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Renal palliative care

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https://www.readbyqxmd.com/read/28097649/hospital-variation-in-utilization-of-life-sustaining-treatments-among-patients-with-do-not-resuscitate-orders
#1
Allan J Walkey, Janice Weinberg, Renda Soylemez Wiener, Colin R Cooke, Peter K Lindenauer
OBJECTIVE: To determine between-hospital variation in interventions provided to patients with do not resuscitate (DNR) orders. DATA SOURCES/SETTING: United States Agency of Healthcare Research and Quality, Healthcare Cost and Utilization Project, California State Inpatient Database. STUDY DESIGN: Retrospective cohort study including hospitalized patients aged 40 and older with potential indications for invasive treatments: in-hospital cardiac arrest (indication for CPR), acute respiratory failure (mechanical ventilation), acute renal failure (hemodialysis), septic shock (central venous catheterization), and palliative care...
January 18, 2017: Health Services Research
https://www.readbyqxmd.com/read/28094071/on-nephrectomy-for-treating-metastatic-renal-cell-carcinoma
#2
C González-Ruiz de León, P Pellejero-Pérez, A Quintás-Blanco, J García-Rodríguez, C Álvarez-Fernández, J M Fernández-Gómez
INTRODUCTION: Systemic treatment for metastatic renal cell carcinoma (mRCC) has changed with the new therapies, and it is not clear if nephrectomy (NEP) has a survival benefit in this kind of patients. OBJECTIVE: To investigate if NEP associated to systemic treatment improves overall survival (OS) and progression-free survival (PFS). MATERIAL AND METHODS: A retrospective, observational, descriptive study of 45 patients with diagnosis of mRCC between 2006-2014...
January 13, 2017: Actas Urologicas Españolas
https://www.readbyqxmd.com/read/28065700/integrating-supportive-care-principles-into-dialysis-decision-making-a-primer-for-palliative-medicine-providers
#3
Alvin H Moss
Despite advances in pre-dialysis care and dialysis technology, patients with advanced chronic kidney disease and end-stage renal disease continue to experience multiple comorbidities, a high symptom burden, a shortened life expectancy and substantial physical, emotional, and spiritual suffering. Patients with acute kidney injury and end-stage renal disease, especially if they are older, often undergo prolonged hospitalizations, greater use of intensive medical treatment, and limited survival. Unfortunately, most nephrologists are not trained to conduct shared decision-making conversations to elicit patients' values, preferences, and goals for treatment and address their patients' multifactorial suffering...
January 5, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28062420/jejunal-perforation-an-unusual-presentation-of-metastatic-cutaneous-squamous-cell-carcinoma-scc-in-an-immunosuppressed-patient
#4
N Hitchen, D Warnapala, R M Fisher, J Dua, P Pratsou, A Freebairn
We report the rare occurrence of a small bowel perforation secondary to a metastatic cutaneous squamous cell carcinoma (cSCC). A 70-year-old woman, who had previously undergone renal transplantation, presented with severe, sudden-onset abdominal pain. She was peritonitic on initial examination, with evidence of free intra-abdominal air on radiographic imaging. During an exploratory laparotomy, she was found to have a perforated jejunum secondary to disseminated metastases seen throughout her peritoneum. Following histopathological analysis, as well as further imaging studies, the primary malignancy was eventually identified as a cSCC on her upper back...
January 6, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28060152/an-elevated-low-cardiac-output-syndrome-score-is-associated-with-morbidity-in-infants-after-congenital-heart-surgery
#5
Kalia P Ulate, Ofer Yanay, Howard Jeffries, Harris Baden, Jane L Di Gennaro, Jerry Zimmerman
OBJECTIVES: To evaluate an empirically derived Low Cardiac Output Syndrome Score as a clinical assessment tool for the presence and severity of Low Cardiac Output Syndrome and to examine its association with clinical outcomes in infants who underwent surgical repair or palliation of congenital heart defects. DESIGN: Prospective observational cohort study. SETTING: Cardiac ICU at Seattle Children's Hospital. PATIENTS: Infants undergoing surgical repair or palliation of congenital heart defects...
