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Power J, Gouldthorpe C, Davies A. Vital Signs in Palliative Care: A Scoping Review. Cancers (Basel) 2023; 15:4641. [PMID: 37760611 PMCID: PMC10527359 DOI: 10.3390/cancers15184641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/13/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023] Open
Abstract
Vital signs are routinely measured in secondary healthcare settings and can be used to detect clinical problems, guide treatment, and monitor response to treatment. Vital signs are less frequently measured in palliative care settings. Reasons for this are unclear. This scoping review aimed to assess the generic use of vital signs in palliative care, and its role in prognostication for adult patients with cancer receiving palliative care. Medline, Embase, and CINAHL were searched for articles involving adult patients with advanced cancer receiving palliative care who had their vital signs measured. Twenty-six articles were identified in which one or a combination of vital signs, with or without other clinical parameters, was used to prognosticate for patients. An additional three articles investigated the generic use of vital signs in patients with advanced cancer. There was significant heterogeneity between identified studies, with some indication that changes in vital signs may indicate that a patient is close to death. However, other studies suggested that patients may maintain normal vital signs until the time of death. Further studies are needed to explore whether abnormal vital signs may be used as a prognostic indicator for patients with cancer receiving palliative care.
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Affiliation(s)
- Jenny Power
- School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland
- Our Lady’s Hospice & Care Services, D6W RY72 Dublin, Ireland
| | - Craig Gouldthorpe
- Our Lady’s Hospice & Care Services, D6W RY72 Dublin, Ireland
- School of Medicine, Trinity College Dublin, D02 PN40 Dublin, Ireland
| | - Andrew Davies
- School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland
- Our Lady’s Hospice & Care Services, D6W RY72 Dublin, Ireland
- School of Medicine, Trinity College Dublin, D02 PN40 Dublin, Ireland
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Hosoi T, Ozone S, Hamano J, Maruo K, Maeno T. Prediction Models for Impending Death Using Physical Signs and Vital Signs in Noncancer Patients: A Prospective Longitudinal Observational Study. Palliat Med Rep 2022; 2:287-295. [PMID: 34970656 PMCID: PMC8713508 DOI: 10.1089/pmr.2021.0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Accurate information on the prognosis
in the last days of life is essential for providing better end-of-life care;
however, few studies have examined the signs of impending death (SID) or
developed short-term prediction models in noncancer patients. Objective: To investigate the prevalence and onset
of SID and to develop models that predict death within 7 days, 72 hours, and 24
hours in noncancer patients. Design: This is a prospective longitudinal
observational study. Setting/Subjects: Subjects were noncancer patients
admitted to a hospital in Japan between 2019 and 2020. Measurements: We investigated 11 physical signs and
vital signs every 12 hours until death after confirming a reduced daily oral
intake to less than a few mouthfuls. Results: We analyzed data from 50 noncancer
patients. The prediction model “pulselessness of the radial artery OR
respiration of mandibular movement OR the shock Index (SI) >1.0”
predicted death within 7 days with an accuracy of 83.9%, whereas the
models developed to predict death within 72 and 24 hours had an accuracy of
65.0% or less. The median onset of all signs was within 3 days of death.
The frequencies of decreased response to verbal stimuli and decreased response
to visual stimuli were 76.0% and 74.0%, respectively. Conclusions: The prediction model using physical
signs and SI predicted death within 7 days in noncancer patients with high
accuracy. The prediction of death within 72 and 24 hours in noncancer patients
requires investigation of physical signs not examined in this study.
