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Dyspnea AND palliative

Helen Senderovich, Akash Yendamuri
INTRODUCTION: Dyspnea is prominently observed in palliative care (PC). Dyspnea can be multifactorial, primarily caused by obstructive or restrictive lung diseases or secondarily induced by various comorbidities. Numerous interventions exist, with route of administration and efficacy requiring further discussion. Despite opioids being the first line of treatment, their adverse effects lead to reluctance on the side of patients to take them, creating limitations in patient management planning...
October 16, 2018: Rambam Maimonides Medical Journal
Haider Javed Warraich, Joseph G Rogers, Shannon M Dunlay, Ellen Hummel, Robert J Mentz
Heart failure (HF) is an increasingly prevalent condition with a very high symptom burden. To address challenges faced by palliative care clinicians, we assembled a team of experts to provide high-yield tips for the management of these patients. Prognosis is unpredictable in HF and many patients and physicians overestimate survival. Ejection fraction, notably, is not predictive of prognosis. It is important to have thorough discussions about implantable cardioverter defibrillators in terminally ill HF patients...
October 11, 2018: Journal of Palliative Medicine
K Ducharlet, V Sundarajan, J Philip, J Weil, N Barker N, R G Langham, J Burchell, H Gock
Symptom and quality of life (QOL) measures in patients with advanced chronic kidney disease (CKD) are recognised indicators of patient-centred care and represent important research, quality and clinical measures. This study examined relationships between symptom burden, QOL and functional status and associations of symptoms and mortality risk. A multisite longitudinal cohort analysis was undertaken in CKD stage 4/5 (no dialysis, ND) and dialysis patients. Patients completed symptom and QOL measures (Palliative Care Outcome Symptom Score (POS-S renal) [1], World Health Organisation QOL, WHOQOL-BREF) [2] and Karnofsky Performance scale [3]...
October 8, 2018: Nephrology
Katherine R Miller, Jai N Patel, James T Symanowski, Connie A Edelen, Declan Walsh
OBJECTIVE: Studies suggest acupuncture improves cancer-related symptoms; however, it is unclear whether patient characteristics predict pain response. This study determined acupuncture's effect on cancer-related pain and identified variables associated with pain response. METHODS: A retrospective chart review included adult patients with cancer referred to palliative medicine and received acupuncture for pain management. Paired t tests compared differences in pain scores from pre- to postacupuncture...
October 4, 2018: American Journal of Hospice & Palliative Care
Ferdinando Garetto, Ferdinando Cancelli, Romina Rossi, Marco Maltoni
Palliative sedation (PS) is performed in the terminally ill patient to manage one or more refractory symptoms. Proportional PS, which means that drugs can be titrated to the minimum effective dose, is the form most widely used. From a quarter to a third of all terminally ill patients undergo PS, with a quarter of these requiring continuous deep sedation. The prevalence of PS varies according to the care setting and case mix. The most frequent refractory physical symptoms are delirium and dyspnea, but PS is also considered for existential suffering or psychological distress, which is an extremely difficult and delicate issue to deal with...
October 2018: CNS Drugs
Nathalie Gaucher, Nago Humbert, France Gauvin
OBJECTIVES: The objective of this study was to describe the characteristics of pediatric palliative care (PPC) patients presenting to a pediatric emergency department (ED) and these patients' ED visits. METHODS: This retrospective chart review was conducted from April 1, 2007, to March 31, 2012, in a tertiary care pediatric university-affiliated hospital. Eligible patients had initial PPC consultations during the study period; all ED visits by these patients were included...
September 25, 2018: Pediatric Emergency Care
Ahsan Azhar, Yu Jung Kim, Ali Haider, David Hui, Vishidha R Balankari, Margeaux Chiou Epner, Minjeong Park, Diane D Liu, Janet Williams, Susan E Frisbee-Hume, Julio A Allo, Eduardo Bruera
BACKGROUND: There is limited evidence about the response of breakthrough pain (BTP) to the most commonly used oral immediate-release (IR) opioids. Our aim was to determine response rate to oral IR opioids for BTP control in patients with advanced cancer. MATERIALS AND METHODS: In this prospective study, palliative care outpatients, with advanced cancer and adequately managed background pain, were asked to complete a self-administered survey. We assessed patients' baseline demographics, pain characteristics, alcoholism (CAGE questionnaire), tobacco and substance abuse, and Edmonton Symptom Assessment Scores (ESAS)...
