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Altawili AA, Altawili MA, Alzarar AH, Abdulrahim NM, Alquraish HH, Alahmari MA, Basyouni MH, Almohaya YA, Alhabshan WMS, Alshahrani AMA, Alamrad JFA, Aljumaah AS, Alsalman MA, Alhafith AA. Adverse Events of the Long-Term Use of Opioids for Chronic Non-cancer Pain: A Narrative Review. Cureus 2024; 16:e51475. [PMID: 38298287 PMCID: PMC10830133 DOI: 10.7759/cureus.51475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND The long-term use of opioids for chronic non-cancer pain (CNCP) has drawn more attention and debate. Although opioids are frequently used to treat chronic pain, their effectiveness and safety over extended periods are still unknown. OBJECTIVES The purpose of this review is to provide an overview of what is currently known about the adverse events of long-term use of opioids in CNCP. It also delivers patient-centered strategies designed to mitigate these risks. METHODS We conducted a literature search in PubMed, MEDLINE, EMBASE, and Web of Science databases. Search terms included CNCP, pain pathophysiology, opioid pharmacodynamics, opioid prescribing trends, guidelines for opioid use, and opioid side effects. Results: Our review highlights that while opioids may provide short-term relief from CNCP, their effectiveness diminishes over time due to the development of opioid tolerance. This tolerance often leads to increased dosages, which can subsequently result in opioid dependence. Additionally, long-term opioid therapy is associated with a spectrum of adverse effects, including constipation, drowsiness, respiratory depression, and potential for drug interactions. Furthermore, our review indicates that alternative pain management strategies play a crucial role in controlling CNCP. They offer significant benefits with fewer adverse events. These strategies include non-opioid medications, physical therapy, cognitive-behavioral therapy (CBT), various interventional procedures, injection therapy, and acupuncture. CONCLUSION Using opioids to manage CNCP presents several challenges. Given these challenges, alternative treatments are being considered as viable options. Moreover, it is crucial to customize treatment plans to align with the patients' specific health requirements, existing conditions, and potential risks to ensure the best possible outcomes.
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Affiliation(s)
- Abdullh A Altawili
- Internal Medicine and Gastroenterology, King Fahad Specialist Hospital, Tabuk, SAU
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2
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Mir AS, Abel WF, Lebel DP. Colonic Lymphangiomatosis. Cureus 2023; 15:e39085. [PMID: 37332407 PMCID: PMC10269742 DOI: 10.7759/cureus.39085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2023] [Indexed: 06/20/2023] Open
Abstract
Lymphangiomas are benign malformations of the lymphatic vessels which can be primary or secondary in etiology. Colonic involvement is rare, and the diagnosis is mostly incidental. Sometimes, the initial endoscopic appearance can be misleading. We present a case of colonic lymphangiomatosis presenting with free air under the diaphragm requiring surgical removal of the involved portion of the colon. The diagnosis was confirmed by the pathology of the resected specimen and its correlation with prior clinical information. The patient recovered well with an uneventful postoperative course and follow-up. This case demonstrates a rare complication of colonic lymphangiomatosis prompting definitive treatment by surgical resection.
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Affiliation(s)
- Adil S Mir
- Gastroenterology, Virginia Tech Carilion School of Medicine, Roanoke, USA
| | | | - David P Lebel
- Pathology, Dominion Pathology Associates, Roanoke, USA
- Basic Science Education, Virginia Tech Carilion School of Medicine, Roanoke, USA
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3
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Morris M, Chye R, Liu Z, Agar M, Razmovski-Naumovski V. A Retrospective Medical Record Review of Adults with Non-Cancer Diagnoses Prescribed Medicinal Cannabis. J Clin Med 2023; 12:jcm12041483. [PMID: 36836018 PMCID: PMC9965412 DOI: 10.3390/jcm12041483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/27/2023] [Accepted: 02/03/2023] [Indexed: 02/16/2023] Open
Abstract
Research describing patients using medicinal cannabis and its effectiveness is lacking. We aimed to describe adults with non-cancer diagnoses who are prescribed medicinal cannabis via a retrospective medical record review and assess its effectiveness and safety. From 157 Australian records, most were female (63.7%; mean age 63.0 years). Most patients had neurological (58.0%) or musculoskeletal (24.8%) conditions. Medicinal cannabis was perceived beneficial by 53.5% of patients. Mixed-effects modelling and post hoc multiple comparisons analysis showed significant changes overtime for pain, bowel problems, fatigue, difficulty sleeping, mood, quality of life (all p < 0.0001), breathing problems (p = 0.0035), and appetite (p = 0.0465) Symptom Assessment Scale scores. For the conditions, neuropathic pain/peripheral neuropathy had the highest rate of perceived benefit (66.6%), followed by Parkinson's disease (60.9%), multiple sclerosis (60.0%), migraine (43.8%), chronic pain syndrome (42.1%), and spondylosis (40.0%). For the indications, medicinal cannabis had the greatest perceived effect on sleep (80.0%), followed by pain (51.5%), and muscle spasm (50%). Oral oil preparations of balanced delta-9-tetrahydrocannabinol/cannabidiol (average post-titration dose of 16.9 mg and 34.8 mg per day, respectively) were mainly prescribed. Somnolence was the most frequently reported side effect (21%). This study supports medicinal cannabis' potential to safely treat non-cancer chronic conditions and indications.
