BMJ Supportive & Palliative Care最新文献

{"title":"Parenteral lacosamide for complex neuropathic pain.","authors":"Helen Crispin, Andrew Jenks","doi":"10.1136/spcare-2024-005063","DOIUrl":"https://doi.org/10.1136/spcare-2024-005063","url":null,"abstract":"","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142124821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Palliative care healthcare professionals' perspective on the Assisted Decision-Making (Capacity) Act 2015 in Ireland.","authors":"Hannah Joan Featherstone, Regina McQuilllan, John Lombard, Geraldine Foley","doi":"10.1136/spcare-2024-005065","DOIUrl":"10.1136/spcare-2024-005065","url":null,"abstract":"<p><strong>Objectives: </strong>People receiving end-of-life care often require assistance with decision-making. We aimed to ascertain from the perspective of palliative care healthcare professionals in Ireland, the impact of the Assisted Decision-Making (Capacity) Act 2015 (as amended) in Ireland on their practice for end-of-life care decision-making with patients and family caregivers.</p><p><strong>Methods: </strong>A qualitative study comprising focus groups was conducted with 22 healthcare professionals from different healthcare professions. Participants were recruited from a large regional specialist palliative care service in Ireland comprising two hospice sites. Data were analysed using thematic analysis.</p><p><strong>Results: </strong>Participants reported uncertainty about the Assisted Decision-Making (Capacity) Act 2015 (as amended) and emphasised a need for more public education to avoid misinterpretation of the Act. Participants felt that patients who need assistance with decision-making should be autonomous in decision-making but expressed concerns when patients made decisions about care that participants considered unwise. Participants considered that the Act would be beneficial in situations to support early communication between patients and their family caregivers about patient preferences for care.</p><p><strong>Conclusions: </strong>Larger scale multicentre examination of the Assisted Decision-Making (Capacity) Act among specialist palliative care providers in Ireland is needed to better understand its utility for practice.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141888444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anti-fibrinolytics for mucosal bleeding in adults with life-limiting illnesses: a systematic review.","authors":"Emma Hooson, Fiona Hargreaves, Emily Holdsworth, Sarah Longwell, Alice Pullinger, Andrew Gill","doi":"10.1136/spcare-2024-005042","DOIUrl":"https://doi.org/10.1136/spcare-2024-005042","url":null,"abstract":"<p><strong>Introduction: </strong>Patients with life-limiting illnesses are at increased risk of mucosal bleeding. Usual management includes anticipatory planning and sedation, alongside anti-fibrinolytics, despite a lack of evidence for their use. Anti-fibrinolytic agents (tranexamic acid and aminocaproic acid) produce effective haemostasis in different clinical settings. Our aim was to synthesise the evidence for anti-fibrinolytic medication use in adult patients with life-limiting illnesses at risk of, or experiencing, mucosal bleeding.</p><p><strong>Methods: </strong>We searched MEDLINE, Embase, CINAHL, Web of Science Conference Proceedings Citation Index, Cochrane Library databases and clinical trial registries (inception to January 2024) to identify studies investigating the use of anti-fibrinolytics in patients with life-limiting illnesses. Results were screened against a priori inclusion criteria, data ere extracted, and quality was appraised using a CASP (Critical Appraisal Skills Programme) checklist or BMJ risk of bias assessment. Data were analysed using narrative synthesis.</p><p><strong>Results: </strong>Five studies meeting our search criteria (one cohort and four case series) were included. Data relating from 87 patients were used in narrative synthesis. Anti-fibrinolytic therapy was used for active mucosal bleeding in 37 patients, of whom 30 achieved total bleeding cessation. Fifty patients received prophylactic anti-fibrinolytics, of whom 32 experienced no bleeding events. Adverse events were reported in 3 of 87 patients (arterial thrombus, severe thrombocytopenia and stomach cramps). Mortality and quality of life were not reported.</p><p><strong>Conclusion: </strong>Anti-fibrinolytics are generally well tolerated within this population and may prevent and reduce mucosal bleeding. Further high-quality research is suggested to investigate current practice and to compare anti-fibrinolytic with placebo in the management of bleeding in patients with life-limiting illnesses.</p><p><strong>Prospero registration number: </strong>CRD42022325529.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Myofascial pain syndrome in patients with cancer: a narrative review.","authors":"Naruaki Kawasaki, Hiroto Ishiki, Sayaka Arakawa, Eriko Satomi, Hiromichi Matsuoka, Hideaki Hasuo","doi":"10.1136/spcare-2024-005064","DOIUrl":"10.1136/spcare-2024-005064","url":null,"abstract":"<p><strong>Purpose: </strong>Myofascial pain syndrome (MPS) is a chronic musculoskeletal pain syndrome. The purpose of this review is to describe the epidemiological and treatment evidence and to address the future research agenda in patients with cancer.</p><p><strong>Methods: </strong>A narrative review of previous reports investigating the prevalence and treatment of MPS in the oncology field is presented. The target population is patients with cancer and cancer survivors.