2022 AAHA Pain Management Guidelines for Dogs and Cats.

These updated guidelines present a practical and logical approach to the assessment and management of acute and chronic pain in canine and feline patients. Recognizing pain is fundamental to successful treatment, and diagnostic guides and algorithms are included for assessment of both acute and chronic pain. Particularly for chronic pain, capturing owner evaluation is important, and pain-assessment instruments for pet owners are described. Expert consensus emphasizes proactive, preemptive pain management rather than a reactive, "damage control" approach. The guidelines discuss treatment options centered on preemptive, multimodal analgesic therapies. There is an extensive variety of pharmacologic and nonpharmacologic therapeutic options for the management of acute and chronic pain in cats and dogs. The guidelines include a tiered decision tree that prioritizes the use of the most efficacious therapeutic modalities for the treatment of acute and chronic pain.

The Role of Outcome Forecasts in Patients' Treatment Decisions--Evidence from a Survey Experiment on Knee Replacement Surgery.

OBJECTIVE: To analyze the effect of personalized outcome probabilities on treatment decisions. DATA SOURCE: American Life Panel. STUDY DESIGN: We designed an experimental survey that respondents answered by recommending replacement surgery for hypothetical patients diagnosed with knee osteoarthritis. The primary manipulation was whether respondents were given personalized outcome probabilities for the patients. PRINCIPAL FINDINGS: Patient-specific outcome forecasts significantly influenced decisions, with effect sizes comparable to those of physicians' opinions and patient testimonials. The presentation format also affected the probabilities' influence on choices. We did not find evidence that the educational level of subjects affected the weight that they give to outcome probabilities in making recommendations. CONCLUSION: Our study points to a need for more research on the use of patient-specific outcome forecasts.

Promoting safe and comfortable driving for elders.

Americans are life-long drivers. It is imperative that aging drivers remain on the road safely. This chapter addresses one strategy for achieving this end, namely the utilization of low-tech vehicle modifications for addressing challenges with driving due to functional deficits that normally occur with aging. It focuses primarily on the selection of useful features to be demonstrated in a video intervention in a research project to assess whether watching the video would increase elders' awareness of and likelihood of using the features. The features were chosen with the assistance of a panel of experts in transportation, aging, rehabilitation, and related fields plus a focus group of older drivers. Selecting the features, developing survey instruments, and producing the video constitute Phase I of the study. Phase II investigates whether watching a video would increase older drivers' awareness of such features and motivate them to use any of them. This chapter also includes an overview of Phase II and some comments with respect to high-tech features and the future of automobile travel.

Contributions of Second Opinions, Outcome Forecasts, and Testimonials to Patient Decisions about Knee Replacement Surgery.

BACKGROUND: Decision aids are now a well-established means of supporting patients in their medical decision making. The widespread use of decision aids invites questions about how their components contribute to patient decisions. OBJECTIVE: The objective of this study was to measure the importance of second opinions, patient-specific outcome forecasts, and patient testimonials relative to patient clinical and socioeconomic factors and the primary physician recommendation on the decision to undergo full knee replacement surgery to treat knee osteoarthritis. METHODS: Middle-aged and older members of the RAND American Life Panel (N = 1616) chose whether to recommend surgery as a treatment for each of 3 hypothetical patients (vignettes) presented in a video-enhanced internet survey. Vignettes randomly sampled levels of scenario attributes. RESULTS: Second opinions, person-specific outcome forecasts, and 2 consistent patient testimonials strongly affected respondents' decision making; a single testimonial, however, did not significantly affect decisions. CONCLUSIONS: Information provided in a decision aid, including person-specific outcome forecasts and testimonials, can affect patient choices. The strong effect of testimonials and respondents' interest in reviewing them reinforces concerns about unwanted influence when testimonials are biased.

Language barriers surrounding medication use among older Latinos.

Limited English language proficiency forms a significant challenge for many Latinos in clinical settings. Although medications are commonly used by older individuals as a means of maintaining good health and managing health problems, the extent to which English proficiency is related to medication use among older Latinos is not known. Focus groups were conducted with Latino, community-residing individuals aged 50 and over in eastern Massachusetts. Qualitative evaluation of the group interviews suggests that language is a barrier in dealing with medication for these individuals. Limited English proficiency appears to be related to feelings of being discriminated against in clinical and pharmacy settings. As well, communicating directly with health professionals in a common language is associated with level of trust and confidence in medical settings. Use of formal and informal interpreters, as well as seeking Spanish-speaking physicians and pharmacies with Spanish-speaking staff, are identified as strategies for overcoming health-related obstacles surrounding language.