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This study was conducted to determine what impact a structured nurse-led educational program has on patient self management and symptom control of hospitalized Chronic Obstructive Pulmonary Disease (COPD) patients in Jordan. An experimental design was used to guide data collection from 100 COPD patients who were randomly assigned to the intervention (n = 50) and control groups (n = 50). Participants in the intervention group underwent a two-week health education program that discussed smoking, medications and how to use them, exercise, and diet. A COPD educational pamphlet was also provided. Participants in the control group received only routine health education. A COPD Assessment Test (CAT) was used to measure the impact of the COPD educational program on wellbeing. The test consists of eight short questions covering cough, sputum production, chest tightness, breathlessness, activity limitations at home, confidence leaving home, sleep, and energy. The independent samples t-test findings revealed a significant difference between the two groups in relation to the post-test results (p = 0.039), with a 95 percent confidence interval −25.24 to −6.46, providing empirical support for the educational program’s success. Moreover, and as compared to the control group, participants in the intervention group showed significantly fewer COPD-related hospital admissions (p = .033). These programs should be integral components of a nurse-led COPD clinic to improve patients’ experience with the disease and reduce the risk of readmission, resulting in reduced cost and improved quality of life. [ABSTRACT FROM AUTHOR]

Medication adherence is a multi-faceted construct associated with several positive consequences in people with chronic conditions. However, non-adherence currently represents a major issue in Parkinson's, potentially due to low perceptions of control. This study investigated the predictive ability of several aspects of perceived control on adherence in people with Parkinson's, while accounting for previously established predictors such as depression and medication variables. An online cross-sectional survey was carried out with 1210 adults with Parkinson's from 15 English-speaking countries. Demographic and clinical questions, as well as measures of depression, aspects of perceived control, and medication adherence were included. Pearson's correlations and a 4-block hierarchical regression analysis were performed to assess the relationship between the variables. Perceived control explained a slightly higher amount of variance in medication adherence compared to medication variables when entered in the last block. Unexpectedly, depression was not significantly related with adherence. Internal locus of control was an independent negative predictor of adherence, while external dimensions of locus of control emerged as independent positive predictors. In people with Parkinson's, perceptions of control may have a larger impact on adherence compared to medication variables. Implications for clinical practice and future research are discussed. Perceived control and depression are considered important constructs for medication adherence in Parkinson's, which in turn is often problematic for affected individuals. The specific predictive value of different aspects of perceived control on medication adherence in Parkinson's is currently unclear. This large-scale study found that perceptions of control may have a larger impact on adherence compared to medication variables, while depression was unrelated to it. A need for psychologically-informed interventions, person-centred approaches to medication management, and Parkinson-specific measures of adherence are highlighted. [ABSTRACT FROM AUTHOR]

The goal of asthma therapy is asthma control. As a chronic disease, asthma may cause considerable physical, emotional and social restrictions impacting quality of life. The aim of this study was to analyze control of asthma symptoms in an outpatient setting in Brazil and its impact on quality of life. A pilot cross-sectional study was performed in two public centers in the metropolitan region of São Paulo, Brazil. Control of asthma symptoms was assessed according to GINA guidelines, and quality of life was analyzed by the Mini Quality of Life Questionnaire (mini-AQLQ). A total of 47 adult patients with asthma were analyzed. Asthma was controlled in 8 patients (17.0%), partially controlled in 26 patients (55.3%) and uncontrolled in 13 patients (27.7%). Patients with controlled asthma showed better mini-AQLQ scores (4.99 ± 1.10) as compared to those with partly controlled (3.66 ± 1.10) and uncontrolled asthma (2.59 ± 0.64; p < 0.001 for both). Most patients (85.1%) were taking inhaled corticosteroids (ICS) and long-acting bronchodilators (LABA) as controller treatment. Better asthma control had a positive impact on Health-Related Quality of Life (HRQoL) contributing to a better disease management. Few patients reached full asthma control in our specialty ambulatory center, suggesting further initiatives are required to improve the quality of asthma care in Brazil. [ABSTRACT FROM AUTHOR]

