You will perform a history of a nose, mouth, throat, or neck problem that your instructor has provided you or one that you have experienced, and you will perform an assessment including nose, mouth, throat, and neck. You will document your subjective and objective findings, identify actual or potential risks, and submit this in a Word document.
Title:
Documentation of problem based assessment of the nose, throat, neck, and regional lymphatics.
Purpose of Assignment:
Learning the required components of documenting a problem based subjective and objective assessment of nose, throat, neck, and regional lymphatics. Identify abnormal findings.
Course Competency:
Demonstrate physical examination skills of the head, ears, and eyes, nose, mouth, neck, and regional lymphatics.
Instructions:
Content: Use of three sections:
Subjective
Objective
Actual or potential risk factors for the client based on the assessment findings with description or reason for selection of them.
Format:
Standard American English (correct grammar, punctuation, etc.)
Resources:
Chapter 5: SOAP Notes: The subjective and objective portion only
Sullivan, D. D. (2012).
Guide to clinical documentation. [E-Book]. Retrieved from
http://ezproxy.rasmussen.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=nlebk&AN=495456&site=eds-live&ebv=EB&ppid=pp_91
Smith, L. S. (2001, September). Documentation dos and donts.
Nursing, 31(9), 30. Retrieved from
http://ezproxy.rasmussen.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=107055742&site=eds-live
Documentation Grading Rubric- 10 possible points
Levels of Achievement
Criteria
Emerging
Competence
Proficiency
Mastery
Subjective
(4 Pts)
Missing components such as biographic data, medications, or allergies. Symptoms analysis is incomplete. May contain objective data.
Basic biographic data provided. Medications and allergies included. Symptoms analysis incomplete. Lacking detail. No objective data.
Basic biographic data provided. Included list of medications and allergies. Symptoms analysis: PQRSTU completed. Lacking detail. No objective data. Information is solely what client provided.
Basic biographic data provided. Included list of medications and allergies. Symptoms analysis: PQRSTU completed. Detailed. No objective data. Information is solely what client provided.
Points: 1
Points: 2
Points: 3
Points: 4
Objective
(4 Pts)
Missing components of assessment for particular system. May contain subjective data. May have signs of bias or explanation of findings. May have included words such as normal, appropriate,
okay, and good.
Includes all components of assessment for particular system. Lacks detail. Uses words such as normal, appropriate, or good. Contains all objective information. May have signs of bias or explanation of findings.
Includes all components of assessment for particular system. Avoided use of words such as normal, appropriate, or good. No bias or explanation for findings evident Contains all objective information
Includes all components of assessment for particular system. Detailed information provided. Avoided use of words such as normal, appropriate, or good. No bias or explanation for findings evident. All objective information
Points: 1
Points: 2
Points: 3
Points: 4
Actual or Potential Risk Factors
(2 pts)
Lists one to two actual or potential risk factors for the client based on the assessment findings with no description or reason for selection of them.
Failure to provide any potential or actual risk factors will result in zero points for this criterion.
Brief description of one or two actual or potential risk factors for the client based on assessment findings with description or reason for selection of them.
Limited description of two actual or potential risk factors for the client based on the assessment findings with description or reason for selection of them.
Comprehensive, detailed description of two actual or potential risk factors for the client based on the assessment findings with description or reason for selection of them.
Points: 0.5
Points: 1
Points: 1.5
Points: 2
SHOW MORE…
Bio 22
see attachment
Guide to an Overall Critique of a Qualitative Research Article
Polit & Beck (2017) p 106-109
Student
Name
Date
Article
Citation
(APA format
)
NUR 610 INSTRUCTIONS: The format of the critique follows the sections of the article. Pay attention
to section headers on this document as that is where you will find information in the article. After
answering YES/NO to the critique question (make answer bold or in italics), follow with a brief
explanation or description of how the research demonstrated that the answer to the question. If the
question does not apply to the study, state that in the box.
