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Primary palliative care

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https://www.readbyqxmd.com/read/29343169/patients-and-carers-perspectives-of-palliative-care-in-general-practice-a-systematic-review-with-narrative-synthesis
#1
Emilie Green, Selena Knight, Merryn Gott, Stephen Barclay, Patrick White
BACKGROUND: General practitioners have overall responsibility for community care, including towards end of life. Current policy places generalists at the centre of palliative care provision. However, little is known about how patients and carers understand the general practitioner's role. AIMS: To explore patient and carer perspectives of (1) the role of the general practitioner in providing palliative care to adult patients and (2) the facilitators and barriers to the general practitioner's capacity to fulfil this perceived role...
January 1, 2018: Palliative Medicine
https://www.readbyqxmd.com/read/29343167/a-cluster-randomised-feasibility-trial-of-clinically-assisted-hydration-in-cancer-patients-in-the-last-days-of-life
#2
Andrew N Davies, Melanie Waghorn, Katherine Webber, Sigurd Johnsen, Jeewaka Mendis, Julia Boyle
BACKGROUND: The provision of clinically assisted hydration at the end-of-life is one of the most contentious issues in medicine. AIM: The aim of this feasibility study was to answer the question 'can a definitive (adequately powered) study be done?' DESIGN: The study was a cluster randomised trial, with sites randomised on a one-to-one basis to intervention 'A' (regular mouth care and usual other care) or intervention 'B' (clinically assisted hydration, mouth care and usual other care)...
January 1, 2018: Palliative Medicine
https://www.readbyqxmd.com/read/29336374/radiotherapy-for-gastrointestinal-stromal-tumors
#3
REVIEW
Emine Elif Ozkan
OBJECTIVE: Gastrointestinal stromal tumors (GISTs) are rare mesenchymal tumors of the gastrointestinal tract, which frequently cause intraabdominal metastases. The current standard of care is surgery for localized cases, and adjuvant imatinib is recommended for tumors with a high risk of recurrence. To date, radiotherapy has not been commonly accepted as a part of multimodality treatment approach other than palliation. However, recently published case reports and some small series suggest that radiotherapy is a valuable option for controlling locally progressive, drug-resistant disease...
January 20, 2018: Chinese Medical Journal
https://www.readbyqxmd.com/read/29327978/in-vivo-cyp3a-activity-in-palliative-care-patients-study-protocol-for-a-single-arm-prospective-trial
#4
Marcus J P Geist, Hubert J Bardenheuer, Jürgen Burhenne, Gerd Mikus
BACKGROUND: Drug interactions are a common cause for escalation of debilitating symptoms in palliative care patients. CYP3A is the most relevant CYP enzyme in humans involved in metabolism of about half of all available pharmaceuticals. OBJECTIVE: To increase knowledge about the CYP3A enzyme and the impact of drug interactions on its activity to improve dosing in palliative care patients. DESIGN: The prospective clinical trial uses a secure method of analyzing CYP3A activity in humans: Administration of a marker substance followed by the determination of its blood concentrations as well as the concentrations of its metabolite at certain points of time and corresponding metabolic clearance calculations...
January 12, 2018: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/29325199/-efficacy-and-safety-of-indwelling-pleural-catheters
#5
Eva Lücke, Uwe Steffen, Sandra Riedel, Jens Schreiber
In symptomatic malignant pleural effusions, mostly in a palliative situation, therapeutic procedures should be chosen to improve dyspnoea and the concomitant impairment of quality of life. Indwelling pleural catheters (IPC) have played an increasing role in recent years. The efficacy and safety of this method have not been adequately clarified under real-life clinical conditions. 94 patients, in whom IPC had been implanted because of a clinical indication, were analysed retrospectively with respect to efficacy and safety, together with patient characteristics, peri- and postinterventional complications, e...
