The role of hydromorphone in cancer pain treatment: a systematic review

The aim of this systematic review is to evaluate the scientific evidence for the efficacy and side effects of hydromorphone in the management of moderate to severe cancer pain. Randomized and non-randomized clinical trials, reporting data on efficacy and/or side effects of hydromorphone, were identified. Thirteen eligible studies, involving 1208 patients, were selected. Seven studies compared hydromorphone with other opioids (five with morphine, one with oxycodone and one with fentanyl and buprenorphine) and five of them were randomized controlled trials (RCTs). Most of the studies were conducted on patients already receiving opioid treatment, often at stabilized doses, and most had methodological limitations. The RCTs comparing hydromorphone with morphine and oxycodone showed similar analgesic results, while the comparison of side effects showed minor differences, not consistent across studies. Due to clinical and methodological heterogeneity of the studies, a meta-analysis was not performed. In conclusion there is evidence to support the efficacy and tolerability of hydromorphone for moderate to severe cancer pain as an alternative to morphine and oxycodone, while there is no evidence to demonstrate its superiority or inferiority in comparison with morphine as the first choice opioid for the same indication.     

Efficacy and safety of traditional Chinese medicine on thromboembolic events in patients with atrial fibrillation: A systematic review and meta-analysis

ObjectivesTraditional Chinese medicine (TCM) in combination with Western medicine (WM) has been widely used worldwide. This systematic review aimed to evaluate the efficacy and safety of TCM in prevention of thromboembolic events in patients with atrial fibrillation (AF).MethodsPotential studies were searched through the Cochrane Library, PubMed, EMBASE, CBM, VIP, CNKI, and Wanfang databases up to February 2016. Randomized controlled trials (RCTs) investigating the thromboembolic events and/or safety outcome of TCM in patients with AF were included.ResultsA total of 905 AF patients from 9 RCTs were identified. Meta-analysis showed that TCM in combination with warfarin was better than warfarin alone for preventing total thromboembolic events with a 68% reduction of risk (risk ratio [RR] 0.32; 95% confidence interval [CI] 0.13–0.78) without increasing the risk of total bleeding (RR 0.71; 95% CI 0.29–1.72). Compared with warfarin, TCM therapy was associated with lower risk of total bleeding (RR 0.13; 95% CI 0.04–0.47), but increased the risk of total thromboembolic events (RR 1.84; 95% CI 1.03–3.27).ConclusionsThis meta-analysis suggests that TCM combined with warfarin is superior to warfarin alone for the prevention of total thromboembolic events in patients with AF, with equal risk of bleeding as warfarin alone.     

The treatment of depression in cancer patients: a systematic review

Goals of the work: To evaluate the efficacy of pharmacological and nonpharmacological treatments for depression in cancer populations. Materials and methods: The Supportive Care Guidelines Group conducted a systematic review of the published literature through June 2005. Search sources includes MEDLINE, EMBASE, CINAHL, PsycInfo, and the Cochrane Library. Comparative studies of treatments for depression in cancer patients were selected for review by two group members based on predefined criteria. Main results: Seven trials of pharmacological agents and four of nonpharmacological interventions were identified. Two trials detected a significant reduction in depressive symptoms for mianserin compared with placebo, and one trial found alprazolam to be superior to progressive muscle relaxation. Four drug trials found no significant difference between groups on depression measures although posttreatment reduction of symptoms was observed for all groups in two trials comparing active treatments (fluoxetine vs desipramine and paroxetine vs amitriptyline). Of the four trials involving nonpharmacological therapies for the management of depression, two detected a benefit for treatment (a multicomponent nurse delivered intervention and an orientation program) over usual care. Conclusion: There is limited evidence for the effectiveness of pharmacological and psychosocial interventions in the treatment of cancer patients with depressive disorders, and no evidence for the superiority of one treatment modality over another. Based on evidence from the general population and other medically ill populations, combined approaches to the treatment of depression may be the most effective. Further research is necessary in cancer patients to determine the relative effectiveness of psychosocial, pharmacological, and combined treatments. A paper presented as an invited lecture at the MASCC/ISOO 18th International Symposium of Supportive Care in Cancer in Toronto, Canada, June 2006, was based in part on this review. A complete list of Supportive Care Guidelines Group members is available at: .     