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Affiliation(s)
- Michael Morris
- South West Sydney Clinical Campuses, Faculty of Medicine & Health, University of New South Wales Sydney (UNSW), Sydney, NSW 2170, Australia
| | - Richard Chye
- Sacred Heart Health Service, St Vincent’s Hospital, Darlinghurst, NSW 2010, Australia
| | - Zhixin Liu
- Stats Central, University of New South Wales Sydney (UNSW), Sydney, NSW 2170, Australia
| | - Meera Agar
- South West Sydney Clinical Campuses, Faculty of Medicine & Health, University of New South Wales Sydney (UNSW), Sydney, NSW 2170, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW 2170, Australia
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Ultimo, NSW 2007, Australia
| | - Valentina Razmovski-Naumovski
- South West Sydney Clinical Campuses, Faculty of Medicine & Health, University of New South Wales Sydney (UNSW), Sydney, NSW 2170, Australia
- Sacred Heart Health Service, St Vincent’s Hospital, Darlinghurst, NSW 2010, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW 2170, Australia
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Ultimo, NSW 2007, Australia
- Correspondence:
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Hamano J, Shinjo T, Fukumoto K, Kodama M, Kim H, Otomo S, Masumoto S, Hashimoto K, Matsuki T, Hisajima K, Miyata N, Suzuki R, Yokoya S, Miyake K, Takayanagi R, Shimizu M, Kataoka Y, Taira H, Ozone S, Takahashi H, Kizawa Y. Unresolved Palliative Care Needs of Elderly Non-Cancer Patients at Home: A Multicenter Prospective Study. J Prim Care Community Health 2023; 14:21501319231221431. [PMID: 38131120 DOI: 10.1177/21501319231221431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
INTRODUCTION/OBJECTIVES There is growing consensus on the benefits of initiating palliative care early in the disease trajectory; however, palliative care needs for non-cancer patients remain to be elucidated. We investigated the trajectory of unresolved palliative care needs of non-cancer patients at home and explored associated factors. METHODS We conducted a multicenter prospective cohort study of elderly non-cancer patients at home in Japan between Jan 2020 and Dec 2020. Physicians assessed their palliative care needs using the Integrated Palliative Care Outcome Scale (IPOS). Unresolved palliative care needs were defined as IPOS symptoms above 2 (moderate). RESULTS In total, 785 patients were enrolled. The most frequent unresolved palliative care needs at enrollment were poor mobility (n = 438, 55.8%), followed by weakness/lack of energy (n = 181, 23.1%) and poor appetite (n = 160, 20.4%). Multivariate logistic regression analysis revealed that female and musculoskeletal disease were significantly positively associated with pain at starting home visits (OR = 1.89, P = .015; OR = 2.69, P = .005). In addition, neurological diseases were significantly positively associated with constipation and poor mobility 3 months after starting home visits (OR = 3.75, P = .047; OR = 3.04, P = .009). CONCLUSIONS The order of the prevalence of unresolved palliative care needs may remain relatively stable over time, even for those receiving home-based palliative care services. We identified several specific diseases and conditions that were significantly associated with unresolved palliative care needs.
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Affiliation(s)
- Jun Hamano
- Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | | | | | - Maiko Kodama
- University of Fukui Hospital, Yoshida-gun, Fukui, Japan
| | - Hongja Kim
- Tottori University, Yonago, Tottoti, Japan
| | - Sen Otomo
- Seimeikan clinic, Sapporo, Hokkaido, Japan
| | - Shoichi Masumoto
- Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
- Tsukuba Central Hospital, Tsukuba, Ibaraki, Japan
| | | | | | | | | | | | - Shoji Yokoya
- Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
- Kitaibaraki Center for Family Medicine, Kitaibaraki, Ibaraki, Japan
| | | | | | | | - Yoshihiro Kataoka
- Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | | | - Sachiko Ozone
- Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | | | - Yoshiyuki Kizawa
- Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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Kasdorf A, Dust G, Schippel N, Pfaff H, Rietz C, Voltz R, Strupp J. Dying in hospital is worse for non-cancer patients. A regional cross-sectional survey of bereaved relatives' views. Eur J Cancer Care (Engl) 2022; 31:e13683. [PMID: 35993254 DOI: 10.1111/ecc.13683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 07/26/2022] [Accepted: 08/02/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study is to examine differences in hospital care between patients with cancer and non-cancer conditions in their dying phase, perceived by bereaved relatives. METHODS A retrospective cross-sectional post-bereavement survey, with the total population of 351 deceased, 91 cancer patients and 46 non-cancer patients, who spent their last 2 days of life in hospital. A validated German version of the VOICES-questionnaire ('VOICES-LYOL-Cologne') was used. RESULTS There were substantial differences between the two groups in the rating of sufficient practical care such as pain relief or support to eat or drink (p = 0.005) and sufficient emotional care needs (p = 0.006) and in the quality of communication with healthcare professionals (p < 0.001), with non-cancer patients scoring lowest in all these dimensions. CONCLUSION In all surveyed dimensions on the quality of care in the dying phase, non-cancer patients' relatives rated the provided care worse than those of cancer patients. To compensate any differences in care in the dying phase between diagnosis groups, hospital care should be provided as needs-oriented and non-indication-specific.
