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https://www.readbyqxmd.com/read/27900726/survey-on-german-palliative-care-specialists-experiences-with-advance-directives
#1
Julia Zenz, Michael Zenz
INTRODUCTION: Advance directives (AD) play a central role in end-of-life treatments, intensive care, and palliative care. However, little is known about the experiences of healthcare professionals with ADs. This study reports on palliative care professionals' views on advance directives (AD). METHODS: A questionnaire was handed out to attendants of a palliative care symposium. RESULTS: Complete answers were obtained from 126 physicians and 276 nurses...
November 29, 2016: Pain and Therapy
https://www.readbyqxmd.com/read/27867410/closed-gastroschisis-vanishing-midgut-and-extreme-short-bowel-syndrome-case-report-and-review-of-the-literature
#2
F A Dennison
Gastroschisis alone has excellent survival rates. Occasionally reported is closed gastroschisis, leading to vanishing small bowel and extreme short bowel syndrome. It is believed that the abdominal wall defect can contract or close in utero, which leads to strangulation of the eviscerated bowel and the rare "vanishing gut syndrome." This has a very poor prognosis with mortality as high as 70%. An 18-year-old primigravid patient's 13 week scan diagnosed a large gastroschisis affecting the fetus. After counselling, she decided to continue with the pregnancy...
August 2016: Ultrasound: Journal of the British Medical Ultrasound Society
https://www.readbyqxmd.com/read/27853740/utility-of-endoscopic-therapy-in-the-management-of-boerhaave-syndrome
#3
K J Dickinson, N Buttar, L M Wong Kee Song, C J Gostout, S D Cassivi, M S Allen, F C Nichols, K R Shen, D A Wigle, S H Blackmon
Background/aims: The optimal intervention for Boerhaave perforation has not been determined. Options include surgical repair with/without a pedicled muscle flap, T tube placement, esophageal resection or diversion, or an endoscopic approach. All management strategies require adequate drainage and nutritional support. Our aim was to evaluate outcomes following Boerhaave perforation treated with surgery, endoscopic therapy, or both. Patients and methods: We performed a 10-year review of our prospectively maintained databases of adult patients with Boerhaave perforations...
November 2016: Endoscopy International Open
https://www.readbyqxmd.com/read/27798016/supporting-the-provision-of-palliative-care-in-the-home-environment-a-proof-of-concept-single-arm-trial-of-a-palliative-carers-education-package-precept
#4
Liz Forbat, Erna Haraldsdottir, Marsha Lewis, Ken Hepburn
INTRODUCTION: Practical educational interventions for palliative carers are needed. Current supports frequently rely on carers travelling to a central venue to receive education. A substantial gap therefore exists around determining how high-quality relevant information can be delivered nationally, with limited cost implications, using educational methods that are acceptable to carers in palliative care. This study seeks to design and assess feasibility and acceptability of a distance-learning approach to educating carers...
October 25, 2016: BMJ Open
https://www.readbyqxmd.com/read/27751743/nutriscore-a-new-nutritional-screening-tool-for-oncological-outpatients
#5
Lorena Arribas, Laura Hurtós, Maria José Sendrós, Inmaculada Peiró, Neus Salleras, Eduard Fort, Jose Manuel Sánchez-Migallón
OBJECTIVES: The aim of this study was to design a new nutritional screening tool (NUTRISCORE) to detect nutritional risk in outpatients with cancer. METHODS: A multicenter, cross-sectional study was conducted. We randomly selected outpatients receiving onco-specific, palliative, or symptomatic treatment for malignant neoplasms (including solid tumors and hematologic malignancies). These patients were assessed using the NUTRISCORE tool, the Malnutrition Screening Tool (MST), and the Patient-Generated Subjective Global Assessment (PG-SGA) to detect risk for malnutrition...
