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1.
Richard Wagland Alison Richardson Sean Ewings Jo Armes Elaine Lennan Matthew Hankins Peter Griffiths 《Supportive care in cancer》2016,24(12):4901-4911
Purpose
The purpose of this study was to identify the treatment-associated problems that most impact on patients undergoing cancer chemotherapy, how problems relate to experiences of supportive care and variations in experience between cancer treatment centres.Methods
A survey administered to patients at six cancer centres in England explored variations of prevalence of 17 cancer chemotherapy-associated problems and associated supportive care. Problem items were identified as the most frequently experienced and severe when experienced in a scoping and consensus exercise. A health-related quality of life (HRQoL) measure, the EQ5D, was included to measure impact of problems.Results
A total of 363 completed questionnaires were returned (response rate 43 %, median 61 %). The most prevalent problem was ‘tiredness/fatigued’ (90 %), followed by ‘changes in taste & smell’ (69 %) and ‘difficulty managing everyday tasks’ (61 %). Significant variations in problem prevalence existed between centres, and some common problems were rarely reported in the literature. Regression analysis found that almost all problems were significantly associated with HRQoL, with social/emotional problems having as much impact on HRQoL as physical/psychological side effects of treatment. Greatest effect size was for difficulty managing everyday tasks. Respondents reported significant variations in supportive care between centres, with more supportive care received for physical/psychological problems than for social/emotional problems. Findings indicated that patients who received increased supportive care experienced less severe problems.Conclusion
The most common and distressing chemotherapy-associated problems were identified. These problems are mitigated by quality supportive care. Routine measurement and monitoring of problem items and supportive care are warranted to facilitate benchmarking and service improvements both within and between cancer centres.2.
Objective
To compare the safety and estimate the response profile of olanzapine, a second-generation antipsychotic, to haloperidol in the treatment of delirium in the critical care setting.Design
Prospective randomized trialSetting
Tertiary care university affiliated critical care unit.Patients
All admissions to a medical and surgical intensive care unit with a diagnosis of delirium.Interventions
Patients were randomized to receive either enteral olanzapine or haloperidol.Measurements
Patient’s delirium severity and benzodiazepine use were monitored over 5 days after the diagnosis of delirium.Main results
Delirium Index decreased over time in both groups, as did the administered dose of benzodiazepines. Clinical improvement was similar in both treatment arms. No side effects were noted in the olanzapine group, whereas the use of haloperidol was associated with extrapyramidal side effects.Conclusions
Olanzapine is a safe alternative to haloperidol in delirious critical care patients, and may be of particular interest in patients in whom haloperidol is contraindicated.3.
S. Dreßke 《Schmerz (Berlin, Germany)》2016,30(4):333-338
Background
Every professional segment has its own typical forms of stress, which for members result in patterns of bodily conception and interpretation of pain. The way individuals cope with these typical forms of pain reflects their social identity, social status and group membership. In this study pain was investigated from a sociological perspective as a medium contributing to socialization processes in stress collectives.Objectives
Cultural conceptions of headache and migraine were investigated in members of blue collar occupations, in service professions and patients in specialized medical pain care.Materials and methods
In this study 49 qualitative biographical interviews were conducted with patients suffering from headache and migraine. The study population included persons from the general outpatient population and patients recruited from specialized inpatient pain clinics.Results
Members of blue collar occupations with specific body-oriented, mechanical stress patterns and dominant masculine attitudes, perceived headache and migraine as atypical deviations, which are contextualized as body pain. Professionals in the service sector with specific communicative-emotional work patterns perceived headache and migraine as typical and accepted deviations. Both pain conceptions represent dominant body norms and social commitments in each group; however, in specialized pain care these everyday concepts are transformed by increasing expert knowledge resulting in medicalized life styles and in identity conceptions conforming to the medical imperative.Conclusion
The success of specialized treatment of headache depends to a certain extent on the ability of patients to impose a medically regulated life style on their significant others; however, this can conflict with the demands of everyday life.4.
Background
Subcutaneous peripheral nerve field stimulation (sPNFS) is an established procedure for the treatment of chronic localized neuropathic pain of peripheral origin. The treatment of nummular headache primarily focuses on conservative methods with limited prospects of success. The role of sPNFS in the treatment of nummular headache has not been investigated as yet.Question
Is the sPNFS an option in the management of nummular headache?Materials and methods
In addition to a summary of established methods in the treatment of nummular headache, sPNFS as a possible form of therapy is discussed.Results
A positive effect of sPNFS in terms of the treatment of nummular headache is shown.Discussion
sPNFS stimulates free subcutaneous nerves and transmits a pleasant form of paraesthesia in the area of pain. If regular conservative therapy has already been exhausted, then sPNFS might be an effective new option in the treatment of nummular headache. sPNFS is a minimally invasive and low-risk procedure. However, the high treatment cost and restrictions regarding fitness to undergo MRI are points of criticism. Further studies are needed to define its potential and role in the treatment of nummular headache.5.