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Affiliation(s)
- Alina Kasdorf
- Department of Palliative Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Gloria Dust
- Department of Palliative Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Nicolas Schippel
- Department of Palliative Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Holger Pfaff
- Institute for Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), Faculty of Human Sciences and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Christian Rietz
- Department of Educational Science and Mixed-Methods-Research, Faculty of Educational and Social Sciences, University of Education Heidelberg, Heidelberg, Germany
| | - Raymond Voltz
- Department of Palliative Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Center for Health Services Research, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO ABCD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Julia Strupp
- Department of Palliative Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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6
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Wang PH, Pan SW, Wang SM, Shu CC, Chang CH. The Impact of Nontuberculous Mycobacteria Species on Mortality in Patients With Nontuberculous Mycobacterial Lung Disease. Front Microbiol 2022; 13:909274. [PMID: 35875534 PMCID: PMC9300315 DOI: 10.3389/fmicb.2022.909274] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/14/2022] [Indexed: 12/03/2022] Open
Abstract
Patients with nontuberculous mycobacterial lung disease (NTM-LD) have increased mortality. The impact of NTM species on the risk of mortality remains unclear, especially that of death by non-cancer causes. We conducted a retrospective cohort study from 2006 to 2018 in a tertiary-care hospital in Taiwan. We enrolled patients who fulfilled the microbiological diagnostic criteria of NTM-LD. The mortality causes within 8 years after diagnosis were identified, and the Cox proportional hazard regression was performed for risk factors of mortality. A total of 1,652 subjects with NTM-LD were included. Among them, 723 (43.8%) were infected by Mycobacterium avium complex (MAC), 408 (24.7%) by M. abscessus complex (MABC), 120 (7.3%) by Mycobacterium kansasii (MK), 304 (18.4%) by other rapid-growing mycobacteria (RGM), and 97 (5.9%) by other slow-growing mycobacteria (SGM) groups. The 8-year all-cause mortality was 45.2% for all and the highest in the MK-LD group (59.2%), followed by the MABC-LD and MAC-LD groups. The adjusted hazard ratios were 2.20 (95% confidence interval: 1.40–3.46) in the MK-LD, 1.85 (1.54–2.22) in the MABC-LD, and 1.65 (1.12–2.41) in the MAC-LD groups for all-cause mortality, compared with the SGM group. Kaplan–Meier survival curves showed that all-cause mortality, non-cancer mortality, and mortality due to chronic airway diseases were significantly correlated with NTM species (log-rank p = 0.0031, < 0.001, and 0.001, respectively). High 8-year mortality rates were found in patients with NTM-LDs according to different NTM species. Notably, the difference was significant in non-cancer mortality causes, especially in chronic airway diseases.
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Affiliation(s)
- Ping-Huai Wang
- Division of Thoracic Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,Department of Nursing, Asia Eastern University of Science and Technology, New Taipei City, Taiwan
| | - Sheng-Wei Pan
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Su-Mei Wang
- Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan
| | - Chin-Chung Shu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chin-Hao Chang
- Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan
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7
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Mirgh SP, Gokarn A, Rajendra A, More A, Kamtalwar S, Katti KS, Singh A, Goli VB, Ravind R, Madala R, Kakoti S, Maitre P, Punatar S, Chichra A, Patil A, Trivedi B, Joshi A, Patkar N, Tembhare P, Khanka T, Rajpal S, Chatterjee G, Kannan S, Subramanian P, Murthy V, Shetty N, Chavan P, Bhat V, Nair S, Khattry N, Gupta S. Clinical characteristics, laboratory parameters and outcomes of COVID-19 in cancer and non-cancer patients from a tertiary Cancer Centre in India. Cancer Med 2021; 10:8777-8788. [PMID: 34786866 PMCID: PMC8646792 DOI: 10.1002/cam4.4379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 09/12/2021] [Accepted: 09/23/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND There is paucity of data regarding clinical characteristics, laboratory parameters and outcomes of coronavirus disease (COVID-19) in cancer versus non-cancer patients, particularly from India. MATERIALS AND METHODS This was an observational, single-centre, retrospective analysis of patients with laboratory-confirmed COVID-19 hospitalised in our institution between 22 May 2020 and 1 December 2020. We compared baseline clinical characteristics, laboratory parameters and outcomes of COVID-19 (overall mortality, time to discharge) between cancer and non-cancer patients. RESULTS A total of 200 COVID-19 infection episodes were analysed of which 109 (54.5%) were patients with cancer and 91 (45.5%) were patients without cancer. The median age was 43 (interquartile range [IQR]:32-57), 51 (IQR: 33-62) and 38 (IQR: 31.5-49.3) years; of whole cohort, cancer and non-cancer patients, respectively. Comparison of outcomes showed that oxygen requirement (31.2% [95% CI: 22.6-40.7] vs. 17.6% [95% CI: 10.4-26.9]; p = 0.03), median time to discharge (11 days [IQR: 6.75-16] vs. 6 days [IQR: 3-9.75]; p < 0.001) and mortality (10.0% [95% CI: 5.2-17.3] vs. 1.1% [95% CI: 0.03-5.9]; p = 0.017) were significantly higher in patients with cancer. In univariable analysis, factors associated with higher mortality in the whole cohort included diagnosis of cancer (10.1% vs. 1.1%; p = 0.027; odds ratio [OR]: 7.04), age ≥60 (17.4% vs. 2.6%; p = 0.001; OR: 7.38), oxygen requirement (22% vs. 0.6%; p < 0.001; OR: 29.01), chest infiltrates (19.2% vs. 1.4%; p < 0.001; OR: 22.65), baseline absolute lymphocyte count <1 × 109 /L (10.8% vs. 1.9%; p = 0.023; OR:5.1), C-reactive protein >1 mg% (12.8% vs. 0%; p = 0.027; OR: 24.69), serum procalcitonin >0.05 ng/ml (22.65% vs. 0%; p = 0.004; OR: 4.49) and interleukin-6 >6 pg/ml (10.8% vs. 1.3%; p = 0.036; OR: 3.08). In multivariable logistic regression, factors significantly associated with mortality were oxygen requirement (p = 0.005; OR: 13.11) and high baseline procalcitonin level (p = 0.014; OR: 37.6). CONCLUSION Cancer patients with COVID-19 have higher mortality and require longer hospital stay. High procalcitonin levels and oxygen requirement during admission are other factors that affect outcomes adversely.