Pharmacotherapy is essential in palliative medicine. Besides potential benefits, pharmacotherapy also poses potential risks that need to be minimized for patient safety. Pharmacists can play an important role in identifying, solving, and avoiding drug-related problems (DRPs). The aim of this study was to evaluate pharmaceutical interventions on safety of drug therapy in patients in an inpatient palliative care unit. All patients admitted to a palliative care unit over a 12-month period were screened for eligibility (ie, life expectancy >4 weeks). To identify and assess DRPs, patients' pharmacotherapy was evaluated by a pharmacist according to various aspects (eg, drug selection, dose selection, or treatment duration according to the Pharmaceutical Care Network Europe classification for DRPs). During the 12-month period, 41 patients were included. Patients received a median of 11 (range, 1–22) different drugs. Overall, 207 DRPs were documented (median 5 DRPs/patient). After recording a DRP, the pharmacist directly intervened 290 times in order to solve the DRP, which was successful in 181/207 (88%). Clinically relevant DRPs are common in palliative medicine. The systematic assessment can support therapy decisions. This can result in optimized drug therapy, subsequently having a positive effect on symptom control and quality of life. [ABSTRACT FROM AUTHOR]

The article discusses the use of oxygen therapy in the final stages of life. It emphasizes the need for comfort care and addresses the limitations and risks associated with it. It reports an alternative approach focusing on symptom relief rather than excessive oxygen use, and it highlights the importance of providing optimal care for patients' well-being and comfort.

BackgroundFatigue is one of the most common symptoms found in patients with advanced cancer. There is interplay between fatigue and other symptoms. AimTo examine the factors associated with fatigue in patients with advanced cancer and the impact of symptom control on improvement in fatigue. DesignProspective observational study. Patients were assessed for symptom burden using the Edmonton Symptom Assessment Scale (ESAS). All the study patients received standard palliative care. They were followed up 15–30 days after the first consult. Analysis of the results was performed using descriptive statistics, correlation, multiple linear regressions and logistic regression of fatigue with other variables. CTRI registration number REF/2014/02/006537. Setting/participantsPalliative Care clinic of a tertiary cancer care hospital, from January to June 2014. Patients had advanced cancer, were registered with the clinic, had ECOG ≤ 3, and ESAS fatigue score ≥ 1. Results500 subjects enrolled at baseline. 402 completed the planned follow-up (median age, 52 years; 51.6% male). Significant improvement in the fatigue score was observed (p < 0.001) at follow-up. Haemoglobin, albumin levels, type of cancer, sites of metastasis, ECOG score, body weight, all items on ESAS scale (except drowsiness) were found to be significantly associated with fatigue at baseline (p < 0.05). The logistic regression model showed that improvement in haemoglobin and albumin levels and in severity of pain and dyspnoea, significantly improved fatigue scores at follow up. ConclusionsFatigue improved with the standard palliative care delivered at our specialty Palliative Care clinic. Certain clinical, biochemical factors and symptoms were associated with fatigue severity at baseline, improvement of which lead to lesser fatigue at follow up. [ABSTRACT FROM AUTHOR]

In palliative care, drugs are considered futile if they do not have a short-term benefit in symptom control or quality of life. The authors examined pharmacotherapy prescribed for patients referred to palliative care to identify futile drugs. This was a retrospective analysis of patients referred over 6 months, focusing on the prescription of gastric protectants, antidiabetic agents, bisphosphonates, anticoagulants, antidementia drugs, statins, and antihypertensive agents. The sample consisted of 448 patients. Gastric protectants were prescribed futilely in 50% of cases (125/248), statins in 97% (69/71), antihypertensive agents in 27% (42/155), antidiabetic drugs in 1% (1/70), bisphosphonates in 27% (4/15), and antidementia drugs in 100% (9/9). This study reveals that many patients with advanced cancer continue to be treated with inappropriate drugs and points to the need for medical training in palliative care, drawing attention to the need for therapeutic review at each medical visit. [ABSTRACT FROM AUTHOR]

Background: Thirst is a common and burdensome symptom of chronic heart failure (CHF) which affects adherence to self-care practices specifically fluid restriction. Despite this, there is no standard clinical practice for managing the symptom of thirst. Aims and objectives: The aim is to identify the current strategies recommended by health professionals to help relieve thirst in CHF patients and their perceived usefulness of these strategies. Methods: A survey was distributed to attendees of the 8th Annual Scientific Meeting of Australasian Cardiovascular Nursing College. Results: There were 42 of 70 respondents to the survey. The majority (33 of 40; 82.5%) had recommended various strategies to alleviate thirst. The most recommended strategy was ice chips (36 of 38; 94.7%). Overall, the respondents reported 'some use' in all of the strategies. Conclusion: Information from this survey may help in the incorporation of thirst-relieving strategies into evidence-based guidelines; further improving the quality of care of patients. [ABSTRACT FROM AUTHOR]

