1,721,045 research outputs found
The use of opioids in the last week of life in an acute palliative care unit.
Full text linkThe aim of this survey was to assess the opioid use in the last week of life of cancer patients admitted at an acute palliative care unit. From a consecutive sample of patients surveyed for a period of one year, patients who died in the unit were selected. Type of opioid, route of administration, and doses were recorded one week before death (or at admission time if the interval admission-death was less than one week) (-7), and on the day of death (Tend). Seventy-seven patients died in the unit in the period taken into consideration (12.4%). Oral morphine equivalents were 170 mg/day and 262 mg/day at -7 and Tend, respectively. Patients were receiving transdermal drugs or intravenous morphine at Tend, with a trend in the use of intravenous morphine at Tend (p=0.07). Intravenous morphine was more frequently used in sedated patients at Tend (p=0.015).No differences in age, gender, opioid doses, and OEI were found among opioids used. In patients who were sedated doses of opioids were significantly increased (p=0.012). In the last week of life intravenous morphine is the preferred modality to deliver opioids in an acute palliative care unit. Doses increases prevalently observed in sedated patients were performed before starting sedation with the purpose to treat concomitant distressing symptoms, such as dyspnoea
100 Gbps PON L-band downstream transmission using IQ-MZM CD digital pre-compensation and DD ONU receiver
Full text linkWe propose a downstream direct-detection 100G-PON solution aided by chromatic dispersion digital pre-compensation using an IQ-MZM, allowing L-band operation and 29 dB power budget with low ONU complexity and without requiring single-sideband modulation
Unexpected death on an acute palliative care unit
No full textAlthough most deaths in patients with advanced cancer are expected, no data are available on unexpected death (UD). This event can be really stressful for physicians who are unable to anticipate, prevent, or discuss UD, and for relatives who are not ready for such an acute emotional burden, despite previous good communication about the short-term prognosis. There is the need for more information, particularly in the setting of an acute palliative care unit where most patients are discharged to follow different therapeutic pathways, including continuing oncologic treatment, home care, or hospice.1,2 The aim of this prospective study was to assess the characteristics of patients who died unexpectedly in an acute palliative care unit.This report highlights that some patients may escape the final pathway commonly reserved to end-of-life care and communication, as well as all the measures used to assure a good death. A larger sample of patients could provide more consistent data, and our data should be considered preliminary. Further studies should be performed with larger numbers of patients and in different settings to provide further information on ED
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
ALTERNATIVE TREATMENTS OF BREAKTHROUGH PAIN IN PATIENTS RECEVEING SPINAL ANALGESICS FOR CANCER PAIN.
No full textExperimental study on 25 Gbps C-band PON over up to 25 km SMF using a 10G-class DML + APD IM-DD system
Full text linkIn this paper we present an experimental analysis of several modulation formats (pulse amplitude modulation (PAM-2), quaternary pulse amplitude modulation (PAM-4) and electrical duobinary (EDB)) for passive optical network (PON) applications at 25 Gbps bit rate in a C-band 10G-class directly modulated lasers (DML) and avalanche photodiode (APD) intensity modulation and direct detection (IM-DD) system over a single mode fiber (SMF) of up to 25 km, optimizing DML operations and demonstrating that PAM-2 is a promising choice. We also theoretically and experimentally analyzed the channel frequency response of DML and SMF affected by DML chirp and SMF chromatic dispersion
Optimization of opioid therapy for preventing incident pain associated with bone metastases
No full textBreakthrough pain is a transitory flare of Pain superimposed on an otherwise stable pain pattern in patients treated with opioids. One form of breakthrough pain is incident pain, which is due to movement and is commonly associated with bone metastases. The development of this pain is rapid and no medication, administered "as needed," has such a rapid onset that it parallels this temporal Pattern of Pain. This study used a construct based on the prevention of this event, and implemented a new experimental paradigm. Specifically, the study determined whether increasing the opioid doses above those sufficient to control pain at rest would. reduce the occurrence of these pains. Twenty-five consecutive Patients with movement-related episodic pain associated with bone metastases, and no evident fractures, were selected for the study. They received a rapid intravenous titration of the opioid dose to obtain pain relief at rest. Then, opioid doses were increased to challenge the therapeutic window. The dose ceiling was determined by the development of limiting adverse effects, rather than optimal pain control at rest. Opioid dose increases were then stopped, or doses were even reduced, according to patients' satisfaction or development, of adverse effects with moderate-severe intensity. Basal pain intensity and pain induced by movement were measured using a numerical scale from 0-10. Opioid-related symptoms were assessed using a scale from 0 to 3 (absent, slight, moderate, severe), and global daily doses Of oral morphine and other symptomatic drugs were also recorded at daily intervals, and at time of discharge, when the best balance was presumed to be reached. Basal pain control was achieved after rapid intravenous titration. The day after, pain induced by movement significantly improved using mean doses of oral morphine equivalents of 102 mg. In the following days, the subsequent increase in opioid doses prescribed despite optimal basal pain control allowed an acceptable level of incident pain intensity until Patients' discharge. A minority of patients developed adverse effects with an intensity of 2-3 on the scale, requiring symptomatic treatment or decreases in opioid doses. Data from this study suggest that the intensity of incident pain may be reduced by increasing the opioid dose above that effective for controlling pain at rest. This approach is based on experimental bone models showing a hypersensitivity to some innocuous stimuli, such as movement, requiring pre-emptive higher doses of basal opioid medication to reduce the increased pain input
Rapid switching between transdermal fentanyl and methadone in cancer patients
Full text linkPurpose
The aim of this study was to examine the clinical effects of switching from transdermal (TTS)fentanyl to methadone, or vice versa, in patients with a poor response to the previous opioid.
Patients and Methods
A prospective study was carried out on 31 patients who switched from TTS fentanyl to oral
methadone, or vice versa, because of poor opioid response. A fixed conversion ratio of
fentanyl to methadone of 1:20 was started and assisted by rescue doses of opioids, and then
doses were changed according to clinical response. Pain and symptom intensity, expressed
as distress score, were recorded before switching doses of the two opioids and after
subsequent doses. The number of changes of the daily doses, time to achieve stabilization,
and hospital stay were also recorded.
Results
Eighteen patients were switched from TTS fentanyl to methadone, and seven patients were
switched from methadone to TTS fentanyl. A significant decrease in pain and symptom
intensity, expressed as symptom distress score, was found within 24 hours after switching
took place in both directions. Unsuccessful switching occurred in six patients, who were
subsequently treated with an alternative therapy.
Conclusion
A rapid switching using an initial fixed ratio of fentanyl to methadone of 1:20 is an effective
method to improve the balance between analgesia and adverse effects in cancer patients
with poor response to the previous opioid. No relationship between the final opioid dose and
the dose of the previous opioid has been found
- …