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8
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Huang LH, Lin LS, Wang CL, Chang YC, Lee LC, Hu CC, Hsu PS, Chu WM. Palliative Care Consultation Services on Terminally Ill Cancer Patients and Non-Cancer Patients: Trend Analysis from a 9-Year-Long Observational Study in Taiwan. Int J Environ Res Public Health 2021; 18:ijerph18189882. [PMID: 34574805 PMCID: PMC8466532 DOI: 10.3390/ijerph18189882] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 09/13/2021] [Accepted: 09/15/2021] [Indexed: 01/03/2023]
Abstract
Early integration of palliative care for terminally ill cancer and non-cancer patients improves quality of life. However, there are sparse data on results of palliative care consultation services (PCCS) between cancer and non-cancer patients. In this 9-year observational study, data were collected from the Hospice-Palliative Clinical Database (HPCD) of Taichung Veterans General Hospital (TCVGH). Terminally ill cancer and non-cancer patients who received PCCS during 2011 to 2019 were enrolled. Trend analysis was performed to evaluate differences in outcomes of PCCS, including duration of PCCS, the awareness of disease of patients and families before and after PCCS, status of PCCS termination, and DNR declaration before and after PCCS among cancer and non-cancer patients throughout study period. In total, 5223 cancer patients and 536 non-cancer patients received PCCS from 2011 to 2019. The number of people who received PCCS increased stably over the decade, both for cancer and non-cancer patients. The average duration of PCCS for cancer and non-cancer patients was 21.4 days and 18.4 days, respectively. Compared with non-cancer patients, cancer patients had longer duration of PCCS, less DNR declaration (82% vs. 98%, respectively), and more transfers to the palliative care unit (17% vs. 11%, respectively), or for palliative home care (12% vs.8%, respectively). Determinants of late referral to PCCS includes age (OR 0.992, 95% CI 0.987–0.996), DNR declaration after PCCS (OR 1.967, 95% CI 1.574–2.458), patients’ awareness after PCCS (OR 0.754, 95% CI 0.635–0.895), and status of PCCS termination. This 9-year observational study showed that the trend of PCCS among cancer and non-cancer patients had changed over the duration of the study, and early integration of PCCS to all patients is essential for both cancer and non-cancer patients.
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Affiliation(s)
- Ling-Hui Huang
- Department of Nursing, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (L.-H.H.); (L.-S.L.)
| | - Lian-Shin Lin
- Department of Nursing, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (L.-H.H.); (L.-S.L.)
| | - Chun-Li Wang
- Department of Family Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (C.-L.W.); (L.-C.L.); (C.-C.H.); (P.-S.H.)
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Yu-Chen Chang
- Technology Transfer and Incubation Center, National Health Research Institutes, Miaoli 35053, Taiwan;
| | - Lung-Chun Lee
- Department of Family Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (C.-L.W.); (L.-C.L.); (C.-C.H.); (P.-S.H.)
- Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung 40705, Taiwan
| | - Chung-Chieh Hu
- Department of Family Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (C.-L.W.); (L.-C.L.); (C.-C.H.); (P.-S.H.)
| | - Pi-Shan Hsu
- Department of Family Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (C.-L.W.); (L.-C.L.); (C.-C.H.); (P.-S.H.)
- Graduate Institute of Microbiology and Public Health, College of Veterinary Medicine, National Chung-Hsing University, Taichung 40220, Taiwan
| | - Wei-Min Chu
- Department of Family Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (C.-L.W.); (L.-C.L.); (C.-C.H.); (P.-S.H.)
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- Department of Occupational Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Institute of Health Policy and Management, National Taiwan University, Taipei 10617, Taiwan
- Correspondence: ; Tel.: +886-4-2359-2525
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9
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Gill FJ, Hashem Z, Stegmann R, Aoun SM. The support needs of parent caregivers of children with a life-limiting illness and approaches used to meet their needs: A scoping review. Palliat Med 2021; 35:76-96. [PMID: 33103579 DOI: 10.1177/0269216320967593] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Provision of paediatric palliative care is complex and optimally covers meeting the individual needs of a heterogenous population of children and their parent caregivers throughout a life-limiting illness. It is unclear whether existing approaches comprehensively address parent caregivers' needs. AIM To examine support needs of parents caring for children with life limiting illnesses and identify specific approaches used to identify and address needs. DESIGN A scoping review. DATA SOURCES MEDLINE, EMBASE, PsycINFO, CINAHL and ProQuest Central, were searched for peer reviewed English language full text research published from 2008 to 2019. Study quality appraisal was undertaken. Fourteen quantitative, 18 qualitative and 12 mixed methods studies were synthesised and themed using summative content analysis and mapped to the Parent Supportive Care Needs Framework (PSCNF). RESULTS Themes were communication, choice, information, practical, social, psychological, emotional and physical. Communication and choice were central and additional to domains of the PSCNF. Unmet were needs for supporting siblings, for respite care, out of hours, psychological, home and educational support. Six articles reported using instruments to identify parent carer support needs. CONCLUSION Support needs of parent caregivers of children with life limiting illnesses are substantial and heterogenous. While studies report evidence of burden and distress in parent caregivers, this rarely translates into improvements in practice through the development of interventions. A systematic and regular assessment of individual parent caregiver support needs is required by using instruments appropriate to use in clinical practice to move the focus to palliative care interventions and improved services for parents.
