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The articles identified in this review noted disparate surgical palliative care access and outcomes across various racial/ethnic groups, age ranges, socioeconomic classes, hospital populations, and regions. However, evidence scarcity necessitates more robust research be performed to adequately identify at risk groups and understand the factors supporting disparity development.Pain is a common source of suffering for seriously ill patients. Typical first-line treatments consist of lifestyle modifications and medication therapy, including opioids. However, medical treatments often fail or are associated with limiting systemic toxicities, and more targeted interventional approaches are necessary. Herein, we present options for minimally invasive techniques for the alleviation of pain in palliative patients from a head-to-toe approach, with a focus on emerging therapies and advanced techniques. Head and neck image-guided interventions targeted to sympathetic ganglia of the head and neck, such as sphenopalatine ganglion (SPG) and stellate ganglion, have been shown to be effective for some forms of sympathetically-maintained and visceral pain. Interventions targeting branches of cranial nerves and upper cervical nerves, such as the glossopharyngeal nerve (GPN), are options in treating somatic head and face pain. Abdominal and Pelvic sympathetic blocks, including celiac plexus, inferior hypogastric, and ganglion impar can relieve visceral abdominal and pelvic pain. Spine and somatic pain fascial plane blocks of the chest and abdominal wall and myofascial trigger point injections can be used for somatic pain indications. Cementoplasties, such as kyphoplasty and vertebroplasty, are used for pain related to bony metastases and compression fractures. Tumor ablative techniques can also be used for lytic lesions of the bone. Spinal cord stimulation (SCS), intrathecal drug delivery systems (IDDS), and cordotomy have also been used successfully in patients requiring advanced options, such as those with significant spinal, ischemic, or visceral pain.
Previous studies have demonstrated gender-specific impacts on symptoms and problems of patients receiving palliative care; however, there is limited knowledge about the impact of gender on the problems and needs of their family caregivers (FCs).
Using a qualitative design, semi-structured interviews with FCs and healthcare professionals (HCPs) of a specialist palliative care inpatient ward were conducted. Themes and categories were identified using qualitative content analysis, with data coded using MAXQDA.
Ten FCs (6 female, 4 male) and 16 HCPs (8 female, 8 male) were interviewed. read more Analysis revealed seven main categories of gendered problems and needs role as FC, physical and emotional burden, self-care and coping strategies, adaptation to new life circumstances, interaction with the palliative care team, use of psychosocial or care-related support, as well as advance care planning and caregiving after inpatient palliative care. Stronger identification with the caregiver role, less consideration of own needs, and more active utilization of professional and informal support were ascribed to female FCs. With regard to male FCs, respondents had the impression of better self-caring strategies, less expressiveness of emotions, less involvement in care and more target-oriented interactions with the palliative care team.
Gender has a relevant impact on roles, coping, communication and support as well as psychosocial needs of FCs of patients receiving palliative care. These gender-related aspects have to be taken into account during palliative care including care for FCs.
Gender has a relevant impact on roles, coping, communication and support as well as psychosocial needs of FCs of patients receiving palliative care. These gender-related aspects have to be taken into account during palliative care including care for FCs.
Chronic liver diseases (CLD), including cirrhosis and non-cirrhotic liver diseases, are globally widespread and create a serious disease burden. Platelet count is a clinically accessible and affordable prognostic indicator of liver disease. We investigated the relationship between platelet count and 90-day prognosis in patients with acute-on-chronic liver diseases (AoCLD).
A total of 3,970 patients with AoCLD from the Chinese Acute-on-Chronic Liver Failure (CATCH-LIFE) study, which included two prospective multi-center cohorts, were included in the study. We grouped the patients according to the platelet count and analyzed the 90-day adverse outcome (death or liver transplantation).
In the final analysis, 3,939 patients with AoCLD were included, of whom 2,802 had definite liver cirrhosis. The cumulative incidence of 90-day adverse outcomes in patients increased with the change of platelet group (log-rank P<0.001). From univariate and multivariate analyses, platelet count was inversely associated with the incidence of 90-day adverse outcomes in patients (P for trend <0.001). The group with platelet count <20×109 /L had the highest risk (odds ratio, 3.15; 95% confidence interval, 1.59-6.25), with 21 (36.8%) of these patients having adverse outcomes within 90 days. The risk of a 90-day adverse outcome in patients increased by 5% for every 10×109 /L decrease in platelet count below 210×109 /L.
Lower platelet count was associated with a higher incidence of 90-day adverse outcomes in patients with AoCLD. Even within the normal platelet count range, the risk of a 90-day adverse outcome in patients increased with decreases in platelet count. Clinical trial number NCT02457637, NCT03641872.
Lower platelet count was associated with a higher incidence of 90-day adverse outcomes in patients with AoCLD. Even within the normal platelet count range, the risk of a 90-day adverse outcome in patients increased with decreases in platelet count. Clinical trial number NCT02457637, NCT03641872.