On October 3, 2016, the U.S. Food and Drug Administration published in theFederal Registeran expanded list of drug products that are not to be used in compounding extemporaneous dosage forms. This list contains numerous analgesic or anti-inflammatory agents and other chemicals sometimes used to manage pain and related symptoms. Because pharmacies are licensed by the states and other jurisdictions (districts, territories) as opposed to the federal government, regulation of extemporaneous compounding is inconsistent across the nation and minimal to nonexistent is some jurisdictions. Clinicians are urged to assure that pharmacies they and their patients use adhere to this list and compound only dosage forms for which there is good evidence of both safety and efficacy. [ABSTRACT FROM AUTHOR]

Objective: To identify which domains/symptoms from the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) were predictive of overall quality of life (QoL) in advanced cancer patients. Methods: Four hundred and forty seven patients with brain metastases or bone metastases from seven countries were enrolled with regression analysis to determine the predictive value of the QLQ-C30 functional/symptom scores for patient reported overall QoL (question 30), overall health (question 29) and the global health status domain (questions 29 and 30). Results: Worse role functioning, social functioning, fatigue and financial problems were the most significant predictive factors for worse QoL. In the bone metastases subgroup (n = 400), role functioning, fatigue and financial problems were the most significant predictors. In patients with brain metastases (n = 47), none of the EORTC domains significantly predicted worse QOL. Conclusion: Deterioration of certain QLQ-C30 functional/symptom scores significantly contributes to worse QoL, overall health and global health status. [ABSTRACT FROM AUTHOR]

Prior to 1960 severe under-treatment of cancer pain was the rule of thumb in Argentina and was described as unavoidable. Cancer prevention, diagnosis, and treatment were subjects of interest, but symptom control was excluded. The majority of cancer patients was not treated for pain at all, or was treated inadequately. In the period from 1960 to 1980, cancer pain management was the duty of some anesthesiologists that performed different analgesic procedures with erratic results. Around 1980 a growing number of health professionals became aware of the magnitude of cancer symptoms and many of them began to provide adequate control for them. Palliative care was then introduced in the medical scenario and since then the health authority, health professionals, and the community slowly and progressively recognized its importance. Yet despite the progress made in the last decades, access to palliative care is inconsistent and only a small fraction of patients with cancer pain receive adequate treatment. The description of interrelated issues that affect the delivery of palliative care, and the actions intended to change the situation will help to understand both its development and current status. [ABSTRACT FROM AUTHOR]

Objective. To compare the effects of continuous 17-β estradiol-only silastic implants with those of continuous 17-β estradiol plus continuous nomegestrol acetate silastic implants on symptom control, lipid profile and tolerability in postmenopausal women. Methods. This was an open-label, parallel-group study. Women with and without uterus and no contraindications to hormone therapy (HT) in this study, we consider as HT the replacement of Estrogens-only and Estrogens + Progestogens Therapy, were enrolled. Each subject was assigned to receive four 17-β estradiol-only silastic implants (women without uterus), or four 17-β estradiol plus one nomegestrol acetate silastic implant (women with intact uterus), for 1 year. Results. A total of 40 subjects were enrolled and received, the silastic implants of which 40 (100.0%) subjects completed the study (n = 20, estradiol only; n = 20, estradiol plus nomegestrol acetate). The incidence of postmenopausal symptoms decreased significantly. No significant decreases in total cholesterol (1.3%), low-density lipoprotein cholesterol (1.1%), triglycerides (1.2%) and fasting glucose ((1.3%) serum levels were observed in both groups, whereas high-density lipoprotein (HDL) cholesterol increased significantly (2.8%), during the study in both groups. The incidences of adverse events were similar in both treatment groups. Conclusions. Women treated with 17-β estradiol-only silastic implants or 17-β estradiol plus nomegestrol acetate silastic implants showed significant improvement of postmenopausal symptoms, including urogenital and sexual health symptoms and a significant increase in HDL cholesterol and no significant differences in other lipid profiles and tolerability. [ABSTRACT FROM AUTHOR]

