BMJ Supportive & Palliative Care最新文献_第4页

Anticipatory prescribing in community end-of-life care. 社区临终关怀中的预期处方。

IF 2 4区医学

BMJ Supportive & Palliative Care Pub Date : 2024-08-19 DOI: 10.1136/spcare-2023-004270

Charlotte Lee, Theresa Tammy Tran, Joy Ross

{"title":"Anticipatory prescribing in community end-of-life care.","authors":"Charlotte Lee, Theresa Tammy Tran, Joy Ross","doi":"10.1136/spcare-2023-004270","DOIUrl":"10.1136/spcare-2023-004270","url":null,"abstract":"Objectives: Our work aims to critically review the use of anticipatory medicines in our inner-city hospice community population and whether our current practices are fit for purpose.Methods: Retrospective audit of community palliative care patients at the end-of-life prescribed anticipatory medicines within a 3-month period. Anticipatory charts and case notes reviewed. Intervention included updating local guidelines, local teaching for medical and non-medical prescribers and sharing results nationally. Eighteen months later, reaudit was performed assessing impact.Results: In total, 76 patients included. 75/76 (99%) were prescribed an analgesic, antiemetic, antisecretory and anxiolytic. 49/76 (64%) were administered 'as required' medications at home. Haloperidol was the favoured antiemetic (88%), costing our hospice ~£2000/month. Case note review highlighted prescribing and administration issues. Reaudit showed a reduction in prescriptions of antisecretory (by 57%) and antiemetic (by 50%), with a wider range of antiemetics (levomepromazine 47%, haloperidol 35%, cyclizine 14%, metoclopramide 3%) indicating individualised prescribing. Those without an antiemetic prescribed did not later require one dispensing.Conclusion: Our work challenges the orthodoxy that an analgesic, antiemetic, antisecretory and anxiolytic medication must always be included for effective anticipatory prescribing. Antiemetics may not be universally required and individualised prescribing was cost-effective and safe at a local level. Further work evaluating the impacts of altered practice on patients, caregivers, professionals and in other community settings is required.","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49674323","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}

引用次数: 0

Gabapentinoids for chemotherapy-induced peripheral neuropathy: systematic review and meta-analysis. 加巴喷丁类药物治疗化疗引起的周围神经病变：系统综述和荟萃分析。

IF 2 4区医学

BMJ Supportive & Palliative Care Pub Date : 2024-08-19 DOI: 10.1136/spcare-2023-004362

Tsung Wei Chang, Fu-Yu Yang, Yu-Chang Liu, Cheng-Hsien Hung

{"title":"Gabapentinoids for chemotherapy-induced peripheral neuropathy: systematic review and meta-analysis.","authors":"Tsung Wei Chang, Fu-Yu Yang, Yu-Chang Liu, Cheng-Hsien Hung","doi":"10.1136/spcare-2023-004362","DOIUrl":"10.1136/spcare-2023-004362","url":null,"abstract":"Introduction: Chemotherapy-induced peripheral neuropathy (CIPN) affects patients' quality of life and treatment effectiveness. Gabapentinoids, like gabapentin and pregabalin, are often used for CIPN treatment, but their efficacy and safety remain uncertain. This study reviews and analyses randomised controlled trial data on this topic.Materials/methods: We searched PubMed, Embase and Cochrane CENTRAL until 29 August 2022 for studies on gabapentinoid use in CIPN. Meta-analysis was performed using RevMan V.5.4 and the Metafor package in R. Outcomes included pain scores, quality of life and adverse drug events.Results: For the prevention setting, our meta-analysis shows that pregabalin did not significantly improve average pain (standardised mean difference (SMD) -0.14, 95% CI -0.51 to 0.23; I2=26% (95% CI 0% to >98%)) or quality of life (mean difference (MD) 2.5, 95% CI -4.67 to 9.67; p=0.49) in preventing CIPN compared with placebo. However, it showed a potential trend towards reducing the worst pain (SMD -0.28, 95% CI -0.57 to 0.01; I2=0% (95% CI 0% to 98%; p=0.06)). For the treatment setting, some studies have shown a potential therapeutic effect of gabapentinoids. However, the results are not consistent between studies. Given the studies' heterogeneity, a meta-analysis in treatment setting was not performed.Conclusion: There is limited evidence to support the use of gabapentinoids in CIPN. In prevention setting, gabapentinoids do not significantly prevent CIPN. In treatment setting, studies have been inconsistent in their conclusions, lacking definitive benefits over placebo. More comprehensive and higher quality research is needed in the future.Prospero registration number: CRD42022361193.","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141466186","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}