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Affiliation(s)
- Fenella J Gill
- Perth Children's Hospital, Child and Adolescent Health Service, Nedlands, Western Australia, Australia.,School of Nursing, Midwifery and Paramedicine, Faculty Health Sciences, Curtin University, Bentley, Western Australia, Australia
| | - Zahraa Hashem
- School of Nursing, Midwifery and Paramedicine, Faculty Health Sciences, Curtin University, Bentley, Western Australia, Australia
| | - Roswitha Stegmann
- School of Psychology and Public Health, La Trobe University, Victoria, Australia
| | - Samar M Aoun
- School of Psychology and Public Health, La Trobe University, Victoria, Australia.,Perron Institute for Neurological and Translational Science, Western Australia, Australia
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10
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Zhang B, Xie R, Hubert SM, Yu Y, Zhang Y, Lei X, Deng W, Chen J, Li Y. Characteristics and Outcomes of 35 Breast Cancer Patients Infected With COVID-19. Front Oncol 2020; 10:570130. [PMID: 33194660 PMCID: PMC7609864 DOI: 10.3389/fonc.2020.570130] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 09/07/2020] [Indexed: 01/01/2023] Open
Abstract
Since December 2019, a novel coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly engulfed the world. Cancer patients infected with COVID-19 are considered to carry higher severity of the disease and higher mortality rate than common COVID-19 patients in previous studies. However, due to the poor clinical information on COVID-19 patients with cancer, the evidences that supported this conclusion are insufficient. At present, rather limited reports have analyzed the clinical data of breast cancer patients infected with COVID-19. Therefore, in this retrospective study, we described the clinical characteristics and the outcomes of 35 COVID-19 patients with breast cancer and compared 55 COVID-19 patients without cancer and 81 COVID-19 patients with other types of cancer as controls. Our data showed that there were no differences in disease severity and outcomes between the COVID-19 patients with breast cancer and the common COVID-19 patients, which was in contrast to previous studies. In addition, compared with other types of cancer patients, asymptomatic infections and mild cases among breast cancer patients made up a substantially larger proportion. Our results indicated that the clinical characteristics of breast cancer patients were milder than those of other types of cancer patients, but there were no significant differences in outcomes between the two groups.
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Affiliation(s)
- Bo Zhang
- Department of Breast and Thyroid Surgery, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Rong Xie
- Department of Breast and Thyroid Surgery, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Shawna M Hubert
- Department of Thoracic Medical Oncology, Department of Genomic Medicine, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Yuanhang Yu
- Department of Breast and Thyroid Surgery, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Yue Zhang
- Department of Breast and Thyroid Surgery, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Xiao Lei
- Department of General Medicine, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Deng
- Department of General Medicine, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Jianying Chen
- Department of Gastrointestinal Surgery, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Yunqiao Li
- Department of Geriatrics, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
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11
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Aoun SM, Gill FJ, Phillips MB, Momber S, Cuddeford L, Deleuil R, Stegmann R, Howting D, Lyon ME. The profile and support needs of parents in paediatric palliative care: comparing cancer and non-cancer groups. Palliat Care Soc Pract 2020; 14:2632352420958000. [PMID: 33033802 PMCID: PMC7525220 DOI: 10.1177/2632352420958000] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/17/2020] [Indexed: 12/05/2022] Open
Abstract
Background: Parents of children with life-limiting illnesses experience considerable
burden and distress, yet few interventions have targeted their
well-being. Objectives: Evaluate the use and feasibility of the Paediatric Carer Support Needs
Assessment Tool (pCSNAT) in assessing and addressing parents’ needs caring
for cancer and non-cancer conditions. Carer well-being outcomes were also
tested. Methods: A non-randomised prospective intervention pilot study. Twenty-eight parents
(out of 42 approached) and 5 health professionals working in paediatric
palliative care services in Western Australia (2018–2019) completed the
pilot study. Results: Two-thirds of eligible parents completed the study. The highest support needs
included having time for yourself; practical help in the home; knowing what
to expect in the future; financial, legal or work issues; and knowing who to
contact if you are concerned. Almost all needs were considerably more
pronounced for the non-cancer group. The pCSNAT seemed feasible and outcomes
demonstrated a tendency to improve. Conclusion: Using the pCSNAT provided a concise and comprehensive ‘one stop shop’ for
health professionals to evaluate difficulties encountered by parents. The
disadvantages reported by the non-cancer group warrant increased attention.
Paediatric palliative care should adopt routine assessment of parents’
support needs to anticipate early and tailored supports including
partnerships with the community.