January 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/27993826/minimal-change-disease-associated-with-malignant-pleural-mesothelioma-case-report-and-review-of-the-literature
#6
Halil Yildiz, Stoian Ioana Andreea, Delphine Hoton, Jean Cyr Yombi
A 77-year-old man with a history of asbestos exposure was admitted to our internal medicine division for generalised weakness, fatigue, loss of weight, night sweats and difficulty for breathing since 3 months. Clinical examination revealed left fine crackles and bilateral leg oedema. Blood test showed elevated C reactive protein level at 142 mg/L, lactate dehydrogenase level at 421 UI, creatinine level at 5.75 mg/dL. Serum albumin level at 30 g/L, urinalysis showed significant proteinuria at 6.4 g/L...
December 19, 2016: BMJ Case Reports
https://www.readbyqxmd.com/read/27986693/cautious-use-and-optimal-dose-of-morphine-for-relieving-malignant-pain-in-a-complex-patient-with-multiple-comorbidities
#7
Vinod Kumar, Rakesh Garg, Nishkarsh Gupta, Sachidanand Jee Bharati
Oral morphine remains the drug of choice for the management of severe pain due to cancer as per WHO ladder of analgesia. Providing adequate pain relief in palliative care settings for pain due to cancer is challenging. Options become limited in cases of associated systemic comorbidities such as renal dysfunction, hypoproteinaemia, anaemia. Patients with renal dysfunction and other comorbidities may develop drug overdose due to abnormal pharmacokinetics. Renal dysfunction affects the pharmacokinetics of morphine by altering its absorption, metabolism and clearance...
December 16, 2016: BMJ Case Reports
https://www.readbyqxmd.com/read/27863475/spanish-modified-version-of-the-palliative-care-outcome-scale-symptoms-renal-cross-cultural-adaptation-and-validation
#8
Daniel Gutiérrez-Sánchez, Juan P Leiva-Santos, Rosa Sánchez-Hernández, Domingo Hernández-Marrero, Antonio I Cuesta-Vargas
BACKGROUND: Patients with chronic kidney disease (CKD) have a high symptoms burden that is related to a poor health-related quality of life (HRQoL) and high costs of care. Validated instruments may be useful for assessing the symptoms and monitoring outcomes in these patients. The Palliative care Outcome Scale-Symptoms Renal (POS-S Renal) is a patient-reported outcome measure for assessing symptoms in CKD stage 4-5. This study is the first cross-cultural adaptation and psychometric analysis of this clinical tool...
November 18, 2016: BMC Nephrology
https://www.readbyqxmd.com/read/27861375/trends-of-do-not-resuscitate-consent-and-hospice-care-utilization-among-noncancer-decedents-in-a-tertiary-hospital-in-taiwan-between-2010-and-2014-a-hospital-based-observational-study
#9
Hsiao-Ting Chang, Ming-Hwai Lin, Chun-Ku Chen, Pesus Chou, Tzeng-Ji Chen, Shinn-Jang Hwang
Do-Not-Resuscitate (DNR) and hospice care are not only applied to cancer patients but also to patients with noncancer progressive illness. However, the trends of DNR consent and hospice utilization are not well explored for noncancer patients. This study aimed to explore the trends of DNR consent and hospice care utilization among noncancer decedents in a tertiary hospital in Taiwan. We analyzed the Death and Hospice Palliative Care Database from the Taipei Veterans General Hospital in Taiwan. The Death and Hospice Palliative Care Database contains information including patient sex, major diagnosis, admission date, date of death, age at death, department at discharge, status of DNR consent, and status of hospice care of patients who died in the Taipei Veterans General Hospital...
November 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/27806150/patterns-of-care-in-hospitalized-vascular-surgery-patients-at-end-of-life
#10
Dale G Wilson, Sheena K Harris, Heidi Peck, Kyle Hart, Enjae Jung, Amir F Azarbal, Erica L Mitchell, Gregory J Landry, Gregory L Moneta
Importance: There is limited literature reporting circumstances surrounding end-of-life care in vascular surgery patients. Objective: To identify factors driving end-of-life decisions in vascular surgery patients. Design, Setting, and Participants: In this cohort study, medical records were reviewed for all vascular surgery patients at a tertiary care university hospital who died during their hospitalization from 2005 to 2014. Main Outcomes and Measures: Patient, family, and hospitalization variables potentially important to influencing end-of-life decisions...
