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  1. Article: Predictors of Nurse Practitioner Prescription of Opioids for Cancer Pain: Quantitative Results.

    McMenamin, Erin / Kellermann, Marye / Cunningham, Regina / Selway, Janet

    Journal of the advanced practitioner in oncology

    2023  Volume 14, Issue 1, Page(s) 22–35

    Abstract: Background: Nurse practitioners (NPs) have assumed a greater role in the management of pain related to cancer. Several studies have associated adequate management of cancer pain with improved survival. Opioids are an essential treatment for cancer pain ... ...

    Abstract Background: Nurse practitioners (NPs) have assumed a greater role in the management of pain related to cancer. Several studies have associated adequate management of cancer pain with improved survival. Opioids are an essential treatment for cancer pain management and thus it is important to understand influences on prescribing these substances. However, due to a lack of previous studies on this topic, little is known about the influences on NP prescription of opioids for patients with pain due to cancer.
    Purpose: Competent decision-making is highly correlated with dominant personality characteristics and dominant decision-making styles in everyday life. The rational approach to decision-making has demonstrated superior performance with different daily tasks, including career-related tasks. However, it is unknown whether dominant personality and/or decision-making style impacts the decisions of medical professionals. Using the Diffusion of Innovations theoretical framework, this study evaluated whether dominant personality, dominant decision style, advanced specialty certification, and/or demographic factors influenced oncology NP opioid prescribing proficiency (termed opioid decision score, or ODS) according to the National Comprehensive Cancer Network (NCCN) Guidelines. Other advanced practice providers (APPs) were excluded from the study due to controlled substance prescribing limitations.
    Methods: An internet-based descriptive comparative study was performed evaluating the dominant personality characteristic and dominant decision-making style as a predictor of opioid prescribing among NPs working in oncology. Participants were recruited using lists from the Oncology Nursing Society (ONS) and American Association of Nurse Practitioners (AANP). A nationwide convenience sample of NPs working with adult oncology patients was evaluated for opioid prescribing according to recommendations in the NCCN Cancer Pain Guidelines.
    Results: Univariate linear regression revealed a statistically significant increase in the ODS as the Big Five Inventory (BFI) Openness scale score increased (estimate = 0.36, standard error [
    Conclusion: This study provides preliminary findings regarding the decision-making of NPs working with oncology patients and prescribing opioids for cancer pain. Nurse practitioners with a dominant personality characteristic of openness and those reporting an advanced specialty certification in oncology and/or hospice or palliative care were more likely to prescribe opioids for patients with cancer according to NCCN Guidelines. Further investigation is needed to determine additional factors impacting prescribing of controlled sub-stance by NPs and other prescribers.
    Language English
    Publishing date 2023-02-01
    Publishing country United States
    Document type Journal Article
    ISSN 2150-0878
    ISSN 2150-0878
    DOI 10.6004/jadpro.2023.14.1.2
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: A randomized clinical trial of high-dosage coenzyme Q10 in early Parkinson disease: no evidence of benefit.

    Beal, M Flint / Oakes, David / Shoulson, Ira / Henchcliffe, Claire / Galpern, Wendy R / Haas, Richard / Juncos, Jorge L / Nutt, John G / Voss, Tiffini Smith / Ravina, Bernard / Shults, Clifford M / Helles, Karen / Snively, Victoria / Lew, Mark F / Griebner, Brian / Watts, Arthur / Gao, Shan / Pourcher, Emmanuelle / Bond, Louisette /
    Kompoliti, Katie / Agarwal, Pinky / Sia, Cherissa / Jog, Mandar / Cole, Linda / Sultana, Munira / Kurlan, Roger / Richard, Irene / Deeley, Cheryl / Waters, Cheryl H / Figueroa, Angel / Arkun, Ani / Brodsky, Matthew / Ondo, William G / Hunter, Christine B / Jimenez-Shahed, Joohi / Palao, Alicia / Miyasaki, Janis M / So, Julie / Tetrud, James / Reys, Liza / Smith, Katharine / Singer, Carlos / Blenke, Anita / Russell, David S / Cotto, Candace / Friedman, Joseph H / Lannon, Margaret / Zhang, Lin / Drasby, Edward / Kumar, Rajeev / Subramanian, Thyagarajan / Ford, Donna Stuppy / Grimes, David A / Cote, Diane / Conway, Jennifer / Siderowf, Andrew D / Evatt, Marian Leslie / Sommerfeld, Barbara / Lieberman, Abraham N / Okun, Michael S / Rodriguez, Ramon L / Merritt, Stacy / Swartz, Camille Louise / Martin, W R Wayne / King, Pamela / Stover, Natividad / Guthrie, Stephanie / Watts, Ray L / Ahmed, Anwar / Fernandez, Hubert H / Winters, Adrienna / Mari, Zoltan / Dawson, Ted M / Dunlop, Becky / Feigin, Andrew S / Shannon, Barbara / Nirenberg, Melissa Jill / Ogg, Mattson / Ellias, Samuel A / Thomas, Cathi-Ann / Frei, Karen / Bodis-Wollner, Ivan / Glazman, Sofya / Mayer, Thomas / Hauser, Robert A / Pahwa, Rajesh / Langhammer, April / Ranawaya, Ranjit / Derwent, Lorelei / Sethi, Kapil D / Farrow, Buff / Prakash, Rajan / Litvan, Irene / Robinson, Annette / Sahay, Alok / Gartner, Maureen / Hinson, Vanessa K / Markind, Samuel / Pelikan, Melisa / Perlmutter, Joel S / Hartlein, Johanna / Molho, Eric / Evans, Sharon / Adler, Charles H / Duffy, Amy / Lind, Marlene / Elmer, Lawrence / Davis, Kathy / Spears, Julia / Wilson, Stephanie / Leehey, Maureen A / Hermanowicz, Neal / Niswonger, Shari / Shill, Holly A / Obradov, Sanja / Rajput, Alex / Cowper, Marilyn / Lessig, Stephanie / Song, David / Fontaine, Deborah / Zadikoff, Cindy / Williams, Karen / Blindauer, Karen A / Bergholte, Jo / Propsom, Clara Schindler / Stacy, Mark A / Field, Joanne / Mihaila, Dragos / Chilton, Mark / Uc, Ergun Y / Sieren, Jeri / Simon, David K / Kraics, Lauren / Silver, Althea / Boyd, James T / Hamill, Robert W / Ingvoldstad, Christopher / Young, Jennifer / Thomas, Karen / Kostyk, Sandra K / Wojcieszek, Joanne / Pfeiffer, Ronald F / Panisset, Michel / Beland, Monica / Reich, Stephen G / Cines, Michelle / Zappala, Nancy / Rivest, Jean / Zweig, Richard / Lumina, L Pepper / Hilliard, Colette Lynn / Grill, Stephen / Kellermann, Marye / Tuite, Paul / Rolandelli, Susan / Kang, Un Jung / Young, Joan / Rao, Jayaraman / Cook, Maureen M / Severt, Lawrence / Boyar, Karyn