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Affiliation(s)
- Samar M Aoun
- Professor, Perron Institute for Neurological and Translational Science, 8 Verdun Street, Nedlands, WA 6009, Australia
| | - Fenella J Gill
- Child and Adolescent Health Service, Perth Children's Hospital, Nedlands, WA, Australia; Curtin University, Perth, WA, Australia
| | - Marianne B Phillips
- Child and Adolescent Health Service, Perth Children's Hospital, Nedlands, WA, Australia
| | - Suzanne Momber
- Child and Adolescent Health Service, Perth Children's Hospital, Nedlands, WA, Australia
| | - Lisa Cuddeford
- Child and Adolescent Health Service, Perth Children's Hospital, Nedlands, WA, Australia
| | - Renee Deleuil
- Child and Adolescent Health Service, Perth Children's Hospital, Nedlands, WA, Australia
| | | | - Denise Howting
- La Trobe University, Melbourne, VIC, Australia; Centre for Medical Research, Harry Perkins Institute of Medical Research, The University of Western Australia, Perth, WA, Australia
| | - Maureen E Lyon
- Children's National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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12
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Affiliation(s)
- Wen Yang Goh
- Department of Palliative Medicine, 63703Tan Tock Seng Hospital, Singapore.,Department of Geriatric Medicine, Institute of Geriatrics and Active Ageing, 63703Tan Tock Seng Hospital, Singapore.,Palliative Care Centre for Excellence in Research and Education, Singapore
| | - Allyn Y M Hum
- Department of Palliative Medicine, 63703Tan Tock Seng Hospital, Singapore.,Department of Geriatric Medicine, Institute of Geriatrics and Active Ageing, 63703Tan Tock Seng Hospital, Singapore.,Palliative Care Centre for Excellence in Research and Education, Singapore
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13
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Abstract
The use of opioids in chronic non-cancer pain (CNCP) has been a fast-rising treatment phenomenon in the last two decades. Though opioids are advocated in various chronic pain management guidelines, their use in chronic non-cancer pain still remains controversial as evidence of this approach is still weak. This paper highlights potential adverse effects associated with opioid use in pain management, including an increase in tolerance, dependence, and addiction outcomes. Nonetheless, opioids have an important place in contemporary CNCP management for selected patients. However, pain management must involve regular monitoring and the use of a multimodal pain management strategy. It is essential that the treating physician must be up-to-date with the form of therapy so that they have the requisite confidence to prescribe opioids and effectively manage adverse effects. Moreover, the adverse effects should be treated promptly to enhance patient compliance. Since this approach is beneficial for some patients, opioid treatment should only be applied on a case by case basis.
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Affiliation(s)
- Alessia Genova
- Medicine, Xavier University School of Medicine, Oranjestad, ABW
| | - Olivia Dix
- Medicine, Xavier University School of Medicine, Oranjestad, ABW
| | - Mala Thakur
- Medicine, Xavier University School of Medicine, Oranjestad, ABW
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14
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Nolte-Buchholtz S, Zernikow B, Wager J. Pediatric Patients Receiving Specialized Palliative Home Care According to German Law: A Prospective Multicenter Cohort Study. Children (Basel) 2018; 5:E66. [PMID: 29857504 DOI: 10.3390/children5060066] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 05/26/2018] [Accepted: 05/28/2018] [Indexed: 12/03/2022]
Abstract
In Germany, every child with a life-limiting condition suffering from symptoms that cannot sufficiently be controlled is eligible by law for specialized pediatric palliative home care (SPPHC). It is the aim of this study to describe the demographic and clinical characteristics of children referred to SPPHC and to compare patients with cancer and non-cancer conditions. The prospective multicenter study includes data on 75 children (median age 7.7 years, 50.7% male). The majority had non-cancer conditions (72%). The most common symptoms were cognitive impairment, somatic pain, impairment in communication or swallowing difficulties. Swallowing difficulties, seizures, and spasticity occurred significantly more often in non-cancer patients (p < 0.01). Cancer patients received antiemetics significantly more often (permanent and on demand) than non-cancer patients (p < 0.01). Significantly more non-cancer patients had some type of feeding tube (57.3%) or received oxygen (33.3%) (p < 0.01). Central venous catheters had been fitted in 20% of the patients, mostly in cancer patients (p < 0.001). Tracheostomy tubes (9.3%) or ventilation (14.7%) were only used in non-cancer patients. In conclusion, patients referred to SPPHC are a diverse cohort with complex conditions including a large range of neurologically originating symptoms. The care of pediatric palliative care patients with cancer is different to the care of non-cancer patients.
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15
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Ferguson AC, Black JC, Sims IB, Welday JN, Elmir SM, Goff KF, Higginbotham JM, Solo-Gabriele HM. Risk Assessment for Children Exposed to Arsenic on Baseball Fields with Contaminated Fill Material. Int J Environ Res Public Health 2018; 15:ijerph15010067. [PMID: 29300352 PMCID: PMC5800166 DOI: 10.3390/ijerph15010067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 12/24/2017] [Accepted: 12/27/2017] [Indexed: 11/16/2022]
Abstract
Children can be exposed to arsenic through play areas which may have contaminated fill material from historic land use. The objective of the current study was to evaluate the risk to children who play and/or spend time at baseball fields with soils shown to have arsenic above background levels. Arsenic in soils at the study sites located in Miami, FL, USA showed distinct distributions between infield, outfield, and areas adjacent to the fields. Using best estimates of exposure factors for children baseball scenarios, results show that non-cancer risks depend most heavily upon the age of the person and the arsenic exposure level. For extreme exposure scenarios evaluated in this study, children from 1 to 2 years were at highest risk for non-cancer effects (Hazard Quotient, HQ > 2.4), and risks were higher for children exhibiting pica (HQ > 9.7) which shows the importance of testing fill for land use where children may play. At the study sites, concentration levels of arsenic resulted in a range of computed cancer risks that differed by a factor of 10. In these sites, the child’s play position also affected risk. Outfield players, with a lifetime exposure to these arsenic levels, could have 10 times more increased chance of experiencing cancers associated with arsenic (i.e., lung, bladder, skin) in comparison to infielders. The distinct concentration distributions observed between these portions of the baseball fields emphasize the need to delineate contaminated areas in public property where citizens may spend more free time. This study also showed a need for more tools to improve the risk estimates for child play activities. For instance, more refined measurements of exposure factors for intake (e.g., inhalation rates under rigorous play activities, hand to mouth rates), exposure frequency (i.e., time spent in various activities) and other exposure factors (e.g., soil particulate emission rates at baseball play fields) can help pinpoint risk on baseball fields where arsenic levels may be a concern.
