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palliative approach

Alessandro Laviano, Gianluca Di Lazzaro Giraldi, Angela Koverech
PURPOSE OF REVIEW: Cachexia is a negative prognostic factor in cancer patients. The pathogenesis is related to a variable combination of reduced food intake and metabolic changes. However, whether nutritional support may contribute to effectively prevent and treat cachexia remains a debated issue. RECENT FINDINGS: Consistent evidence demonstrates that anabolic windows of opportunity occur during the clinical trajectory of cancer patients. Also, the use of specific nutrients, namely omega-3 fatty acids, may enhance the efficacy of nutritional support when tumor-driven inflammatory response is high...
October 7, 2016: Current Opinion in Supportive and Palliative Care
Mimi Jenko, Nancy M Short
Bereavement services for families are an established part of hospice and palliative care. However, patients also die in the acute care and long-term care environments. Often, hospice is not involved, creating a potential gap in care. This article recounts a journey to improve care for all families of deceased patients, despite the presence or absence of hospice. A palliative care clinical nurse specialist led a quality improvement team, which used a systems thinking approach to develop and implement a downloadable bereavement booklet for families...
November 2016: Dimensions of Critical Care Nursing: DCCN
Oliver Sartor
Radiopharmaceuticals used in the treatment of castrate-resistant prostate cancer are reviewed herein with an emphasis on sequential and combination therapies. Four bone-seeking radiopharmaceuticals had been approved in the United States. Three of these are β-emitters (phosphorus-32, strontium-89, samarium-153-ethylenediaminetetramethylene-phosphonic acid) that are approved for palliative purposes. One α-emitter (radium-223 [Ra]) is approved for prolongation of survival in bone metastatic castrate-resistant prostate cancer...
September 2016: Cancer Journal
Maria Norinder, Ida Goliath, Anette Alvariza
OBJECTIVE: Patients who receive palliative home care are in need of support from family members, who take on great responsibility related to caregiving but who often feel unprepared for this task. Increasing numbers of interventions aimed at supporting family members in palliative care have been described and evaluated. It is not known whether and how these interventions actually affect the care or support provided to a patient, even though it has been suggested that family members would be likely to provide better care and support and thus allow for positive experiences for patients...
October 17, 2016: Palliative & Supportive Care
Stephanie Jones-Berry
A palliative care charity has developed a new approach to end of life care based on the Human Rights Act (HRA).
September 14, 2016: Nursing Standard
Jeffrey J Tosoian, Michael A Gorin, Ashley E Ross, Kenneth J Pienta, Phuoc T Tran, Edward M Schaeffer
The oligometastatic state has been proposed as an intermediate stage of cancer spread between localized disease and widespread metastases. With improvements in diagnostic modalities such as functional imaging, oligometastatic prostate cancer is being diagnosed with greater frequency than ever before. Furthermore, the paradigm for treatment of advanced prostate cancers is shifting toward a more aggressive approach. Many questions surround the understanding of the process and consequences of oligometastasis, meaning that the contemporary literature offers a wide variety of definitions of oligometastatic prostate cancer...
October 11, 2016: Nature Reviews. Urology
Christian Michael Horvath, Martin Horvath Brutsche, Otto Dagobert Schoch, Bernarde Schillig, Florent Baty, Dieter vonOw, Jochen Julius Rüdiger
Non-invasive ventilatory support is frequently used in patients with severe respiratory failure (SRF), but is often limited to intensive care units (ICU). We hypothesized that an instantaneous short course of NIV (up to 2 h), limited to regular working hours as an additional therapy on the emergency department (ED) would be feasible and could improve patient´s dyspnoea measured by respiratory rate and Borg visual dyspnea scale. NIV was set up by an interdisciplinary respiratory care team. Outside these predefined hours NIV was performed in the ICU...
October 8, 2016: Internal and Emergency Medicine
Christian P Strassburg
BACKGROUND: Hepatocellular carcinoma (HCC) represents an increasing health burden worldwide and a challenging disease both in terms of diagnosis and treatment. METHODS: The literature available on PubMed for the period of 1990-2016 was reviewed with reference to liver allocation, HCC, liver transplantation (LT), and prediction, and the allocation rules of the German Transplant Act were reviewed. RESULTS: Due to etiological and geographical diversity, HCC is not a homogeneous disease...