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Affiliation(s)
- Takahiro Hosoi
- Department of General Medicine and Primary Care, University of Tsukuba Hospital, Tsukuba, Japan.,Kamisu Clinical Education and Training Center, Faculty of Medicine, University of Tsukuba, Kamisu, Japan
| | - Sachiko Ozone
- Department of General Medicine and Primary Care, University of Tsukuba Hospital, Tsukuba, Japan.,Primary Care and Medical Education, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Jun Hamano
- Department of General Medicine and Primary Care, University of Tsukuba Hospital, Tsukuba, Japan.,Primary Care and Medical Education, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kazushi Maruo
- Department of Biostatistics, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Tetsuhiro Maeno
- Department of General Medicine and Primary Care, University of Tsukuba Hospital, Tsukuba, Japan.,Primary Care and Medical Education, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Oxygen use and survival in patients with advanced cancer and low oxygen saturation in home care: a preliminary retrospective cohort study. Palliat Care 2020; 19:3. [PMID: 31900147 PMCID: PMC6942361 DOI: 10.1186/s12904-019-0511-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 12/26/2019] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The role of oxygen therapy in end-of-life care for patients with advanced cancer is incompletely understood. We aimed to evaluate the association between oxygen use and survival in patients with advanced cancer and low oxygen saturation in home care.
Methods
We conducted a retrospective cohort study at a primary care practice in suburban Tokyo. Adult patients in home care with advanced cancer demonstrating first low oxygen saturation (less than 90%) detected in home visits were consecutively included in the study. Cox proportional hazards regression was used to investigate the effect of oxygen use on overall survival and survival at home, adjusted for systolic blood pressure, decreased level of consciousness, dyspnea, oral intake, performance status, and cardiopulmonary comorbidity.
Results
Of 433 identified patients with advanced cancer, we enrolled 137 patients (oxygen use, n = 35; no oxygen use, n = 102) who developed low oxygen saturation. In multivariable analysis, the adjusted hazard ratio (HR) of oxygen use was 0.68 (95% confidence interval 0.39–1.17) for death and 0.70 (0.38–1.27) for death at home. In patients with dyspnea, the HR was 0.35 (0.13–0.89) for death and 0.33 (0.11–0.96) for death at home; without dyspnea, it was 1.03 (0.49–2.17) for death and 0.84 (0.36–1.96) for death at home.
Conclusions
Oxygen use was not significantly associated with survival in patients with advanced cancer and low oxygen saturation, after adjusting for potential confounders. It may not be necessary to use oxygen for prolongation of survival in such patients, particularly in those without dyspnea.
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Cheng TH, Sie YD, Hsu KH, Goh ZNL, Chien CY, Chen HY, Ng CJ, Li CH, Seak JCY, Seak CK, Liu YT, Seak CJ. Shock Index: A Simple and Effective Clinical Adjunct in Predicting 60-Day Mortality in Advanced Cancer Patients at the Emergency Department. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17134904. [PMID: 32646021 PMCID: PMC7370122 DOI: 10.3390/ijerph17134904] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/25/2020] [Accepted: 06/30/2020] [Indexed: 12/13/2022]
Abstract
Deciding between palliative and overly aggressive therapies for advanced cancer patients who present to the emergency department (ED) with acute issues requires a prediction of their short-term survival. Various scoring systems have previously been studied in hospices or intensive care units, though they are unsuitable for use in the ED. We aim to examine the use of a shock index (SI) in predicting the 60-day survival of advanced cancer patients presenting to the ED. Identified high-risk patients and their families can then be counseled accordingly. Three hundred and five advanced cancer patients who presented to the EDs of three tertiary hospitals were recruited, and their data retrospectively analyzed. Relevant data regarding medical history and clinical presentation were extracted, and respective shock indices calculated. Multivariate logistic regression analyses were performed. Receiver operating characteristic (ROC) curves were plotted to evaluate the predictive performance of the SI. Nonsurvivors within 60 days had significantly lower body temperatures and blood pressure, as well as higher pulse rates, respiratory rates, and SI. Each 0.1 SI increment had an odds ratio of 1.39 with respect to 60-day mortality. The area under the ROC curve was 0.7511. At the optimal cut-off point of 0.94, the SI had 81.38% sensitivity and 73.11% accuracy. This makes the SI an ideal evaluation tool for rapidly predicting the 60-day mortality risk of advanced cancer patients presenting to the ED. Identified patients can be counseled accordingly, and they can be assisted in making informed decisions on the appropriate treatment goals reflective of their prognoses.
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Affiliation(s)
- Tzu-Heng Cheng
- Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan; (T.-H.C.); (H.-Y.C.); (C.-J.N.); (C.-H.L.); (S.I.)