6.
David Traficante Alexander Riss Steven Hochman 《International journal of emergency medicine》2016,9(1):23
Background
Intracranial abscesses are rare and life-threatening conditions that typically originate from direct extension from nearby structures, hematogenous dissemination or following penetrating cerebral trauma or neurosurgery.Findings
A 36-year-old male presented to our emergency department with complaints of left eye swelling, headache and drowsiness. On physical exam, the patient was febrile and his left upper eyelid was markedly swollen with fluctuance and drainage. Maxillofacial computed tomography was obtained to evaluate for orbital pathology but revealed bifrontal brain abscesses.Conclusions
Brain abscesses should be considered in the differential diagnosis for patients who present with the classic triad of headache, fever and neurological deficit.7.
Background
Palliative care is an approach that improves the quality of life of patients with incurable and progressive illnesses; therefore, in these situations physiotherapy can play an important role.Aim
This study was carried out to examine the integration and utilization of physiotherapy in palliative and hospice care services in Germany.Methods
A cross-sectional survey including all palliative care units, specialized outpatient palliative care teams and hospices in Germany (n = 680) in 2013 was carried out.Results
The response rate was 43.5?% (n = 296). Physiotherapy is predominantly applied in palliative care units (79?%) but rarely in hospices (38?%) and outpatient palliative care teams (30?%). A structured physiotherapeutic assessment is rarely carried out even on palliative care units (26?%). Positive effects of physiotherapy are especially described for symptoms, such as edema, pain, constipation and dyspnea.Conclusion
Despite its significant potential to relieve symptoms, physiotherapy is not systematically integrated into palliative care practice in Germany.8.
Johna K. Register-Mihalik Christina B. Vander Vegt Michael Cools Kevin Carnerio 《Current pain and headache reports》2018,22(11):75
Purpose of Review
The purpose of this review is to (1) describe factors both pre- and post-injury that are associated with post-concussion headache, (2) describe the influence of post-concussion headache on recovery following concussion, and (3) provide potential post-concussion treatment options that may reduce the burden of headache, as well as other symptoms to facilitate recovery.Recent Findings
Various factors may be associated with post-concussion headache presentation. These may include pre-injury or historical factors such as sex, family and self-history of headache and migraine, concussion history, and mood disorders. In addition, post-injury presentation factors for consideration may include injury mechanism, symptom clusters, cervicogenic dysfunction, and post-concussion physiologic dysfunction. Despite this complex interplay of factors, many treatment options may improve headache symptoms and recovery post-concussion including rehabilitation programs focusing on deficits such as visual-vestibular dysfunction, sub-symptom threshold exercise, and potential pharmacological interventions.Summary
Concussion is a complex injury that results in a variety of sequelae with headache being one of the most common. Understanding factors related to post-concussion headache presentation and the available options for treatment may improve patient care and outcomes post-concussion.9.
Purpose of Review
The purpose of this review is to summarize the most up-to-date literature on bath-related headache, a rare disorder.Recent Findings
Initially described in middle-aged Asian women, it is now reported in a wider demographic. More information is available about the pathophysiology of bath-related headache, including its classification as a subtype of reversible cerebral vasoconstriction syndrome (RCVS). Nimodipine can be effective in patients both with and without vasospasm.Summary
Bath-related headache is a rare form of thunderclap headache. Although its mechanism is still unclear, it is associated with vasospasm and RCVS. Controlled trials investigating the use of nimodipine and other agents may be useful in furthering our understanding of and treatment of this phenomenon.10.
Joanne M. Shaw Heather L. Shepherd Ivana Durcinoska Phyllis N. Butow Winston Liauw David Goldstein Jane M. Young 《Supportive care in cancer》2016,24(6):2403-2410
Purpose
Migrants diagnosed with cancer in Australia have high unmet need and poorer psychosocial outcomes than comparable Australian-born patients. It is possible that migrants also experience worse coordination of their cancer care. The purpose of this study was to describe migrant patients’ experience of care coordination to inform the development of items for inclusion in a cancer care coordination questionnaire sensitive to the specific cultural needs of these patients.Methods
Eighteen Chinese (Mandarin and Cantonese), Arabic and Macedonian patients and carers from two metropolitan cancer centres in Sydney, Australia, were recruited. Two focus groups and 11 telephone interviews were conducted in the participants’ own language. A semi-structured interview format was utilised to qualitatively explore participants’ experiences of cancer care coordination during treatment. Themes were identified using a thematic analysis.Results
Cancer care was generally perceived to be well coordinated. Four themes were identified that impacted on the quality of care coordination as a direct result of a patient’s migrant status: (1) the impact of language on understanding and information access, (2) the role of interpreters and (3) access to services and (4) understanding the roles and responsibilities of the team.Conclusions
Despite their care generally being well coordinated, migrants require additional assistance such as information in a form appropriate to their language proficiency and understanding of the new health system. Development of a culturally specific measure of cancer care coordination will enable evaluation of future strategies to improve care.11.