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Affiliation(s)
- Alesia C Ferguson
- Environmental and Occupational Health, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
| | - Jennifer C Black
- Department of Civil, Architectural, and Environmental Engineering, University of Miami, Coral Gables, FL 33146, USA.
| | - Isaac B Sims
- Environmental and Occupational Health, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
| | - Jennifer N Welday
- Department of Civil, Architectural, and Environmental Engineering, University of Miami, Coral Gables, FL 33146, USA.
| | - Samir M Elmir
- Florida Department of Health at Miami-Dade County, Miami, FL 33056, USA.
| | - Kendra F Goff
- Florida Department of Health, Tallahassee, FL 32399, USA.
| | | | - Helena M Solo-Gabriele
- Department of Civil, Architectural, and Environmental Engineering, University of Miami, Coral Gables, FL 33146, USA.
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16
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Rainsford S, Glasgow NJ, MacLeod RD, Neeman T, Phillips CB, Wiles RB. Place of death in the Snowy Monaro region of New South Wales: A study of residents who died of a condition amenable to palliative care. Aust J Rural Health 2017; 26:126-133. [PMID: 29226464 DOI: 10.1111/ajr.12393] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2017] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To describe the place of death of residents in a rural region of New South Wales. DESIGN Cross-sectional quantitative study using death data collected from local funeral directors (in person and websites), residential aged-care facilities, one multipurpose heath service and obituary notices in the local media (newspapers/radio). SETTING Snowy Monaro region (New South Wales Australia). PARTICIPANTS Residents, with advanced frailty or one of 10 conditions amenable to palliative care, who died between 1 February 2015 and 31 May 2016. MAIN OUTCOME MEASURE Place of death. RESULTS Of 224 deaths in this period, 138 were considered amenable to palliative care. Twelve per cent of these deaths occurred in a private residence, 38% in the usual place of residence and 91% within the region. CONCLUSION Most rural residents with conditions amenable to palliative care died in the region. Most did not die in their usual place of residence. Further qualitative work is needed to determine palliative care patients' and family caregivers' preferences for, and the importance placed on, place of death. While there may be a need to support an increase in home deaths, local rural hospitals and residential aged-care facilities must not be overlooked as a substitute for inpatient hospices.
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Affiliation(s)
- Suzanne Rainsford
- Medical School, Australian National University, Canberra, New South Wales, Australia
| | - Nicholas J Glasgow
- Medical School, Australian National University, Canberra, New South Wales, Australia
| | - Rod D MacLeod
- HammondCare, Sydney, Australia.,Palliative Medicine, University of Sydney, Sydney, Australia
| | - Teresa Neeman
- Statistical Consulting Unit, Australian National University, Canberra, New South Wales, Australia
| | - Christine B Phillips
- Medical School, Australian National University, Canberra, New South Wales, Australia
| | - Robert B Wiles
- Rural Clinical School, Australian National University, Cooma, New South Wales, Australia
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17
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Black JC, Welday JN, Buckley B, Ferguson A, Gurian PL, Mena KD, Yang I, McCandlish E, Solo-Gabriele HM. Risk Assessment for Children Exposed to Beach Sands Impacted by Oil Spill Chemicals. Int J Environ Res Public Health 2016; 13:E853. [PMID: 27618904 DOI: 10.3390/ijerph13090853] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 08/12/2016] [Accepted: 08/17/2016] [Indexed: 12/24/2022]
Abstract
Due to changes in the drilling industry, oil spills are impacting large expanses of coastlines, thereby increasing the potential for people to come in contact with oil spill chemicals. The objective of this manuscript was to evaluate the health risk to children who potentially contact beach sands impacted by oil spill chemicals from the Deepwater Horizon disaster. To identify chemicals of concern, the U.S. Environmental Protection Agency’s (EPA’s) monitoring data collected during and immediately after the spill were evaluated. This dataset was supplemented with measurements from beach sands and tar balls collected five years after the spill. Of interest is that metals in the sediments were observed at similar levels between the two sampling periods; some differences were observed for metals levels in tar balls. Although PAHs were not observed five years later, there is evidence of weathered-oil oxidative by-products. Comparing chemical concentration data to baseline soil risk levels, three metals (As, Ba, and V) and four PAHs (benzo[a]pyrene, benz[a]anthracene, benzo[b]fluoranthene, and dibenz[a,h]anthracene) were found to exceed guideline levels prompting a risk assessment. For acute or sub-chronic exposures, hazard quotients, computed by estimating average expected contact behavior, showed no adverse potential health effects. For cancer, computations using 95% upper confidence limits for contaminant concentrations showed extremely low increased risk in the 10−6 range for oral and dermal exposure from arsenic in sediments and from dermal exposure from benzo[a]pyrene and benz[a]anthracene in weathered oil. Overall, results suggest that health risks are extremely low, given the limitations of available data. Limitations of this study are associated with the lack of toxicological data for dispersants and oil-spill degradation products. We also recommend studies to collect quantitative information about children’s beach play habits, which are necessary to more accurately assess exposure scenarios and health risks.