September 25, 2018: Oncologist
Guilherme D Carvalho, Fernanda P Costa, João Alberto M Peruchi, Geris Mazzutti, Igor G Benedetto, Josiane F John, Lia A Zorzi, Marcius C Prestes, Marina V Viana, Moreno C Santos, Patrícia Schwarz, Paula P Berto, Thais C D Buttelli, Wagner Nedel, André Luís F Azeredo-da-Silva, Márcio M Boniatti
BACKGROUND: Despite the increase in the identification of patients at the end of life after the introduction of rapid response team (RRT), there is doubt as to whether there has been an improvement in the quality of care offered to these patients. Proper end-of-life care is the next expected step after identifying patients who are dying. OBJECTIVE: To evaluate the end-of-life care after limitations of medical treatment (LOMTs) as defined by an RRT. DESIGN: This is a single-center retrospective cohort study at a tertiary teaching hospital in Porto Alegre, Brazil, from July 2014 to July 2016...
September 22, 2018: Journal of Palliative Medicine
Lakshmi Saladi, Sai Mounica Maddu, Masooma Niazi, Ajsza Matela
Recent advances in imaging techniques led to an increase in the incidence of synchronous and metachronous primary lung cancers due to early detection. Management of these patients is challenging and prognosis depends on the stage of the tumor at initial diagnosis and histological type. A 68-year-old African American male patient with medical history of hypertension and diabetes mellitus presented to our emergency department with right sided chest pain, worsening dyspnea and dry cough of 2-week duration. He also reported significant weight loss and was a smoker with 25 pack-years smoking history...
August 2018: World Journal of Oncology
Max Lacour, Claudio Caviezel, Walter Weder, Didier Schneiter
The aim of lung volume reduction surgery (LVRS) for patients suffering from severe emphysema is to improve lung function and palliate dyspnea. Careful patient selection in a multidisciplinary approach in a high-volume center is mandatory for a successful outcome. Pulmonary complications including air leak and pneumonia as well as cardiac complications are the most common complications after LVRS. The following article will focus on most common complications observed after LVRS and review the management strategies to improve surgical outcome...
August 2018: Journal of Thoracic Disease
Rachel Shaw, Hallie Seegal, Joy G Miller, Jessica Keim-Malpass
Current research demonstrates that pediatric symptom management care is often initiated in the late stages of disease once clinicians are no longer able to meaningfully impact symptom burden. Given that physicians or nurse practitioners are responsible for initiating palliative care referrals, it is incumbent upon registered nurses to advocate when improved symptom management care is needed. The pediatric palliative care screening instrument pilot provides a centralized instrument to document and quantify a patient's symptom profile, giving registered nurses the opportunity to objectively communicate and track a patient's need for improved symptom management care within the areas of pain, secretions, dyspnea, intractable seizures, nausea, vomiting, constipation, diarrhea, anorexia, cachexia, sleep disturbance, lethargy, anxiety, depression, and/or agitation...
October 2018: Journal of Hospice and Palliative Nursing: JHPN
Erin McKenzie, Matthew K Hwang, Stephanie Chan, Liying Zhang, Pearl Zaki, May Tsao, Elizabeth Barnes, Yasmeen Razvi, Leah Drost, Caitlin Yee, Edward Chow
BACKGROUND: More than 70% of patients with advanced cancer experience dyspnea. Dyspnea is predictive of shorter survival and interferes with quality of life (QOL). The present study aimed to identify predictors of the presence and severity of dyspnea in advanced cancer patients. METHODS: A prospective database collected from patients attending a palliative radiotherapy clinic was analyzed for patient demographics, Edmonton Symptom Assessment System (ESAS) scores, Patient-Reported Functional Status (PRFS), history of smoking and respiratory conditions, pulse oximetry readings, and primary cancer site...
July 13, 2018: Annals of Palliative Medicine
Leanna R Jaward, Thomas A O'Neil, Adam Marks, Michael A Smith
BACKGROUND: Corticosteroids are frequently utilized in the palliative care setting to combat symptoms such as fatigue, dyspnea, pain, weakness, anorexia, cachexia, nausea, and vomiting. Often times, adverse effects arise with corticosteroid use, and it is unclear whether switching to another corticosteroid would reduce the risk of specific adverse effects or what measures can be taken to alleviate the adverse effects. OBJECTIVE: This article aims to review the differentiating pharmacokinetics, potency, and adverse effect profiles of corticosteroids and summarize their clinical applicability...