The management of dyspnea in cancer patients: a systematic review

Goals of work The goal of the study is to evaluate the effectiveness of four drug classes (opioids, phenothiazines, benzodiazepines, and systemic corticosteroids) for relieving dyspnea experienced by advanced cancer patients. Materials and methods A systematic literature review was conducted to July 2006. Search sources included MEDLINE, EMBASE, HealthSTAR, CINAHL, and the Cochrane Library. Four reviewers selected evidence using predefined criteria: controlled trials not limited to cancer and involving the specified drug classes for dyspnea treatment. Main results Three systematic reviews, one with meta-analysis, two practice guidelines, and 28 controlled trials were identified. Most examined the effect of opioids, generally morphine, on dyspnea. Although the results of individual trials were mixed, the systematic review with meta-analysis detected a significant benefit for dyspnea with systemic opioids; two small placebo-controlled trials in cancer patients found systemic morphine reduced dyspnea, and dihydrocodeine also significantly reduced dyspnea in four placebo-controlled trials. Nebulized morphine was not effective in controlling dyspnea in any study or the meta-analysis. No controlled trials examined systemic corticosteroids in the treatment of cancer patients, and of the other non-opioid drugs examined, only oral promethazine, a phenothiazine, showed some benefit in the relief of dyspnea. Studies varied in methodological quality. Conclusions Systemic opioids, administered orally or parenterally, can be used to manage dyspnea in cancer patients. Oral promethazine may also be used, as a second-line agent if systemic opioids cannot be used or in addition to systemic opioids. Nebulized morphine, prochlorperazine, and benzodiazepines are not recommended for the treatment of dyspnea, and promethazine must not be used parenterally. A complete list of Supportive Care Guidelines Group members is available at: .     

Thalassemia trait and arterial thromboembolic events: a systematic review and a meta‐analysis of the literature

Summary. Background: An increased risk of venous thromboembolic events has been reported in thalassemic patients, in particular in patients with thalassemia intermedia. The association between β‐thalassemia trait and atherothrombotic cardiovascular events is not well established. Methods: In a systematic review and meta‐analysis of the literature, we evaluated the association between β‐thalassemia trait and arterial cardiovascular disease. Studies were identified from the MEDLINE and EMBASE (until July 2010) electronic databases. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated with a random‐effects model. Statistical heterogeneity was evaluated with the I² statistic. Results: Of the 354 identified articles, eight case–control studies were eligible for the analysis. β‐Thalassemia trait was associated with a reduced risk of arterial cardiovascular disease (OR 0.45; 95% CI 0.45–0.60). Heterogeneity among studies was low (I² = 13%). The protective effect of β‐thalassemia trait was confined to male patients (OR 0.39; 95% CI 0.24–0.62), and was not observed in female subjects (OR 0.89; 95% CI 0.52–1.53). Conclusions: β‐Thalassemia trait may act as a protective factor against the development of arterial cardiovascular and cerebrovascular disease in male subjects. Larger prospective studies are necessary to confirm these preliminary findings and to further investigate the mechanisms underlying this protective effect.     