Aspect of the Research Article
Title
1 Is the title a good one, suggesting the key phenomenon and the group or community
under study? Explain:
Yes
or No
Abstract
2. Does the abstract clearly and concisely summarize the main features of the report?
Explain:
Yes
or No
Introduction
Statement of Problem
3. Was the problem stated unambiguously, and was it easy to identify? Explain: Yes
or No
4. Is the problem significant for nursing? Explain: Yes
or No
5. Was there a good match between the research problem and the use of a qualitative
approach, versus quantitative, to find the answer? Explain:
Yes
or No
Hypothesis or research questions
6. Were research questions explicitly stated? Explain: Yes
or No
7. Were the questions consistent with the studys philosophical basis, underlying tradition,
or ideological orientation?
Yes
or No
Literature Review
1
Guide to an Overall Critique of a Qualitative Research Article
Polit & Beck (2017) p 106-109
8. Did the article adequately summarize the existing body of knowledge related to the
problem or phenomenon of interest? Explain:
Yes
or No
9. Was the literature review up-to-date (ideally less than 5 years unless classic)?
Describe:
Yes
or No
10. Did the literature review provide support that the research performed in the article
needed to be done (identify gap in literature/knowledge)? Explain:
Yes
or No
Conceptual Underpinnings
11. Were key concepts adequately defined conceptually? Explain: Yes
or No
12. Was the philosophical basis, underlying tradition (phenomenology, ethnography, or
grounded theory), conceptual framework, or ideological orientation made explicit and was
it appropriate for the problem ? Explain:
Yes
or No
Method
Protection of Human Rights
13. Were appropriate procedures used to safeguard rights of the study participants?
Explain:
Yes
or No
14. Was the study reviewed by an Institutional Review Board (or ethics committee)?
Explain:
Yes
or No
Research Design
15. Was the identified research tradition (if any) congruent with the methods used to
collect and analyze data? Explain:
Yes
or No
16. Was an adequate amount of time spent with study participants? Explain: Yes
or No
17. Did the design unfold during data collection, giving researchers opportunities to
capitalize on early understandings? Explain:
Yes
or No
18. Was there an adequate number of contacts with study participants? Explain: Yes
or No
Sample and Setting
19. Was the group or population of interest adequately described? Were the setting and
sample described in sufficient detail? Explain:
Yes
or No
20. Was the approach used to recruit participants or gain access to the site productive and
appropriate? Explain:
Yes
or No
21. Was the best possible method of sampling used to enhance information richness and
address the needs of the study? Explain:
Yes
or No
2
Guide to an Overall Critique of a Qualitative Research Article
Polit & Beck (2017) p 106-109
22. Was the sample size adequate? Was saturation achieved? Explain: Yes
or No
Data collection
23. Were the methods of gathering data appropriate? Were data gathered through two or
more methods to achieve triangulation? Explain:
Yes
or No
24. Did the researcher ask the right questions or make the right observations, and were
they recorded in an appropriate fashion? Explain:
Yes
or No
25. Was a sufficient amount of data gathered? Were the data of sufficient depth and
richness? Explain:
Yes
or No
Procedures
26. Were data collection and recording procedures adequately described and do they
appear appropriate? Explain:
Yes
or No
27. Were data collected in a manner that minimized bias? Were the staff who collected
data appropriately trained? Explain:
Yes
or No
Enhancement of trustworthiness
28. Did the researchers use effective strategies to enhance the trustworthiness/integrity of
the study, and was there a good description of those strategies? Explain:
Yes
or No
29. Did the researcher document research procedures and decision processes sufficiently
that findings are auditable and confirmable? Explain:
Yes
or No
30. Was there thick description of the context, participants, and findings, and was it at a
sufficient level to support transferability? Explain:
