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Clinical course and end-of-life care in patients who have died after allogeneic stem cell transplantation.

PURPOSE: Allogeneic stem cell transplantation may cure approximately 50% of patients, however, a significant part of the other half might benefit from a high-quality palliative care medicine at the end of life. Somatic, psychic and spiritual needs of these patients may differ from those of patients suffering from incurable solid tumours and are not comprehensively evaluated so far. METHODS: To address this question, data from charts of 123 patients who have died after allogeneic stem cell transplantation were extracted. In detail, the time line of the clinical course, the symptoms, the admini

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… The increases for some other drugs were even considerable but less impressive: steroids: 9.8% to maximal 36.6%, antiemetic drugs: 1.6–23.6%, laxatives: 3.3% to maximal 15.4%. … The use of laxatives increased only slightly to 10.6% at the last assessment. This is in accordance with the observation that obstipation is no major problem after SCT. …

Emergency Department Management of Common End-of-Life and Palliative Care Symptoms: Three Cases

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… If there is no evidence of bowel obstruction, patients with opioid-induced constipation despite prophylaxis can be treated with rectal therapy, such as bisacodyl or glycerin suppository, or an osmotic laxative, such as polyethylene glycol or magnesium. … Laxatives or methylnaltrexone for the management of constipation in palliative care patients. Brick N. Clin J Oncol Nurs. 2013;17:91–92. doi: 10.1188/13.CJON.91-92. 14. Mercadante S. UpToDate. Waltham, MA: UpToDate; 2023. Palliative care of bowel obstruction in cancer patients. 15. …

A Comparison of the Clinical Effectiveness Between Low-Dose Strong Opioids and Non-Steroidal Anti-Inflammatory Drugs in the Treatment of Mild Cancer Pain: A Randomized Trial.

ObjectiveThe present study aims to explore the effectiveness and safety of low-dose strong opioids compared with non-steroidal anti-inflammatory drugs (NSAIDs) in the treatment of mild cancer pain.MethodsFrom September 2016 to September 2018, 66 patients with a malignant tumor and mild cancer pain admitted to the Department of Oncology of Dalian Fifth People's Hospital were divided into the group A (treated with ibuprofen sustained-release tablets for pain relief) and the group B (treated with oxycodone hydrochloride sustained-release tablets for pain relief). After 7 days of treatment, the pa

Планы последующего ухода за больными раком крови взрослых - потенциальная оценка результатов, связанных со здоровьем, использование ресурсов и качество жизни.

Информация о последующих мерах по оказанию помощи лицам, пережившим рак крови, является ограниченной. Исследование, проведенное на основе вопросника "Последовательный уход за лицами, пережившими рак крови" (ABC), было направлено на выявление моделей последующего ухода в Германии и сопоставление различных типов последующих учреждений. МЕТОДЫ: ИЗУЧЕНИЕ 18-month В будущей части сопоставляются контрольные учреждения, указанные в предыдущей ретроспективной части (академические онкологи, общинные онкологи, врачи первичной медико-санитарной помощи). Вопросники были заполнены врачами-специалистами. Ре

When to Use Methadone for pain: A Case-Based Approach.

The case studies are written in this article to illustrate how methadone might be used for pain in the Indian context. These cases might be used for discussion in a multidisciplinary team, or for individual study. It is important to understand that pain requires a multidisciplinary approach as opioids will assist only with physical, i.e. neuropathic and nociceptive pain, but not emotional, spiritual, or relational pain or the pain of immobility. The social determinants of pain were included to demonstrate how emotional, relational, and psychological dimensions of pain amplify the physical aspe

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… Reassure Rathode that we will be working together to alleviate his suffering from pain – described below Resolve constipation by optimizing stimulant/lubricant laxatives Provide inputs from a therapist with skills in speech/swallow rehabilitation exercises. … His bowels are working while on laxatives. For the past 3 days, his bed sheets have increased his reports of pain “all over”. He feels uncomfortable when his wife tries to touch or massage his back. He has difficulty with activities of daily living, poor sleep and his mood is low. …

COVID-19 and Palliative Care Services: Comparative Patterns of Inpatient, Outpatient, and Consultation Services in a Tertiary Care Center in Riyadh.