引用次数: 0

A Spiritual care department: practical experience. 精神护理部：实践经验。

IF 2 4区医学

BMJ Supportive & Palliative Care Pub Date : 2024-08-19 DOI: 10.1136/spcare-2024-004809

Nadereh Memaryan, Fatemeh Rezaei Khodadadi

引用次数: 0

What does the general public know about palliative care? A population-based survey. 公众对姑息关怀了解多少？一项基于人口的调查。

IF 2 4区医学

BMJ Supportive & Palliative Care Pub Date : 2024-08-19 DOI: 10.1136/spcare-2023-004384

Marjolein Matthys, Kenneth Chambaere, Kim Beernaert, Joachim Cohen, Leen Van Brussel, Benedicte Deforche, Bert Quintiens, Luc Deliens, Naomi Dhollander

{"title":"What does the general public know about palliative care? A population-based survey.","authors":"Marjolein Matthys, Kenneth Chambaere, Kim Beernaert, Joachim Cohen, Leen Van Brussel, Benedicte Deforche, Bert Quintiens, Luc Deliens, Naomi Dhollander","doi":"10.1136/spcare-2023-004384","DOIUrl":"10.1136/spcare-2023-004384","url":null,"abstract":"Objectives: The need for public education on palliative care has been widely argued for. To develop effective educational strategies, a stronger evidence base is needed on what exactly is known and unknown about palliative care as well as what the differences are between subgroups.Methods: We conducted a cross-sectional population-based survey. Mail questionnaires were sent to a random sample of 4400 citizens (aged ≥16 years) within 4 municipalities in Flanders, Belgium. The Palliative Care Knowledge Scale (PaCKS) was used to measure knowledge. Associations between knowledge and sociodemographics and various experiential factors were tested, as well as the congruence between actual and self-perceived knowledge scores.Results: Response was obtained from 2008 (45.6%) citizens. The mean PaCKS score was 7.87 (SD 3.41; range 0-13) with the highest proportion (84.7%) correctly answering that palliative care is not specifically for older adults and the lowest (32.1%) correctly answering that improving the ability to participate in daily life is a palliative care goal. Being aged between 30 and 59, non-religious, more highly educated, having professional healthcare experience and knowing palliative care through personal experience were significantly associated with higher knowledge, while sex and informal caregiving experience were not. 52.4% self-perceived their knowledge as lower than it actually was.Conclusions: While the general public seems to be familiar with some basic concepts of palliative care, several key aspects remain unknown. Educational strategies, with suggested potential for community-based and experience-based approaches, may need to focus specifically on these aspects and not just on the broader palliative care concept.","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10221090","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}

引用次数: 0

How can existential or spiritual strengths be fostered in palliative care? An interpretative synthesis of recent literature. 如何在姑息关怀中培养存在感或精神力量？近期文献的解释性综述。

IF 2 4区医学

BMJ Supportive & Palliative Care Pub Date : 2024-08-19 DOI: 10.1136/bmjspcare-2020-002379

Marc Haufe, Carlo Leget, Marieke Potma, Saskia Teunissen

{"title":"How can existential or spiritual strengths be fostered in palliative care? An interpretative synthesis of recent literature.","authors":"Marc Haufe, Carlo Leget, Marieke Potma, Saskia Teunissen","doi":"10.1136/bmjspcare-2020-002379","DOIUrl":"10.1136/bmjspcare-2020-002379","url":null,"abstract":"Background: Patients receiving palliative care may benefit greatly when their existential or spiritual strengths are fostered. To date however, there has not been a comprehensive literature review of patient and care professional approaches that are available.Aims: To describe and synthesise existential or spiritual strength-based approaches within the context of palliative care.Methods: Literature search of 2436 articles between January 1999 and March 2019 in Scopus, Web of Science, CINAHL and PsycINFO. Articles were included if they deal with a palliative care situation, focus on the patient, specific existential/spiritual strength, discernible strength approach and an analysis of the workings of that approach. The interpretative synthesis consisted of a thematic analysis of the included articles and an integration of themes.Results: In the 14 included articles, 5 different strengths were found to be fostered by 16 approaches: (1) Meaning was fostered by: maintaining normalcy, experiencing sanctuaries, reassessing importance and reconstructing positive self; (2) Connection by: opening up, giving/receiving care and envisioning continuation; (3) Agency by: maintaining control, refocusing goals and continuous adaptation; (4) Hope through: setting special targets, imagining alternate outcomes, building a collection and extending wishes; (5) Faith through: living the tradition and relating to a benevolent force. Strengths and approaches are visualised in an overarching analytical framework: 'the Propeller'.Conclusions: The constructed Propeller framework can be used to become aware of, apply and further develop approaches to foster existential or spiritual strengths among patients receiving palliative care.","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11347204/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38476541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Palliative care simulation for internal medicine trainees: development and pilot study. 针对内科学员的姑息关怀模拟：开发与试点研究。

