BMJ Supportive & Palliative Care最新文献

{"title":"Mortality predictors for ICU end-of-life decisions: delta-SOFA and SAPS 3 - retrospective evaluation.","authors":"Maria Carmen Sala-Trull, Pablo Monedero, Francisco Guillen-Grima, Pilar Leon-Sanz","doi":"10.1136/spcare-2024-005357","DOIUrl":"https://doi.org/10.1136/spcare-2024-005357","url":null,"abstract":"<p><strong>Objectives: </strong>End-of-life decisions in intensive care units (ICUs) are complex, influenced by patient severity, treatment efficacy and resource constraints. This study assessed the predictive value of delta-Sequential Organ Failure Assessment (SOFA) scores on days 2, 3 and 5, both independently and combined with Simplified Acute Physiology Score (SAPS) 3, for in-hospital mortality.</p><p><strong>Methods: </strong>A retrospective cohort study analysed ICU patients with stays of≥5 days from 2018 to 2020. Clinical data included SAPS 3 and SOFA scores at admission, 48 hours and on days 3 and 5, alongside mortality outcomes. Logistic regression and discriminant analysis identified mortality predictors and evaluated model performance.</p><p><strong>Results: </strong>Among 200 patients, 26% died in hospital. Non-survivors had significantly higher SAPS 3 scores (mean 51.9±11.9 vs 45.6±11.9 in survivors, p=0.001) and worsening SOFA scores, particularly on days 3 and 5. Combining SAPS 3 with delta-SOFA on day 5 produced an area under the receiver operating characteristic (AUROC) of 0.71 (95% CI: 0.63 to 0.79), indicating moderate predictive ability.</p><p><strong>Conclusions: </strong>Integrating the delta-SOFA score on day 5 with SAPS 3 improves in-hospital mortality predictions during prolonged ICU stays. Findings suggest early treatment limitations within 48 hours may be premature, as patient responses evolve and shared decision-making becomes more feasible over time.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440010","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":"Distress thermometer problem list and distress and depression in psycho-oncology.","authors":"Lyndsey Wallace, Anjishnu Banerjee, Jessica Molinaro, Julie Murray, Carrie Danhieux-Poole, Ann Marie Uselmann, Jennifer M Knight","doi":"10.1136/spcare-2024-005092","DOIUrl":"https://doi.org/10.1136/spcare-2024-005092","url":null,"abstract":"<p><strong>Purpose: </strong>This study examines the relationship between specific problem categories endorsed by patients with cancer seeking psycho-oncology services and their levels of distress and depression. Additionally, we investigate the potential associations between demographic and clinical characteristics and the endorsement of specific problem categories.</p><p><strong>Methods: </strong>A non-randomised interventional study was conducted with adult patients referred for psycho-oncology services. Patients attended 1-2 psycho-oncology sessions, completing the distress thermometer, problem checklist and Patient Health Questionnaire at the start of each visit and repeated the distress thermometer at visit end. Analyses evaluated the associations between problem checklist categories and levels of distress and depression.</p><p><strong>Results: </strong>Patients who endorsed a higher problem load, regardless of problem category, endorsed higher levels of distress and depression. Notably, younger patients, non-white patients and patients with breast cancer endorsed higher problem loads.</p><p><strong>Conclusion: </strong>The findings emphasise the importance of addressing problem load as a contributor to distress and depression among patients with cancer. While problem load was associated with patient characteristics, further investigation is needed to understand how these characteristics may influence distress and depression directly. Interventions should focus on reducing problem load to improve psychological well-being.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143405634","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":"Purple urine bag syndrome: case series.","authors":"Jewell Joseph, Jenifer Jeba Sundararaj, Susan Shekinah, Shakila Murali, Anitha Gladys, Ramu Kandaswamy","doi":"10.1136/spcare-2024-005336","DOIUrl":"https://doi.org/10.1136/spcare-2024-005336","url":null,"abstract":"<p><p>Purple urine bag syndrome is an uncommon condition that occurs in patients with long-standing indwelling urinary catheters, due to urinary tract infection (UTI) by bacteria producing sulfatase or phosphatase enzymes. This results in the formation of the pigments indigo (blue) and indirubin (red), together providing a purple appearance to urine. Management includes a change of catheter and appropriate antibiotics. Although prognosis is usually favourable, rare incidences of complications like Fournier's gangrene have been reported.We report three patients who developed purple urine bag syndrome: a man in his late 50s, a woman in her early 30s and a woman in her early 70s, who were on home-based care with regular home visits by the specialist palliative care team. None of them had any other signs or symptoms suggestive of UTIs. Their urinary catheters and collection bags were changed and proper catheter care was reinforced. All three patients were given antibiotics based on urine culture and sensitivity results. Following the same, urine colour reverted to normal in all patients and none of them had any recurrence.We would like to underline the importance of identifying purple urine bag syndrome as an indicator of underlying UTI, especially in palliative care settings, where patients may not manifest the classical signs and symptoms of UTI. We also would like to highlight the importance of patient and caregiver education on proper catheter care for prevention.