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Dyspnea AND palliative

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
Yvette S Zeng, Connie Wang, Kristina E Ward, Anne L Hume
CONTEXT: The aim of palliative care is to improve quality of life for patients with serious illnesses by treating their symptoms and adverse effects. Hospice care also aims for this for patients with a life expectancy of six months or less. When conventional therapies do not provide adequate symptom management or produce their own adverse effects, patients, families and caregivers may prefer complementary or alternative approaches in their care. OBJECTIVES: To evaluate the available evidence on the use of complementary or alternative medicine (CAM) in hospice and palliative care and to summarize their potential benefits...
August 1, 2018: Journal of Pain and Symptom Management
Shih-Ling Huang, Wei-Su Lai, Su-Ying Fang
BACKGROUND: Dyspnea is a subjective symptom of breathing discomfort that is commonly experienced by terminally ill patients in the last few weeks of life. Fans have been used to reduce breathlessness in clinical practice for terminally ill patients. However, reviews in the systematic literature are insufficient to make definite conclusions regarding the effectiveness of this intervention and to provide a consistent protocol for clinical application. PURPOSE: The purpose of the present study was to evaluate the effects and clinical application of using fans in dyspnea patients...
August 2018: Hu Li za Zhi the Journal of Nursing
Paloma Millan-Billi, Candela Serra, Ana Alonso Leon, Diego Castillo
Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive and fatal disease. The treatment is challenging and nowadays a comprehensive approach based not only in pharmacological strategies is necessary. Identification and control of comorbidities, non-pharmacological treatment, prevention and management of exacerbations as well as other areas of care (social, psychological) are fundamental for a holistic management of IPF. Gastroesophageal reflux, pulmonary hypertension, obstructive sleep apnea, combined with emphysema, lung cancer and cardiovascular involvement are the main comorbidities associated with IPF...
July 24, 2018: Medical Sciences: Open Access Journal
Birgit Basedow-Rajwich, Thomas Montag, Andreas Duckert, Christian Schulz, Gennadij Rajwich, Ingo Kleiter, Jürgen Koehler, Gabriele Lindena
Context: During the last decade, numerous in-patient Palliative Care Consultation Service (PCCS) units were established throughout Germany. Objective: To provide an epidemiological overview on a whole year cohort of palliative patients in terms of demography, complaints, and therapy on admission to PCCS and the impact of PCCS treatment, and identify differences and similarities in different palliative patient subgroups. Methods: Chi-square, analysis of variance (ANOVA), Kruskal-Wallis followed by Games-Howell analysis of HOspice and Palliative care Evaluation (HOPE 2013) data on 4 PCCS centers and in total 919 patients, with solid tumors (237), metastatic cancer (397), leukemia and lymphoma (99), neurological (109, mostly multiple sclerosis [MS]), and noncancer, nonneurological disease (NCNND, 77)...
2018: Palliative Care
Jun Kako, Tatsuya Morita, Takuhiro Yamaguchi, Masamitsu Kobayashi, Asuko Sekimoto, Hiroya Kinoshita, Asao Ogawa, Sadamoto Zenda, Yosuke Uchitomi, Hironobu Inoguchi, Eisuke Matsushima
CONTEXT: Dyspnea is a common distressing symptom among patients with advanced cancer. OBJECTIVE: To determine the effect of fan therapy on dyspnea in terminally ill cancer patients. METHODS: This parallel arm, randomized controlled trial included 40 patients with advanced cancer from a palliative care unit at the National Cancer Center Hospital in Japan. All patients experienced dyspnea at rest with a score of at least 3 points on a subjective 0-10-point numerical rating scale (NRS), showed peripheral oxygen saturation levels of ≥90%, an Eastern Cooperative Oncology Group grade of 3 or 4, and were aged 20 years or more...
July 12, 2018: Journal of Pain and Symptom Management
Ashley Shreves, Trevor R. Pour, Nachi Gupta, Jeffrey Nusbaum
Dyspnea is one of the most distressing symptoms experienced by dying patients, and it is a common reason for such patients to seek care in the emergency department. Many underlying disease states and acute illnesses cause shortness of breath at the end of life, and management tends to be symptomatic rather than diagnostic, particularly in those for whom comfort is the most important goal. Opioids are the most effective and widely studied agents available for palliation of dyspnea in this population, while adjuvant therapies such as oxygen, noninvasive positive pressure ventilation, and hand-held fans may also be used...
July 1, 2018: Emergency Medicine Practice
Pia von Blanckenburg, Nico Leppin
PURPOSE OF REVIEW: To provide an update on recent studies about psychological interventions in palliative (mainly cancer) care with a focus on physical, psychological, spiritual, and social aspects. RECENT FINDINGS: Some promising psychological interventions for physical challenges, such as fatigue, pain, dyspnea, and insomnia do exist, but further research is needed. Regarding psychological aspects, current reviews showed small to large effects in the reduction of depression and anxiety symptoms through cognitive behavioral-based interventions, mindfulness-based interventions, and meaning-based interventions...
September 2018: Current Opinion in Psychiatry
Tanja Sprave, Vivek Verma, Robert Förster, Ingmar Schlampp, Thomas Bruckner, Tilman Bostel, Stefan Ezechiel Welte, Eric Tonndorf-Martini, Rami El Shafie, Nils Henrik Nicolay, Jürgen Debus, Harald Rief
PURPOSE: Radiation therapy (RT) provides an important treatment approach in the palliative care of vertebral metastases, but radiation-induced toxicities in patients with advanced disease and low performance status can have substantial implications for quality of life. Herein, we prospectively compared toxicity profiles of intensity-modulated radiotherapy (IMRT) vs. conventional three-dimensional conformal radiotherapy (3DCRT). METHODS: This was a prospective randomized monocentric explorative pilot trial to compare radiation-induced toxicity between IMRT and 3DCRT for patients with spinal metastases...