Introduction The coronavirus disease 2019 (COVID-19) outbreak caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) marked the third introduction of a highly pathogenic and large-scale epidemic coronavirus into the human population in the 21st century. The World Health Organization declared the COVID-19 outbreak as a pandemic on March 11, 2020. Lockdowns were imposed in multiple countries affecting patient flow in hospitals. Methods This is a retrospective study conducted at King Fahad Medical City (KFMC), a tertiary care hospital in Riyadh, Saudi Arabia, which examined th

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… Discharge Type | | | 0.054 Carried Over | 19 (19.6%) | 28 (23.5%) | Discharged Home | 24 (24.7%) | 43 (36.1%) | Passed Away | 42 (43.3%) | 44 (37.0%) | Transferred | 11 (11.3%) | 4 (3.4%) | DAMA | 1 (1.0%) | 0 (0.0%) | Opioids | | | Yes | 97 (100%) | 119 (100%) | No | 0 (0%) | 0 (0%) | Laxatives … All our patients received opioids and laxatives. In Australia, the average length of stay (ALOS) for palliative care patients is reported to be 10.6 days, and this number is considered to be about four times longer than the average LOS of 2.8 days for all hospitalizations [ 9 ]. …

Tapentadol prolonged release for patients with multiple myeloma suffering from moderate-to-severe cancer pain due to bone disease.

CONTEXT: Myeloma bone disease (MBD) is a devastating complication of multiple myeloma that leads to severe pain. OBJECTIVES: The aim of this study was to evaluate the efficacy and tolerability of tapentadol prolonged release (PR) in the management of patients with MBD suffering from moderate-to-severe cancer pain. METHODS: A 12-week prospective study was carried out in 25 opioid-naïve MBD patients. Patients initially received twice-daily doses of tapentadol PR 50 mg. Doses were then managed to maintain adequate relief or dose-limiting toxicity. The following parameters were recorded at weekl

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… Symptomatic drugs (anti-emetics and laxatives), corticosteroids, bisphosphonates, radiotherapy, and chemotherapy were used according to clinical needs. Patients were visited or contacted at least once weekly to monitor therapy and adjust it if needed, according to the clinical status. … The percentage of patients taking laxatives reduced from 16% at W 0 to 9.1% at W 12 . No patients required antiemetics. …

Potassium binders for chronic hyperkalaemia in people with chronic kidney disease.

BACKGROUND: Hyperkalaemia is a common electrolyte abnormality caused by reduced renal potassium excretion in patients with chronic kidney di … e study). The comparative effects whether potassium binders were administered with or without food, laxatives, or sorbitol, were very uncertain with insufficient data to perform meta-analysis. AUTHORS' CONCLUSIONS: Evidence supporting clinical decision-making for different potassium binders to treat chronic hyperkalaemia in adults with CKD is of low certai …

An approach to treating older adults with chronic kidney disease.

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… cyclosilicate and patiromer) have become available in Canada, which have been shown to be safer and effective for potassium control, and may allow continuation of RAAS blockers while allowing for diet liberalization. 27 A common and treatable cause of hyperkalemia in older adults is constipation. 29 Osmotic laxatives … , such as lactulose and polyethylene glycol, are safe when used judiciously in such patients, and can help excrete potassium with or without added potassium binders. 29 Sorbitol and phosphate-based enemas should be avoided, and magnesium-based laxatives should be used with caution, given the risk of …

Complementary and alternative medicine (CAM) supplements in cancer outpatients: analyses of usage and of interaction risks with cancer treatment.

PurposeThe aim of our study was to analyze the use of complementary and alternative medicine (CAM) supplements, identify possible predictors, and analyze and compile potential interactions of CAM supplements with conventional cancer therapy.MethodsWe included outpatient cancer patients treated at a German university hospital in March or April 2020. Information was obtained from questionnaires and patient records. CAM-drug interactions were identified based on literature research for each active ingredient of the supplements consumed by the patients.Results37.4% of a total of 115 patients consu

Percutaneous endoscopic cecostomy for management of Ogilvie's syndrome: a case series and literature review with an update on current guidelines (with video).

IntroductionPercutaneous endoscopic cecostomy (PEC) is a viable treatment option for patients with persistent or recurrent acute colonic pseudo-obstruction (ACPO; Ogilvie's syndrome). It should be generally considered in patients that are refractory to pharmacologic and endoscopic decompression, especially those not amenable to surgical intervention due to an increased perioperative risk. Physicians are rather unfamiliar with this approach given the limited number of reports in the literature and paucity of guideline resources, although guidelines concerning ACPO and covering the role of endos

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… Table 1 Main conditions associated with Ogilvie’s syndrome (according to [ 2 – 4 ]) Category | Examples Medication | Opioids, anticholinergics, Ca ++ channel blockers, laxative abuse, cytotoxics, antipsychotics, benzodiazepines, dopaminergics, epidural anesthesia Trauma and Orthopedics | Pelvic and hip … the large bowel without evidence of any abrupt transition point or mechanically obstructing lesion Case 2 A 67-year-old male with generalized salivary gland carcinoma and multiple comorbid conditions developed severe obstipation with abdominal distension, necessitating protracted use of enemas and laxatives …

The role of technological progress vs. accidental discoveries and clinical experience.