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143373614","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":"Routine data and equitable palliative and end-of-life care.","authors":"Joanna M Davies, Katherine E Sleeman, Peter May","doi":"10.1136/spcare-2024-005161","DOIUrl":"https://doi.org/10.1136/spcare-2024-005161","url":null,"abstract":"","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143363651","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":"Enteral and parenteral nutrition in patients with cancer: complication rates compared-updated systematic review and meta-analysis.","authors":"Ronald Chow, James H B Im, Jann Arends, Egidio Del Fabbro, Lukas Mortensen-Truscott, Denis Qeska, Shilpa Balaji, Chris Walsh, Geoffrey Watson, Michael Lock, Elizabeth Prsic, Lawson Eng, Camilla Zimmermann, Eduardo Bruera","doi":"10.1136/spcare-2024-005244","DOIUrl":"https://doi.org/10.1136/spcare-2024-005244","url":null,"abstract":"<p><strong>Background: </strong>The aim of this systematic review and meta-analysis is to compare the complication rates of enteral nutrition (EN) (oral or tube feeding (TF)) and parenteral nutrition (PN) in patients with any cancer.</p><p><strong>Methods: </strong>A systematic review of the literature until 2024 was conducted, including randomised controlled trials comparing EN and PN with respect to one or more of four endpoints: (1) infection, (2) nutrition support complications, (3) major complications and (4) mortality. A meta-analysis was conducted to generate summary effect estimates. Analysis was stratified by paediatric (≤21 years old) versus adults (>21 years old) patients. Subgroup analyses were conducted, based on including patients with (vs without) protein-energy malnutrition (PEM) and type of EN. Cumulative meta-analysis and leave-one-out analysis was conducted. Type I error was set at 0.05.</p><p><strong>Results: </strong>49 studies reporting on 6361 patients were included: 41 reported on adults and 8 on children. Among adults, the infection rate was higher for PN compared with EN (risk ratio=1.07, 95% CI: 1.00 to 1.14), with no differences in rates of nutrition support complications, major complications or mortality. Among children, there were no differences in all four endpoints. On cumulative meta-analysis, EN was overall marginally superior to PN for infection, although results fluctuated over time between superiority and no difference. Subgroup analysis found no differences in effects among patients with (vs without) PEM and patients provided with EN options of standard care versus TF.</p><p><strong>Discussion: </strong>From the perspective of complications, EN and PN are equivalent, with EN demonstrating marginal superiority for infection among adults.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143073578","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":"Home-based physical symptom management for family caregivers: systematic review and meta-analysis.","authors":"Daniel Eric Schoth, Simone Holley, Margaret Johnson, Emma Stibbs, Kate Renton, Emily Harrop, Christina Liossi","doi":"10.1136/spcare-2024-005246","DOIUrl":"https://doi.org/10.1136/spcare-2024-005246","url":null,"abstract":"<p><strong>Background: </strong>Patients with life-limiting conditions are often cared for at home by family, typically without adequate training to carry out the challenging tasks performed. This systematic review assessed the efficacy of interventions designed to help family caregivers manage pain and other symptoms in adults and children with life-limiting conditions at home.</p><p><strong>Methods: </strong>A systematic search was performed on seven databases. A narrative synthesis was conducted, along with a meta-analysis comparing outcomes in those who received an intervention to those who did not, or to preintervention scores.</p><p><strong>Results: </strong>84 eligible studies were identified. Significant improvements in pain and fatigue in patients with cancer were found compared with patients in the control group and baseline. Caregivers of patients with cancer receiving an intervention, compared with the control group caregivers, showed significant improvements in self-efficacy and active coping and lower avoidant coping. This group also showed significant improvements in burden, self-efficacy, anxiety and depression, and decreases in avoidant coping pre- to post intervention. Patients with dementia whose caregivers received an intervention showed significantly reduced pain intensity and improvements in quality of life pre- to post intervention. Caregivers of patients with dementia showed significantly reduced distress pre- to post intervention. No beneficial effects were found for caregivers of patients with Parkinson's disease or heart failure, although only limited analyses could be performed.</p><p><strong>Conclusions: </strong>Interventions targeting family caregivers can improve both patient symptoms and caregiver outcomes, as demonstrated in cancer and dementia care. Future mixed-methods research should collect data from caregiver and patient dyads, identifying key intervention components. There is also need for more studies on caregivers of paediatric patients.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143073580","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":"Resilience-building in palliative care professionals: scoping review.","authors":"Suwanan Yongpraderm, Patcharanat Inpithuk, Itthipon Wongprom","doi":"10.1136/spcare-2024-005144","DOIUrl":"https://doi.org/10.1136/spcare-2024-005144","url":null,"abstract":"<p><p>Resilience-building in palliative care professionals: scoping review BACKGROUND: Burnout, demoralisation and compassion fatigue are common among palliative care professionals. Practising palliative care necessitates a quality of resilience in order to ensure constant and optimal patient care. However, there is no universal approach to prevent burnout or raise resilience among palliative care professionals. This study aims to provide an overview of interventions and explore their effectiveness in building resilience in palliative care professionals.</p><p><strong>Methods: </strong>The search was conducted in four databases: MEDLINE, Embase, CINAHL, PsycINFO and Cochrane Database. Two independent investigators reviewed eligibility, with conflicts resolved by a third investigator. One reviewer performed data extraction, later reviewed by a second investigator. All eligible studies were manually re-reviewed. Quantitative and qualitative data synthesis were conducted.