January 11, 2018: Zentralblatt Für Chirurgie
https://www.readbyqxmd.com/read/29316883/active-ingredients-of-a-person-centred-intervention-for-people-on-hiv-treatment-analysis-of-mixed-methods-trial-data
#6
Keira Lowther, Richard Harding, Victoria Simms, Aabid Ahmed, Zipporah Ali, Nancy Gikaara, Lorraine Sherr, Hellen Kariuki, Irene J Higginson, Lucy Ellen Selman
BACKGROUND: A new model of care is required to meet the changing needs of people living with HIV (PLWH), particularly in low and middle-income countries, where prevalence is highest. We evaluated a palliative care intervention for PLWH in Mombasa, Kenya. Although we found no effect on pain (primary outcome), there was a positive effect on mental health (secondary outcome) in the intervention group. To inform replication and implementation, we have determined the active ingredients of the intervention and their mechanisms of action...
January 10, 2018: BMC Infectious Diseases
https://www.readbyqxmd.com/read/29310605/a-randomized-controlled-trial-of-a-skills-training-for-oncologists-and-a-communication-aid-for-patients-to-stimulate-shared-decision-making-about-palliative-systemic-treatment-choice-study-protocol
#7
I Henselmans, E M A Smets, J C J M de Haes, M G W Dijkgraaf, F Y de Vos, H W M van Laarhoven
BACKGROUND: Systemic treatment for advanced cancer offers uncertain and sometimes little benefit while the burden can be high. Hence, treatment decisions require Shared Decision Making (SDM). The CHOICE trial examines the separate and combined effect of oncologist training and a patient communication aid on SDM in consultations about palliative systemic treatment. METHODS: A RCT design with four parallel arms will be adopted. Patients with metastatic or irresectable cancer with a median life expectancy <12 months who meet with a medical oncologist to discuss the start or continuation of palliative systemic treatment are eligible...
January 8, 2018: BMC Cancer
https://www.readbyqxmd.com/read/29307505/practical-considerations-in-medical-cannabis-administration-and-dosing
#8
REVIEW
Caroline A MacCallum, Ethan B Russo
Cannabis has been employed medicinally throughout history, but its recent legal prohibition, biochemical complexity and variability, quality control issues, previous dearth of appropriately powered randomised controlled trials, and lack of pertinent education have conspired to leave clinicians in the dark as to how to advise patients pursuing such treatment. With the advent of pharmaceutical cannabis-based medicines (Sativex/nabiximols and Epidiolex), and liberalisation of access in certain nations, this ignorance of cannabis pharmacology and therapeutics has become untenable...
January 4, 2018: European Journal of Internal Medicine
https://www.readbyqxmd.com/read/29307208/implementation-issues-relevant-to-outpatient-neurology-palliative-care
#9
Benzi M Kluger, Michael J Persenaire, Samantha K Holden, Laura T Palmer, Hannah Redwine, Julie Berk, C Alan Anderson, Christopher M Filley, Jean Kutner, Janis Miyasaki, Julie Carter
BACKGROUND: There is growing interest in the application of palliative care principles to improve care for patients and families affected by neurologic diseases. We developed an interdisciplinary outpatient clinic for patients and families affected by neurologic disorders to better address the problems faced by our highest need patients. We have developed and improved this program over the past three years and share several of our most important lessons as well as ongoing challenges and areas where we see our clinic evolving in the future...
November 29, 2017: Annals of Palliative Medicine
https://www.readbyqxmd.com/read/29305245/home-parenteral-nutrition-increases-fat-free-mass-in-patients-with-incurable-gastrointestinal-cancer-results-of-a-randomized-controlled-trial
#10
Sine Roelsgaard Obling, Benedicte Vibjerg Wilson, Per Pfeiffer, Jens Kjeldsen
OBJECTIVE: Preventing loss of muscle mass and function is an enduring challenge in malnourished patients with incurable cancer. The benefit of supplemental home parenteral nutrition has not been firmly established. Our aim was to evaluate the effects of supplemental home parenteral nutrition, the primary endpoint being fat free mass (FFM) and secondary: muscle function, quality of life and overall survival. DESIGN AND METHODS: In a single centre open-label randomised controlled trial, patients with incurable gastrointestinal cancer, nutritionally at risk, were randomly assigned to either; a) best practice nutritional care and dietetic counselling (non-sHPN) or b) dietetic counselling and supplemental home parenteral nutrition (sHPN group)...