</p><p><strong>Results: </strong>There have been three prospective and two retrospective studies investigating the prevalence of MPS. MPS is as high as 38%-45% in patients with advanced or incurable cancer and 11.9%-44.8% in cancer survivors. A total of nine reports investigated the efficacy of the following interventions: trigger point injection (TPI), myofascial techniques and ischaemic compression. TPI has been reported to be effective in four observational studies. One randomised study reported the efficacy of myofascial techniques, but two randomised studies reported no added beneficial effects of it in breast cancer survivors. Two randomised studies investigated the efficacy of ischaemic compression, but the obtained results were contradictory.</p><p><strong>Conclusions: </strong>MPS is highly prevalent. We should know that non-cancer pain is also common in both patients with cancer and survivors. In treating such pain, careful physical examination is essential. Then, non-pharmacological treatment should be considered as well as pharmacotherapy. As evidence regarding MPS in the oncology field is scarce, further research is warranted.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141987456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nutritional support clinical efficacy in tuberculosis: quasi-experimental study.","authors":"Yi Li, Hong Zhou, Chuan Zhao, Min Tan, Li Shu, Feng Yang","doi":"10.1136/spcare-2023-004608","DOIUrl":"https://doi.org/10.1136/spcare-2023-004608","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to investigate the impact of nutritional support on the clinical efficacy in hospitalised tuberculosis patients with nutritional risk.</p><p><strong>Methods: </strong>We selected a total of 266 eligible patients with tuberculosis for the experimental and 190 patients for control groups. The patients in intervention group received adjusted dietary structure, enteral nutrition via oral intake or gastric tube, total parenteral nutrition and combined enteral and parenteral nutrition. We recorded various factors, including age, sex, underlying disease, tuberculosis type, nutritional risk at admission, serum albumin (ALB), body mass index, complications during hospitalisation, nutritional support status, serum ALB before discharge and length of hospital stay.</p><p><strong>Results: </strong>The incidences of nutritional risk in the control and experimental groups were 64.41% and 64.72%, respectively, with no statistically significant differences in baseline characteristics. The occurrence rates of complications and secondary infections in the experimental group were 57.89% and 51.5%, respectively, which were significantly lower than the control group's rates of 70.00% and 56.31%. These differences were statistically significant. The experimental group had a significantly shorter hospital stay (16.5±7.54 days) compared with the control group (19.55±7.33 days). Furthermore, the serum ALB levels of patients in the experimental group were higher on discharge than at admission.</p><p><strong>Conclusion: </strong>Hospitalised patients with tuberculosis often face a high incidence of nutritional risk. However, the implementation of standardised nutritional support treatment has shown promising results in improving the nutritional status of tuberculosis patients with nutritional risk. This approach not only helps reduce the occurrence of complications but also enhances short-term prognosis and improves overall clinical efficacy.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and outcomes of falls in an inpatient palliative care unit: a single-centre retrospective study.","authors":"Paul Stack, Amanda Fischer, Phillip Good","doi":"10.1136/spcare-2024-005132","DOIUrl":"https://doi.org/10.1136/spcare-2024-005132","url":null,"abstract":"<p><strong>Background: </strong>Falls are a significant concern in healthcare settings. While comprehensive strategies to prevent falls are employed in hospitals, there is a lack of information regarding falls within inpatient palliative care units.</p><p><strong>Method: </strong>This retrospective cohort study analysed fall incidence, characteristics and outcomes in a metropolitan inpatient palliative care unit over a 1 year period. Falls were identified using the online incident reporting system and patient characteristics, fall risk assessment and prevention measures were obtained through the electronic patient records.</p><p><strong>Results: </strong>During the study period, there were 61 falls by 51 patients out of a total of 525 admitted patients. The incidence of falls was 9.7% and the rate of falls was 5.8 falls per 1000 bed days for all admitted patients. Though more than half of falls resulted in no injury, 41% of patients with falls died within a week post-fall. Fall risk assessment was completed for 97% of patients at the time of the fall.</p><p><strong>Conclusion: </strong>This study contributes to the understanding of falls in inpatient palliative care units. Fall risk assessment and prevention measures did not appear to alter the rate of falls among patients who fell. Fall prevention strategies need to be tailored to meet patient autonomy, end of life goals and maintain healthcare standards.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Repeated radiological procedures in the last 6 months of life in old age: a retrospective study.","authors":"Joseph Hawkins, Sam Beardsmore-Rust, Myra Adra, Zoe Halford","doi":"10.1136/spcare-2024-005078","DOIUrl":"https://doi.org/10.1136/spcare-2024-005078","url":null,"abstract":"<p><strong>Objectives: </strong>This novel study looks at the use of radiological procedures in an elderly cohort of patients in their last 6 months of life. Radiological imaging plays a central part of clinical investigations, but too many may override the judgement of benefits, risks and resources. There is little information on the burden of radiological procedures performed towards the end of life in patients of old age.