1,720,962 research outputs found
Treatment of nausea and vomiting with prokinetics and neuroleptics in palliative care patients. A review
No full textMany recommendations concerning the treatment of nausea and vomiting in palliative care patients exist but what is the evidence for this? Most studies dealing with this topic have focused on cancer patients under chemotherapy and/or radiation therapy or on patients with postoperative nausea. Cancer patients without chemotherapy or radiation therapy, patients without postoperative nausea, and patients having other diseases with palliative care aspects, such as acquired immunodeficiency syndrome (AIDS), chronic obstructive pulmonary disease (COPD), progressive heart failure, amyotrophic lateral sclerosis (ALS) and multiple sclerosis (MS) have been underrepresented in studies on nausea and vomiting so far. The aim of this review was to determine the level of evidence for the treatment of nausea and vomiting with prokinetics and neuroleptics in palliative care patients suffering from far advanced cancer and no longer being treated with chemotherapy or radiation therapy, AIDS, COPD, progressive heart failure, ALS or MS. Two different electronic databases (PubMed und Embase) were used to identify studies. Furthermore, a hand search for related articles was performed. No restriction was made concerning study types. Studies with patients undergoing chemotherapy radiation therapy or suffering from postoperative nausea, pediatric studies and studies published neither in English nor in German were excluded. A total of 30 studies fulfilling the inclusion criteria were found. All studies focused on cancer patients. Despite intensive research studies in patients with AIDS, COPD, heart failure, ALS or MS were not detected. Metoclopramide is seen as an effective drug in many studies whereas the evidence for it is moderate at best. Within the group of neuroleptics, levosupiride and levomepromazine seem to have good antiemetic potential but the evidence level is low. In patients with advanced cancer not being treated with chemotherapy or radiation therapy, metoclopramide can be used to reduce nausea and vomiting. Neuroleptics, such as levosulpiride or levomepromazine are alternatives but their adverse effects have to be considered carefully. The evidence level for prokinetics and neuroleptics is moderate to low. Concerning palliative care of patients with diseases other than cancer no studies exist. More well designed studies in palliative care patients are needed in order to facilitate evidence based antiemetic therapy. The English full text version of this article will be available in SpringerLink as of November 2012 (under "Supplemental")
Cytokine-producing T cells in systemic lupus erythematosus: comment on the article by Akahoshi et al
No full textTreatment of nausea and vomiting with 5HT3 receptor antagonists, steroids, antihistamines, anticholinergics, somatostatinantagonists, benzodiazepines and cannabinoids in palliative care patients.A systematic review
No full textVarious recommendations exist for the treatment of nausea and vomiting in palliative care but only few studies and even less systematic reviews look into antiemetic therapy for patients receiving palliative care. This systematic review aims to analyze the current evidence for antiemetic treatment with 5HT3 receptor antagonists, steroids, antihistamines, anticholinergics, somatostatin analogs, benzodiazepines and cannabinoids in palliative care patients with far advanced cancer not receiving chemotherapy or radiotherapy, acquired immune deficiency syndrome (AIDS), chronic obstructive pulmonary disease (COPD), progressive heart failure, amyotrophic lateral sclerosis (ALS) or multiple sclerosis (MS). Results regarding evidence of treatment with prokinetic and neuroleptic agents will be published separately. The electronic databases PubMed and EmBase were systematically searched for studies (published 1966-2011) dealing with antiemetic therapy in palliative care and electronic retrieval was completed by manual searching. Studies with patients undergoing chemotherapy or radiotherapy, pediatric studies and studies published in languages other than English or German were excluded. Studies addressing therapy with 5HT3 receptor antagonists, steroids, antihistamines, anticholinergics, somatostatin analogs, benzodiazepines or cannabinoids were identified and selected for this systematic review. In the general search 75 relevant studies were found. Of those 36 addressed 5HT3 receptor antagonists, steroids, antihistamines, anticholinergics, somatostatin analogs, benzodiazepines and cannabinoids, 13 considered 5HT3 receptor antagonists, 10 somatostatin antagonists, 9 steroids, 5 cannabinoids, 4 anticholinergics, 1 antihistamines and none benzodiazepines. Furthermore six systematic reviews exist. Evidence for any drug used as an antiemetic is low. Concerning 5HT3 receptor antagonists data are insufficient for recommendations on the treatment of patients with AIDS and MS due to the small size of included patient groups. For patients with cancer contradictory results were published: the larger studies showed a positive effect of 5HT3 receptor antagonists and better efficacy, as compared to metoclopramide, dexamethasone and neuroleptics. Heterogeneous results were found for steroids, with a positive trend for patients with cancer. Data are insufficient for antihistamines. Studies prove effectiveness of butylscopolammonium in the treatment of nausea and vomiting caused by malignant gastrointestinal obstruction, whereas octreotide is superior to butylscopolammonium. Regarding benzodiazepines for symptom control of nausea and vomiting in palliative care patients no studies were detected. Cannabinoids were found to relieve nausea and vomiting in patients with cancer and AIDS but with notable side effects. Furthermore, the studies compared cannabinoids to less recent antiemetic drugs but not, for example to 5HT3 receptor antagonists. Regarding symptom control of nausea and vomiting in patients with COPD, progressive heart failure and ALS no studies were undertaken in patients receiving palliative care. In palliative care patients with nausea and vomiting 5HT3 receptor antagonists can be used if treatment with other antiemetics, such as metoclopramide and neuroleptics is not sufficient. There is a trend that steroids in combination with other antiemetics improve symptom relief. Cannabinoids rather have a status as a second line antiemetic. In cases of nausea and vomiting caused by malignant gastrointestinal obstruction octreotide showed the best and butylscopolammonium bromide the second best results. Concerning antihistamines and benzodiazepines insufficient data was found. Recommendations in the literature are mainly based on studies in patients with cancer. The overall strength of evidence is low. More well designed studies in palliative care patients are needed in order to provide evidence-based therapy. The English full text version of this article will be available in SpringerLink as of November 2012 (under "Supplemental")