Objective. To investigate the maintained efficacy of antipsychotic therapy in stable patients with bipolar disorder transitioned directly to risperidone long-acting injectable (RLAI). Methods. Within a large multi-centre European trial (StoRMi), adults with bipolar I disorder (DSM-IV) stable on a medication regimen for ≥1 month, but requiring a change of antipsychotic therapy, received injections of RLAI 25mg i.m. (increased to 37.5 or 50 mg if necessary), every 14 days for 6 months. Results. Sixteen patients were included in this subgroup analysis. Reasons for changing to RLAI included non-compliance (eight patients), insufficient efficacy (four patients) and side effects (three patients), associated with previous therapy. Twelve patients completed the 6-month trial. The most common dosage at endpoint was 25mg (seven patients). Disease symptoms (CGI Disease Severity) were significantly reduced from baseline to endpoint (P=0.0225). Patient satisfaction with treatment increased from baseline to endpoint, with 36% of patients rating their treatment satisfaction as “very good” versus 0% at baseline. Mean total score of ESRS improved from baseline to endpoint. Conclusion. Patients with bipolar disorder showed maintained symptom control over a 6-month treatment period with RLAI. Controlled studies in this population are required. [ABSTRACT FROM AUTHOR]

The aim of this study was to contrast protein binding of morphine and morphine-6 glucuronide in cord blood and children with adults and examine impact of chemotherapy and other factors. Morphine binding was measured in spiked samples from 18 adults and 18 neonates (cord blood), and compared with six children with cancer receiving morphine. The influence of the for lowing was examined: Human serum albumin (HSA), alpha-1 acid glycoprotein (AAG), non-esterified fatty acids (NEFA); palmitic acid and oleic acid, pH, vincristine, methotrexate, 6-mercaptopurine and M6G. binding correlated with concentrations of albumin and alpha-1 acid glycoprotein. In vitro, binding was not altered by vincristine, 6-mercaptopurine, methotrexate or M6G. Compared with HSA alone, AAG increased binding, palmitic acid reduced it and oleic acid had no effect. Binding was unaffected by pH in samples from patients. Morphine binding was influenced by concentrations of albumin, AAG and morphine itself, but not by age. [ABSTRACT FROM AUTHOR]

For more than thirty years, adults suffering from life-threatening or terminal conditions have been able to access specialist skills in palliative medicine. It has taken much longer for children to start to have access to the same expertise. Paediatric palliative medicine adopts a robust and rational approach to symptom control, based on a thorough understanding of pathophysiology and therapeutics. At the same time, it recognises that physical issues are only one aspect of a child's quality of life and, by adopting a multi-dimensional approach, aims to address psychosocial and spiritual or existential concerns. [ABSTRACT FROM AUTHOR]

As in other developed and developing countries, the most common chronic disorders affecting the Chilean population are cardiovascular disease, cancer, cirrhosis, diabetes, chronic obstructive pulmonary disease and external injuries. Availability of oncology services is not extensive and there are no academic programs to adequately train practitioners in either palliative medicine or comprehensive palliative care for allied health professionals including nurses, psychologists and chaplains. Major efforts have been made to incorporate palliative care as an important health care focus in the last decade and in the development of effective policies for opioid availability. Chile now meets 84% of the 17 criteria outlined by the World Health Organization and the International Narcotics Control Board for opioid availability. Postgraduate medical education in symptom control, clinical use of opioids and end-of-life care remains relatively poor as judged by the results of a questionnaire administered to 158 resident physicians at the Pontificia Universidad Católica de Chile. Improvements in symptom control and the development of palliative care in Chile will depend on the effective assessment of symptom control effectiveness and improved education and training of health professionals in clinical pharmacology, symptom control, clinical ethics, and end-of-life care. [ABSTRACT FROM AUTHOR]

Many patients do not indicate preferences for the types of care they will receive as they approach death, but even when such preferences are explicitly expressed, the patient's wishes of tenare not honored. This commentary reviews two recent publications on this topic and comments on it. Honoring patient's wishes regarding symptom control, resuscitation and other aspects of their end of life care should become a priority. [ABSTRACT FROM PUBLISHER]