August 2016: Visc Med
Daryl Bainbridge, Deanna Bryant, Hsien Seow
INTRODUCTION: Measuring palliative care experience using patient-reported outcomes is becoming important for assessing and improving quality, though most validated outcome tools solely use scaled questions. We analyzed open text survey responses from bereaved caregivers to identify strengths and weaknesses in the quality of end-of-life care services and to assess the usefulness of qualitative survey data for quality improvement. METHODS: This was a retrospective observational study involving bereaved caregivers of decedents who had received palliative homecare services in one of six healthcare regions in Ontario, Canada...
October 5, 2016: Journal of Pain and Symptom Management
Emanuele D'Amico, Aurora Zanghì, Francesco Patti, Mario Zappia
Multiple sclerosis (MS) is a progressive disease of the central nervous system with unknown etiology. It could be associated with severe disability and losses of physical, psychological and social role functioning over time. People with MS share experiences in common with people affected by diseases with a shorter and clearer terminal phase. Therefore, it is appropriate to offer a palliative care approach to people with severe MS and their caregivers. Areas covered: Benefits for severe MS patients and their caregivers were shown when palliative care was included in their care...
October 8, 2016: Expert Review of Neurotherapeutics
Julie C McDonald, Jeanne M du Manoir, Nanor Kevork, Lisa W Le, Camilla Zimmermann
PURPOSE: The purposes of the study were to assess awareness and prevalence of advance directives (ADs) among patients with advanced cancer undergoing active outpatient care and to determine factors associated with AD completion before and after the diagnosis of cancer. METHODS: Patients with advanced solid tumor malignancy receiving treatment at the Chemotherapy Day Unit were approached for recruitment. They completed an onsite questionnaire about completion and timing of ADs, demographic information, and perceived health; a review of their medical records was conducted to document their cancer care and co-morbidities...
October 7, 2016: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
Mohammed Rafique Moosa, Jonathan David Maree, Maxwell T Chirehwa, Solomon R Benatar
Universal access to renal replacement therapy is beyond the economic capability of most low and middle-income countries due to large patient numbers and the high recurrent cost of treating end stage kidney disease. In countries where limited access is available, no systems exist that allow for optimal use of the scarce dialysis facilities. We previously reported that using national guidelines to select patients for renal replacement therapy resulted in biased allocation. We reengineered selection guidelines using the 'Accountability for Reasonableness' (procedural fairness) framework in collaboration with relevant stakeholders, applying these in a novel way to categorize and prioritize patients in a unique hierarchical fashion...
2016: PloS One
Marco Rogante, Claudia Giacomozzi, Mauro Grigioni, Dahlia Kairy
AIMS: To evaluate the quality of systematic reviews on telemedicine applications in palliative care. METHODS: A structured literature review was conducted to identify systematic reviews dealing with telemedicine in palliative care; the AMSTAR (Assessment of Multiple Systematic Reviews) checklist was used to appraise the evidence related to the systematic reviews. RESULTS: 405 records were initially identified; of these 14 were eligible for full-text analysis...
July 2016: Annali Dell'Istituto Superiore di Sanità
Stefano Bogliolo, Chiara Cassani, Mattia Dominoni, Anna Orlandini, Simone Ferrero, Anna Daniela Iacobone, Franco Viazzo, Pier Luigi Venturini, Arsenio Spinillo, Barbara Gardella
Endometrial cancer is the most common malignancy of the female genital tract in industrialized countries. The traditional treatment of endometrial cancer is based on a surgical approach. In recent years, systemic endocrine therapy has demonstrated good efficacy in recurrent or metastatic setting, delaying progression, ameliorating quality of life and palliating symptoms. Areas covered: Phase I and II studies on selective estrogen receptor down-regulators used for the treatment of endometrial cancer treatment have been reviewed...
