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Pain and symptoms related to palliative care (pain and palliative care [PPC]) are often undertreated. This is largely owing to the complexity in the provision of care and the potential discrepancy in education among the various health care professionals required to deliver care. Pharmacists are frequently involved in the care of PPC patients, although pharmacy education currently does not offer or require a strong curriculum commitment to this area of practice. The Strategic Planning Summit for the Advancement of Pain and Palliative Care Pharmacy was convened to address opportunities to improve the education of pharmacists and pharmacy students on PPC. Six working groups were charged with objectives to address barriers and opportunities in the areas of student and professional assessment, model curricula, postgraduate training, professional education, and credentialing. Consensus was reached among the working groups and presented to the Summit Advisory Board for adoption. These recommendations will provide guidance on improving the care provided to PPC patients by pharmacists through integrating education at all points along the professional education continuum.

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The use of "as-needed" or "PRN" range orders for opioid analgesics in the management of acute pain is a common clinical practice. This approach provides flexibility in dosing to meet individual patients' unique analgesic requirements. Range orders enable necessary and safe dose adjustments based on an individual's response to treatment. This paper presents the consensus statement of the American Society for Pain Management Nursing and the American Pain Society on the use of "as-needed" range orders for opioid analgesics in the management of acute pain.

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The use of "as needed" or "PRN" range orders for opioid analgesics in the management of acute pain is a common clinical practice. This approach provides flexibility in dosing to meet individual patients' unique analgesic requirements. Range orders enable necessary and safe dose adjustments based on an individual's response to treatment. The purpose of this paper is to present the consensus statement of the American Society for Pain Management Nursing and the American Pain Society on the use of "as-needed" range orders for opioid analgesics in the management of acute pain. The implementation of this statement should promote quality pain management through safe medication practices and the appropriate use of range orders for opioid analgesics in acute pain management.

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OBJECTIVE: To identify methods targeted at improving adherence to antihypertensives and determine their effect on adherence using meta-analytic techniques. METHODS: A literature search from 1970 to December 2000 using MEDLINE, International Pharmaceutical Abstracts, PsychLit, ERIC, and EMBASE was performed using the terms compliance, adherence, and medication. Randomized articles with an intervention directed at a patient/caregiver, a comparator group, and a minimum of 10 subjects in each intervention group were identified by 3 independent reviewers. Articles that did not report sample size data or adequate results of the intervention were excluded. Sixteen citations focusing on antihypertensive adherence were identified. Of the 16 citations, 6 studied either more than one intervention in the same population or different interventions in different patient populations, yielding 24 cohorts with 2446 patients. RESULTS: Fifty-eight percent of the methods focused on behavioral interventions (BIs), 29% studied the effect of a combination of behavioral and educational interventions (BEIs), and 13% utilized educational interventions (EIs) alone. Overall, the study groups were nonhomogenous (Q = 183.92; p < 0.001). However, when the groups were separated by the intervention type, the BIs were homogenous (Q = 1.19; p = 1.00) with an overall effect size (ES) of 0.04 (95% CI -0.01 to -0.09), indicating a trend toward improved adherence. Fifty percent of the BIs were performed in the physician's office; however, setting did not influence the intervention's impact (p = 0.13). Within the BIs, no single intervention improved adherence over others. CONCLUSIONS: Based on the interventions included in this meta-analysis, there is no single intervention that improves adherence to antihypertensives over others; therefore, a patient-specific approach should be modeled.

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Targeted therapies for cancer are discussed. Research into the molecular biology of cancer has revealed critical differences between normal and tumor cells and has pinpointed key processes that regulate the growth and progression of cancers. This has in turn allowed for the development of agents that specifically target these molecules and pathways, particularly those regulating the signaling transduction pathway that controls cell replication, differentiation, tumor metastasis, and apoptosis. Such novel targeted therapies include those that can inhibit the function of cellular growth factors or their receptors essential for signal transduction, block angiogenesis required for tumor growth and metastasis, and antisense strategies designed to suppress the expression of specific genes. These approaches have resulted in clinical benefit for selected tumor types, yet challenges remain such as determining the optimal dose and administration of these agents, alone or in combination with standard cytotoxic chemotherapy, and at what stage of disease they might have the greatest influence.

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Bone metastases are one of the most common problematic complications of advanced cancers. In addition to causing significant pain, bone metastases often result in fractures and debilitation. Stimulation of osteoclast activity by factors secreted by tumor cells is believed be the primary mechanism of bone destruction. Bisphosphonates inhibit osteoclast-related bone resorption, and have become standard therapy in the treatment of hypercalcemia of malignancy and postmenopausal osteoporosis. More recently, bisphosphonates have been shown to decrease pain and skeletal fractures associated with bone metastases. Structural changes in bisphosphonates influence their relative potency as well as other potentially beneficial effects such as inhibition of tumor growth factors, alteration of adhesion molecules, and apoptosis of tumor cells.

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