Cachexia

Cachexia is a frequent syndrome in patients suffering from advanced cancer; it is characterized by anorexia, weight loss, and malnutrition, which combined with other psychic and social consequences lead to a deterioration in a patient's quality of life. Various factors play a role in the development of cachexia; these depend on the patient, the type of tumor, and the treatments received. Its complexity warrant the intervention of an interdisciplinary team, in which nursing plays an essential role. Up to present time, the results of pharmaceutical treatment have been rather unfavorable; therefore, nutritional treatments based on advise for concrete problems and dietary supplements gain importance; enteral or parenteral nutrition are reserved for selected cases. Other important aspects are psychological support, control of associated symptoms and the prevention and treatment of any complication which may appear.     

Psychosomatic pain: new insights and management strategies

At least 40 to 60 percent of women and at least 20 percent of men with chronic pain disorders report a history of being abused during childhood and/or adulthood. This incidence of abuse is two to four times higher than in the general population. Patients with more severe or frequent abuse, usually during childhood and worse if sexual in nature. often develop specific syndromes or combinations of syndromes. These syndromes include posttraumatic stress disorder, fibromyalgia, and other conditions characterized by repression, somatization, and increased utilization of medical care. Psychosomatic symptoms and dysfunctional behaviors may emerge as these patients seek attention and validation of their suffering, while paradoxically repressing painful memories of trauma. Behavioral observations and key features of the physical examination may greatly help the clinician identify both the presence and severity of psychosomatic disease. In addition, it is very interesting that various studies document physiologic changes in the brains of patients with a history of abuse and in patients with a diagnosis of fibromyalgia. These studies suggest that abuse may physiologically and developmentally increase a person's susceptibility to pain and that some organic changes may be associated with psychogenic disease. Diagnosis and treatment of even the most challenging patients with chronic pain is much more effective if it includes (a) careful inquiry about any history of past or present abuse or other severe trauma, (b) empathy and constructive validation of disease and suffering, (c) recognition of dysfunctional pain behaviors and personality traits, (d) documentation of nonanatomic as well as anatomic features on examination, (e) multidisciplinary treatments including psychotherapy whenever indicated, and (f) noninvasive procedures and alternatives to potentially habit-forming medications whenever possible and appropriate. Furthermore, it has been shown that helping patients gain insight about the relationship between abuse and their current symptoms leads to decreased health care utilization. Practical guidelines are provided for identifying psychopathology, communicating effectively, and achieving better treatment outcomes for these unfortunate patients.     

SARS: current knowledge and management

Severe acute respiratory syndrome (SARS) was identified as a new infectious disease in Asia early in 2003. Since then an unprecedented global public health response has been mounted. This article describes current knowledge of the infection and outlines the management of SARS in the UK.     

Reperfusion therapy in out-of-hospital cardiac arrest: current insights

Although early care in out-of-hospital cardiac arrest has been improved over the past decades, survival remains poor and neurological performance after survival is often impaired. Consequently, new therapies are needed to improve outcome. As thrombotic processes such as acute myocardial infarction or pulmonary embolism are frequent causes of cardiac arrest, therapies like fibrinolysis or percutaneous coronary intervention are of interest. Both therapies can restore coronary and pulmonary perfusion in cardiac arrest patients and, additionally, fibrinolysis might prevent microthrombi to the brain. In this review, the rationale, safety and efficacy of reperfusion therapy in patients with out-of-hospital cardiac arrest will be discussed.     

Cachexia and anorexia: cancer's covert killer

 Cachexia and anorexia are often not observed at the time of diagnosis of cancer. While the initial medical intervention for cancer patients includes antitumor therapy and pain management, the consequences of cachexia and anorexia may be ignored, to the detriment of the patient's quality of life and his or her potential response to chemotherapy. The importance of a well-defined therapeutic strategy to treat cachexia is in order if the patient's overall wellbeing is to improve. Presented is a review of the pharmacological management of anorexia and cachexia, including a four-step ladder approach to medical management. Published online: 13 March 2000     

Cutaneous leishmaniasis: current and future management

Leishmaniasis remains a major world health problem that continues to increase in incidence. This review considers epidemiology, clinical features, diagnosis and current treatment options. Recent developments in the treatment of simple cutaneous leishmaniasis are discussed followed by speculation about future therapies.     

