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- Preliminary Development and Validation of a New End-of-Life Patient-Reported Outcome Measure Assessing the Ability of Patients to Finalise Their Affairs at the End of Life. [Journal Article]
- PLoS One 2014; 9(4):e94316.
The ability of patients to finalise their affairs at the end of life is an often neglected aspect of quality of life (QOL) measurement in palliative care effectiveness research despite compelling evidence of the high value patients place on this domain.This paper describes the preliminary development and evaluation of a new, single-item, end-of-life patient-reported outcome measure (EOLPRO) designed to capture changes in the ability of patients to finalise their affairs at the end of life.Cognitive interviews with purposively sampled Australian palliative care patients (N = 9) were analysed thematically to explore content validity. Simultaneously, secondary analysis of data from a randomised controlled trial comparing ketamine and placebo for the management of cancer pain (N = 185) evaluated: construct validity; test-retest reliability; and responsiveness.Preliminary findings suggest patients interpret the new measure consistently. The EOLPRO captures the ability to complete physical tasks and finalise practical matters although it is unclear whether emotional tasks or resolution of relationship issues are considered. Personal and financial affairs should be separated to allow for differences in ability for these two types of affairs. The significant correlation between performance status and EOLPRO scores (r = 0.41, p<0.01, n = 137) and expected relationships between EOLPRO and proximity to death and constipation demonstrated construct validity. Pre- and post-treatment EOLPRO scores moderately agreed (n = 14, κ = 0.52 [95% CI 0.19, 0.84]) supporting reliability. The measure's apparent lack of sensitivity to discriminate between treatment responders and non-responders may be confounded.Based on the preliminary findings, the EOLPRO should be separated into 'personal' and 'financial' affairs with further testing suggested, particularly to verify coverage and responsiveness. Initial evaluation suggests that the single-item EOLPRO is a useful addition to QOL outcome measurement in palliative care effectiveness research because common palliative care specific QOL questionnaires do not include or explicitly capture this domain.
- Are they too old? Surgical treatment for metastatic epidural spinal cord compression in patients aged 65 years and older. [JOURNAL ARTICLE]
- Neurol Res 2014 Apr 16.:1743676114Y0000000160.
Objectives: We aimed to assess the efficacy of surgical decompression of metastatic epidural spinal cord compression (MESCC) in patients ≧65 years and review our multidisciplinary surgical decision-making process. Methods: We identified all patients operated for MESCC from August 2008 to June 2012. Patients ≧65 years, with a single area of cord compression, back/radicular pain, neurological signs of cord compression, surgery within 48 hours after onset of MESCC-related paraplegia, and follow-up for ≧1 year or until death were included. Files were reviewed retrospectively. The requirement for informed consent was waived. Neurological status was assessed with the American Spinal Injury Association (ASIA) Impairment Scale (AIS). Duration of ambulation and survival were assessed with Kaplan-Meier and Cox regression analysis. Results: Twenty-one patients met inclusion criteria (11 women/10 men; mean age 73 years, range 65-87). All presented with debilitating back/neck pain. Ten patients (48%) were not ambulatory before surgery and four suffered urinary incontinence/constipation (19%). Preoperative AIS was E in 5 patients (24%), D in 11 (62%), and C in 5 (24%). Motor symptoms had been present for a mean of 3·8 days (range 1-14). All patients regained ambulation. Overall, mean survival was 320 days (range 19-798) and mean ambulation was 302 days (range 18-747). On 31 March 2013, 7 patients (33%) were alive and ambulatory at a mean of 459 days (range 302-747); 14 patients had died (67%) at a mean of 251 days (range 19-798), with a mean ambulation of 223 days (range 18-730). Discussion: With careful patient selection, surgery may achieve long duration of ambulation in patients ≧65 years with MESCC.
- Prucalopride Improves Bowel Function and Colonic Transit Time in Patients With Chronic Constipation: An Integrated Analysis. [JOURNAL ARTICLE]
- Am J Gastroenterol 2014 Apr 15.
