effect of cardiac microstructure and interstitial resistivity in regions of source–load mismatch is largely unknown. The aim of this study was to investigate how microstructural variations in cell arrangement and increased interstitial resistivity influence the spatial distribution of conduction delays and block in poorly coupled regions of tissue. Methods and results Two-dimensional 0.6 cm × 0.6 cm computer models with idealized and realistic cellular structure were used to represent a monolayer of ventricular myocytes. Gap junction connections were distributed around the periphery of each cell at 10 μm intervals. Regions of source–load mismatch were added to the models by increasing the gap junction and interstitial resistivity in one-half of the tissue. Heterogeneity in cell shape and cell arrangement along the boundary between well-coupled and poorly coupled tissue increased variability in longitudinal conduction delays to as much as 10 ms before the onset of conduction block, resulting in wavefront Breakthroughs with pronounced curvature at distinct points along the boundary. Increasing the effective interstitial resistivity reduced source–load mismatch at the transition boundary, which caused a decrease in longitudinal conduction delay and an increase in the number of wavefront Breakthroughs. Conclusion Microstructural variations in cardiac tissue facilitate the formation of isolated sites of wavefront Breakthrough that may enable abnormal electrical activity in small regions of diseased tissue to develop into more widespread reentrant activity.
Martin R Cowie - One of the best experts on this subject based on the ideXlab platform.
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disparities between clinician and patient perception of Breakthrough pain control
Journal of Pain and Symptom Management, 2016Co-Authors: Katherine Webber, Andrew Davies, Martin R CowieAbstract:Abstract Context There are disparities in the level of symptom severity as perceived by patients and health professionals. There is limited information about patients' and clinicians' global assessment of Breakthrough pain control, the need to change analgesics, and change in Breakthrough pain over time. Objectives To establish whether patients and clinicians independently agree on adequacy of Breakthrough pain control, management strategy, and impression of change over time. Methods One hundred patients with Breakthrough cancer pain were assessed and followed up one week later by a palliative medicine specialist. The patient and clinician independently answered the same questions about the adequacy of the patient's Breakthrough pain control and Breakthrough pain management. The results were compared with items on the Breakthrough Pain Assessment Tool (BAT). Results At initial consultation, 35% of patients rated their Breakthrough cancer pain as inadequately controlled compared with 72% of clinicians. Breakthrough pain analgesics were changed in 68% of cases. At one-week follow-up consultation, 62% of patients considered their Breakthrough cancer pain to be better, and in 57% of cases, the clinicians also categorized the pain this way. Conclusion There are significant differences in global impressions of Breakthrough pain between patients and pain clinicians that become less disparate as a therapeutic relationship evolves. Therapeutic decisions were based on clinical rather than patient perceptions.
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development and validation of the Breakthrough pain assessment tool bat in cancer patients
Journal of Pain and Symptom Management, 2014Co-Authors: Andrew Davies, Giovambattista Zeppetella, Katherine Webber, Martin R CowieAbstract:Abstract Context The successful management of Breakthrough pain depends on a combination of adequate assessment, appropriate (individualized) treatment, and adequate re-assessment. Currently, there is no fully validated clinical assessment tool for Breakthrough pain in cancer patients. Objectives The aim of this project was to develop and validate a Breakthrough pain assessment tool (the BAT) for use in the clinical setting. Methods The content of the BAT was determined by reviewing the medical literature, conducting a Delphi process with experts in Breakthrough pain and/or pain assessment and conducting semi-structured interviews with cancer patients with Breakthrough pain. The tool was then subjected to a series of standard psychometric tests to assess its factor structure, validity (i.e., content validity, construct validity), reliability (i.e., internal consistency, test-retest reliability), and responsiveness to change. Results The BAT comprised two pages with 14 questions. Factor analysis confirmed the presence of two underlying factors. Psychometric testing confirmed that the tool is valid, reliable, and responsive to change. Conclusion This study provides initial evidence for the validity and reliability of the Breakthrough pain assessment tool which may be used to facilitate the management of patients with Breakthrough cancer pain in the clinical setting.
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Breakthrough pain a qualitative study involving patients with advanced cancer
Supportive Care in Cancer, 2011Co-Authors: Katherine Webber, Andrew Davies, Martin R CowieAbstract:Breakthrough cancer pain is associated with a high burden of physical, psychological and social problems in quantitative studies. Individual experiences of living with Breakthrough pain have not been studied. This study aims to explore the individual experience of living with Breakthrough cancer pain using a qualitative methodology. In depth semi-structured interviews were conducted in ten patients with Breakthrough cancer pain, and a qualitative content analysis was performed. The overarching themes that emerged were daily living, communication with health care professionals and management of Breakthrough pain. Recognising the impact of Breakthrough pain and the issues expressed by patients regarding communication and medication gives the clinician a framework for assessment and intervention.