    JAMA neurology

    2014  Volume 71, Issue 5, Page(s) 543–552

    Abstract: Importance: Coenzyme Q10 (CoQ10), an antioxidant that supports mitochondrial function, has been shown in preclinical Parkinson disease (PD) models to reduce the loss of dopamine neurons, and was safe and well tolerated in early-phase human studies. A ... ...

    Abstract Importance: Coenzyme Q10 (CoQ10), an antioxidant that supports mitochondrial function, has been shown in preclinical Parkinson disease (PD) models to reduce the loss of dopamine neurons, and was safe and well tolerated in early-phase human studies. A previous phase II study suggested possible clinical benefit.
    Objective: To examine whether CoQ10 could slow disease progression in early PD.
    Design, setting, and participants: A phase III randomized, placebo-controlled, double-blind clinical trial at 67 North American sites consisting of participants 30 years of age or older who received a diagnosis of PD within 5 years and who had the following inclusion criteria: the presence of a rest tremor, bradykinesia, and rigidity; a modified Hoehn and Yahr stage of 2.5 or less; and no anticipated need for dopaminergic therapy within 3 months. Exclusion criteria included the use of any PD medication within 60 days, the use of any symptomatic PD medication for more than 90 days, atypical or drug-induced parkinsonism, a Unified Parkinson's Disease Rating Scale (UPDRS) rest tremor score of 3 or greater for any limb, a Mini-Mental State Examination score of 25 or less, a history of stroke, the use of certain supplements, and substantial recent exposure to CoQ10. Of 696 participants screened, 78 were found to be ineligible, and 18 declined participation.
    Interventions: The remaining 600 participants were randomly assigned to receive placebo, 1200 mg/d of CoQ10, or 2400 mg/d of CoQ10; all participants received 1200 IU/d of vitamin E.
    Main outcomes and measures: Participants were observed for 16 months or until a disability requiring dopaminergic treatment. The prospectively defined primary outcome measure was the change in total UPDRS score (Parts I-III) from baseline to final visit. The study was powered to detect a 3-point difference between an active treatment and placebo.
    Results: The baseline characteristics of the participants were well balanced, the mean age was 62.5 years, 66% of participants were male, and the mean baseline total UPDRS score was 22.7. A total of 267 participants required treatment (94 received placebo, 87 received 1200 mg/d of CoQ10, and 86 received 2400 mg/d of CoQ10), and 65 participants (29 who received placebo, 19 who received 1200 mg/d of CoQ10, and 17 who received 2400 mg/d of CoQ10) withdrew prematurely. Treatments were well tolerated with no safety concerns. The study was terminated after a prespecified futility criterion was reached. At study termination, both active treatment groups showed slight adverse trends relative to placebo. Adjusted mean changes (worsening) in total UPDRS scores from baseline to final visit were 6.9 points (placebo), 7.5 points (1200 mg/d of CoQ10; P = .49 relative to placebo), and 8.0 points (2400 mg/d of CoQ10; P = .21 relative to placebo).
    Conclusions and relevance: Coenzyme Q10 was safe and well tolerated in this population, but showed no evidence of clinical benefit.
    Trial registration: clinicaltrials.gov Identifier: NCT00740714.
    MeSH term(s) Aged ; Antioxidants/administration & dosage ; Antioxidants/metabolism ; Dose-Response Relationship, Drug ; Double-Blind Method ; Early Diagnosis ; Female ; Humans ; Male ; Middle Aged ; Parkinson Disease/diagnosis ; Parkinson Disease/drug therapy ; Parkinson Disease/enzymology ; Prospective Studies ; Treatment Outcome ; Ubiquinone/administration & dosage ; Ubiquinone/analogs & derivatives ; Ubiquinone/blood
    Chemical Substances Antioxidants ; Ubiquinone (1339-63-5) ; coenzyme Q10 (EJ27X76M46)
    Language English
    Publishing date 2014-03-24
    Publishing country United States
    Document type Clinical Trial, Phase III ; Journal Article ; Multicenter Study ; Randomized Controlled Trial ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 2702023-X
    ISSN 2168-6157 ; 2168-6149
    ISSN (online) 2168-6157
    ISSN 2168-6149
    DOI 10.1001/jamaneurol.2014.131
    Database MEDical Literature Analysis and Retrieval System OnLINE

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