November 2, 2016: JAMA Surgery
https://www.readbyqxmd.com/read/27791232/treatment-of-advanced-renal-cell-carcinoma-recent-advances-and-current-role-of-immunotherapy-surgery-and-cryotherapy
#11
Alessia Mennitto, Elena Verzoni, Giuseppina Calareso, Carlo Spreafico, Giuseppe Procopio
Renal cell carcinoma (RCC) is the 10th most common cancer in Western countries. The prognosis of metastatic disease is unfavorable but may be different according to several risk factors, such as histology and clinical features (Karnofsky performance status, time from nephrectomy, hemoglobin level, neutrophils and thrombocytes count, lactate dehydrogenase and calcium serum value, sites and extension of the disease). In this review, we focused on some recent developments in the use of immunotherapy, surgery and cryotherapy in the treatment of advanced disease...
October 26, 2016: Tumori
https://www.readbyqxmd.com/read/27777776/high-dose-interleukin2-a-10-year-single-site-experience-in-the-treatment-of-metastatic-renal-cell-carcinoma-careful-selection-of-patients-gives-an-excellent-outcome
#12
S Chow, V Galvis, M Pillai, R Leach, E Keene, A Spencer-Shaw, A Shablak, J Shanks, T Liptrot, F Thistlethwaite, R E Hawkins
BACKGROUND: VEGF-targeted therapy has become the mainstay of treatment for majority of mRCC patients. For most patients, benefit is short-lived and therefore treatment remains palliative in intent. HD IL2 is an effective immunotherapy treatment capable of durable remission in some patients but its unselected use has been difficult due to its modest response rate and considerable adverse effects. Using set pathology criteria as a selection tool in clinical practice, we have been able to show improved outcomes in our previous report...
2016: Journal for Immunotherapy of Cancer
https://www.readbyqxmd.com/read/27737420/palliative-care-for-patients-with-hiv-aids-admitted-to-intensive-care-units
#13
Paola Nóbrega Souza, Erique José Peixoto de Miranda, Ronaldo Cruz, Daniel Neves Forte
OBJECTIVE: To describe the characteristics of patients with HIV/AIDS and to compare the therapeutic interventions and end-of-life care before and after evaluation by the palliative care team. METHODS: This retrospective cohort study included all patients with HIV/AIDS admitted to the intensive care unit of the Instituto de Infectologia Emílio Ribas who were evaluated by a palliative care team between January 2006 and December 2012. RESULTS: Of the 109 patients evaluated, 89% acquired opportunistic infections, 70% had CD4 counts lower than 100 cells/mm3, and only 19% adhered to treatment...
September 2016: Revista Brasileira de Terapia Intensiva
https://www.readbyqxmd.com/read/27726521/use-of-methadone-as-an-adjuvant-medication-to-low-dose-opioids-for-neuropathic-pain-in-the-frail-elderly-a-case-series
#14
Tammy Vu Bach, Jonathan Pan, Anne Kirstein, Cindy Joanne Grief, Daphna Grossman
Palliative care clinicians are increasingly involved in the care of elderly patients suffering from chronic malignant and nonmalignant illnesses, of which neuropathic pain is a prevalent problem. As a person becomes more frail, pain medications such as opioid analgesics and adjuvant pain medications can result in unwanted effects such as sedation, confusion, and increased risk of falls. Treating pain in patients with advanced dementia or neurodegenerative diseases that can affect swallowing is particularly challenging because most adjuvant pain medications used to ameliorate neuropathic pain must be taken orally...
December 2016: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/27697783/conservative-management-and-end-of-life-care-in-an-australian-cohort-with-esrd
#15
Rachael L Morton, Angela C Webster, Kevin McGeechan, Kirsten Howard, Fliss E M Murtagh, Nicholas A Gray, Peter G Kerr, Michael J Germain, Paul Snelling
BACKGROUND AND OBJECTIVES: We aimed to determine the proportion of patients who switched to dialysis after confirmed plans for conservative care and compare survival and end-of-life care among patients choosing conservative care with those initiating RRT. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: A cohort study of 721 patients on incident dialysis, patients receiving transplants, and conservatively managed patients from 66 Australian renal units entered into the Patient Information about Options for Treatment Study from July 1 to September 30, 2009 were followed for 3 years...