Alexisomia is a clinical concept that describes difficulties in the awareness and expression of bodily feelings regarding physical diseases and symptoms. The study aim was to investigate whether incurable cancer patients with alexisomia had a higher incidence of latent trigger points, higher pain intensity, and higher pain-improvement goals.
A multicenter cross-sectional survey was conducted among patients with incurable cancer referred to a palliative care service at two university hospitals in Japan. Alexisomia was evaluated using the Shitsu-Taikan-Sho Scale (STSS). All patients were manually examined on their upper trapezius to identify latent trigger points. Patients who experienced pain reported their pain numerical rating scale (PNRS) and personalized pain goal (PPG) scores.
A total of 262 patients were selected as participants. Incurable cancer patients with alexisomia were observed in 30.2% of all participants [95% confidence interval (CI) 24.7-35.7]. The latent trigger points risk ratio in the alexisomic group versus the non-alexisomic group was 4.06 (95% CI 2.24-7.37). Incurable cancer patients with alexisomia tended to have higher PNRS and PPG scores (P<0.001), but there was no significant difference in PPG achievement (P=0.641).
In examining incurable cancer patients with alexisomia, we must recognize that their latent trigger points risk ratio and PPGs are higher (lower symptom improvement goals) than cancer patients without alexisomia, and their rate of seeking help for pain may be low.
In examining incurable cancer patients with alexisomia, we must recognize that their latent trigger points risk ratio and PPGs are higher (lower symptom improvement goals) than cancer patients without alexisomia, and their rate of seeking help for pain may be low.
Programmed death protein-1 (PD-1) inhibitors and liver transplantation (LT) are alternative treatments for hepatocellular carcinoma (HCC) patients. The application of PD-1 inhibitors for HCC therapy increases T cell immune activity, while immunosuppression is required for patients receiving transplantation. More clinical investigation is required to determine methods to balance these treatment effects. In this article, we are the first to describe the clinical characteristics, imaging findings, and outcomes of 5 LT patients who had a history of HCC and received anti-PD-1 therapy.
Data from 5 patients who were diagnosed with HCC and received LT after PD-1 inhibition were analyzed. The doses and courses of PD-1 and preoperative and postoperative characteristics were compared and analyzed.
The mean interval between PD-1 inhibition and LT was 63.80±18.26 days. One patient experienced recurrence in the liver, vertebrae and lungs after 7 months, and 1 patient experienced recurrence in the lungs after 3 months. All patients displayed normal liver function at the latest follow-up visit. No acute allograft rejections occurred in any patient.
PD-1 inhibitors may be safe for the treatment of HCC before LT when the interval between the two treatments is sufficient. Further investigations are needed for to validate these findings.
PD-1 inhibitors may be safe for the treatment of HCC before LT when the interval between the two treatments is sufficient. Further investigations are needed for to validate these findings.
This investigation established a scoring scale for predicting the incidence of postoperative complications in patients after spinal tuberculosis debridement.
A total of 232 spinal tuberculosis patients who underwent debridement surgery between January 2012 to May 2020 were included in this retrospective study. The study cohort was divided into 2 groups according to the presence or absence of postoperative complications. The complications were defined as abnormal or impaired body function caused by surgical factors (such as nerve injury and internal fixation looseness) or other factors (such as chemotherapy and bed stay). Clinical characteristics include age, body mass index (BMI), diabetes mellitus, pulmonary tuberculosis, smoking history, preoperative serum albumin, preoperative C-reactive protein (CRP), Cobb angle correction, surgical approach, operation time, etc. operative blood loss was recorded and analyzed. The clinical characteristics of spinal tuberculosis patients who suffered postoperative comple were 60.8% and 81.8%, respectively, based on the validation set.
Using the scoring scale, spinal tuberculosis patients with a score between 4 to 9 would be considered at high risk of postoperative complications, while patients with a score of 0 to 3 would likely be at low risk of developing postoperative complications.
Using the scoring scale, spinal tuberculosis patients with a score between 4 to 9 would be considered at high risk of postoperative complications, while patients with a score of 0 to 3 would likely be at low risk of developing postoperative complications.
Palliative care evidently increases the quality of life among the patients with advanced cancer. However, there are very few studies on the aspects of the physicians' ideas, conceptions, or the effects of their ideas in palliative care quality, especially in Asian countries. This study aimed to evaluate the conception and perspective on palliative care in Thai gynecologic oncologists.
The online survey was distributed to all certificated Thai gynecologic oncologists. The survey could be accessed via working email address, hyperlink, or QR code during May 2020 and January 2021. A 5-point Likert scale captured the perspectives and concepts of palliative care. The association between respondents' characteristics and their choices of content in palliative care, together with their decision making in specified clinical scenarios was analyzed.
A total of 207 completed surveys from 320 Thai gynecologic oncologists were received (64.69% participation rate). They prospected a willingness to give the advices to both patients and their families (85.
