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  • 1
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    Online Resource
    Predictors of treatment outcome in children with medically unexplained pain seeking primary care: A prospective cohort study
    Wiley ; 2019
    In:  European Journal of Pain Vol. 23, No. 8 ( 2019-09), p. 1507-1518
    Details
    In: European Journal of Pain, Wiley, Vol. 23, No. 8 ( 2019-09), p. 1507-1518
    Abstract: Medically unexplained pain in children and adolescents is a common and increasing health care problem. Primary care is usually the first point of contact for these patients. It is the overall objective of this study to investigate treatment outcome of medically unexplained pain in paediatric primary care and to identify predictors of treatment failure. Method In a prospective observational cohort study with three assessments over 6 months, N  = 266 children (6–17 years) presenting to paediatric primary care due to medically unexplained pain were included. The primary outcome is treatment failure after 6 months defined as disabling chronic pain. Risk factors for treatment failure were identified by means of logistic regression analyses. Results At the 6‐months follow‐up, treatment proved unsuccessful in 22.6% of patients. In patients with headaches, high functional impairment and strong emotional pain burden at study inclusion, the risk for treatment failure was increased. However, when also including data on the initial treatment response, pain location and functional impairment were no longer significant. Patients who did not respond to treatment within the first 3 months were more likely to experience treatment failure (OR = 203.7 ; p  〈  0.001) at 6 months, as were children with a higher emotional pain burden at study inclusion (OR = 1.3; p  = 0.007; R 2  = 0.781). Conclusions This study indicates that paediatric primary care is not sufficient for nearly one‐quarter of the children with medically unexplained pain. Individuals without a positive treatment response after 3 months are at increased risk for treatment failure. Significance This study investigates the treatment outcome of medically unexplained pain in paediatric primary care. Individuals with a higher emotional pain burden at the first visit and those without positive treatment response after 3 months are at increased risk for treatment failure. Therefore, a stepped‐care approach seems warranted. After an insufficient primary care trial of 3 months, patients should be transferred to pain specialists for a more intense treatment.
    Type of Medium: Online Resource
    ISSN: 1090-3801 , 1532-2149
    URL: Issue
    URL: Article
    DOI: 10.1002/ejp.v23.8
    DOI: 10.1002/ejp.1426
    Language: English
    Publisher: Wiley
    Publication Date: 2019
    detail.hit.zdb_id: 2002493-9
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  • 2
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    Specialized pediatric palliative care services for children dying from cancer: A repeated cohort study on the developments of symptom management and quality of care over a 10-year period
    SAGE Publications ; 2019
    In:  Palliative Medicine Vol. 33, No. 3 ( 2019-03), p. 381-391
    Details
    In: Palliative Medicine, SAGE Publications, Vol. 33, No. 3 ( 2019-03), p. 381-391
    Abstract: About one quarter of children affected with cancer die. For children and their families, the end-of-life period is highly distressing. Aim: This study focused on how end-of-life care in pediatric cancer patients changed over a period of 10 years and if changes in pediatric palliative care structures were associated with quality of care. Design: Over a 10-year period, all pediatric oncology departments in one German federal state were invited to participate in a repeated cross-sectional cohort study at three time-points (2005, 2010, 2015). Departments invited parents whose children died due to cancer 5 years earlier to participate. Identical semi-structured interviews were conducted with each cohort by the Survey of Caring for Children with Cancer. In addition, departments provided information on their pediatric palliative care infrastructure. Participants: In total, 124 families participated; 73% of interviews were conducted with mothers, 18% with fathers, and 9% with both parents. Results: Parents’ perception of symptom occurrence, symptom burden, and effectiveness of symptom-related treatment remained stable over the 10-year period. Over time, the availability of pediatric palliative care ( p  〈  0.001) as well as quality and satisfaction ratings of care ( p  〈  0.001) increased significantly. A growing number of children received specialized pediatric palliative care at home during the end-of-life period ( p = 0.009). Along with this development, more families had the chance to plan the location of death ( p = 0.003), and more children died at the preferred location ( p = 0.001). Conclusion: Advances in the availability of pediatric palliative care were associated with improvement in some aspects of quality of care (e.g. location of death) while other aspects, such as effectiveness of symptom management, remained unchanged. Further research is required to determine whether additional improvement in structural quality may increase the effectiveness of symptom management.
    Type of Medium: Online Resource
    ISSN: 0269-2163 , 1477-030X
    URL: Article
    DOI: 10.1177/0269216318818022
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2019
    detail.hit.zdb_id: 2027566-3
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