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18
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Dalkin SM, Lhussier M, Philipson P, Jones D, Cunningham W. Reducing inequalities in care for patients with non-malignant diseases: Insights from a realist evaluation of an integrated palliative care pathway. Palliat Med 2016; 30:690-7. [PMID: 26819327 DOI: 10.1177/0269216315626352] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The need for palliative care is growing internationally with an increasing prevalence of non-malignant diseases. The integrated care pathway was implemented in primary care by multidisciplinary teams from 2009 in a locality in the North East of England. Fourteen general practitioner practices provided data for the study. AIM To find whether, how, and under what circumstances palliative care registrations are made for patients with non-malignant diseases in primary care. DESIGN General practitioner practice data were analysed statistically and qualitative data were collected from health care professionals and members of relevant organisations. FINDINGS A mixed-effects logistic model indicated a significant difference beyond the 0.1% level (p < 0.001) in registrations between the malignant and non-malignant groups in 2011, with an odds ratio of 0.09 (=exp(-2.4266)), indicating that patients in the non-malignant group are around 11 times (1/0.09) less likely to be registered than patients in the malignant group. However, patients with non-malignant diseases were significantly more likely to be registered in 2012 than in 2011 with an odds ratio of 1.46, significant beyond the 1% level. Qualitative analyses indicate that health care professionals find registering patients with non-malignant diseases stressful, yet feel that their confidence in treating this population is increasing. CONCLUSION The integrated care pathway began to enable the reduction in inequalities in care by identifying, registering and managing an increasing number of palliative patients with non-malignant diseases. Consensual and inclusive definitions of palliative care were developed in order to legitimise the registration of such patients.
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Affiliation(s)
- Sonia Michelle Dalkin
- Department of Public Health and Wellbeing, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK; Fuse, The Centre for Translational Research in Public Health, Newcastle Upon Tyne, UK
| | - Monique Lhussier
- Northumbria University, Fuse, The Centre for Translational Research in Public Health, Newcastle Upon Tyne, UK
| | | | - Diana Jones
- Northumbria University, Newcastle upon Tyne, UK
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19
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Stiel S, Matthies DMK, Seuß D, Walsh D, Lindena G, Ostgathe C. Symptoms and problem clusters in cancer and non-cancer patients in specialized palliative care-is there a difference? J Pain Symptom Manage 2014; 48:26-35. [PMID: 24417808 DOI: 10.1016/j.jpainsymman.2013.08.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 08/14/2013] [Accepted: 08/16/2013] [Indexed: 10/25/2022]
Abstract
CONTEXT In clinical practice, some symptoms and problems frequently occur in combination, which may have consequences for symptom management. OBJECTIVES Facing a growing number of non-cancer patients in palliative care, this study aimed to differentiate symptom clusters in the non-cancer population from those in cancer patients. METHODS Inpatient data from the German Hospice and Palliative Care Evaluation between 2007 and 2011 were used for a cluster analysis of a 16-item symptom and problem checklist. An agglomerative hierarchical method was chosen. Coefficients from distance matrix ranging between 0 and 1 were calculated to indicate the interrelationship of clustered symptoms. RESULTS The analysis identified five clusters in cancer patients: 1) nausea and vomiting (d = 0.000); 2) anxiety, tension, and feeling depressed (d = 0.125); 3) wound care and disorientation/confusion (d = 0.229); 4) organization of care and overburdening of family (d = 0.202); and 5) weakness, tiredness, need for assistance with activities of daily living, and loss of appetite (d = 0.207). Five comparable clusters were identified in non-cancer patients: 1) nausea and vomiting (d = 0.000); 2) anxiety, tension, and feeling depressed (d = 0.166); 3) organization of care and overburdening of family (d = 0.187); 4) weakness and need for assistance with activities of daily living (d = 0.139); and 5) tiredness and loss of appetite (d = 0.182). CONCLUSION As symptom clusters do not significantly differ between cancer and non-cancer patients, specific frequent symptoms in non-cancer patients should be assessed. Identification of symptom clusters may help to target therapies and focus the use of medications to improve patients' quality of life.
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Affiliation(s)
- Stephanie Stiel
- Department of Palliative Medicine, CCC Erlangen - EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Comprehensive Cancer Center, CCC Erlangen - EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
| | - Dominik M K Matthies
- Department of Palliative Medicine, CCC Erlangen - EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Dominik Seuß
- Cognitive Systems Group, Faculty Information Systems and Applied Computer Science, University of Bamberg, Bamberg, Germany
| | - Declan Walsh
- The Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic Taussig Cancer Center, Cleveland, Ohio, USA
| | - Gabriele Lindena
- Clinical Analysis, Research and Application (CLARA), Kleinmachnow, Germany
| | - Christoph Ostgathe
- Department of Palliative Medicine, CCC Erlangen - EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Comprehensive Cancer Center, CCC Erlangen - EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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