IF 2 4区医学

BMJ Supportive & Palliative Care Pub Date : 2024-08-19 DOI: 10.1136/bmjspcare-2021-003272

Felicity Dewhurst, Kate Howorth, Hannah Billett, Jolene Brown, Maxwell Charles, Elizabeth Fleming, Craig Gouldthorpe, Amy Huggin, Emily Kavanagh, Rachel Kiltie, Lucy Robinson, Grace Rowley, Lauri Simkiss, Donna Wakefield, Elizabeth Woods, Deepta Churm, Rowan Warmsley, Kerry Waterfield

{"title":"Palliative care simulation for internal medicine trainees: development and pilot study.","authors":"Felicity Dewhurst, Kate Howorth, Hannah Billett, Jolene Brown, Maxwell Charles, Elizabeth Fleming, Craig Gouldthorpe, Amy Huggin, Emily Kavanagh, Rachel Kiltie, Lucy Robinson, Grace Rowley, Lauri Simkiss, Donna Wakefield, Elizabeth Woods, Deepta Churm, Rowan Warmsley, Kerry Waterfield","doi":"10.1136/bmjspcare-2021-003272","DOIUrl":"10.1136/bmjspcare-2021-003272","url":null,"abstract":"Objectives: Shape of training has recognised that 'Managing End-of-Life and Applying Palliative Care Skills' is a key competency for internal medicine trainees. It provides the opportunity and challenge to improve palliative care training for generalist physicians. Simulation has been recognised internationally as a holistic teaching and assessment method. This study aimed to produce a palliative medicine simulation training package for internal medicine trainees for delivery by palliative medicine trainees providing the former opportunity to practice assessment and management of patients with life-limiting illness and the latter teaching and management opportunities.Methods: A regional group of palliative medicine trainees were trained in simulation and debrief. Nominal and focus group techniques designed a simulation training package. Learning outcomes were mapped to the internal medicine curriculum descriptors.Results: Palliative simulation for internal medicine trainees (PALL-SIM-IMT) is a training package meeting internal medicine trainees' curriculum requirements. Regional pilots have demonstrated feasibility for delivery by palliative medicine trainees and improvement in recipients' confidence in all curriculum descriptors.Conclusions: PALL-SIM-IMT can aid competency achievement for the provision of generalist palliative care by internal medicine trainees. It allows reciprocal development of palliative medicine trainees' leadership and teaching skills. National adoption and evaluation is ongoing.","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39424520","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}

引用次数: 0

Subcutaneous tranexamic acid for bleeding associated with a mycotic aortic aneurysm. 皮下注射氨甲环酸治疗与霉菌性主动脉瘤相关的出血。

IF 2 4区医学

BMJ Supportive & Palliative Care Pub Date : 2024-08-19 DOI: 10.1136/spcare-2023-004312

Mhairi Kilpatrick, Susan Bateman, Amy Baggott, Anna Sutherland

引用次数: 0

Osimerinib haematological toxicities in non-small cell lung cancer: a randomised controlled trials meta-analysis. 奥希替尼在非小细胞肺癌中的血液学毒性：随机对照试验荟萃分析。

IF 2 4区医学

BMJ Supportive & Palliative Care Pub Date : 2024-08-19 DOI: 10.1136/spcare-2024-005113