Palliative and emergency medicine: Teamwork through communication
No full textDemands for improvement of palliative care have increased in Germany in the last years. Suitable models of care have been established that enable patients to stay at home in the last days of their life. Nevertheless, relatives can be challenged by acute exacerbations of symptoms and call the emergency, initiating a sequence of emergency actions. In these situations conflicts between principles of palliative and emergency medicine can rise. We report an emergency in a male patient with cardiac arrest suffering from terminal carcinoma of the prostate. Despite patient's refusal for treatment the relatives called an ambulance after the patient had got unresponsive due to cardiac arrest. After a short period of cardiopulmonary-resuscitation spontaneous circulation could be established. Only then the emergency physician was told that the patient had refused resuscitation. After this information was communicated, intensive care treatment was not considered and the emergency physician arranged direct admission to our palliative care unit. This case demonstrates that emergency physicians can be confronted with palliative care patients. A cooperation of both disciplines (palliative and emergency medicine) is necessary to achieve the best care for the patient. Moreover involvement of a palliative care team (PCT) in combination with a written document, called palliative emergency form ("Palliativkrisenbogen"), as well as an advance directive can improve accepting patient's wishes in terminal care. The "Palliativkrisenbogen" contains patient's history and his advance directive. Communication between palliative care and emergency medicine may help to find out the patients preferences quickly. This facilitates the kind of care a patient wants. The use of a "Palliativkrisenbogen" should be co-ordinated with the juridical regulations in the future
The Gottingen Palliative Emergency Card The "Yellow Card for Emergency Medical Services"
No full textActually more and more cancer patients will be treated at home especially at the final stage of their disease. Therefore relatives and nursing set-vices will be confronted with acute emergency situations of these patients. The handling of those acute situations may be out of the relatives' depth. For that reason the prehospital emergency system will be confronted (2.5 % of all emergency calls) with the specific needs of these patients. Emergency Situations of palliative patients at home are more predictable as in other circumstances. Therefore it is possible to get a practicable preparation for those emergency Situations. For this an individual "emergency plan" should be created. The plan may be processed in an emergency situation. Therefore it might be possible to avoid emergency calls, and for the patient it is possible to stay at home. This promotes the quality of life a and the patient's predominant des ire to stay at home after the arrest. An advance directive should be created to show the patient's will. Because of the complexity of an advance directive it is necessary to show the patient's will in emergency cases in a short and quick form. This is one of the reasons for creating a short version like the "Gottingen palliative emergency card". Therefore in acute Situations it is possible to show the patient's will very quick. The patient might get the possibility to stay at home after emergency situation is treated successfully
The Gottingen palliative emergency card - the "yellow card for emergency medical services"
No full textCharacteristics of a palliative care consultation service with a focus on pain in a German university hospital
No full textBackground: A minority of patients with incurable and advanced disease receive specialised palliative care. Specialised palliative care services that complement the care of difficult and complex cases ought to be integrated with services that deliver general care for most patients. A typical setting in which this integrative concept takes place is the hospital setting, where patients suffering from incurable and advanced disease are treated in many different departments. The aim of the study is to investigate the profile and spectrum of a palliative care consultation service (PCCS) at a German university hospital with special reference to pain therapy. Methods: We retrospectively analysed the PCCS documentation of three years. Results: Most patients were referred from non-surgical departments, 72% were inpatients, and 28% were outpatients. 98% of the patients suffered from cancer. Counselling in pain therapy was one of the key aspects of the consultation: For 76% of all consulted patients, modifications of the analgesic regimen were recommended, which involved opioids in 96%. Recommendations on breakthrough-pain medication were made for 70% of the patients; this was an opioid in most cases (68%). The most commonly used opioid was morphine. For 17% of the patients, additional diagnostic procedures were recommended. Besides pain management palliative care consultation implied a wide range of recommendations and services: In addition to organising home care infrastructure, palliative care services supported patients and their families in understanding the life-limiting diseases. They also coordinated physical therapy and social and legal advice. Conclusion: This survey clearly shows that for a consultation service to support patients with incurable or advanced disease, a multi-disciplinary approach is necessary to meet the complex requirements of a needs-adapted palliative care in inpatient or outpatient settings. Timely integration of palliative expertise may support symptom control and may give the required advice to patients, their carers, and their families
- …