Yes
or No
Results
Data Analysis
31. Were the data management and data analysis methods adequately described?
Explain:
Yes
or No
32. Was the data analysis strategy compatible with the research tradition and with the
nature and type of data gathered? Explain:
Yes
or No
33. Did the analytic procedures suggest the possibility of biases? Explain: Yes
or No
Findings
34. Were the findings effectively summarized, with good use of quotes and supporting
arguments? Explain:
Yes
or No
35. Does it appear that the researcher satisfactorily conceptualized the themes or patterns Yes
or No
3
Guide to an Overall Critique of a Qualitative Research Article
Polit & Beck (2017) p 106-109
in the data? Explain:
36. Did the analysis yield an insightful, provocative, authentic, and meaningful picture of
the phenomenon under investigation? Explain:
Yes
or No
Theoretical integration
37. Were figures, maps, or models used effectively to summarize conceptualizations? Yes
or No
Discussion
Interpretation of the findings
38. Were the findings interpreted within an appropriate social or cultural context? Explain: Yes
or No
39. Were major findings interpreted and discussed within the context of prior studies?
Explain:
Yes
or No
Implications/Recommendations
40. Did the researchers discuss the implications of the study for clinical practice or further
research – and were those implications reasonable and complete? Explain:
Yes
or No
General Issues
Presentation
41. Was the article well-written, organized, and sufficiently detailed for critical analysis?
Explain:
Yes
or No
42. Was the description of the methods, findings, and interpretations sufficiently rich and
vivid? Explain:
Yes
or No
43. Was the report written in a manner that makes the findings accessible to practicing
nurses? Explain:
Yes
or No
Researcher Credibility
44. Do the researchers clinical, substantive, or methodologic qualifications and
experience enhance confidence in the findings and their interpretation?
Yes
or No
Summary Assessment
45. Does the study contribute any meaningful evidence that can be used in nursing
practice or that is useful to the nursing discipline?
Yes
or No
When completed, sum the yes answers. While still subjective, the greater number of yes answers,
the stronger the study is likely to be.
4 Guide to an Overall Critique of a Quantitative Research Article
Polit & Beck (2017) p 102-105
Student
Name
Date
Article
Citation
(APA format )
NUR 610 INSTRUCTIONS: The format of the critique follows the sections of the article. Pay attention to
section headers on this document as that is where you will find information in the article. After
answering YES/NO to the critique question (make answer bold or in italics), follow with a brief
explanation or description of how the research demonstrated that the answer to the question. If the
question does not apply to the study, state that in the box.
Aspect of the Research Article
Title
1. Is the title logical, succinctly suggesting key variables and the study population? Explain: Yes
or No
Abstract
2. Does the abstract clearly and concisely summarize the main features of the research
article (problem, methods, results, conclusions)? Explain:
Yes
or No
Introduction
Statement of Problem
3. Was the problem stated clearly and was it easy to identify? Explain: Yes
or No
4. Is the problem significant for nursing? Explain: Yes
or No
Was there a good match between the research problem and the use of a quantitative
method to find the answer (versus qualitative)? Explain:
Yes
or No
Hypothesis or research questions
5. Was the research question (or questions) and/or hypotheses clearly stated? Explain: Yes
or No
Literature Review
6. Did the article adequately summarize the existing body of knowledge related to the
problem or phenomenon of interest? Explain:
Yes
or No
7. Was the literature review up-to-date (ideally less than 5 years unless classic)? Describe: Yes
or No
1
Guide to an Overall Critique of a Quantitative Research Article
Polit & Beck (2017) p 102-105
8. Did the literature review provide support that the research performed in the article needed
to be done (identify gap in literature/knowledge)? Explain:
Yes
or No
Conceptual/Theoretical Framework
9. Were the key concepts adequately defined? Explain: Yes
or No
10. Was the framework articulated clearly? Explain: Yes
or No
Methods
Protection of Human Rights
11. Were appropriate procedures used to safeguard rights of the study participants? Explain: Yes