Fangfang Xiong, Yunzhu Shen, Ting Liu, Yin Zhang, Xuehui Jiang

{"title":"Osimerinib haematological toxicities in non-small cell lung cancer: a randomised controlled trials meta-analysis.","authors":"Fangfang Xiong, Yunzhu Shen, Ting Liu, Yin Zhang, Xuehui Jiang","doi":"10.1136/spcare-2024-005113","DOIUrl":"https://doi.org/10.1136/spcare-2024-005113","url":null,"abstract":"Objective: Osimertinib plays a crucial role in patients with non-small cell lung cancer (NSCLC). However, the haematological toxicities caused by osimertinib in such a population have not been well characterised. This analysis was performed to determine the incidence of osimertinib-related haematological toxicity in patients with NSCLC.Method: A literature search was conducted in PubMed, Embase, Cochrane Library and Web of Science. Eligible studies were included to describe the pooled incidences of anaemia, neutropenia and thrombocytopenia secondary to osimertinib in NSCLC patients.Results: 1288 patients from 10 studies were enrolled in this study. The overall incidences of osimertinib-related all-grade anaemia, neutropenia and thrombocytopenia in NSCLC patients were 21.1% (95% CI 10.9% to 33.3%), 14.6% (95% CI 5.9% to 26.1%) and 28.4% (95% CI 12.4% to 47.6%), respectively. In items of high-grade haematological toxicities, there were 0.5% (95% CI 0.1% to 1.1%) for anaemia, 2.0% (95% CI 0.3% to 4.6%) for neutropenia and 0.4% (95% CI 0% to 1.1%) for thrombocytopenia.Conclusions: There is non-negligible haematological toxicity associated with osimertinib, and it should be taken seriously.","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142003623","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}

引用次数: 0

Drug dependence epidemiology in palliative care medicinal cannabis trials. 姑息治疗药物大麻试验中的药物依赖流行病学。

IF 2 4区医学

BMJ Supportive & Palliative Care Pub Date : 2024-08-19 DOI: 10.1136/spcare-2023-004583

Chee Yen Lee, Phillip Good, Georgie Huggett, Ristan Greer, Janet Hardy

{"title":"Drug dependence epidemiology in palliative care medicinal cannabis trials.","authors":"Chee Yen Lee, Phillip Good, Georgie Huggett, Ristan Greer, Janet Hardy","doi":"10.1136/spcare-2023-004583","DOIUrl":"10.1136/spcare-2023-004583","url":null,"abstract":"Objectives: Drug dependence is becoming increasingly common and meeting palliative care patients with substance use disorders is inevitable. However, data on substance use in these patients are lacking. This study aims to evaluate the prevalence of drug dependence in palliative care patients with advanced cancer and correlate with symptom distress and opioid use.Methods: Palliative care patients with advanced cancer interested in participation in a medicinal cannabis trial were required to complete Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), Edmonton Symptom Assessment Scale (ESAS) and record of concomitant medications including baseline opioid use as part of the eligibility screen.Results: Of the 182 participants, 167 (92%) reported lifetime alcohol and 132/182 (73%) lifetime tobacco use. No participant reached the threshold criteria for high risk of drug dependence with majority being low risk. There was no correlation between ASSIST score, ESAS and oral morphine equivalent.Conclusion: This study identified alcohol and tobacco as the main substances used in this group of patients and that most were of very low risk for drug dependence. This suggests routine drug screening for palliative care patient may not be justified, but the high possibility of questionnaire bias is acknowledged.","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41092959","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}

引用次数: 0

Destitute and dying: interventions and models of palliative and end of life care for homeless adults - a systematic review. 贫困与死亡：为无家可归的成年人提供姑息治疗和临终关怀的干预措施和模式--系统综述。

IF 2 4区医学

BMJ Supportive & Palliative Care Pub Date : 2024-08-17 DOI: 10.1136/spcare-2024-004883

Megan Rose Coverdale, Fliss Murtagh

{"title":"Destitute and dying: interventions and models of palliative and end of life care for homeless adults - a systematic review.","authors":"Megan Rose Coverdale, Fliss Murtagh","doi":"10.1136/spcare-2024-004883","DOIUrl":"https://doi.org/10.1136/spcare-2024-004883","url":null,"abstract":"Background: Homeless adults experience a significant symptom burden when living with a life-limiting illness and nearing the end of life. This increases the inequalities that homeless adults face while coping with a loss of rootedness in the world. There is a lack of palliative and end of life care provision specifically adapted to meet their needs, exacerbating their illness and worsening the quality of their remaining life.Aim: To identify interventions and models of care used to address the palliative and end of life care needs of homeless adults, and to determine their effectiveness.Methods: Standard systematic reviewing methods were followed, searching from 1 January 2000 the databases: Ovid MEDLINE, EMBASE, SCOPUS, Web of Science, CINAHL and PsycInfo. Results were reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and described using a narrative synthesis. Study quality was assessed using Hawker's Quality Assessment Tool.Results: Nine studies primarily focused on: education and palliative training for support staff; advance care planning; a social model for hospice care; and the creation of new roles to provide extra support to homeless adults through health navigators, homeless champions or palliative outreach teams. The voices of those experiencing homelessness were rarely included.Conclusion: We identified key components of care to optimise the support for homeless adults needing palliative and end of life care: advocacy; multidisciplinary working; professional education; and care in the community. Future research must include the perspectives of those who are homeless.","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141995305","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}

引用次数: 0