</p><p><strong>Results: </strong>The search initially revealed 11 470 potentially eligible citations. 12 studies were included in the analysis. Most studies had a small number of participants. The studies varied in sample size, interventions and assessment tools, making it challenging to identify the most effective resilience-building interventions. However, our analysis revealed commonly found elements among these interventions: five essential elements (regularity, self-care, mindfulness, reflective practice and cognitive-behavioural therapy) and three supporting elements (peer support, educational sessions and organisational support).</p><p><strong>Discussion: </strong>While the effectiveness of specific interventions remains inconclusive, this review highlights essential and supporting elements that should be considered in designing resilience-building programmes for palliative care professionals. Future research should focus on developing assessment tools specific to palliative care, conducting well-designed studies, and creating replicable, standardised interventions.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143058115","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":"Muscle metric: re-evaluating prognostic markers in metastatic breast cancer.","authors":"Aynur Aktas, Rebecca Sheaff Greiner, Lejla Hadzikadic-Gusic, Danielle Boselli, Declan Walsh","doi":"10.1136/spcare-2024-005328","DOIUrl":"https://doi.org/10.1136/spcare-2024-005328","url":null,"abstract":"","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143027785","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":"Assessment of blended learning palliative care educational programme in cancer treatment centres in India.","authors":"Sushma Bhatnagar, Apoorva Mittal, Shirlynn Ho, Giam Cheong Leong, Raghav Gupta, Naveen Salins","doi":"10.1136/spcare-2024-005232","DOIUrl":"https://doi.org/10.1136/spcare-2024-005232","url":null,"abstract":"<p><strong>Objectives: </strong>The study evaluates the fifth cohort of the palliative care cancer treatment centres (CTC) educational programme in India with the aim of refining the course on the basis of participant feedback thereby improving palliative care services at cancer centres.</p><p><strong>Methods: </strong>The intervention included participation in the CTC 5 teaching and training programme, which encompassed foundation course, refresher course, access to palliative care training modules, clinical training and mentorship under palliative care experts. The feedback was taken from all 57 participants (29 doctors and 28 nurses) of CTC 5 programme representing 14 hospitals across nine regions in India. The assessment tools included Likert scale ratings and free-text comments. 3-point and 5-point Likert scale ratings were used to gauge the usefulness of course topics, quality of content and delivery. A mixed methods approach was used for a comprehensive evaluation by taking both quantitative measures of participant inputs and qualitative insights into their experiences and suggestions. The knowledge gained by the participants was analysed using pre-training and post-training assessments.</p><p><strong>Results: </strong>The feedback obtained from the participants highlighted both strengths and scope for improvement. The foundation course received positive feedback for its sessions, especially on communication skills and pain management. The refresher course received positive feedback for team presentations but lacked sufficient case discussions. The interactive nature of sessions was well-received. Following the CTC 5 programme, participants showed a 30.38% knowledge gain. Overall, the programme exceeded expectations for 62% of participants, highlighting its impact on personal development and clinical practices in palliative care.</p><p><strong>Conclusion: </strong>The study provides useful insights for designing future palliative care educational courses to address the needs of health professionals. The CTC programme has promising potential to bring about positive changes in both the personal and professional development of participants ultimately improving palliative care services across India.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142999841","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":"Rational use of human albumin: plan-do-check-act cycle in clinical practice.","authors":"Xiaowei Huang, Xuehui Jiang, Fangfang Xiong, Xinyang Fu, Lei Hong, Xiaohui Xu, Zhihang Lin","doi":"10.1136/spcare-2024-005268","DOIUrl":"https://doi.org/10.1136/spcare-2024-005268","url":null,"abstract":"<p><strong>Objective: </strong>Improper use of human albumin (HA) is now common in clinical settings. This study aims to explore the feasibility of the plan-do-check-act (PDCA) cycle in promoting the rational use of HA.</p><p><strong>Methods: </strong>The differences between the control and observation groups (after the PDCA cycle) in terms of serum albumin detection rate, serum albumin values, HA usage, and rationality were analysed and compared using a before-and-after control method.</p><p><strong>Results: </strong>A total of 372 patients were recruited, including 186 in each of the control and observation groups. On comparison, it was observed that the overall use of HA improved after the PDCA cycle compared with the preintervention period, and the rational rate of HA prescriptions increased from 68.3% to 96.2%. The serum albumin detection rate before applying for HA increased from 83.9% to 98.9%, and the median values decreased from 26.7 (22.8-30.9) g/L to 24.7 (22.7-27.2) g/L. Regarding the use of HA, the median amount of HA used was reduced by 20 g compared with the preintervention period, meanwhile, the median duration was shortened by 2 days.</p><p><strong>Conclusion: </strong>The PDCA cycle is desirable when employed to promote the rational use of HA.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143000039","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}