January 2017: Nutrition
https://www.readbyqxmd.com/read/27750261/does-nutrition-support-have-a-role-in-managing-cancer-cachexia
#6
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
https://www.readbyqxmd.com/read/27729480/baby-o-and-the-withdrawal-of-life-sustaining-medical-treatment-in-the-devastated-neonate-a-review-of-clinical-ethical-and-legal-issues
#7
Joseph Sacco, Rebecca Virata
The discontinuation of life sustaining medical treatment (LSMT) in severely and permanently impaired neonates, especially artificial nutrition and hydration (ANH) is subject to uncertainty and controversy. Definitive clinical guidelines are lacking, clinical research is limited, ethical disagreement is commonplace, and while case and statutory law provide legal underpinning for the practice in defined circumstances, uncertainty in this realm likely influences clinical practice. We use the case of a neurologically devastated neonate to highlight and review these arenas, and show how, using available legal, ethical, and clinical standards and practice, the case of Baby O was resolved, and to underline the need for further research in neonatal palliative care...
October 11, 2016: American Journal of Hospice & Palliative Care
https://www.readbyqxmd.com/read/27703567/the-association-between-malnutrition-and-pressure-ulcers-in-elderly-in-long-term-care-facility
#8
Lenche Neloska, Katerina Damevska, Andjelka Nikolchev, Lidija Pavleska, Biljana Petreska-Zovic, Milenko Kostov
BACKGROUND: Malnutrition is common in elderly and is a risk factor for pressure ulcers. AIM: The aim of the present study was to determine the prevalence of malnutrition in geriatric and palliative patients hospitalised in long-term care facility, and to examine the influence of nutritional status on the prevalence of pressure ulcers (PU). MATERIAL AND METHODS: Descriptive, observational and cross-sectional study including 2099 patients admitted to the Hospital during a 24 month period (January 2013 to December 2014)...
September 15, 2016: Open Access Macedonian Journal of Medical Sciences
https://www.readbyqxmd.com/read/27645556/identifying-patients-with-advanced-chronic-conditions-for-a-progressive-palliative-care-approach-a-cross-sectional-study-of-prognostic-indicators-related-to-end-of-life-trajectories
#9
J Amblàs-Novellas, S A Murray, J Espaulella, J C Martori, R Oller, M Martinez-Muñoz, N Molist, C Blay, X Gómez-Batiste
OBJECTIVES: 2 innovative concepts have lately been developed to radically improve the care of patients with advanced chronic conditions (PACC): early identification of palliative care (PC) needs and the 3 end-of-life trajectories in chronic illnesses (acute, intermittent and gradual dwindling). It is not clear (1) what indicators work best for this early identification and (2) if specific clinical indicators exist for each of these trajectories. The objectives of this study are to explore these 2 issues...
September 19, 2016: BMJ Open
https://www.readbyqxmd.com/read/27640365/estimating-the-palliative-effect-of-percutaneous-endoscopic-gastrostomy-in-an-observational-registry-using-principal-stratification-and-generalized-propensity-scores
#10
Pallavi S Mishra-Kalyani, Brent A Johnson, Jonathan D Glass, Qi Long
Clinical disease registries offer a rich collection of valuable patient information but also pose challenges that require special care and attention in statistical analyses. The goal of this paper is to propose a statistical framework that allows for estimating the effect of surgical insertion of a percutaneous endogastrostomy (PEG) tube for patients living with amyotrophic lateral sclerosis (ALS) using data from a clinical registry. Although all ALS patients are informed about PEG, only some patients agree to the procedure which, leads to the potential for selection bias...
