Methods of assessing late radiotherapy effects on bowel function
Purpose of review Pelvic radiation disease in the form of chronic radiation-induced consequences of treatment is under recognized by healthcare professionals and under reported by patients. Gastrointestinal symptoms are not routinely assessed, and may not be causally associated with previous radiotherapy. These symptoms are therefore often under treated. Recent findings A literature search was conducted in Ovid Medline, which included Epub Ahead of Print, In-Process &Other Non-Indexed Citations and Ovid Embase for articles published between 2016 and April 2018. A total of 11 articles were selected for review. A wide range of patient reported outcome measure instruments are used in research and practice. Clinical symptom grading is restricted to a fewer number of tools but may not always capture issues, such as urgency, that are important to the patient. Clinician and patient concordance in the assessment of outcomes is limited. Initiatives to prompt communication of the relative risks of the late consequences of treatment and comparative effectiveness of treatments decisions are developing, as are new techniques to limit irradiation of healthy tissue. Summary Nonstandardized outcome measurement reduces the ability to aggregate toxicity and patient outcomes across clinical trials. The development of standardized screening and treatment algorithms for gastrointestinal symptoms can systematically locate and treat gastrointestinal late effects of treatment.
Discussions? J Palliat Care. 2019 Oct 10;:825859719880518 Authors: Marks S Abstract Being able to elicit the fundamental values, hopes, and care preferences that drive clinical decision-making for patients with a life-limiting illness is considered a core clinical skill for many specialist and generalist clinicians. Such clinical skills have been described as a crucial component of patient-centered care, especially for those with serious illness who often are confronted with complex and immediate medical decisions. Yet, being able to identify what matters most to a patient or what brings a patient the ...
ConclusionCutaneous metastases secondary to urothelial bladder carcinoma are exceptional especially in its inflammatory presentation. Diagnosis is based on immunohistochemical study. Treatment is based on chemotherapy and the prognosis is poor.
Conclusions: ICU-based end-of-life care resources do not appear to change mortality but are associated with increased hospice utilization. Given that this finding was not confirmed by the instrumental variable analysis, future studies should attempt to verify this finding, and identify specific resources or processes of care that impact the care of ICU patients at the end of life.
Conclusions: In spite of the lack of high-quality evidence, recommendations for pain management at the end-of-life in the ICU are homogeneous and are justified by ethical principles and agreement among experts. Considering the growing demand for the involvement of palliative care teams in the management of the dying patients in the ICU, there is a need to clearly define their early involvement and to further develop comprehensive evidence-based pain management strategies. Based on the study findings, we propose a management algorithm to improve the overall care of dying critically ill patients.
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Publication date: Available online 11 October 2019Source: Revista Española de Cardiología (English Edition)Author(s): Samuel D. Slavin, Haider J. WarraichAbstractHeart failure (HF) is a progressive condition with high mortality and heavy symptom burden. Despite guideline recommendations, cardiologists refer to palliative care at rates much lower than other specialties and very late in the course of the disease, often in the final 3 days of life. One reason for delayed referral is that prognostication is challenging in patients with HF, making it unclear when and how the limited resources of specialist palliat...
Publication date: Available online 10 October 2019Source: Canadian Journal of CardiologyAuthor(s): Marie-A. Chaix, Michael A. Gatzoulis, Gerhard-Paul Diller, Paul Khairy, Erwin N. OechslinAbstractEisenmenger syndrome is the most severe and extreme phenotype of pulmonary arterial hypertension associated with congenital heart disease. A large non-restrictive systemic left-to-right shunt triggers the development of pulmonary vascular disease, progressive pulmonary arterial hypertension and increasing pulmonary vascular resistance at the systemic level, which ultimately results in shunt reversal. Herein, we review the changing...
CONCLUSIONS: While a majority of pediatric cardiothoracic surgeons are familiar with palliative care, there is variation in perception of appropriate timing of consultation. Significant barriers to consultation still exist, including concern that parents will think they are "giving" up, undermining parental hope, and influence of palliative care on the medical care team's approach. PMID: 31597507 [PubMed - as supplied by publisher]
Publication date: November 2019Source: The Lancet Global Health, Volume 7, Issue 11Author(s): Felicia Knaul, Afsan Bhadelia, Rifat Atun, Liliana De Lima, Lukas Radbruch
Publication date: 12–18 October 2019Source: The Lancet, Volume 394, Issue 10206Author(s): Rachel Coghlan, Mhoira Leng, Omar Shamieh, Khamis Elessi, Liz Grant