Background
There is scarcity of questionnaires specifically on the quality of the nursing care provided to patients diagnosed with cancer. The available questionnaires have been developed without attributing a holistic approach to the care provided with important patient’s needs remaining without assessment. The main aim was to develop a self-administered cancer specific questionnaire exploring patients’ views on quality nursing care provided in oncology settings.Methods
The development of the scale proceeded through three phases. As part of the first development phase areas of concern and items of interest were identified through a literature review. The second phase included a pilot study of the QONCS and a subsequent validation phase through a multicentre study in 3 hospitals, 4 departments and 418 patients diagnosed with cancer and receiving care as inpatients. The study was designed to select items, identify dimensions, measure reliability, content and construct validity.Results
The QONCS consisted of 34 items. A factorial analysis grouped the items into five categories that define quality nursing care: a) Being supported and confirmed, b) Spiritual caring c) Sense of belonging, d) Being valued and e) Being respected. Cronbach’s alpha was 0.95 for the entire questionnaire. The factor solution explained 68.53% of the variance.Conclusions
QONCS appears to measure with adequate reliability and validity the attributes of quality nursing care within the oncological settings and to patients with a variety of cancer diagnoses and at different phases of the cancer trajectory. The instrument is quick to disseminate and easy to complete, making it a suitable instrument for nursing professionals to evaluate patients’ self-perceived quality of nursing care as a mean to promote the quality of the care provided in oncological settings.12.
Background
Until now, headache disorders have not been established as a risk factor for dementia. The aim of this study was to determine whether headache was associated with an increased risk of dementia.Methods
We systematically searched electronic databases, including PubMed, Embase, and Web of Science, for studies investigating the association between headache and dementia. We then conducted a meta-analysis to determine a pooled-effect estimate of the association.Results
We identified 6 studies (covering 291,549 individuals) to investigate the association between headache and the risk of all-cause dementia or Alzheimer’s disease (AD). Pooled analyses showed that any headache was associated with a 24% greater risk of all-cause dementia (relative risk [RR]?=?1.24; 95% confidential interval [CI]: 1.09–1.41; P?=?0.001), and that any headache was not statistically significantly associated with an increased risk of AD (RR?=?1.47; 95% CI: 0.82–2.63; P?=?0.192).Conclusions
Our results indicated that any headache was associated with an increased risk of all-cause dementia. However, additional studies are warranted to further confirm and understand the association.13.
Tyler J. Bradshaw Martin J. Voorbach David R. Reuter Anthony M. Giamis Sarah R. Mudd John D. Beaver 《Molecular imaging and biology》2016,18(3):377-385
Purpose
Zr-89 positron emission tomography (PET) is a valuable tool for understanding the biodistribution and pharmacokinetics of antibody-based therapeutics. We compared the image quality of Zr-89 PET and F-18 PET in the Siemens microPET Focus 220 preclinical scanner using different reconstruction methods.Procedures
Image quality metrics were measured in various Zr-89 and F-18 PET phantoms, including the NEMA NU 4-2008 image quality phantom. Images were reconstructed using various algorithms.Results
Zr-89 PET had greater image noise, inferior spatial resolution, and greater spillover than F-18 PET, but comparable recovery coefficients for cylinders of various diameters. Of the reconstruction methods, OSEM3D resulted in the lowest noise, highest recovery coefficients, best spatial resolution, but also the greatest spillover. Scatter correction results were found to be sensitive to varying object sizes.Conclusions
Zr-89 PET image quality was inferior to that of F-18, and no single reconstruction method was superior in all aspects of image quality.14.