September 19, 2016: Scientific Reports
https://www.readbyqxmd.com/read/27635765/practical-multimodal-care-for-cancer-cachexia
#11
Matthew Maddocks, Jane Hopkinson, John Conibear, Annie Reeves, Clare Shaw, Ken C H Fearon
PURPOSE OF REVIEW: Cancer cachexia is common and reduces function, treatment tolerability and quality of life. Given its multifaceted pathophysiology a multimodal approach to cachexia management is advocated for, but can be difficult to realise in practice. We use a case-based approach to highlight practical approaches to the multimodal management of cachexia for patients across the cancer trajectory. RECENT FINDINGS: Four cases with lung cancer spanning surgical resection, radical chemoradiotherapy, palliative chemotherapy and no anticancer treatment are presented...
December 2016: Current Opinion in Supportive and Palliative Care
https://www.readbyqxmd.com/read/27626318/esophageal-stenting-for-benign-and-malignant-disease-european-society-of-gastrointestinal-endoscopy-esge-clinical-guideline
#12
Manon C W Spaander, Todd H Baron, Peter D Siersema, Lorenzo Fuccio, Brigitte Schumacher, Àngels Escorsell, Juan-Carlos Garcia-Pagán, Jean-Marc Dumonceau, Massimo Conio, Antonella de Ceglie, Janusz Skowronek, Marianne Nordsmark, Thomas Seufferlein, André Van Gossum, Cesare Hassan, Alessandro Repici, Marco J Bruno
This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE), endorsed by the European Society for Radiotherapy and Oncology (ESTRO), the European Society of Digestive Endoscopy (ESDO), and the European Society for Clinical Nutrition and Metabolism (ESPEN). The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was adopted to define the strength of recommendations and the quality of evidence. Main recommendations for malignant disease 1 ESGE recommends placement of partially or fully covered self-expandable metal stents (SEMSs) for palliative treatment of malignant dysphagia over laser therapy, photodynamic therapy, and esophageal bypass (strong recommendation, high quality evidence)...
October 2016: Endoscopy
https://www.readbyqxmd.com/read/27589258/recommending-small-frequent-meals-in-the-clinical-care-of-adults-a-review-of-the-evidence-and-important-considerations
#13
Hassan S Dashti, Kris M Mogensen
Small, frequent meals (SFMs) are a dietary regimen characterized by multiple small eating episodes throughout the day. Clinical nutrition guidelines recommend SFMs (eg, 6-10 meals) to patients experiencing common symptoms (eg, early satiety) and gastrointestinal-related symptoms. However, whether the provision of SFMs palliatively improves morbidity of nutritionally at-risk individuals has yet to be elucidated. This narrative review summarizes current clinical guidelines recommending SFMs for the management of diseases in adult patients (≥18 years), with supporting experimental and epidemiologic evidence, and it provides suggestions pertaining to this recommendation by drawing on potential considerations from investigations in healthy adults...
September 1, 2016: Nutrition in Clinical Practice
https://www.readbyqxmd.com/read/27555780/alpers-huttenlocher-syndrome-the-role-of-a-multidisciplinary-health-care-team
#14
REVIEW
Russell P Saneto
Alpers-Huttenlocher syndrome (AHS) is a mitochondrial DNA-depletion syndrome. Age of onset is bimodal: early onset at 2-4 years and later adolescent onset at 17-24 years of age. Early development is usually normal, with epilepsy heralding the disorder in ~50% of patients. The onset of seizures is coupled with progressive cognitive decline. Hepatopathy is variable, and when present is a progressive dysfunction leading to liver failure in many cases. These features of seizures, cognitive degeneration, and hepatopathy represent the "classic triad" of AHS...
2016: Journal of Multidisciplinary Healthcare
https://www.readbyqxmd.com/read/27535399/multidisciplinary-care
#15
Megan E Daly, Jonathan W Riess
Optimal multidisciplinary care of the lung cancer patient at all stages should encompass integration of the key relevant medical specialties, including not only medical, surgical, and radiation oncology, but also pulmonology, interventional and diagnostic radiology, pathology, palliative care, and supportive services such as physical therapy, case management, smoking cessation, and nutrition. Multidisciplinary management starts at staging and tissue diagnosis with pathologic and molecular phenotyping, extends through selection of a treatment modality or modalities, management of treatment and cancer-related symptoms, and to survivorship and end-of-life care...