or No
12. Was the study reviewed by an Institutional Review Board (or ethics committee)? Explain: Yes
or No
Research Design
13. Was the most rigorous design used for the research (Experimental (RCT),
Quasi-experimental, Non-experimental)? Explain:
Yes
or No
14. Were the data collection points appropriate (when the data was measured based on the
study design)? Explain:
Yes
or No
15. Did the design minimize biases and threats to the internal and external validity of the
study? Explain:
Yes
or No
Population and Sample
16. Was the population identified/ the sample described sufficiently? Explain: Yes
or No
17. Was the best sampling design used to enhance representation of population? Explain: Yes
or No
18. Was the sample size adequate? Explain: Yes
or No
Data collection and measurement
19. Were the key variables measured using an appropriate method? Explain: Yes
or No
20. Were the tools or instruments used adequately described and appropriately
administered? Was the validity of the tools described? Explain:
Yes
or No
21. Did the report provide evidence that the data collection methods yielded data that were
reliable and valid? Explain:
Yes
or No
Procedures
2
Guide to an Overall Critique of a Quantitative Research Article
Polit & Beck (2017) p 102-105
22. If there was an intervention, was it adequately described and implemented? Explain: Yes
or No
23. Were data collected in a manner that minimized bias? If more than one person collected
data, was their training described? Explain:
Yes
or No
Results
Data Analysis
24. Were appropriate statistical methods used, given the level of measurement of the
variables, number of groups being compared, and assumptions of the tests? Explain:
Yes
or No
25. Were type I and type II errors avoided or minimized? Explain: Yes
or No
26. Were values missing? How were they evaluated and addressed? Explain: Yes
or No
Findings
27. Was information about statistical significance presented? Information about effect size
and precision of estimates? Explain:
Yes
or No
28. Were the findings adequately summarized, with good use of tables and figures? Explain: Yes
or No
Discussion
Interpretation of the findings
29. Were all major findings interpreted and discussed? Explain: Yes
or No
30. Were causal inferences or correlation discussed? Explain: Yes
or No
31. Was the issue of clinical significance discussed? Explain: Yes
or No
32. Did the report address the issue of the generalizability of the findings? Explain: Yes
or No
Implications/Recommendations
33. Did the researchers discuss the implications of the study for clinical practice or further
research – and were those implications reasonable and complete? Explain:
Yes
or No
General Issues
Presentation
34. Was the report well-written, organized, and sufficiently detailed for critical analysis?
Explain:
Yes
or No
3
Guide to an Overall Critique of a Quantitative Research Article
Polit & Beck (2017) p 102-105
35. In intervention studies, was a CONSORT flowchart provided to show the flow of
participants in the study? If does not apply, note that here:
Yes
or No
36. Was the report written in a manner that makes the findings accessible to practicing
nurses? Explain:
Yes
or No
Researcher Credibility
37. Do the researchers clinical, substantive, or methodologic qualifications and experience
enhance confidence in the findings and their interpretation?
Yes
or No
Summary Assessment
38. Does the study contribute any meaningful evidence that can be used in nursing practice
or that is useful to the nursing discipline?
Yes
or No
When completed, add up the yes answers. While still subjective, the greater number of yes answers,
the stronger the study is likely to be.
# Yes answers out of 38 possible
What is your overall
assessment of this
research article?
4 Medical Marijuana
Evidence lacking to support cannabis
for treating PTSD, chronic pain
S ide effects across all categories were
more frequently reported with ket-
amine treatment compared with placebo for
depression, a systematic review has found,
but few of the studies that were included in
the review examined long-term effects of ket-
amine dosing. The researchers recommended
the initiation of large-scale trials involving
repeated doses of ketamine. Results of the re-
view were published online July 27 in Lancet
Psychiatry.
The need for more rapidly acting an-
tidepressant treatments has contributed to
the growing interest in the use of ketamine.