Symptom prevalence in patients with incurable cancer: a systematic review

The suffering of patients with incurable cancer is determined to a large degree by the presence and intensity of the symptoms of their disease. Knowledge of symptom prevalence is important for clinical practice. The main aim of this study was to obtain a reliable estimation of symptom prevalence in patients with incurable cancer by performing a systematic review of studies assessing this topic. We included 44 studies (including 25,074 patients) on overall symptom prevalence (Group 1) and six studies (including 2,219 patients) on symptom prevalence during the last one to two weeks of life (Group 2). In these studies, symptom prevalence was assessed by a questionnaire, a standardized interview, or the medical record. We identified 37 symptoms assessed in at least five studies. Almost all symptoms occurred in more than 10% of the patients. Five symptoms (fatigue, pain, lack of energy, weakness, and appetite loss) occurred in more than 50% of the patients of Group 1. Weight loss occurred significantly more often in Group 2 compared to Group 1, and pain, nausea, and urinary symptoms occurred significantly less often. Generally, symptom prevalence was highest if assessed by a questionnaire. The results of this study should be used to guide doctors and nurses in symptom management. Proper attention to symptom burden and suffering should be the basis for individually tailored treatment aimed at improving or maintaining quality of life of patients in their last period of life.     

食管癌患者放疗期间体质指数及机体组成成分分析

目的：动态分析食管癌患者放疗期间体质指数（body mass index，BMI）及体成分的变化，以期更好地为此类患者提供营养支持方案。方法：选取32例食管癌患者入组，放疗期间动态行体成分测定，包括机体总含水量（total body water，TBW）、蛋白质、矿物质、机体脂肪含量（body fat mass，BFM）、机体骨骼肌含量（skeletal muscle mass，SMM）。动态分析食管癌患者放疗期间不同时间点BMI与机体组成成分的相关性。结果：放疗开始后患者的TBW、蛋白质、BFM、SMM均开始逐渐下降，BMI与BFM明显相关（P<0.01），与矿物质含量的相关性最不明显。结论：食管癌患者放疗期间机体组成中的蛋白质、水分、脂肪、肌肉都明显下降；BMI下降主要由体脂含量下降所致，适当增加膳食脂肪含量有助于提高其放疗耐受性及生存质量。     

Body mass index and all-cause mortality in patients with cardiogenic shock: A systematic review and meta-analysis

BackgroundThe association between body mass index (BMI) and all-cause mortality of patients with Cardiogenic Shock (CS) is still controversial. The objective of this analysis is to summarize the available evidence of this association and perform meta-analysis using adjusted estimates.MethodsPubMed, Embase and Cochrane databases were systematically searched for eligible studies up to July 2020. Studies were considered eligible if they described the association between BMI and all-cause mortality of patients with CS, and those reporting adjusted estimates were included in the meta-analysis.ResultsThree studies were identified and included total 345,281 participants. The pooled hazard ratio of all-cause mortality was 0.88(95% confidence interval (CI): 0.71–1.08, P = 0.23) when compared obesity with non-obese. In subgroup analysis, A subgroup analysis based on geographic region showed that obese patients had lower mortality compared with non-obese patients (OR = 0.71,95% CI 0.65–0.77, P < 0.00001) in USA, developed country and the retrospective study. Heterogeneity was not explained in pre-specified subgroups analysis.ConclusionObesity was associated with increased adjusted all-cause mortality of patients with Cardiogenic Shock when compared to non-obese. Unexplained heterogeneity and suboptimal quality of studies limit the strength of the results. This seemingly paradoxical finding needs to be confirmed with further research.     