July 5, 2018: Strahlentherapie und Onkologie: Organ der Deutschen Röntgengesellschaft ... [et Al]
Ashley Shreves, Trevor R Pour
Dyspnea is one of the most distressing symptoms experienced by dying patients, and it is a common reason for such patients to seek care in the emergency department. Many underlying disease states and acute illnesses cause shortness of breath at the end of life, and management tends to be symptomatic rather than diagnostic, particularly in those for whom comfort is the most important goal. Opioids are the most effective and widely studied agents available for palliation of dyspnea in this population, while adjuvant therapies such as oxygen, noninvasive positive pressure ventilation, and hand-held fans may also be used...
July 2018: Emergency Medicine Practice
Jutara Srivali Teal, Dana N Rutledge, Sue Robertson, Eve Cruz
The Supportive Care Nursing Clinical Protocol (SCNCP) was developed to guide holistic nursing care for seriously ill hospitalized patients. The SCNCP uses national guidelines and evidence-based interventions as its foundation. Seriously ill patients may require palliative care, which is synonymous with supportive care. Acute care nurses may not be proficient in providing holistic supportive care for patients with life-limiting illness. At a 670-bed public acute care hospital, palliative care consultation requires a physician order and palliation may arrive late in an illness...
July 2018: Holistic Nursing Practice
Yoshihiro Yamamoto, Hiroaki Watanabe, Aina Sakurai, Yuko Deguchi, Shigeki Hirano, Yoshimi Okumura, Akiko Kumon, Norio Watanabe, Takashi Osada, Keiko Yamamura, Takuya Odagiri
Aim: Dyspnea is among symptoms that decrease quality of life for terminal cancer patients. There are few reports of the positive effects of oxycodone for the treatment of dyspnea, and no studies have focused on opioid-naïve patients. This study aimed to determine the efficacy and safety of continuous intravenous oxycodone infusion for opioid-naïve cancer patients with dyspnea. Methods: Eligible patients were opioid-naïve cancer inpatients who received continuous oxycodone infusion as a treatment for dyspnea under the care of the palliative care team at Komaki City Hospital between November 2013 and December 2016...
June 11, 2018: Japanese Journal of Clinical Oncology
Chiu-Fan Chen, Min-Hsi Lin, Kuo-An Chu, Wen-Shan Liu, Shih-Hung Hsiao, Ruay-Sheng Lai
Cardiac radiotherapy is rarely used in clinical practice because of concern of adverse effects on the heart. We present a case of a 64-year-old man with advanced small cell lung cancer (SCLC) treated with chemo-radiotherapy who attained partial remission initially but had disease progression to bulky cardiac metastasis and significant pericardial effusion. Severe heart failure with hepatic failure was found. Chemotherapy and pericardiocentesis were contraindicated because of the associated high risk and bleeding tendency...
April 2018: Journal of Thoracic Disease
Jana Pilkey, Allison Pedersen, James W Tam, Amrit Malik, Jonathan Wong
BACKGROUND: Dyspnea is distressing in palliative patients with end-stage heart failure and many are hospitalized to optimize this symptom. We hoped to conduct a pilot study to determine whether the administration of intranasal fentanyl would decrease activity-induced dyspnea in this patient population. METHODS: Patients performed two 6-minute walk tests with and without the administration of 50 μg of intranasal fentanyl. Vital signs were recorded before and after each walk, as were participant reported dyspnea and adverse events scores...
January 1, 2018: Journal of Palliative Care
Miriam S Menezes, Maria das Graças Mota da Cruz de Assis Figueiredo
BACKGROUND AND OBJECTIVE: Palliative sedation is a medical procedure that has been used for more than 25 years to relieve refractory symptoms not responsive to any previous treatment in patients with no possibility of cure and near the end of life. Many uncertainties persist on the issue regarding definition, indications, decision making, most appropriate place to perform the procedure, most used drugs, need for monitoring, fluids and nutritional support, and possible ethical dilemmas...
May 15, 2018: Revista Brasileira de Anestesiologia
Jacqueline Oehme, Caitlin Sheehan
BACKGROUND: Dying is ubiquitous, yet the optimal management of hydration in the terminal phase is undetermined. Palliative care (PC) doctors' practices may act as a de facto measure of the benefits and burdens of artificial hydration (AH) use. OBJECTIVE: To identify PC doctors' AH prescribing practices for imminently dying patients and possible influencing factors. METHODS: An online survey of doctors belonging to the Australian and New Zealand Society of Palliative Medicine...
May 15, 2018: Journal of Palliative Medicine
Jun Kako, Masamitsu Kobayashi, Yusuke Kanno, Asao Ogawa, Tomofumi Miura, Yoshihisa Matsumoto
CONTEXT: Terminally ill patients with cancer experience various physical and emotional symptoms that have a negative impact on quality of life and activities of daily living. Recently, revised Edmonton Symptom Assessment System (ESAS-r) scores have been proposed for assessing symptoms in terminally ill patients with cancer. OBJECTIVE: To determine the optimal cutoff point for expressing ESAS-r scores as binary data, indicating the presence or absence of symptoms...
January 1, 2018: American Journal of Hospice & Palliative Care
Lee Ai Chong, Poh Heng Chong, Joyce Chee
BACKGROUND: The provision of pediatric palliative care in Asia Pacific varies between countries and availability of essential medications for symptoms at the end of life in this region is unclear. OBJECTIVE: To determine medications available and used in the management of six symptoms at the end of life among pediatric palliative care practitioners in Asia Pacific. To identify alternative pharmacological strategies for these six symptoms if the oral route was no longer possible and injections are refused...
May 7, 2018: Journal of Palliative Medicine
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