However, few of the completed studies of
S ystematic reviews published online
Aug. 15 in the Annals of Internal
Medicine concluded that there is insufficient
evidence to support the use of cannabis in
treating post-traumatic stress disorder (PTSD)
and chronic pain. The review of research on
cannabis in pain treatment did find limited
evidence suggesting that the drug can relieve
neuropathic pain in some patients, but that
review also found evidence that cannabis use
can generate or exacerbate psychotic or manic
symptoms.
With more than half of the states in the
United States now authorizing medical use of
marijuana, such use has become increasingly
common and accepted, with pain manage-
ment and treatment of PTSD cited among the
adverse effects
VOLUME 28, NUMBER 12
DECEMBER 2017
ISSN 1068-5308
ONLINE ISSN 1556-7532
Editor:
Lawrence H. Price, M.D.
Highlights
Our top story this month
illustrates the continuing difficulty
of drawing firm conclusions about
the possible therapeutic effects of
cannabis. Systematic reviews of
cannabis for post-traumatic stress
disorder and chronic pain both
concluded that there remains a
lack of well-designed studies on the
drug’s effects.
Inside
drug-drug interactions . . .2
Warfarin and SSRIs
Whats neW in research
Risk of relapse to binge eating
disorder lower for lisdexamfetamine
compared with placebo . . . . . . . .3
Neonatal drug withdrawal
risk increased by concurrent
psychotropic plus opioid
treatment versus opioid alone . .4
research roundup
Omega-3 supplements improve
symptoms in children with ADHD . .7
Variable benefit of antidepressants
for youths with depressive, anxiety
disorders . . . . . . . . . . . . . . . . . . .7
Use of SSRIs not associated
with bone density change . . . . . .8
FREE PATIENT HANDOUT: MEMANTINE (GENERIC) NAMENDA (BRAND)
KetaMine, continued on page 6
evidence, continued on page 5
View this newsletter online at
wileyonlinelibrary.com
DOI: 10.1002/pu
Review of ketamine safety highlights
need for analyses of long-term effects
prcis
Two systematic reviews were conducted
to evaluate the benefits and harms
of cannabis in the treatment of post-
traumatic stress disorder (PTSD) and
chronic pain.
Researchers concluded in both cases that
methodological limitations in most of the
existing studies make it difficult to draw
broad conclusions about the therapeutic
effects of cannabis. There is some low-
strength evidence that cannabis may
alleviate neuropathic pain.
The researchers raised concern about
evidence showing an association between
cannabis use and the development or
worsening of psychotic symptoms.
prcis
A systematic review encompassing 60
studies examined the safety of ketamine
treatment for depression.
In studies that included a placebo group,
side effects across all categories were
more common in ketamine patients than
in placebo patients. Anxiety was the most
commonly reported acute psychiatric
side effect, and dissociation was the most
commonly reported psychotomimetic side
effect.
More research on longer-term effects
of ketamine is needed before ketamine
can be formally recommended for use in
depression treatment, the researchers
suggested.
decemBer 2017 The Brown UniversiTy PsychoPharmacology UPdaTe 5
most common reasons for medical use.
However, little comprehensive informa-
tion about the potential benefits and harms
of cannabis for either of these conditions
has been available.
Maya E. ONeil, Ph.D., and Shannon
M. Nugent, Ph.D., both of the VA Port-
land Health Care System in Oregon, led
systematic reviews of the effects of canna-
bis in the treatment of PTSD and chronic
pain, respectively. The review of evidence
in chronic pain treatment also included an
overview of the physical and mental health
effects of cannabis use.
Study methods
PTSD
The review of studies of cannabis for
PTSD involved a comprehensive search of
data published through March 2017. Stud-
ies eligible for inclusion were those that
assessed the effects of plant-based can-
nabis preparations or whole-plant extracts,
such as the nonsynthetic pharmaceutical
agent nabiximols (Sativex). Synthetic
pharmaceutical cannabinoids were not in-
cluded in the analysis because they are
generally not available in medical mari-
juana dispensaries.