Objectives:Constipation is often characterized by slow colonic transit, but the relationship between colonic transit time (CTT) and symptoms is unclear. The aims of this study were to investigate the effect of prucalopride, a 5-hydroxytryptamine receptor-4 agonist, on CTT and assess the relationship between CTT and symptoms.Methods:This was an integrated analysis of three randomized, placebo-controlled, phase 2 dose-finding trials of prucalopride in patients with chronic constipation (ClinicalTrials.gov identifiers: NCT00617513; NCT00631813; and NCT00596596). Measurements of CTT were analyzed using radio-opaque markers at the start and end (4 or 12 weeks) of treatment. At these visits, patients assessed the presence and severity of their symptoms.Results:In total, 280 patients had CTT measurements before and at the end of treatment and were included in the analysis. Their mean age was 43 years, 93% were women, and mean duration of constipation was 19 years. After a once daily treatment with prucalopride 2 mg (n=98) and 4 mg (n=70), CTT was reduced by 12.0 h (95% confidence interval (CI): -18.9, -5.1) and 13.9 h (95% CI: -20.5, -7.4), respectively; CTT increased by 0.5 h (95% CI: -4.5, 5.5) with placebo (n=112). At the end of the trial, symptoms including bloating/flatulence/distension and straining were rated as severe or very severe by a higher proportion of patients with slow or very slow CTT (>48 h) than by those with normal CTT.Conclusions:There was a clear relationship between increased CTT and increased symptom severity in patients with chronic constipation. Treatment with prucalopride accelerated CTT in these individuals.Am J Gastroenterol advance online publication, 15 April 2014; doi:10.1038/ajg.2014.74.
- Hydnocarpus: An Ethnopharmacological, Phytochemical and Pharmacological Review. [REVIEW]
- J Ethnopharmacol 2014 Apr 11.
The genus Hydnocarpus (Flacourtiaceae) includes forty species that are spread across the globe. In the Indian System of Medicine, Hydnocarpus pentandrus (Buch.-Ham.) Oken. is primarily used for treating leprosy and other skin disorders. It is known as "Chaulmoogra" and is also used to treat other indications including constipation, inflammation, blood disorders, and worm infestations. Various species of Hydnocarpus are also used in traditional medicine in China, Thailand, Malaysia, and Myanmar for several skin disorders.To assess the therapeutic potential of species from the Hydnocarpus genus and to determine future avenues for research.All relevant scientific literature published up to the end of December 2013 was retrieved via a library and electronic search (SciFinder, PubMed, ScienceDirect, and Google Scholar). Manual searches of traditional books like to ancient classics, including Vaidya Yoga Ratnavali, Siddha Materia Medica, and contemporary references including The Ayurvedic Pharmacopoeia of India and The Ayurveda Formulary, were also performed.Seed oil from species of the Hydnocarpus genus is used for medicinal purposes, predominantly for various skin disorders. This oil is reported to contain a characteristic class of compounds known as cyclopentenyl fatty acids. Furthermore, seeds of this genus are reported to contain triglycerides of fatty acids, sterols, flavonoids, and flavonolignans. Hydnocarpin, a flavonolignan, is reported to potentiate antimicrobial and anticancer activity. The extracts and compounds isolated from this plant show a wide spectrum of pharmacological properties, including antibacterial, antileprotic, antitubercular, antipsoriatic, antirheumatic, hypolipidemic, antidiabetic, anticancer, anti-inflammatory, and antioxidant activities. The antileprotic activity is postulated to be due to the cyclopentenyl fatty acids present in the seed oil.Flavonolignans have an interesting chemical motif, and hydnocarpin and its congeners should be investigated for their activities and the mechanism underlying these activities. Multi-drug-resistant microbes are on the increase, and the possible inhibitory effect of these compounds when used with current antimicrobials should also be evaluated. Furthermore, unique cyclopentenyl fatty acids should also be investigated to understand the exact mechanism of action underlying antileprotic activity. Additional in depth phytochemical investigations of seed oil and extracts are required to tap the true potential of species from the Hydnocarpus genus.
- Meta-analysis of Chinese herbal Xiaoyao formula as an adjuvant treatment in relieving depression in Chinese patients. [REVIEW]
- Complement Ther Med 2014 Apr; 22(2):362-370.
Chinese herbal Xiaoyao formula (XYF) has been widely used as an adjuvant treatment for depression in China. The objective of this meta-analysis was to assess the efficacy and safety of XYF in relieving depression in Chinese patients.Systematic literature searches were carried out on the Pubmed, Embase, Cochrane Library, China National Knowledge Infrastructure, and Wanfang database (prior to June 2013). Only randomized controlled trials (RCTs) comparing XYF plus antidepressants with antidepressants alone for patients with depression were selected. The main outcomes were changes in weighted mean difference (WMD) and 95% confidence interval (CI) of the Hamilton depression scale (HAMD) and risk ratios (RRs) and 95% CI for adverse events.Ten RCTs involving 735 patients were identified and analyzed. All of the included RCTs were associated with a moderate to high risk of bias. In the meta-analysis, XYF plus antidepressants reduced the HAMD scores compared with antidepressants alone (WMD -2.15; 95% CI -3.56 to -0.74) in a random effect model. In subgroup analysis, XYF plus antidepressants reduced WMD was not observed in the treatment duration less than 8 weeks' subgroup (WMD -1.37; 95% CI -2.92 to 0.19) and XYF powder subgroup (WMD -2.87; 95% CI -7.40 to 1.66). The adverse events included hyperhidrosis, dry mouth, nausea, and constipation. No serious adverse events were reported in any of the included trials.XYF as an adjuvant treatment appeared to have benefits on depressive patients. In addition, XYP appeared to reduce insomnia and constipation related to antidepressants.
