Pain, depression, and fatigue as a symptom cluster in advanced cancer

Context

Pain, depression, and fatigue are common symptoms in cancer populations. They often coexist and have been suggested as a specific symptom cluster. Systemic inflammation (SI) may be a possible common mechanism.

Objective

This study examined whether pain, depression, and fatigue exist as a symptom cluster in advanced cancer patients with cachexia and might be related to the presence of SI.

Methods

Secondary data analysis was undertaken of two clinical trials in patients with cancer cachexia (n = 654). Pain, depression, and fatigue were assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30. Plasma C-reactive protein (CRP) was measured as a marker of SI in a subgroup (n = 436). Multivariate analysis and a series of regression analyses were undertaken relating pain, depression, fatigue, and CRP.

Results

Pain, depression, and fatigue clustered, with between two and four times as many patients having all three symptoms as would be expected if the symptoms only coexist by chance (P < 0.001). CRP was not related to the symptom cluster. There was a strong relationship between the pattern of symptoms and physical functioning (P < 0.001).

Conclusion

Pain, depression, and fatigue is an identifiable symptom cluster in a cohort of cachexic cancer patients and is associated with reduced physical functioning.     

Support for Australian carers from community pharmacy: Insight into carer perspectives of a novel service

The feasibility of an individualised carer support service delivered in community pharmacies was assessed from the perspective of carer participants using a pre–post questionnaire and semistructured interviews. Eligible pharmacies were required to offer a medication management service relevant to carers and have a semiprivate space for conversations. Carers were required to self‐identify as an unpaid support person for someone with a chronic condition or disability. Between September 2016 and March 2017, staff from 11 community pharmacies in South‐East Queensland, Australia were trained, and provided with ongoing mentoring from a pharmacist and carer to support service implementation. Identification of carers and support to achieve a personal and care‐giving goal were key features of the service. Questionnaires included the EQ‐5D‐3L, the Bakas Caregiving Outcomes Scale, and questions relating to goal achievement, carer roles, and responsibilities. Seven follow‐up carer interviews were undertaken between March and May 2017 and analysed thematically. Pre–post questionnaires were available for 17 carers (one withdrew, two incomplete). Of the 29 goals set, 10 were achieved and 14 partially achieved. EQ‐5D‐3L scores were unchanged, while 7 of the 15 items comprising the Bakas score improved (p < 0.05). Carer service evaluation was generally favourable, and these two main interview themes were the impact of caring and pharmacy experience. The impact of caring, while variable, was significant. Pharmacy experiences were mostly positive and the opportunity for carers to further engage with pharmacy staff was appreciated. The service was feasible and initial reported benefits to carers may support further research potentially in terms of a larger controlled trial.     

药学服务对丙氨酰-谷氨酰胺合理使用的干预效果

目的:研究药学服务对丙氨酰-谷氨酰胺(Ala-Gln)合理使用的干预效果。方法:查阅本院2013年5月248例使用过丙氨酰-谷氨酰胺的出院病历以获取基线数据,针对发现的问题实施一系列药学干预。2014年5月再次查阅228例使用过丙氨酰-谷氨酰胺的出院病历,比较和分析2组病历在药学干预前后丙氨酰-谷氨酰胺的使用差异。结果:实施药学干预后,选药适宜率(P<0.01)、稀释载体准确率(P<0.01)、氨基酸占比达标率(P<0.01)等评价指标均显著改善。结论:药学干预对丙氨酰-谷氨酰胺的合理使用产生显著的有益影响。     

临床药师对高血压患者的药学服务及效果比较

目的：探讨临床药师为高血压患者提供药学服务的效果和意义。 方法：100例依从性差、血压控制不佳的高血压病患者随机分为干预组和对照组各50例。临床药师通过问卷调查了解患者高血压用药知识和潜在问题,对干预组患者实施个体化药学服务,对照组不予以干预,并分别在干预前和干预后3个月对患者的治疗结果、用药依从性、用药知识等进行随访研究。结果：干预组患者的用药依从性、血压控制情况等较对照组有明显改善,高血压用药知识水平也较对照组有明显提高。结论：临床药师通过面向高血压患者的药学服务可及时发现和解决患者治疗过程中的潜在问题,有助于提高患者的治疗效果、治疗依从性和用药知识水平,避免严重药物不良反应的发生。     

慢性病毒性肝炎伴糖代谢紊乱患者药学监护的分析

摘要 慢性病毒性肝炎尤其伴肝硬化时,常出现糖代谢紊乱,病情十分复杂,治疗中需要解决的药学问题有很多。本文以降糖药物、保肝药物及抗菌药物使用监护为切入点,结合我院临床药师参与药学监护的3例典型病例,提出慢性病毒性肝炎伴糖代谢紊乱药学监护要点为：降血糖药物应避免使用损害肝功能的口服降糖药物,尽量选用胰岛素;保肝药物应避免使用可能升高血糖的甘草酸制剂等药物;抗菌药物使用时应避免使用对肝功能有损害及对血糖有影响的抗菌药物。实施这些药学监护,对慢性病毒性肝炎伴糖代谢紊乱患者血糖控制、肝功能恢复等均有重要临床意义。     

临床药师参与2例肺曲霉菌感染合理用药病例报道

本文报道临床药师参与2例肺曲霉菌感染合理应用抗真菌治疗方案制定,取得良好疗效,避免了药物不良反应。临床药师深入临床一线,提供药学服务有助于提高疗效,减少不良反应。