体力活动和体质量指数与冠状动脉粥样硬化性心脏病患者心血管事件的关系

目的:分析体力活动和体质量指数是否与冠状动脉粥样硬化性心脏病(简称冠心病)心血管事件有关。方法:①入选2003-08/2004-07于北京朝阳医院门诊就诊确诊为冠心病的患者941例,其中男691例,女250例,平均年龄(61.4±9.7)岁。②将入选冠心病患者按体质量指数分为正常体质量组(18.5￣23.9kg/m2)、超重组(24.0￣27.9kg/m2)和肥胖组(>28kg/m2);按有无体力活动分为体力活动组(每周3次以上,每次不少于30min的有氧体力活动)和无体力活动组。③使用统一设计的调查问卷,对患者体质量指数、危险因素、实验室检查结果等相关资料进行收集比较,并应用SPSS12.0软件包进行Logistic回归模型分析。结果:①正常体质量组、超重组和肥胖组相比,吸烟、呼吸睡眠障碍、血脂、最高舒张压、心肌梗死、冠状动脉介入术、冠状动脉搭桥手术、再梗死、缺血再入院、主要不良心脏事件无统计学差异(P>0.05),而肥胖组男性比例高于其他2组,年龄、最高收缩压、糖尿病和体力活动比例低于其他2组(P<0.05)。②有无体力活动组比较:性别、吸烟、呼吸睡眠障碍、胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、心肌梗死、冠状动脉搭桥手术、再梗死、血管重建、主要不良心脏事件无统计学差异(P>0.05),无体力活动组年龄、最高收缩压和糖尿病比例高于体力活动组,三酰甘油、冠状动脉介入术比例低于体力活动组(P<0.05)。③Logistic回归显示年龄(OR=1.029)、冠状动脉搭桥手术(OR=2.659)、高脂血症(OR=1.434)、心肌梗死(OR=7.972)是主要不良心脏事件事件的独立危险因素(P<0.05),体力活动和体质量指数不是其独立危险因素(P>0.05)。④对主要不良心脏事件事件中的血管重建、心肌缺血再入院和再梗死分别作为因变量进行Logistic回归分析,结果表明体质量指数与此3项均不相关(P>0.05),但体力活动是心肌缺血再入院的独立危险因素(OR=1.633,P=0.014)。结论:体力活动减少为缺血再入院患者的独立危险因素,体质量指数不是心血管事件的独立危险因素。     

The impact of body mass index on the physiology of patients with polytrauma

Purpose

Obesity is a growing problem in industrial nations. The aim was to test the hypothesis that overweight patients face early physiologic impairment.

Methods

A total of 651 patients were included in this retrospective study, with an injury severity score greater than 16 and 16 years or older. The sample was subdivided into 3 groups: body mass index (BMI) less than 25 kg/m², BMI of 25 to 30 kg/m², and BMI greater than 30 kg/m². Physiologic scores—Murray, Goris, Marshall and Sequential Organ Failure Assessment scores—were analyzed at admission and at the day of their maximum. Analysis of variance and χ² tests were used, and the significance level was set at P < .05.

Results

All 4 scores showed significant differences at their maxima according to the 3 BMI groups, respectively: Murray score (P < .001), Goris score (P < .05), Marshall score (P < .001), and Sequential Organ Failure Assessment score (P <.05). The injury severity score values of the 3 groups at admission were 27.6 ± 12.0, 29.6 ± 13.2, and 25.3 ± 9.2, respectively (P < .05). The overall mortality rates in the 3 groups were 15.1%, 21.0%, and 20%, respectively (P < .001).

Conclusions

Anticipating BMI-specific critical trauma problems will become mandatory for effective polytrauma treatment in industrialized nations given their increasing prevalence of obesity.     

Physical activity in patients with advanced-stage cancer: a systematic review of the literature

The importance of physical activity for chronic disease prevention and management has become generally well accepted. The number of research interventions and publications examining the benefits of physical activity for patients with cancer has been rising steadily. However, much of that research has focused on the impact of physical activity either prior to or early in the cancer diagnosis, treatment, and survivorship process. Research focusing on the effects of physical activity, specifically for patients with advanced-stage cancer and poorer prognostic outcomes, has been addressed only recently. The purpose of this article is to examine the state of the science for physical activity in the advanced-stage disease subset of the cancer population. Exercise in a variety of intensities and forms, including yoga, walking, biking, and swimming, has many health benefits for people, including those diagnosed with cancer. Research has shown that, for people with cancer (including advanced-stage cancer), exercise can decrease anxiety, stress, and depression while improving levels of pain, fatigue, shortness of breath, constipation, and insomnia. People diagnosed with cancer should discuss with their oncologist safe, easy ways they can incorporate exercise into their daily lives.     