- Complementary effects of auricular acupressure in relieving constipation symptoms and promoting disease-specific health-related quality of life: A randomized placebo-controlled trial. [Journal Article]
- Complement Ther Med 2014 Apr; 22(2):266-77.
Constipation has been identified as a worldwide health problem among elderly people. Currently, it is not effectively relieved by the use of laxatives and lifestyle modification. Previous studies reported promising results in managing constipation with auricular acupressure (AA), although its effectiveness was not affirmed. This study is to evaluate the complementary effects of AA in relieving constipation symptoms and in promoting disease-specific health-related quality of life (HRQOL) among elderly residential care home (RCH) residents in Hong Kong.Randomized placebo-controlled trial.Elderly RCH.Ninety-nine participants were randomly assigned to either experimental group (AA using auricular plasters with magnetic pellets), placebo-controlled group (AA using auricular plasters with Semen Vaccariae), or usual care group (AA using auricular plasters only). AA was applied onto seven auricular acupoints for 10 days.Constipation symptoms and disease-specific HRQOL were measured before AA, at the completion of AA (D10), and at the 10th-day follow-up time (D20).Significant group×time interaction effect was found in the change of satisfaction subscale between the experimental group and placebo-controlled group at D10 (p=0.016) and D20 (p=0.016) relative to the baselines. For both constipation symptoms and disease-specific HRQOL, the experimental group demonstrated the greatest improvement after receiving AA at both D10 and D20 compared with the other two groups.The current findings indicated positive clinical value of AA with magnetic pellets in managing constipation in elderly RCH residents. AA was also found to be a safe and acceptable intervention.
- The impact of radiotherapy on quality of life for cancer patients: a longitudinal study. [JOURNAL ARTICLE]
- Support Care Cancer 2014 Apr 12.
The aim of this study was to assess for changes in quality of life (QOL) among cancer patients who undergo radiotherapy (RT) and to identify factors that influence QOL in this group.Three hundred sixty-seven cancer patients who received curative RT were investigated using the EORTC QLQ-C30 questionnaire at the start of RT, end of RT, and 1 and 6 months post-RT.The patients were 49 % women, 51 % men, and median age at diagnosis was 57 years (range, 16-86 years). Compared to pre-RT, at the end of RT, the global health status score (p < 0.001), nausea/vomiting (p < 0.001), and apetite loss scores (p < 0.001) were significantly poorer. Compared to the end of RT, at 1 and 6 months post-RT, global health status, all functional, and all symptom scores were significantly improved (p < 0.001). Patient sex influenced scores for pain (p = 0.036), appetite loss (p = 0.027), and financial difficulty (p = 0.003). Performance status influenced scores for global health status (p = 0.006), physical functioning (p < 0.001), cognitive functioning (p = 0.001), and role functioning (p = 0.021). Comorbidity influenced fatigue score (p < 0.001). Cancer stage influenced scores for physical functioning (p = 0.001), role functioning (p = 0.010), and fatigue (p < 0.001). Treatment modality (chemoRT vs. RT alone) influenced scores for physical functioning (p = 0.016), fatigue (p < 0.001), nausea/vomiting (p = 0.009), and appetite loss (p < 0.001); and RT field influenced scores for nausea/vomiting (p = 0.001), appetite loss (p = 0.003), and diarrhea (p = 0.037). Radiotherapy dose functioning (p < 0.001), cognitive functioning (p < 0.001), social functioning (p < 0.001), fatigue (p < 0.001), and pain (<60 vs ≥60 Gy) had an effect on scores for physical functioning (p < 0.001), role functioning (p < 0.001), emotional (p < 0.001), insomnia (p < 0.001), constipation (p < 0.001).While RT negatively affects cancer patients' QOL, restoration tends to be rapid and patients report significant improvement by 1 month post-RT. Various patient- and disease-specific factors and RT modality affect QOL in this patient group. We advocate measuring cancer patients' QOL regularly as part of routine patient management.
- The laxative effect of emodin is attributable to increased aquaporin 3 expression in the colon of mice and HT-29 cells. [JOURNAL ARTICLE]
- Fitoterapia 2014 Apr 9.