Asthma management and prevention: current perspectives

The continuing evolution of asthma treatment and prevention are reflected in updated guidelines from the National Asthma Education and Prevention Program and Global Initiative for Asthma as well as other recent publications. The 2007 Expert Panel Report 3 guidelines designate severity and control, mediated by considerations of current impairment and future risk, as the primary concepts in assessing and monitoring asthma. Severity should ideally be determined at the time of diagnosis, after which control becomes the central focus of asthma management. In the area of treatment, inhaled corticosteroids (ICSs) remain first-line therapy for longterm asthma management in children and adults. For patients whose severity of asthma requires more than low-dose ICSs, or whose asthma cannot be well controlled on monotherapy with low-dose ICSs, evidence supports the efficacy of combination therapy consisting of an ICS plus an inhaled long-acting beta2-agonist (LABA) or an increase to medium-dose ICSs. For children >5 years of age and adults not controlled on low-dose ICSs, the combination of a low-dose ICS plus an inhaled LABA is equivalent in terms of outcomes to the use of medium-dose ICS. For children <5 years of age not controlled on low-dose ICSs, increasing the dose of ICSs is preferred to the addition of a LABA to low-dose ICS therapy as no studies using combination therapy have been conducted for patients in this age group. With regard to asthma prevention, approaches to primary prevention (to avoid allergen sensitization) and secondary prevention (to avoid disease progression) are still very much in the developmental stage, while tertiary prevention (to avoid asthmatic stimuli) has been more successful particularly in pediatric patients. Written action plans as part of self-management processes appear to improve physician-patient communication and disease status tracking. Other considerations in successful asthma management include patient education and monitoring of adherence to treatment regimens.     

Cutaneous leishmaniasis: current and future management

Leishmaniasis remains a major world health problem that continues to increase in incidence. This review considers epidemiology, clinical features, diagnosis and current treatment options. Recent developments in the treatment of simple cutaneous leishmaniasis are discussed followed by speculation about future therapies.     

Low-grade glioma: current management and controversies

The question of optimal management of patients with low-grade gliomas continues to generate considerable controversy. Retrospective studies have helped delineate prognostic factors for patients with these tumors as well as the relative efficacy of surgery, radiation and chemotherapy. Results of recently completed and ongoing prospective, multi-institutional trials will help guide the treatment of these patients in the future. Other advances include the molecular characterization of these tumors that should assist in selection of existing and development of future therapies.     

Subtrochanteric fractures: current management options

PURPOSE: To review current management options for subtrochanteric fractures of the femur. These fractures behave differently from other proximal femoral fractures and have their own management pitfalls and problems. METHOD: Articles were identified from Medline. Papers on the management of subtrochanteric fractures were assessed, and included if they contained relevant information. The articles were divided into groups depending on the type of management described. Conservative and operative management were considered separately. Operative management was classified according to the type of device used into extramedullary and intramedullary. CONCLUSIONS: Conservative management gives satisfactory results in 56% of patients compared to 70 - 80% for operative methods. The studies on conservative methods are mostly dated, with less stringent outcome measures. Conservative management is safe, and has a low frequency of non-union. It is most applicable in regions where facilities are suboptimal, in patients unfit for surgery, and in children. When considering operative management, intramedullary devices appear to give better results than extramedullary devices, particularly when the medial buttress of the proximal femur is compromised. However, when operative treatment is undertaken, it should be by experienced surgeons using the technique with which they are most familiar.     

Parotid fistula: current management.

The most common cause of parotid fistula is trauma. Other causes include operative complications, infection, and malignancy. In the acute phase of ductal injury, primary reconstruction, if possible, is the treatment of choice. Acute parenchymal injury is treated by tight closure and expectancy. When diverting or flow-blocking measures fail to correct chronic ductal fistula, the treatment of choice for this situation as well as for chronic parenchymal fistula may be tympanic neurectomy, which can be done under local anesthesia, is associated with low morbidity, is relatively uncomplicated and has given excellent results to date in our hands.     

Osteoarthritis: current concepts in diagnosis and management

Most patients with osteoarthritis seek medical attention because of pain. The safest initial approach is to use a simple oral analgesic such as acetaminophen (perhaps in conjunction with topical therapy). If pain relief is inadequate, oral nonsteroidal anti-inflammatory drugs or intra-articular injections of hyaluronic acid-like products should be considered. Intra-articular corticosteroid injections may provide short-term pain relief in disease flares. Alleviation of pain does not alter the underlying disease. Attention must also be given to nonpharmacologic measures such as patient education, weight loss and exercise. Relief of pain and restoration of function can be achieved in some patients with early osteoarthritis, particularly if an integrated approach is used. Patients with advanced disease may eventually require surgery, which generally provides excellent results.     

Malignant mesothelioma: risk factors and current management

Malignant mesothelioma is a cancer of the pleura and peritoneum often associated with asbestos exposure. Although rare its incidence is increasing, principally as a result of the long latency period of the disease. This article presents a review of mesothelioma, looking at the disease process, risk factors, causes, and current management strategies--namely surgery, chemotherapy, and radiotherapy. Some of the nursing implications are discussed along with the resources currently available to patients with mesothelioma in the UK.     

Post-thrombotic syndrome: current prevention and management strategies

The post-thrombotic syndrome (PTS) is the most commonly occurring long-term complication of deep vein thrombosis (DVT) with a cumulative incidence of up to 50% within the first 2 years after the thrombotic event. It is characterized by the development of various symptoms and signs related to chronic venous disease in a limb previously affected by DVT. PTS is a condition that significantly impairs quality of life and results in substantial burden to patients and society. So far, treatment options for PTS are limited, and strategies that prevent PTS occurrence are therefore of pivotal importance. These include compression therapy, prevention of recurrent ipsilateral DVT and possibly endovascular catheter-directed thrombolytic procedures. Clinical predictors of PTS are progressively characterized, but the ability to predict which patient with DVT is likely to develop PTS remains limited.