</p><p><strong>Methods: </strong>Data from every fourth patient aged 80 years and over who died between 4 July 2021 and 30 December 2021 in a National Health Service (NHS) hospital were collected. All radiological procedures performed within the last 6 months of the patients' life were recorded from clinical documentation and related to their age.</p><p><strong>Results: </strong>96 patients were studied with a total of 699 radiological procedures performed. When scaled up, costs of CT and MRI scans alone are conservatively estimated as £312 000/annum in patients aged ≥80 years in their last 6 months of life for a single medium-sized NHS hospital.</p><p><strong>Conclusions: </strong>A very large number of radiological procedures were performed towards the end of life among patients of old age. This is consistent with the national trend of increased medicalisation and poor recognition of dying.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142079183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Private sector business interactions with bereaved people: UK Commission on Bereavement secondary analysis.","authors":"Jodie Crooks, Rachel Warren, Briony Hudson","doi":"10.1136/spcare-2024-005074","DOIUrl":"https://doi.org/10.1136/spcare-2024-005074","url":null,"abstract":"<p><strong>Objectives: </strong>Evidence suggests that 61% of adults who were bereaved in the past 5 years had difficulties with at least one practical or administrative task following bereavement. We aimed to explore individual's experiences of interacting with private sector businesses following a bereavement.</p><p><strong>Methods: </strong>Qualitative secondary analysis of data collected via an online survey within the UK Commission on Bereavement. Data from 1133 survey respondents was extracted verbatim, and thematic analysis was carried out. Participants were adults who had experienced a bereavement within the past 5 years and lived in the UK. They were eligible to take part in the survey.</p><p><strong>Results: </strong>Three core themes were developed: (1) needs of bereaved people outside of 'business as usual', (2) admin burden while grieving and (3) the impact and experience of organisational failures. The results of this secondary analysis outline that bereaved individuals often struggle with several points of interaction with private businesses, including facing resistance when making initial contact, insensitive or non-empathetic interactions, facing unrealistic timelines for administrative tasks that are not then returned by the business, and difficulty understanding and completing paperwork. Participants emphasised the difficulty in navigating this while in the initial period following a bereavement.</p><p><strong>Conclusions: </strong>People experiencing a bereavement experience a high degree of mental load and emotional burden linked with interacting with private businesses following a bereavement. Given that this forms only one element of a person's whole bereavement experience, it is important that changes to policy and practice are made to allow a simple, positive experience for bereaved customers.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142054945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Palliative care screening tools and patient outcomes: a systematic review.","authors":"Meiying Zhang, Yuxia Zhao, Mengyun Peng","doi":"10.1136/spcare-2024-005093","DOIUrl":"https://doi.org/10.1136/spcare-2024-005093","url":null,"abstract":"<p><strong>Background: </strong>Palliative care (PC) refers to providing patients with physical, psychological, mental, and other care and humanistic care services in a multidisciplinary collaborative mode with end-of-stage patients and family members as the centre. The PC screening tool (PCST) was developed to identify individuals who may benefit from PC services and is widely assumed to improve patient outcomes.</p><p><strong>Objectives: </strong>The purpose is to understand which specific PCST has been applied to clinical patients and to analyse and summarise the impact of using these tools on patient outcomes.</p><p><strong>Methods: </strong>A systematic review of articles published on PCST was performed in PubMed, Web of Science, CINAHL and MEDLINE in January 2024. All original research articles on PCST fulfilling the following eligibility criteria were included (1) utilisation and evaluation of tools was the primary objective and (2) at least one patient outcome was reported.</p><p><strong>Results: </strong>A total of 22 studies were included, 12 studies used a prospective study, 4 studies used a non-RCT and 6 studies used an RCT. The studies were heterogeneous regarding study characteristics, especially patient outcomes. In total, 24 different patient outcomes were measured, of which 16 outcomes measured in 12 studies significantly improved.</p><p><strong>Conclusions: </strong>We found that the majority of included studies reported that implementing PCST can improve patient outcomes to some extent, especially when used to improve in reducing hospitalisation time and patient readmission rate. However, there is a lack of high-quality research on this widely used screening tool.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142054855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Palliative care screening tools in Japan: cross-sectional utility study.","authors":"","doi":"10.1136/spcare-2023-004761corr1","DOIUrl":"https://doi.org/10.1136/spcare-2023-004761corr1","url":null,"abstract":"","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142054854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}