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Estimating Life Expectancy From Chinese Medicine Could Improve End-of-Life Care in Terminally Ill Cancer Patients. Holist Nurs Pract 2018; 32:247-252. [PMID: 30113958 DOI: 10.1097/hnp.0000000000000285] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Preparing for a good death is an important and meaningful concept in Chinese culture because people hope to know residual life to make effort for their unfinished business. However, the family of terminally ill patients with cancer may be annoyed and frustrated about unexpected bereavement if they have unresolved conflicts with the loved one, missing a chance for declaring love, untimely apologizing and saying goodbye. The study aimed to explore this difficult issue. The medical records of 121 deceased terminally ill patients with cancer at National Cheng Kung University Hospital between December 2010 and February 2012 were reviewed. The signs and awareness of dying among these patients were collected using palliative routine instruments in the hospice ward. The top 3 most prevalent dying signs were coolness and cyanosis (prevalence 98.3%, median period from the first documented dying sign to death 2 days, P = .028), mirror-like tongue (prevalence 94.2%, median period 5 days, P = .007), and earlobe crease (prevalence 93.4%, median period 4 days, P = .052). In addition, the prevalence of dying awareness was 71.1% (median period 4 days, P = .001). Furthermore, terminal agitation was identified more frequently in terminally ill patients with hepatoma and colon cancer (adjusted odds ratio = 3.240, P = .043), but turbid sclera with edema was noted more often in terminally ill patients with head and neck cancer (adjusted odds ratio = 5.698, P = .042). The results provide evidence to support clinical practice, offering knowledge and techniques to health care providers, and increasing quality of life for terminally ill patients with cancer.
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Correale M, Carpagnano GE, Brunetti ND, Forte L, Monaco I, Ferraretti A, Sabato R, Barbaro MPF, Di Biase M, Lacedonia D. Respiratory drive in patients with chronic heart failure and central sleep apnea: Data from the Daunia Heart Failure Registry. Int J Cardiol 2017; 230:630-633. [PMID: 28065692 DOI: 10.1016/j.ijcard.2016.12.172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 12/17/2016] [Accepted: 12/25/2016] [Indexed: 11/18/2022]
Affiliation(s)
| | | | | | - Lucia Forte
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Ilenia Monaco
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Armando Ferraretti
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | | | | | - Matteo Di Biase
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Donato Lacedonia
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
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Bekfani T, Abraham WT. Current and future developments in the field of central sleep apnoea. Europace 2016; 18:1123-34. [DOI: 10.1093/europace/euv435] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 11/23/2015] [Indexed: 12/22/2022] Open
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Anastasopoulos DL, Chalkias A, Iakovidou N, Xanthos T. Effect of cardiac pacing on sleep-related breathing disorders: a systematic review. Heart Fail Rev 2016; 21:579-90. [PMID: 27112558 DOI: 10.1007/s10741-016-9558-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Sleep-related breathing disorders are commonly encountered in the middle-aged population, negatively affecting quality of life. Central sleep apnea is associated with congestive heart failure, whereas obstructive sleep apnea is related to different pathophysiologic mechanisms, such as the total or partial occlusion of upper airway tract. Both sleep-related disorders have been associated with increased morbidity, and hence, they have been a target of several treatment strategies. The aim of this systematic review is to evaluate the effect of different types of cardiac pacing on sleep-related breathing disorders in patients with or without heart failure. The PubMed and Cochrane Central Register of Controlled Trials were examined from April 2015 to January 2016. Of the initial 360 studies, 22 eligible trials were analyzed. The included studies were classified according to the type of sleep disorder and the intervention undertaken. The evidence shows that cardiac resynchronization therapy but not atrial overdrive pacing can reduce apneic events in central sleep apnea patients. However, their effect on obstructive sleep apnea is controversial. It can be assumed that pacing cannot be used alone as treatment of sleep-related breathing disorders. Further research is needed in order to elucidate the effect of these interventions in sleep apnea patients.
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Affiliation(s)
- Dimitrios L Anastasopoulos
- National and Kapodistrian University of Athens, Medical School, MSc "Cardiopulmonary Resuscitation", Athens, Greece.
- Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece.
| | - Athanasios Chalkias
- National and Kapodistrian University of Athens, Medical School, MSc "Cardiopulmonary Resuscitation", Athens, Greece
- Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece
| | - Nicoletta Iakovidou
- National and Kapodistrian University of Athens, Medical School, MSc "Cardiopulmonary Resuscitation", Athens, Greece
- Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece
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Correale M, Brunetti ND, Forte L, Passero T, Monaco I, Ferraretti A, Totaro A, Carpagnano GE, Foschino Barbaro MP, Di Biase M, Lacedonia D. Tissue Doppler Imaging predicts central sleep apnea in patients with chronic heart failure: data from the Daunia Registry. Eur J Clin Invest 2015; 45:1153-60. [PMID: 26365893 DOI: 10.1111/eci.12520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 08/16/2015] [Indexed: 01/18/2023]
Abstract
BACKGROUND Tissue Doppler imaging (TDI) is used to improve risk stratification in patients with chronic heart failure (CHF). So far, few studies have used this method to investigate the characteristics of subjects with CHF and Cheyne-Stokes breathing (CSB). The aim of this study was therefore to evaluate whether TDI assessment may predict the presence of CSB in patients with CHF. MATERIALS AND METHODS A total of 41 consecutive patients with CHF enrolled in the Daunia Heart Failure Registry underwent echocardiography assessment and nocturnal polygraphy to evaluate the presence of sleep apnea and CSB. Conventional echocardiography and TDI parameters were calculated. We have also quantified by TDI a combined index (EAS index) of diastolic and systolic performance: E'/(A' × S'). RESULTS Subjects with evidence of CSB (N = 8) were characterized by lower values of A' (5·03 ± 2·64 vs. 7·88 ± 2·64 cm/s, P < 0·01). A' and EAS index values were related to Cheyne-Stokes episode rates (r = -0·49 and 0·52, P < 0·05 and <0·01 respectively), EAS index values also with the number of episodes of central apnea (r = 0·39, P < 0·05). A' values predicted the presence of CSB at poly-somnography examination with an OR 0·62 (95% CI 0·40-0·96, P < 0·05) even after correction for age and gender. CONCLUSIONS Tissue Doppler imaging values (A') are associated with the presence of sleep apnea at nocturnal polygraphy.
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Affiliation(s)
| | | | - Lucia Forte
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Tommaso Passero
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Ilenia Monaco
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Armando Ferraretti
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Antonio Totaro
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | | | | | - Matteo Di Biase
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Donato Lacedonia
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
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Grayburn RL, Kaka Y, Tang WHW. Contemporary insights and novel treatment approaches to central sleep apnea syndrome in heart failure. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2014; 16:322. [PMID: 24874028 DOI: 10.1007/s11936-014-0322-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OPINION STATEMENT Central sleep apnea (CSA) is a common and under-diagnosed condition commonly associated with Cheyne-Stokes respiration. It is particularly prevalent in the heart failure population affecting up to 40 % of all patients with heart failure. The pathophysiology associated with CSA is based on the underlying effects of hypoventilation and hyperventilation, with neurologic dysregulation of respiratory control as the primary defect. However, therapeutic options are limited because of the prevailing perception that CSA is a consequence, rather than cause of morbidity and mortality. At present, the main focus remains treating the underlying problem (ie, intensifying heart failure therapeutics, decongestion), whereas additional suggestions of using acetazolamide, progesterone, nocturnal oxygen, and theophylline have not been validated with contemporary clinical trials. Positive pressure ventilation is currently the primary recommendation for all patients with sleep-disordered breathing (CSA included), and in some patients may effectively reduce the apnea-hypopnea index. However, significant research is ongoing to determine how to treat this complex patient population.
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Affiliation(s)
- Ryan L Grayburn
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J3-4, Cleveland, OH, USA
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Wahab R, Basner RC. Nocturnal non-invasive ventilation for cardio-respiratory disorders in adults. Expert Rev Respir Med 2013; 7:615-29. [PMID: 24175738 DOI: 10.1586/17476348.2013.839246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Following the classic 'iron lung' non-invasive negative pressure ventilator, non-invasive positive pressure ventilation (NIPPV), particularly used 'nocturnally' has developed a broad role in both the acute hospital setting and domiciliary long-term use for many cardio-respiratory disorders associated with acute and chronic ventilatory failure. This role is based in part upon the perceived relative ease of application and discontinuation of NIPPV, ability to avoid intubation or tracheostomy and their associated morbidities and availability of increasingly portable pressure and volume cycled NIPPV devices. Nevertheless, the many methodologies necessary for optimal NIPPV use are often underappreciated by health care workers and patients alike. This review focuses on the rationale, practice, and future directions for 'nocturnal' use of non-invasive positive pressure ventilation (nNIV) in cardio-respiratory disorders in adults which are commonly associated with sleep-related apnea, hypoventilation and hypoxemia: congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), obesity hypoventilation syndrome (OHS), cystic fibrosis (CF) and neuromuscular disorders.
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Affiliation(s)
- Romina Wahab
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University College of Physicians and Surgeons, 622 West 168th Street, NY 10032, USA
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Zhang XL, Ding N, Wang H, Augostini R, Yang B, Xu D, Ju W, Hou X, Li X, Ni B, Cao K, George I, Wang J, Zhang SJ. Transvenous Phrenic Nerve Stimulation in Patients With Cheyne-Stokes Respiration and Congestive Heart Failure. Chest 2012; 142:927-934. [DOI: 10.1378/chest.11-1899] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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