December 7, 2016: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/27673684/the-association-of-hydration-status-with-physical-signs-symptoms-and-survival-in-advanced-cancer-the-use-of-bioelectrical-impedance-vector-analysis-biva-technology-to-evaluate-fluid-volume-in-palliative-care-an-observational-study
#16
Amara Callistus Nwosu, Catriona R Mayland, Stephen Mason, Trevor F Cox, Andrea Varro, John Ellershaw
BACKGROUND: Hydration in advanced cancer is a controversial area; however, current hydration assessments methods are poorly developed. Bioelectrical impedance vector analysis (BIVA) is an accurate hydration tool; however its application in advanced cancer has not been explored. This study used BIVA to evaluate hydration status in advanced cancer to examine the association of fluid status with symptoms, physical signs, renal biochemical measures and survival. MATERIALS AND METHODS: An observational study of 90 adults with advanced cancer receiving care in a UK specialist palliative care inpatient unit was conducted...
2016: PloS One
https://www.readbyqxmd.com/read/27669324/symptom-management-in-patients-with-stage-5-ckd-opting-for-conservative-management
#17
REVIEW
Sheila Johnston
Chronic kidney disease (CKD) stages 3-5 now affects 8.5% of adults in the United Kingdom; with 4% of patients expected to reach stage 5 CKD. Increasing numbers of older patients are contributing to the growth of demand of kidney services. With the exception of transplantation, dialysis has been the main form of renal replacement therapy (RRT) for advanced CKD. This elderly population is usually too frail and has many other co-existing medical complaints or co morbidities to undergo transplantation. Dialysis is an invasive treatment, and some frail elderly patients can experience many dialysis related symptoms...
September 22, 2016: Healthcare (Basel, Switzerland)
https://www.readbyqxmd.com/read/27648336/successful-resection-of-isolated-para-aortic-lymph-node-recurrence-from-advanced-sigmoid-colon-cancer-following-156-courses-of-folfiri-regimen
#18
Kaoru Takeshima, Kazuo Yamafuji, Atsunori Asami, Hideo Baba, Nobuhiko Okamoto, Hidena Takahashi, Chisato Takagi, Kiyoshi Kubochi
Isolated para-aortic lymph node (PLN) recurrence from colorectal cancer (CRC) is rare, with no currently validated treatments. Few reports have described the successful resection of isolated PLN involvement from CRC following chemotherapy. We report the case of a 63-year-old man who underwent sigmoidectomy for sigmoid colon cancer at our hospital. Pathological examination demonstrated advanced sigmoid colon cancer with metastatic involvement in both of the tested PLNs. Palliative chemotherapy was initiated four weeks after surgical resection, with administration of the FOLFIRI regimen...
2016: Case Reports in Surgery
https://www.readbyqxmd.com/read/27559004/treatment-of-end-stage-kidney-failure-without-renal-replacement-therapy
#19
Barnaby Hole, Sarah Tonkin-Crine, Fergus J Caskey, Paul Roderick
For the majority of patients with end-stage kidney failure (ESKF) replacement of excretory renal function by dialysis or transplantation (RRT) can extend life and alleviate symptoms. Historically, the availability of RRT has been insufficient and this remains the case for much of the world. However, RRT is now widely available in healthcare systems of higher income countries. Increasing numbers of elderly patients are developing ESKF. RRT in this population is largely by dialysis, comorbidity is high and life expectancy short...
November 2016: Seminars in Dialysis
https://www.readbyqxmd.com/read/27495813/understanding-patterns-and-factors-associated-with-place-of-death-in-patients-with-end-stage-kidney-disease-a-retrospective-cohort-study
#20
Natasha Lovell, Chris Jones, Dawn Baynes, Sarah Dinning, Katie Vinen, Fliss Em Murtagh
BACKGROUND: Meeting place-of-death preferences is an important measure of the quality of end-of-life care. Systematic review shows that 42% of end-stage kidney disease patients prefer home death. Little research has been undertaken on place of death. AIM: To understand patterns of place of death in patients with end-stage kidney disease known in one UK renal unit. DESIGN: A retrospective cohort study of all patients with chronic kidney disease stage 4-5, age ⩾75 and known to one UK renal unit, who died between 2006 and 2012...
August 5, 2016: Palliative Medicine
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