The primary outcome in the analy-
sis was the effect of cannabis on PTSD
symptoms and severity, with secondary
outcomes including quality of life, mental
health, and health care utilization. A meta-
analysis was not conducted because of the
small overall number of available studies
and differences in their methodology.
Chronic pain
The review of studies of cannabis for
chronic pain originally examined research
published through February 2016, and
then updated the search to include new
randomized controlled trials and system-
atic reviews in March 2017. As in the case
of the PTSD review, only studies of plant-
based cannabis preparations or whole-
plant extracts were considered for inclu-
sion. Studies of cannabis for neuropathic
pain were included in a meta-analysis to
examine how many patients experienced
a clinically significant improvement of at
least 30% in their pain. The review also
examined the potential harms of cannabis
use, including in this analysis case series
and descriptive studies of emerging harms
believed to be related to cannabis use.
Results
PTSD
The review of studies of cannabis in
PTSD treatment identified two system-
atic reviews and three individual studies.
One of the systematic reviews consisted
of six studies, but two were prospective,
open-label trials without a control group
and one was a case series. The authors of
that review concluded that evidence was
insufficient to evaluate the effectiveness
of cannabis. The other systematic review
evaluated four observational studies, with
three finding that cannabis was associated
with less severe PTSD symptoms but the
other finding that it was associated with
worsening PTSD symptoms.
A large individual study of 47,000 vet-
erans in VA programs for PTSD between
1992 and 2011 found that individuals who
either started using cannabis after program
admission or continued previous use had
worse PTSD symptoms at 4 months than
those who stopped cannabis use after
program admission or had never used.
Those who started or continued use also
had higher levels of drug abuse, and can-
nabis starters had a higher level of violent
behavior than the other groups.
A study that examined cannabiss
effect on PTSD symptom severity after
cognitive behavioral therapy for PTSD
with substance use found that more fre-
quent cannabis use was associated with
more severe PTSD symptoms in the early
stages of treatment, but less severe symp-
toms later on. Overall, we found insuffi-
cient evidence regarding the benefits and
harms of plant-based cannabis prepara-
tions for patients with PTSD, authors of
the systematic review wrote.
Chronic pain
The review of studies of cannabis in
pain management identified 13 system-
atic reviews and 62 individual studies.
Research examining the effects of canna-
bis on neuropathic pain related to various
health conditions found low-strength evi-
dence that cannabis may alleviate pain.
More patients using cannabis in these
studies showed clinically significant pain
relief up to several months later. One
study of 246 patients found a significant
decrease in pain among study completers
only, with reductions in pain no longer
statistically significant when all of the
enrolled participants were included.
There was insufficient evidence to sup-
port the use of cannabis in the treatment
of pain for patients with multiple sclerosis
or cancer, the researchers reported, based
primarily on a small number of studies and
their methodological limitations.
The researchers did not find evidence
of a higher risk of general adverse events
from cannabis in the majority of the exam-
ined pain trials. However, one systematic
review and eight individual studies found
an association between cannabis use and
the development of psychotic symptoms,
based largely on the tetrahydrocannabinol
(THC) content of the drug. In addition,
a systematic review of six studies found
low-strength evidence of an association be-
tween cannabis use and worsening of manic
symptoms in patients with bipolar disorder.
Implications
Researchers for both reviews stated
that the evidence is too limited to draw
firm conclusions about the potential ben-
efits and harms of cannabis for PTSD and
pain. While there have been numerous an-
ecdotal reports of individuals with PTSD
benefiting from cannabis, ONeil and col-
leagues stated that it cannot be determined
whether these perceived effects result from
the drug, a placebo effect, or the natural
progression of symptoms.