December 21, 2017: Clinical Nutrition: Official Journal of the European Society of Parenteral and Enteral Nutrition
https://www.readbyqxmd.com/read/29304789/fractionated-palliative-thoracic-radiotherapy-in-non-small-cell-lung-cancer-futile-or-worth-while
#11
Malene Støchkel Frank, Dorte Schou Nørøxe, Lotte Nygård, Gitte Fredberg Persson
BACKGROUND: Palliative thoracic radiotherapy (PTR) can relieve symptoms originating from intra-thoracic disease. The optimal timing and fractionation of PTR is unknown. Time to effect is 2 months. The primary aim of this retrospective study was to investigate survival after PTR, hypothesizing that a significant number of patients received futile fractionated PTR. The secondary aim was to find prognostic factors to guide treatment decisions. METHODS: Patients with non-small-cell lung cancer (NSCLC) planned for PTR in the period of 2010-2011 at the University Hospital of Copenhagen were included...
January 5, 2018: BMC Palliative Care
https://www.readbyqxmd.com/read/29301524/what-does-complex-mean-in-palliative-care-triangulating-qualitative-findings-from-3-settings
#12
Emma Carduff, Sarah Johnston, Catherine Winstanley, Jamie Morrish, Scott A Murray, Juliet Spiller, Anne Finucane
BACKGROUND: Complex need for patients with a terminal illness distinguishes those who would benefit from specialist palliative care from those who could be cared for by non-specialists. However, the nature of this complexity is not well defined or understood. This study describes how health professionals, from three distinct settings in the United Kingdom, understand complex need in palliative care. METHODS: Semi-structured qualitative interviews were conducted with professionals in primary care, hospital and hospice settings...
January 4, 2018: BMC Palliative Care
https://www.readbyqxmd.com/read/29299618/heart-transplantation-in-children-with-turner-syndrome-analysis-of-a-linked-dataset
#13
Joshua D Chew, Jonathan H Soslow, Cary Thurm, Matt Hall, Debra A Dodd, Brian Feingold, Jill Simmons, Justin Godown
Turner syndrome (TS) patients with hypoplastic left heart syndrome (HLHS) have poor single ventricle palliation outcomes; therefore, consideration of other potential management strategies is important. Little is known about heart transplantation (HTx) in this group, as standard HTx databases do not allow for identification of TS. This study describes experiences and outcomes of HTx in TS using a unique linkage between the Scientific Registry of Transplant Recipients and the Pediatric Health Information System databases...
January 3, 2018: Pediatric Cardiology
https://www.readbyqxmd.com/read/29298400/exploring-opportunities-for-primary-outpatient-palliative-care-for-adults-with-cystic-fibrosis-a-mixed-methods-study-of-patients-needs
#14
Mara R Hobler, Ruth A Engelberg, J Randall Curtis, Kathleen J Ramos, Miriam I Zander, Shacole S Howard, Christopher H Goss, Moira L Aitken
BACKGROUND: Persons with cystic fibrosis (CF) experience high morbidity and mortality, yet little is known about their palliative care needs and how clinicians may address these needs. OBJECTIVES: (1) To identify palliative care and advance care planning needs of patients with CF and their families; and (2) to identify clinicians' potential roles in meeting these needs. METHODS: A mixed-methods study of adult patients (age ≥18 years) with moderate-to-severe CF [forced expiratory volume in the first second (FEV1) <65% predicted] were recruited from a CF Center...
January 3, 2018: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/29285946/implementation-of-a-metastatic-malignancy-of-unknown-primary-origin-service-led-by-a-palliative-physician
#15
David Brooks, Philippa Hughes, Clare Farrington, Peter A Bath, Mary McGregor, Wasim Ahmed, Bill Noble
BACKGROUND: Cancer of unknown primary is the fourth most common cause of cancer death in the United Kingdom. National guidance in 2010 recommended the establishment of a dedicated unknown primary team to facilitate targeted investigation and symptom control. A service development project was undertaken to identify those affected by malignancy of unknown origin and institute a pathway for coordinating their care led by a palliative physician. AIM: To describe the patient population and illness trajectory and to assess the effect of the new pathway on the clinical outcomes...