October 4, 2016: Expert Opinion on Drug Metabolism & Toxicology
Sharon L Cheatham, Grace M Deyo
Hybrid stage I palliation combines cardiothoracic surgery and interventional transcatheter procedures for treatment of hypoplastic left heart syndrome. The approach is an alternative to the Norwood procedure, the traditional first stage of surgical palliation. Hybrid stage I palliation involves placing bilateral branch pulmonary artery bands and a patent ductus arteriosus stent through a median sternotomy, performed without cardiopulmonary bypass. The purpose of the bands is to control blood flow to the lungs and protect the pulmonary bed while the stent sustains systemic cardiac output...
October 2016: Critical Care Nurse
Gianluigi Perri, Sergio Filippelli, Rachele Adorisio, Roberta Iacobelli, Francesca Iodice, Giuseppina Testa, Maria Giovanna Paglietti, Domenico D'Amario, Massimo Massetti, Antonio Amodeo
OBJECTIVE: We report our experience with the use of a left ventricular assist device (LVAD) as destination therapy (DT) for the management of patients with cardiac end-stage dystrophinopathies. METHODS: From February 2011 to February 2016, 7 patients with dystrophinopathies and dilated cardiomyopathy (DCM) were treated with LVADs at our institution. Median age at surgery was 16.5 years (range, 14.2-23.4 years). All patients were preoperatively evaluated by a multidisciplinary team approach...
August 28, 2016: Journal of Thoracic and Cardiovascular Surgery
István Hartyánszky, Gábor Bogáts
INTRODUCTION: Congenital heart defects are frequently present in patients with Down syndrome. AIM: The authors analyzed the impact of changing approach in surgical management of congenital heart defect on the life expectancy of patients with Down syndrome. METHOD: Between 1974 and 1997 the data of 359 children with Down syndrome were collected. Among them 255 patients had no surgery and the mortality in this group was 25.9%, whereas the mortality in the group of 104 patients who underwent palliative surgery was 8...
October 2016: Orvosi Hetilap
Shrikant Atreya
Patients with advanced malignancy often experience symptoms of disease and treatment that contribute to distress and diminish their quality of life. Most of these patients present to the emergency department thus raising its importance in providing such care especially at the end of life situation. An approach that is aimed at controlling these symptoms, whether or not undergoing curative therapy, is a key feature of high-quality patient-centered care. This paper explores the potential role of palliative medicine in the emergency room and how early integration with emergency care can help improve the quality of life of patients and thus achieve better outcomes...
July 2016: Indian Journal of Medical and Paediatric Oncology
Ly Tu, Maria-Rosa Ghigna, Carole Phan, Jennifer Bordenave, Morane Le Hiress, Raphaël Thuillet, Nicolas Ricard, Alice Huertas, Marc Humbert, Christophe Guignabert
Pulmonary arterial hypertension (PAH) is a disorder in which mechanical obstruction of the pulmonary vascular bed is largely responsible for the rise in mean pulmonary arterial pressure (mPAP), resulting in a progressive functional decline despite current available therapeutic options. There are multiple mechanisms predisposing to and/or promoting the aberrant pulmonary vascular remodeling in PAH, and these involve not only altered crosstalk between cells within the vascular wall but also sustained inflammation and dysimmunity, cell accumulation in the vascular wall and excessive activation of some growth factor-stimulated signaling pathways, in addition to the interaction of systemic hormones, local growth factors, cytokines, and transcription factors...
2016: Biologie Aujourd'hui
Jiaywei Tsauo, Moon-Won Yoo, Jung-Hoon Park, Ho-Young Song, Eun Jung Jun, Young Chul Cho, Guk Bae Kim
BACKGROUND: Self-expandable metallic stent (SEMS) placement is a well-established palliative treatment approach for malignant gastroduodenal obstruction. In patients with a long (>10 cm) stricture, multiple stents placed in an overlapping fashion are often required. PURPOSE: To investigate the outcomes of overlapping SEMS placement for the palliative treatment of malignant gastroduodenal obstruction in patients with a long (>10 cm) stricture. MATERIAL AND METHODS: The medical records of 40 patients who underwent fluoroscopic overlapping SEMS placement for malignant gastroduodenal obstruction due to a long (>10 cm) stricture were reviewed...
September 28, 2016: Acta Radiologica
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