ONeil told The Update that high-quality
randomized controlled trials are needed in
order to determine whether cannabis is ef-
fective for PTSD. Since there is some evi-
dence that cannabis has been associated with
adverse mental health and cognitive effects,
future studies should carefully keep track of
evidence
continued from page 1
continued on next page
There is a growing body
of evidence that pretty
consistently shows can-
nabis use is associated
with an increased risk of
psychotic symptoms, and
perhaps also an increased
risk of psychotic spectrum
disorders.
Shannon M. Nugent, Ph.D.
6 The Brown UniversiTy PsychoPharmacology UPdaTe decemBer 2017
KetaMine
continued from page 1
ketamines safety have been randomized
controlled trials, and few have examined
the effects of repeated treatments, which
is emerging as a strategy in the use of ket-
amine for depression.
In order to gain a broader under-
standing of the acute and longer-term ef-
fects of ketamine treatment, Brooke Short,
M.D., of the New South Wales Institute
of Psychiatry in Australia, and colleagues
conducted the first systematic review of
ketamines safety after single and repeated
doses in the treatment of depression.
Study methods
The researchers conducted a search for
studies between 1999 and 2016. Studies
were eligible if they reported on the ef-
fects of one or more doses of ketamine in
adults with unipolar or bipolar depression,
with change in depression status included
as a primary outcome. Numerous study
designs were eligible for inclusion.
Information collected for each study
included but was not limited to ketamine
administration details and pre-adminis-
tration health screening for issues such
as pre-existing medical conditions and
concurrently used medications. Adverse
effects from treatment were categorized
into subgroups that included psychiatric,
psychotomimetic or dissociative, cardio-
vascular, neurological, and other.
The researchers also examined factors
affecting the quality of study data, such as
selective outcome reporting, withdrawal
from treatment, and use of a control group.
Plans to conduct a meta-analysis were
discarded because of a lack of consistency
among selected studies in their dosing and
reporting methods, as well as variation
in the level of reporting bias among the
studies.
Results
Sixty studies were included in the anal-
ysis, encompassing a total of 899 patients
receiving at least one dose of ketamine.
Most of the studies did not include a pla-
cebo group, and only 20% of the studies
examined long-term side effects. Among
these effects and should be conducted for a
long enough period of time to get a sense
of the duration of benefits and whether po-
tential harms might emerge with long-term
use, she said. She added that future research
will need to test a number of different can-
nabis preparations with varying amounts of
THC and cannabidiol.
Nugent told The Update that while a
great deal still needs to be researched in
the area of the mental health effects of
cannabis use, There is a growing body
of evidence that pretty consistently shows
cannabis use is associated with an in-
creased risk of psychotic symptoms, and
perhaps also an increased risk of psychotic
spectrum disorders. The other area of con-
cern is the risk of substance use disorder.
About one in three people reporting any
cannabis use in the last year have cannabis
use disorder.
For both conditions examined in the
systematic reviews, there are well-designed
studies underway that should expand the
knowledge base on cannabiss effects. Nu-
gent said that seven ongoing clinical tri-
als in pain management are examining a
more broad range of cannabis preparations
and various routes of administration, and
include chronic pain populations that have
previously been understudied.
In an editorial accompanying the jour-
nal articles, Sachin Patel, M.D., Ph.D., of
Vanderbilt Psychiatric Hospital in Nash-
ville, Tennessee, theorized that the results
of the ongoing studies might not do much
to sway the direction of public policy or
public opinion that increasingly favors the
use of cannabis for a variety of medical
conditions.
Even if future studies reveal a clear
lack of substantial benefit of cannabis for
pain or PTSD, legislation is unlikely to
remove these conditions from the list of
indications for medical cannabis, Patel
wrote. It will be up to front-line practic-
ing physicians to learn about the harms
and benefits of cannabis, educate their pa-
tients on these topics, and make evidence-
based recommendations about using can-
nabis and related products for various
health conditions.