Emodin (1, 3, 8-trihydroxy-6-methylanthraquinone) is a stimulant laxative and used to treat constipation. Aquaporin 3 (AQP3) plays an important role in regulating water transfer in the colon. In the study, we investigated whether the laxative effect of emodin is associated with the regulation of AQP3 in the colon. Our results showed that treatment with emodin increased the fecal water content in the colon of mice and evaluation index of defecation in a dose-dependent manner. More interestingly, emodin significantly increased the AQP3 protein and mRNA expression both in the colon of mice and in human intestinal epithelial cells (HT-29). Mechanistically, emodin obviously upregulated the cyclic adenosine monophosphate (cAMP)-dependent protein kinase A catalytic subunits α (PKA C-α) and phosphorylated cAMP response element-binding protein (p-CREB Ser133) expression in HT-29 cells. These results suggest that the laxative effect of emodin is associated with the increased expression of AQP3 by upregulating PKA/p-CREB signal pathway.
- Impact of a Clinical Pharmacist-Led Guidance Team on Cancer Pain Therapy in China: A Prospective Multicenter Cohort Study. [JOURNAL ARTICLE]
- J Pain Symptom Manage 2014 Apr 8.
Cancer treatment capacity in China is severely limited relative to the enormous size of the population; and many aspects of treatment, such as opioid protocols for pain control, are not standardized. To improve the quality of drug treatment, clinical pharmacists are taking a more active role in patient care.This study compared the effectiveness of opioid treatment between cancer patients receiving interventions from Clinical Pharmacist-Led Guidance Teams (CPGTs) and a comparable control group.This was a prospective, multicenter, double-arm, controlled study conducted in China. Multidisciplinary guidance teams were established and led by clinical pharmacists with expertise in cancer pain therapy. The CPGTs provided pre-therapy consultation and drug education to physicians, monitored prescriptions during treatment, and conducted patient follow-up. The process and outcome parameters of therapy were collected and analyzed with overall statistics and logistic regression.A total of 542 patients were enrolled, 269 in the CPGT intervention group (CPGT group) and 273 controls. Standardization of opioid administration was improved significantly in the CPGT group, including more frequent pain evaluation (P<0.001), more standardized dosing titration (P<0.001), and less frequent meperidine prescriptions (P<0.001). The pain scores in the CPGT group were significantly improved compared with the control group (P<0.05). The incidences of gastrointestinal adverse events were significantly lower in the CPGT group (constipation: P=0.041; nausea: P=0.028; vomiting: P=0.035), and overall quality of life was improved (P=0.032). No opioid addiction was encountered in the CPGT group. Risk analysis revealed that patient follow-up by pharmacists and the controlled dosing of opioids were the major factors in improving treatment efficacy.The CPGTs significantly improved standardization, efficiency, and efficacy of cancer pain therapy in China. In a country where clinical pharmacy is still developing, this is a valuable service model that may enhance cancer treatment capacity and efficacy while promoting recognition of the clinical pharmacy profession.
- Prevalence of lower urinary tract symptoms in individuals with Down syndrome. [JOURNAL ARTICLE]
- J Pediatr Urol 2014 Mar 22.
Down syndrome (DS), which is caused by the trisomy of chromosome 21, is the most frequent of all genetic syndromes. The current study aims to estimate the prevalence of lower urinary tract symptoms (LUTS) in individuals with DS buy using the Dysfunctional Voiding Symptom Score (DVSS) and correlate with functional constipation, age, and gender, as well as determine the most sensitive and specific factors associated with LUTS.LUTS was assessed in individuals with DS using a cross-sectional study through the application of a validated and adapted version of the DVSS for the Brazilian population. The presence of functional constipation was evaluated according to the Rome III criteria.Of the 114 individuals assessed, 84 were included in the study (median age 16 ± 5.0 years, 66.7% female). The prevalence of LUTS was 27.3%. The symptoms were more frequent in males (OR 3.0, 95% CI 1.1-8.3, p = 0.03) and in individuals younger than 10 years of age (OR 5.2, 95% CI 1.8-14, p = 0.001). Functional constipation was observed in 50% of subjects. It was detected in 95.65% of the individuals with LUTS and 32.78% without LUTS (OR 45.1, 95% CI 5.66-301, p = 0.001). The symptom listed in question 8 ("push to pee") was the most specific indicator. When present, this symptom indicated a higher probability of LUTS (LR+ = 6.3), while the symptom listed in question 4 ("push for bowel movements to come out") showed high sensitivity and, when absent, indicated a lower probability of LUTS (LR- = 0.1).LUTS was more prevalent in young males with DS and appeared to improve with age. Functional constipation was strongly associated with LUTS. These findings will contribute to raising the awareness of professionals involved in the follow-up of individuals with DS regarding the clinical manifestations and the need for a standardized investigation of LUTS.