The role of hypothermia in post-cardiac arrest patients with return of spontaneous circulation: a systematic review

ObjectivesTo update a comprehensive systematic review of the use of therapeutic hypothermia after cardiac arrest that was undertaken initially as part of the 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science. The specific question addressed was: ‘in post-cardiac arrest patients with a return of spontaneous circulation, does the induction of mild hypothermia improve morbidity or mortality when compared with usual care?’MethodsPubmed was searched using (“heart arrest” or “cardiopulmonary resuscitation”) AND “hypothermia, induced” using ‘Clinical Queries’ search strategy; EmBASE was searched using (heart arrest) OR (cardiopulmonary resuscitation) AND hypothermia; The Cochrane database of systematic reviews; ECC EndNote Library for “hypothermia” in abstract OR title. Excluded were animal studies, reviews and editorials, surveys of implementation, analytical models, reports of single cases, pre-arrest or during arrest cooling and group where the intervention was not hypothermia alone.Results77 studies met the criteria for further review. Of these, four were meta-analyses (LOE 1); seven were randomised controlled trials (LOE 1), although six of these were from the same set of patients; nine were non-randomised, concurrent controls (LOE 2); 15 were trials with retrospective controls (LOE 3); 40 had no controls (LOE 4); and one was extrapolated from a non-cardiac arrest group (LOE 5).ConclusionThere is evidence supporting the use of mild therapeutic hypothermia to improve neurological outcome in patients who remain comatose following the return of spontaneous circulation after a cardiac arrest; however, much of the evidence is from low-level, observational studies. Of seven randomised controlled trials, six use data from the same patients.     

Changes in body weight and body mass index among psychiatric patients receiving lithium,valproate, or topiramate: an open-label,nonrandomized chart review

BACKGROUND: Subsets of psychiatric patients gain excess body weight while receiving mood-stabilizing agents such as lithium carbonate or valproate sodium. Patients who gain excess weight may discontinue therapy, with severe consequences. Among the newer anticonvulsant agents, topiramate is a candidate agent for bipolar disorder and is associated with weight loss when used as adjunctive treatment. OBJECTIVE: This open-label, nonrandomized, chart-review study assessed changes in body weight and body mass index (BMI) in patients receiving topiramate, lithium, or valproate. METHODS: Data were extracted from the medical charts of patients admitted in 1999 and 2000 to a state psychiatric hospital with either schizophrenia, schizoaffective disorder, bipolar disorder, or other psychiatric diagnoses who were prescribed valproate, lithium, or topiramate and were reviewed for changes in body weight and BMI. The use of concomitant psychotropic medicines was recorded (eg, antipsychotic agents, antidepressant agents, other mood stabilizers such as gabapentin or carbamazepine). Continuous variables were analyzed using a factorial analysis of variance and the Student t test. Contingency statistics were used to analyze categorical variables. RESULTS: A total of 214 patients were included in the chart review (123 men, 91 women; mean age, 39.4 years). Significantly more women than men received topiramate (P = 0.004). Patients receiving either lithium or valproate gained a mean (SD) of 6.3 (9.0) kg and 6.4 (9.0) kg, respectively, whereas patients receiving topiramate lost a mean 1.2 (6.3) kg (F = 11.54, df = 2,198; P < 0.001). Lithium- or valproate-treated patients experienced an increase in BMI (mean, 2.1 [3.0] for both groups), whereas topiramate-treated patients experienced a reduction in BMI (mean, -0.5 [2.4]); this result was statistically significant (F = 11.40, df = 2,198; P < 0.001). Finally, lithium- or valproate-treated patients gained >8% of their baseline body weight (8.2% [11.5%] for lithium-treated patients and 8.5% [11.9%] for valproate-treated patients), whereas topiramate-treated patients lost 0.7% (7.2%) of their body weight (F = 9.93, df= 2,198; P < 0.001). CONCLUSIONS: Controlled studies for the efficacy of topiramate therapy in various psychiatric conditions are awaited. These data indicate that patients receiving topiramate experience body weight loss and a reduction in BMI. This advantage of topiramate may promote long-term adherence to treatment among psychiatric patients and possibly decrease the medical risks associated with obesity.