[Editors note: We addressed the co-
nundrum of medical marijuana in a Com-
mentary in our September 2011 issue. At
that time, we observed: pretending
that the problem of criminalized mari-
juana is solved by the current process of
medicalizing it demeans and trivializes
the entire drug evaluation system we have
developed to ensure the integrity of our
pharmacopoeia. Its inconceivable that any
other pharmaceutical agent would be simi-
larly approved for prescription by physi-
cians without regard to provenance, purity,
dosage, indication, safety, or efficacy. Ul-
timately, this is bad for medicine and bad
for the public. If we want to use marijuana
for medical purposes, we should subject it
to the kind of rigorous research we have
come to require for those purposes. Six
years later, these two important reviews
underscore those comments.]
PTSD study co-author Benjamin J. Morasco,
Ph.D., reported receiving grants from the U.S. De-
partment of Veterans Affairs during the study.
RefeRences
ONeil ME, Nugent SM, Morasco BJ, et al. Ben-
efits and harms of plant-based cannabis for post-
traumatic stress disorder: A systematic review. Ann
Intern Med 2017; published online Aug 15; doi:
10.7326/M17-0477. Correspondence to: Maya E.
ONeil, Ph.D., VA Portland Health Care System,
RD 66, 3710 Southwest U.S. Veterans Hospital
Road, Portland, OR 97239; Email: [emailprotected]
va.gov.
Nugent SM, Morasco BJ, ONeil ME, et al. The
effects of cannabis among adults with chronic pain
and an overview of general harms: A systematic
review. Ann Intern Med 2017; published online
Aug 15; doi: 10.7326/M17-0155. Correspondence
to: Shannon M. Nugent, Ph.D., VA Portland Health
Care System, RD 66, 3710 Southwest U.S. Veter-
ans Hospital Road, Portland, OR 97239; Email:
[emailprotected]
Patel S. Cannabis for pain and posttraumatic stress
disorder: More consensus than controversy or vice
versa? Ann Intern Med 2017; published online Aug
15; doi: 10.7326/M17-1713. Correspondence to:
Sachin Patel, M.D., Ph.D., Vanderbilt Psychiatric
Hospital, 1601 23rd Avenue South, Nashville, TN
37232; Email: [emailprotected]
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without the copyright holder’s express written permission. However, users may print,
download, or email articles for individual use. Medical Cannabis Use: Exploring the Perceptions and Experiences of Older Adults
with Chronic Conditions
Lydia Manning PhD and Lauren Bouchard MS
College of Graduate and Studies/Center for Gerontology, Concordia University-Chicago, River Forest, Illinois, USA
ABSTRACT
Objectives: Although the rate of cannabis use by older adults is increasing more quickly than all
other age groups, little is known about the reasons older adults use cannabis and the outcomes
they experience. With this research, we investigated older adults perceptions and experiences of
medical cannabis use to treat and/or manage chronic conditions, specifically as a substitute for
prescription drugs.
Methods: Researchers relied on qualitative inquiry in the form of semi-structured, one-on-one
interviewing to investigate the phenomenon of medical cannabis use for the management of
chronic conditions.
Results: Our findings suggest that older adults are open to medical cannabis as an alternative to
pharmaceutical drugs, hopeful with regard to the management of symptoms and pain, and aware
of and astute at managing issues related to stigma both from their physicians and family and
friends. Furthermore, older adults describe the frustrations with education, awareness, and lack of
support with dosing.
Conclusions: Participations found medical cannabis use to be beneficial in managing chronic
conditions and alleviating symptoms such as chronic pain. Findings are presented as an interpreta-
tion of the participants perceptions of their medical cannabis use. Implications for putting medical
cannabis use into everyday practice as well as policy implications are considered.
Clinical Implications: This information will help clinicians better support older adults desiring to
use medical cannabis. This research will help clinicians learn more about factors impacting medical
cannabis use, and the types of information an