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Department of Emergency Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City 23652, Taiwan
| | - Yi-Da Sie
- Department of Emergency Medicine, China Medical University Hospital, Taichung 404332, Taiwan;
| | - Kuang-Hung Hsu
- Laboratory for Epidemiology, Department of Health Care Management, and Healthy Aging Research Center, Chang Gung University, Taoyuan 33302, Taiwan;
| | - Zhong Ning Leonard Goh
- Sarawak General Hospital, Kuching, Sarawak 93586, Malaysia; (Z.N.L.G.); (J.C.-Y.S.); (C.-K.S.)
| | - Cheng-Yu Chien
- Department of Emergency Medicine, Ton-Yen General Hospital, Zhubei, Hsinchu County 30268, Taiwan;
| | - Hsien-Yi Chen
- Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan; (T.-H.C.); (H.-Y.C.); (C.-J.N.); (C.-H.L.); (S.I.)
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Chip-Jin Ng
- Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan; (T.-H.C.); (H.-Y.C.); (C.-J.N.); (C.-H.L.); (S.I.)
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Chih-Huang Li
- Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan; (T.-H.C.); (H.-Y.C.); (C.-J.N.); (C.-H.L.); (S.I.)
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Joanna Chen-Yeen Seak
- Sarawak General Hospital, Kuching, Sarawak 93586, Malaysia; (Z.N.L.G.); (J.C.-Y.S.); (C.-K.S.)
| | - Chen-Ken Seak
- Sarawak General Hospital, Kuching, Sarawak 93586, Malaysia; (Z.N.L.G.); (J.C.-Y.S.); (C.-K.S.)
| | - Yi-Tung Liu
- School of Medicine, National Defense Medical Center, Taipei 11490, Taiwan;
| | - Chen-June Seak
- Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan; (T.-H.C.); (H.-Y.C.); (C.-J.N.); (C.-H.L.); (S.I.)
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Department of Emergency Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City 23652, Taiwan
- Correspondence:
| | - SPOT Investigators
- Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan; (T.-H.C.); (H.-Y.C.); (C.-J.N.); (C.-H.L.); (S.I.)
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Department of Emergency Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City 23652, Taiwan
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Al Aseri Z, Al Ageel M, Binkharfi M. The use of the shock index to predict hemodynamic collapse in hypotensive sepsis patients: A cross-sectional analysis. Saudi J Anaesth 2020; 14:192-199. [PMID: 32317874 PMCID: PMC7164438 DOI: 10.4103/sja.sja_780_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 01/09/2020] [Indexed: 12/29/2022] Open
Abstract
Objectives: Septic shock, defined as sepsis with hypotension not responding to fluid resuscitation or requiring vasopressor support, results in the worst outcomes in sepsis patients. This subtype of the patient is often difficult to detect. The shock index (SI) has demonstrated the potential for predicting hemodynamic compromise and collapse and predicting patient outcomes in multiple medical and surgical settings. In our study, we assessed the utility of the SI as a hemodynamic screening tool to identify patients likely to fail to respond to fluids and ultimately to be diagnosed with septic shock. Methodology: A single-center cross-sectional analysis of patients presenting with hypotension and septicemia over 1 year. The study was conducted using the electronic medical records of the emergency department patients presenting to King Saud University Medical City. The charts were reviewed from 2 May 2015 to 24 April 2016 using the local medical registry. The study was approved by the hospital institutional review board (IRB). Data extraction was performed using a standardized form. Results: The area under the curve was 0.77 (P < 0.001) for the prediction of hemodynamic collapse. An initial SI ≥0.875 had a sensitivity of 81% and a specificity of 72% for the identification of patients in whom fluid resuscitation would fail. Conclusions: Based on our findings, we found that the SI was a reliable screening tool for the identification of hypotensive patients with sepsis who would ultimately be diagnosed with septic shock.