Ala’ S Aburub B. Gagnon A. M. Rodríguez Nancy E. Mayo 《Supportive care in cancer》2016,24(9):3831-3838
Purpose
People with advanced cancer experience different sequelae which have unique effects on quality of life (QOL). The patient-generated index (PGI) is a personalized measure that allows patients to nominate, rate, and value areas that have the most impact on QOL. Fatigue, pain, and aspects of physical function are among the top 10 areas with QOL impact. An area of validation that is lacking for the PGI is the extent to which spontaneously nominated areas of QOL that patients are concerned with, agree with ratings obtained from standard patient reported outcomes (PROs).Methods
Data from 192 patients were used to compare ratings on fatigue, pain, and physical function obtained from PGI to those from standard outcome measures.Results
Within one severity rating, agreement ranged from 32.1 to 76.9 % within the fatigue domain, 34.2 to 95.24 % for pain, and between 84.2 and 94.7 % for physical function. Of the 10 items where the PGI had the highest agreement, 7 came from the RAND-36. At the domain level, people nominating an area scored in the more impaired range on standard measures than people who did not.Conclusion
PGI gives comparable information as do standard measures.Implications for cancer
PGI provides important information to guide clinical care of the patient and also produces a legitimate total score suitable for research.15.
Karin E. Johnson Tracy M. Mroz Marie Abraham Marlaine Figueroa Gray Mary Minniti Wendy Nickel Robert Reid Jennifer Sweeney Dominick L. Frosch Debra L. Ness Clarissa Hsu 《Advances in therapy》2016,33(8):1417-1439
Introduction
Ambulatory practices that actively partner with patients and families in quality improvement (QI) report benefits such as better patient/family interactions with physicians and staff, and patient empowerment. However, creating effective patient/family partnerships for ambulatory care improvement is not yet routine. The objective of this paper is to provide practices with concrete evidence about meaningfully involving patients and families in QI activities.Methods
Review of literature published from 2000–2015 and a focus group conducted in 2014 with practice advisors.Results
Thirty articles discussed 26 studies or examples of patient/family partnerships in ambulatory care QI. Patient and family partnership mechanisms included QI committees and advisory councils. Facilitators included process transparency, mechanisms for acting on patient/family input, and compensation. Challenges for practices included uncertainty about how best to involve patients and families in QI. Several studies found that patient/family partnership was a catalyst for improvement and reported that partnerships resulted in process improvements. Focus group results were concordant.Conclusion
This paper describes emergent mechanisms and processes that ambulatory care practices use to partner with patients and families in QI including outcomes, facilitators, and challenges.Funding
Gordon and Betty Moore Foundation.16.
Background
Healthcare quality improvement (QI) is a global priority, and understanding the perspectives of frontline healthcare workers can help guide sustainable and meaningful change. We report a qualitative investigation of emergency department (ED) staff priorities for QI at a tertiary care hospital in Ghana. The aims of the study were to educate staff about the World Health Organization’s (WHO) definition of quality in healthcare, and to identify an initial focus for building a departmental QI program.Methods
Semi-structured interviews were conducted with ED staff using open-ended questions to probe their understanding and valuation of the six dimensions of quality defined by the WHO. Participants were then asked to rank the dimensions in order of importance for QI. Qualitative responses were thematically analyzed, and ordinal rank-order was determined for quantitative data regarding QI priorities.Results
Twenty (20) members of staff of different cadres participated, including ED physicians, nurses, orderlies, a security officer, and an accountant. A majority of participants (61%) ranked access to emergency healthcare as high priority for QI. Two recurrent themes - financial accessibility and hospital bed availability - accounted for the majority of discussions, each linked to all the dimensions of healthcare quality.Conclusions
ED staff related all of the WHO quality dimensions to their work, and prioritized access to emergency care as the most important area for improvement. Participants expressed a high degree of motivation to improve healthcare quality, and the study helped with the development of a departmental QI program focused on the broad topic of access to ED services.17.
Background
The study was performed to reveal the effect of an individualized personal outpatient therapy program, based on a multidisciplinary assessment, on pain and health-related quality of life in patients with chronic pain.Methods
Fifty patients were prospectively evaluated before and 3 months after establishment of an individualized outpatient therapy program. Health-related quality of life, pain and pain-related disability, depression and motivation to adopt self-management of chronic pain were assessed. Therapy adherence was tested with a structured interview.Results
Only marginal improvements were observed in terms of pain and health-related quality of life. Therapy adherence varied between the different therapies.Conclusions
An individualized personal outpatient therapy program has only marginal effects on pain and health-related quality of life in patients with chronic pain.18.
Purpose of Review
Pituitary tumors account for approximately 17% of all intracranial neoplasms, with the majority being pituitary adenomas. Often, these are found incidentally during a workup for headache; however, the relationship between symptom and pathology remains unclear. The purpose of this article is to review the most recent literature on the epidemiology, pathophysiology, and management of headaches in patients with pituitary tumors.Recent Findings
The current literature is limited, with few prospective trials focusing on this question. With the exception of pituitary apoplexy, the relationship between headaches and pituitary masses remains unclear. Intervention does not always improve headache and can lead to development of new headache syndromes.Summary
Further research is needed to better elucidate the relationship between pituitary tumors and headaches. Headache alone is rarely an indication for surgical management of a pituitary adenoma.20.