2016: Cancer Treatment and Research
https://www.readbyqxmd.com/read/27514291/supportive-and-symptomatic-management-of-amyotrophic-lateral-sclerosis
#16
REVIEW
Esther V Hobson, Christopher J McDermott
The main aims in the care of individuals with amyotrophic lateral sclerosis (ALS) are to minimize morbidity and maximize quality of life. Although no cure exists for ALS, supportive and symptomatic care provided by a specialist multidisciplinary team can improve survival. The basis for supportive management is shifting from expert consensus guidelines towards an evidence-based approach, which encourages the use of effective treatments and could reduce the risk of harm caused by ineffective or unsafe interventions...
September 2016: Nature Reviews. Neurology
https://www.readbyqxmd.com/read/27465048/geriatric-assessment-factors-are-associated-with-mortality-after-hospitalization-in-older-adults-with-cancer
#17
Sushma Jonna, Leslie Chiang, Jingxia Liu, Maria B Carroll, Kellie Flood, Tanya M Wildes
PURPOSE: Survival in older adults with cancer varies given differences in functional status, comorbidities, and nutrition. Prediction of factors associated with mortality, especially in hospitalized patients, allows physicians to better inform their patients about prognosis during treatment decisions. Our objective was to analyze factors associated with survival in older adults with cancer following hospitalization. METHODS: Through a retrospective cohort study, we reviewed 803 patients who were admitted to Barnes-Jewish Hospital's Oncology Acute Care of Elders (OACE) unit from 2000 to 2008...
November 2016: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
https://www.readbyqxmd.com/read/27454577/treatment-approaches-in-motor-neurone-disease
#18
Thanuja Dharmadasa, José M Matamala, Matthew C Kiernan
PURPOSE OF REVIEW: Although there is no cure for motor neurone disease (MND), the advent of multidisciplinary care and neuroprotective agents has improved treatment interventions and enhanced quality of life for MND patients and their carers. RECENT FINDINGS: Evidence-based multidisciplinary care, respiratory management and disease-modifying therapy have improved the outcomes of patients diagnosed with MND. Supportive approaches to nutritional maintenance and optimization of symptomatic treatments, including management of communication and neuropsychiatric issues, improve the quality of life for MND patients...
October 2016: Current Opinion in Neurology
https://www.readbyqxmd.com/read/27403411/feeding-challenges-in-patients-with-esophageal-and-gastroesophageal-cancers
#19
REVIEW
Daniel Reim, Helmut Friess
BACKGROUND: Patients undergoing treatment for esophagogastric or esophageal cancer are exposed to a considerably high risk of malnutrition due to early obstruction of the gastrointestinal passage. Presently most of the patients undergo modern multimodal therapies which require chemoradiation or chemotherapy ahead of surgery. Therefore reconstruction of the obstructed gastrointestinal passage is considerably delayed. Surgery as the only curative option after neoadjuvant treatment is the mainstay of therapy in this setting...
May 2016: Gastrointestinal Tumors
https://www.readbyqxmd.com/read/27381722/palliative-care-needs-in-malawi-care-received-by-people-living-with-hiv
#20
Esmie Mkwinda, Eucebious Lekalakala-Mokgele
BACKGROUND: Infection with human immunodeficiency virus (HIV) has changed from an acute to a chronic illness in the past decade, because of highly active antiretroviral therapy (ART). Malawi's response to the HIV challenge included provision of ART for people living with HIV or AIDS (PLWHA), which significantly reduced HIV- and AIDS-related mortality. In addition, palliative care for PLWHA was introduced as a strategy that improves the success of ART. OBJECTIVE: The purpose of the study was to explore the needs of PLWHA concerning care received from primary caregivers and palliative care nurses in Malawi...
2016: Curationis
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