December 29, 2017: Hospital Practice (Minneapolis)
https://www.readbyqxmd.com/read/29283870/resources-for-educating-training-and-mentoring-nurses-and-unregulated-nursing-care-providers-in-palliative-care-a-review-and-expert-consultation
#16
Barbara Pesut, Madeleine Greig
BACKGROUND: Nurses and nursing care providers provide the most direct care to patients at end of life. Yet, evidence indicates that many feel ill-prepared for the complexity of palliative care. OBJECTIVE: To review the resources required to ensure adequate education, training, and mentorship for nurses and nursing care providers who care for Canadians experiencing life-limiting illness and their families. METHODS: This is a systematic search and narrative review in the Canadian context...
January 2018: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/29282114/risk-factors-for-addiction-among-patients-receiving-prescribed-opioids-a-systematic-review-protocol
#17
Amber Cragg, Jeffrey P Hau, Stephanie A Woo, Christine Liu, Mary M Doyle-Waters, Corinne M Hohl
BACKGROUND: Opioid addiction prevention has become an urgent public health priority, with several countries declaring a state of emergency due to rising death tolls from opioid abuse. Reducing the risk of developing addiction among opioid-naïve patients exposed to prescribed opioids during the process of medical care may be an important primary prevention strategy. Our objective is to synthesize the available evidence about factors associated with the development of addiction among patients first exposed to prescribed opioids, with a focus on opioid-naïve patients...
December 28, 2017: Systematic Reviews
https://www.readbyqxmd.com/read/29275945/the-supply-of-prescription-opioids-contributions-of-episodic-care-prescribers-and-high-quantity%C3%A2-prescribers
#18
Todd Schneberk, Brian Raffetto, David Kim, David L Schriger
STUDY OBJECTIVE: We determine episodic and high-quantity prescribers' contribution to opioid prescriptions and total morphine milligram equivalents in California, especially among individuals prescribed large amounts of opioids. METHODS: This was a cross-sectional descriptive analysis of opioid prescribing patterns during an 8-year period using the de-identified Controlled Substance Utilization Review and Evaluation System (CURES) database, the California subsection of the prescription drug monitoring program...
December 21, 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/29275224/staging-and-surgical-approaches-in-gastric-cancer-a-systematic-review
#19
REVIEW
Natalie Coburn, Roxanne Cosby, Laz Klein, Gregory Knight, Richard Malthaner, Joseph Mamazza, C Dale Mercer, Jolie Ringash
BACKGROUND: Gastric adenocarcinoma accounted for 6.8% of new cancer cases and 8.8% of cancer deaths worldwide in 2012. Although resection is the cornerstone for cure, several aspects of surgical intervention remain controversial or sub-optimally applied at the population level. These include staging, extent of lymph node dissection (LND), optimal requirements of LN assessment, minimum resection margins, surgical technique (laparoscopic vs. open), relationship between surgical volumes and patient outcomes, and resection of stage IV gastric cancer...
December 13, 2017: Cancer Treatment Reviews
https://www.readbyqxmd.com/read/29273480/high-ionized-calcium-concentration-is-associated-with-prolonged-length-of-stay-in-the-intensive-care-unit-for-postoperative-pediatric-cardiac-patients
#20
Satoshi Kimura, Tatsuo Iwasaki, Katsunori Oe, Kazuyoshi Shimizu, Tomohiko Suemori, Tomoyuki Kanazawa, Naohiro Shioji, Yasutoshi Kuroe, Yuto Matsuoka, Hiroshi Morimatsu
OBJECTIVE: There has been controversy regarding the beneficial effects of calcium on myocardial contractility and the harmful effects on myocardial cells, especially in children. The aim of this study was to investigate an association between ionized calcium concentration (iCa) and outcomes for pediatric patients after cardiac surgery. DESIGN: A retrospective, single-center study from May 2013 to December 2014. SETTING: Referral high-volume pediatric cardiac center in a tertiary teaching hospital...
November 8, 2017: Journal of Cardiothoracic and Vascular Anesthesia
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