Pain assessment for people with dementia: a systematic review of systematic reviews of pain assessment tools.

BACKGROUND: There is evidence of under-detection and poor management of pain in patients with dementia, in both long-term and acute care. Accurate assessment of pain in people with dementia is challenging and pain assessment tools have received considerable attention over the years, with an increasing number of tools made available. Systematic reviews on the evidence of their validity and utility mostly compare different sets of tools. This review of systematic reviews analyses and summarises evidence concerning the psychometric properties and clinical utility of pain assessment tools in adults with dementia or cognitive impairment. METHODS: We searched for systematic reviews of pain assessment tools providing evidence of reliability, validity and clinical utility. Two reviewers independently assessed each review and extracted data from them, with a third reviewer mediating when consensus was not reached. Analysis of the data was carried out collaboratively. The reviews were synthesised using a narrative synthesis approach. RESULTS: We retrieved 441 potentially eligible reviews, 23 met the criteria for inclusion and 8 provided data for extraction. Each review evaluated between 8 and 13 tools, in aggregate providing evidence on a total of 28 tools. The quality of the reviews varied and the reporting often lacked sufficient methodological detail for quality assessment. The 28 tools appear to have been studied in a variety of settings and with varied types of patients. The reviews identified several methodological limitations across the original studies. The lack of a 'gold standard' significantly hinders the evaluation of tools' validity. Most importantly, the samples were small providing limited evidence for use of any of the tools across settings or populations. CONCLUSIONS: There are a considerable number of pain assessment tools available for use with the elderly cognitive impaired population. However there is limited evidence about their reliability, validity and clinical utility. On the basis of this review no one tool can be recommended given the existing evidence

Local delivery of hormonal therapy with silastic tubing for prevention and treatment of breast cancer

Abstract Broad use of germline testing has identified an increasing number of women at risk for breast cancer with a need for effective chemoprevention. We report a novel method to selectively deliver various anti-estrogens at high drug levels to the breast tissue by implanting a device comprised of silastic tubing. Optimized tubing properties allow elution of otherwise poorly bioavailable anti-estrogens, such as fulvestrant, into mammary tissue in vitro and in vivo with levels sufficient to inhibit estrogen receptor activation and tumor cell proliferation. Implantable silastic tubing delivers fulvestrant selectively to mouse mammary fat tissue for one year with anti-tumor effects similar to those achieved with systemic fulvestrant exposure. Furthermore, local delivery of fulvestrant significantly decreases cell proliferation, as assessed by Ki67 expression, most effectively in tumor sections adjacent to tubing. This approach may thereby introduce a potential paradigm shift and offer a promising alternative to systemic therapy for prevention and early interception of breast cancer

Photosynthetic performance of lichen transplants as early indicator of climatic stress along an altitudinal gradient in the arid Mediterranean area

A climatic change was simulated transplanting samples of the lichens Evernia prunastri (L.) Ach. and Pseudevernia furfuracea (L.) Zopf v. furfuracea along a 1,400 m altitudinal gradient in the northern side of the island of Crete (Greece). The working hypothesis was that the photosynthetic performance (i.e. pigment content, chlorophyll degradation and photosynthetic efficiency) of transplanted lichens varies along the altitudinal gradient. The overall effect observed was a general depression of the photosynthetic performance along the gradient. Concentrations of chlorophyll a, chlorophyll b and carotenoids decreased with decreasing elevation and along with the hottest and driest months of the year, with chlorophyll b being the most sensitive parameter to dry conditions. Chlorophyll degradation decreased with increasing elevation. The exposure period was the main factor affecting photosynthetic efficiency, with lower values during summer months. We argued that the water content of lichen thalli is the most important factor determining differences in photosynthesis under the experimental conditions. This allowed to suggest that the lichen photosynthetic performance deserves further investigation as early biological indicator of atmospheric stress induced by dry conditions and, to a greater extent, for the assessment of the desertification risk in the arid Mediterranean environment