Notice bibliographique
Résumé
The hospice database survey by Bercovitch et al.1 generates some evidence with which to dispel some of the underlying myths associated with the phenomenon of “opiophobia” in the treatment of the terminally ill. Unfortunately, the apparent preoccupation with this agenda has resulted in the authors inadvertently ignoring the potential for opioid side effects, commonly referred to as opioid toxicity in this patient population. Our comments therefore are offered to redress the balance in relation to the use of high dose morphine and opioid toxicity. The authors report constipation in 41 of 55 patients (74.6%) receiving high dose morphine and mild myoclonus in 1 patient. The absence of any other reported side effects in the total group of 453 patients (all of whom were within an average of approximately 2 weeks from death in a hospice setting) begs the obvious question: what was the level of assessment of these patients in relation to cognitive impairment and other side effects? Furthermore, the authors fail to acknowledge that a retrospective study might fail to capture an accurate recording of such side effects. The authors draw a simple conclusion that survival is not influenced by the average daily morphine dose, which is true in the context of their study findings. However, the extrapolation of these findings to all advanced cancer patients is potentially misleading. Unfortunately, the authors do not comment on the complex clinical reality in which the occurrence of adverse opioid effects often is manifested with even lower doses against a clinical background of multisystem failure (particularly renal impairment) and increased patient vulnerability to side effects.2 Furthermore, use of the average morphine daily dose as an index fails to reflect the dynamic of temporal variation truly, in which a dramatic increase in daily morphine consumption over 2 or 3 days clearly can be associated with adverse effects. The authors failed to mention many reports that have documented opioid-induced neurotoxicity associated with high dose morphine and hydromorphone, particularly in the context of renal failure.3, 4 We applaud the authors in their efforts to allay some of the mythic fears surrounding opioid use. However, instead of allowing the promotion of high dose opioids to dominate our educational agenda, we suggest that our efforts could be more appropriately used to promote the judicious use of opioids (whatever the dose) in the context of a disciplined multidimensional assessment of terminally ill patients. The goal of opioid therapy is to achieve a favorable balance between analgesia and side effects through careful dose titration.5 Furthermore, we need to appreciate that opioid side effects are not uncommon, while reassuring clinicians and patients that these side effects can be managed effectively in the majority of situations with simple measures such as dose reduction, opioid switching, and rehydration.6 Peter Lawlor M.B.*, Gary Frank R.N.*, * Edmonton Regional Palliative Care Program, Grey Nun's Hospital, Edmonton, Alberta, Canada
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,005 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».