August 30, 2018: American Journal of Hospice & Palliative Care
Rachel Wells, Deborah Ejem, J Nicholas Dionne-Odom, Gulcan Bagcivan, Konda Keebler, Jennifer Frost, Andres Azuero, Alan Kono, Keith M Swetz, Marie Bakitas
BACKGROUND: Little has been reported about protocol-driven outpatient palliative care consultation (OPCC) for advanced heart failure (HF). OBJECTIVES: To describe evaluation practices and treatment recommendations made during protocol-driven OPCCs for advanced HF. METHODS: We performed content analysis of OPCCs completed as part of ENABLE CHF-PC, an early palliative care HF intervention, conducted at sites in the Northeast and Southeast. T-tests, Fisher's exact, and Chi-square tests were used to evaluate sociodemographic, outcome measures, and site content differences...
August 21, 2018: Heart & Lung: the Journal of Critical Care
Chelsea Hagmann, Arlene Cramer, Allison Kestenbaum, Carlota Durazo, Anna Downey, Michelle Russell, Jaydee Geluz, Joseph D Ma, Eric J Roeland
OBJECTIVE: To review effective approaches for non-pain symptom management for cancer patients focusing on treatment of nausea and vomiting, constipation, diarrhea, anorexia/cachexia, fatigue, and dyspnea. DATA SOURCES: Peer-reviewed articles, clinical practice guidelines, professional organization position statements. CONCLUSION: Oncology nurses are key advocates for optimal symptom management. Maximizing palliation of symptoms improves quality of life and prolongs survival...
August 2018: Seminars in Oncology Nursing
Prima Agustia Nova
OBJECTIVE: The aim of this study was to investigate the perceptions of patients with chronic heart failure regarding palliative care needs. METHOD: The study used a qualitative design. Five patients with chronic heart failure (New York Heart Association functional classes III or IV) were interviewed in inpatient unit at the main referral government hospital in Indonesia. Data was analyzed using content analysis. RESULTS: Patients reported dyspnea and fatigue as the most common signs and symptoms of chronic heart failure...
February 2018: Enfermería Clínica
K Oechsle
Improvement in the quality of life of patients with life-threatening illnesses or incurable progressive diseases, including patients with cancer and also several internal medical diseases, represents the major aim of palliative care. Basic principles are to also address the needs of the family caregiver and a comprehensive understanding of physical symptoms and psychosocial as well as spiritual aspects. Treatment planning for physical symptoms, e.g., pain, dyspnea and nausea, in patients in need of palliative care has to include the subjective symptom distress of the patient, factors that can be treated causally and the treatment limitations resulting from the underlying life-threatening or incurable disease...
September 2018: Der Internist
Jinah Kim, Jung Hwa Hwang, Bo Da Nam, Young Woo Park, Yoon Mi Jeen
RATIONALE: Mediastinal and retroperitoneal fibrosis as a manifestation of metastasis from malignancies is rare disease and particularly, cases of mediastinal fibrosis have been rarely reported. PATIENT CONCERNS: A 60-year-old woman presented with dyspnea and bilateral flank pain. The patient had no previous history of malignancy. DIAGNOSES: A contrast-enhanced chest computed tomography scan revealed a left breast mass and infiltrative soft tissue masses in the mediastinum and retroperitoneum, which showed high fluorodeoxyglucose uptake on positron emission tomography scan...
August 2018: Medicine (Baltimore)
M A Benítez-Rosario, T Morita
PURPOSE: To explore the consistency in international expert opinions about palliative sedation. METHODS: A modified electronic-Delphi procedure was carried out in two rounds. On hundred nine eligible experts were identified from their publications in MEDLINE related with terminal delirium, dyspnea and palliative sedation in the last 3 years. Delphi study included three vignettes of cancer patients and two non-cancer patients, with an estimated survival of days and severe suffering secondary to refractory complications...
August 10, 2018: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
Sabreen Mkalaluh, Marcin Szczechowicz, Saeed Torabi, Anton Sabashnikov, Ahmed Mashhour, Matthias Karck, Alexander Weymann
BACKGROUND:  Cardiac metastases are more common than primary malignant tumors of the heart and are usually treated surgically as a palliative approach. In this study, we reviewed our experience with the surgical treatment of patients with cardiac metastases of various types of malignant tumors. METHODS:  Between 2003 and 2016, 10 patients underwent surgery for cardiac metastases at our institution. RESULTS:  The mean age was 53.5 ± 19 years...
August 9, 2018: Thoracic and Cardiovascular Surgeon
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