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Affiliation(s)
- Zohair Al Aseri
- Emergency Medicine and Critical Care Departments, College of Medicine, King Saud University, 11472, Riyadh, Saudi Arabia
| | - Mohammed Al Ageel
- Emergency Medicine and Critical Care Departments, College of Medicine, King Saud University, 11472, Riyadh, Saudi Arabia
| | - Mohammed Binkharfi
- Emergency Medicine and Critical Care Departments, College of Medicine, King Saud University, 11472, Riyadh, Saudi Arabia
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Hosoi T, Ozone S, Hamano J. Survival time after marked reduction in oral intake in terminally ill noncancer patients: A retrospective study. J Gen Fam Med 2020; 21:9-14. [PMID: 32161695 PMCID: PMC7060293 DOI: 10.1002/jgf2.290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 11/11/2019] [Accepted: 11/19/2019] [Indexed: 01/04/2023] Open
Abstract
Background Methods Results Conclusion
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Affiliation(s)
- Takahiro Hosoi
- Faculty of Medicine Division of Clinical Medicine Department of General Medicine University of Tsukuba Tsukuba Ibaraki Japan
- Faculty of Medicine Kamisu Clinical Education and Training Center University of Tsukuba Kamisu Ibaraki Japan
| | - Sachiko Ozone
- Faculty of Medicine Division of Clinical Medicine Department of General Medicine University of Tsukuba Tsukuba Ibaraki Japan
| | - Jun Hamano
- Faculty of Medicine Division of Clinical Medicine University of Tsukuba Tsukuba Ibaraki Japan
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Hasuo H, Kanbara K, Fujii R, Uchitani K, Sakuma H, Fukunaga M. Factors Associated with the Effectiveness of Intravenous Administration of Chlorpromazine for Delirium in Patients with Terminal Cancer. J Palliat Med 2018; 21:1257-1264. [PMID: 29757064 DOI: 10.1089/jpm.2017.0669] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Delirium in patients with terminal cancer is irreversible and increases treatment resistance, which leads to a deterioration in quality of life. OBJECTIVE To investigate factors affecting the effectiveness and safety of intravenous chlorpromazine for irreversible delirium in patients with terminal cancer. DESIGN/MEASUREMENTS Multiple regression analysis for factors affecting treatment effectiveness was carried out based on a retrospective comparison between responders and nonresponders to intravenous chlorpromazine. SETTING/SUBJECTS Ninety-seven patients with terminal cancer who were treated with intravenous chlorpromazine for irreversible delirium were included. RESULTS The rate of patients with ≥50% improvement in mean Nursing Delirium Screening Scale score from pretreatment to day three of chlorpromazine treatment was 0.48 (95% confidence interval [CI]: 0.38-0.58). Factors affecting chlorpromazine treatment effectiveness were hyperactive delirium (odds ratio [OR]: 6.25, 95% CI: 1.14-34.5) and longer survival (OR: 1.096, 95% CI: 1.05-1.14). The mean chlorpromazine dose was low, at 17.9 mg/day. Adverse events were reported in 11 patients (11.3%) by day three of chlorpromazine treatment, and all were observed in patients who survived less than two weeks after chlorpromazine treatment. Patients who died, who had decreased blood pressure during chlorpromazine administration, and who showed acute akathisia all displayed shock index ≥1. CONCLUSIONS Intravenous administration of low-dose chlorpromazine may be an effective and safe treatment option for delirium in patients with terminal cancer who have hyperactive delirium, longer predictive prognosis, and shock index <1.
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Affiliation(s)
- Hideaki Hasuo
- Department of Psychosomatic Medicine, Kansai Medical University , Hirakata, Osaka, Japan
| | - Kenji Kanbara
- Department of Psychosomatic Medicine, Kansai Medical University , Hirakata, Osaka, Japan
| | - Ryohei Fujii
- Department of Psychosomatic Medicine, Kansai Medical University , Hirakata, Osaka, Japan
| | - Kazuki Uchitani
- Department of Psychosomatic Medicine, Kansai Medical University , Hirakata, Osaka, Japan
| | - Hiroko Sakuma
- Department of Psychosomatic Medicine, Kansai Medical University , Hirakata, Osaka, Japan
| | - Mikihiko Fukunaga
- Department of Psychosomatic Medicine, Kansai Medical University , Hirakata, Osaka, Japan
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