The 50th anniversary of dialysotherapy celebrated by nephrologists around the world in 2012 provided an opportunity for discussion on the role of clinical experience in relation to technological progress in the evolution of dialysis, especially of recently observed inadequate decrease in mortality/morbidity rates of patients on chronic dialysis. My report, based on almost 50 years of career in nephrology, refers the evolution of dialysis, from catharsis to modern dialysotherapy with special attention devoted to nowadays gravely underestimated role of clinical experience and personalized profes

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… Hot baths, inducing vomiting, enemas and laxatives were most prescribed means to physical catharsis. Bloodletting was also meant to be highly effective. Hippocrates (460–377 b.c.) and Galen (130–200 a.c.) are considered to be fathers of the idea of catharsis. … At present the idea of catharsis is raised in relation to contemporary theories of removing uremic toxins such as p-cresol sulphate and indoxyl sulphate produced by intestinal bacteria using only laxatives or sorbents administered internally without the necessity of prolonging or increasing frequency …

Pharmacovigilance in oncology.

Background Side effects of cancer therapy are one of the most important issues faced by cancer patients during their illness. Pharmacovigilance, namely the science and activities aimed at monitoring the safety of drugs, is particularly important in oncology, due to the intrinsic biologic toxicity of antineoplastic agents, their narrow therapeutic windows, and the high doses and rigid timing of treatment regimens. Aim of the review To identify the main issues in carrying out an effective pharmacovigilance activity in oncology. Method We searched PubMed for articles about pharmacovigilance in re

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… For constipation: laxatives (osmotic or stimulant), opioid antagonists (e.g. methylnaltrexone) for opioid-induced constipation Fatigue Microtubule agents Consider concomitant factors (e.g. pain, anxiety) Suggest behavioral modifications; provide nutritional, physical and psychological support; consider … For constipation: laxatives (osmotic or stimulant), opioid antagonists (e.g. methylnaltrexone) for opioid-induced constipation Fatigue | Microtubule agents | Consider concomitant factors (e.g. pain, anxiety) | Suggest behavioral modifications; provide nutritional, physical and psychological support; …

Mu-opioid antagonists for opioid-induced bowel dysfunction in people with cancer and people receiving palliative care.

BACKGROUND: Opioid-induced bowel dysfunction (OIBD) is characterised by constipation, incomplete evacuation, bloating, and gastric reflux. It is one of the major adverse events of treatment for pain in cancer and in palliative care, resulting in increased morbidity and reduced quality of life.This is an update of two Cochrane reviews. One was published in 2011, Issue 1 on laxatives and methylnaltrexone for the management of constipation in people receiving palliative care; this was updated in 2015 and excluded methylnaltrexone. The other was published in 2008, Issue 4 on mu-opioid antagonists …

Gastrointestinal toxicities of proteasome inhibitor therapy.

PurposeProteasome inhibitors (PIs), which cause cell death via tumor suppressor and pro-apoptotic proteins, are integral to treatment of many hematologic malignancies but are limited by their gastrointestinal adverse effects. Evidence regarding these PI-related adverse effects is scant. In this study, we evaluated gastrointestinal adverse events caused by PIs and compared gastrointestinal toxicities between bortezomib, carfilzomib, and ixazomib.MethodsWe conducted a retrospective study of cancer patients treated with PIs at a tertiary care cancer center to investigate the clinical characterist

Progressive multiple sclerosis: Evaluating current therapies and exploring future treatment strategies.

Progressive forms of multiple sclerosis (MS) include primary progressive MS (PPMS) and secondary progressive MS (SPMS). Unlike relapsing-remitting MS (RRMS), progressive MS is recognized by relentless progression with accumulating disability, rare to no relapses nor new activity on MRIs. Clinically, neurologic worsening in MS can occur in the relapsing-remitting (RRMS) phase of disease due to incomplete recovery from neuroinflammatory relapses. However, a progressive disease course is the dominant factor related to accumulating disability. There is persistent central nervous system (CNS) compa

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… Bowel dysfunction Laxatives, stool softeners (e.g., polyethylene glycol) Used to manage constipation, fiber supplements may also be beneficial. Cognitive impairment Donepezil, rivastigmine Cholinesterase inhibitors, although evidence is limited. … Bowel dysfunction Laxatives, stool softeners (e.g., polyethylene glycol) Used to manage constipation, fiber supplements may also be beneficial. Cognitive impairment Donepezil, rivastigmine Cholinesterase inhibitors, although evidence is limited. …

Management of an oral ingestion of transdermal fentanyl patches: a case report and literature review.

Purpose. Fentanyl is available as a transdermal system for the treatment of chronic pain in opioid-tolerant patients; however, it carries a black box warning due to both the potency of the product and the potential for abuse. In this report, we describe a case of transbuccal and gastrointestinal ingestion of fentanyl patches and the management of such ingestion. Summary. A 32-year-old man was brought to the emergency department (ED) via emergency medical services for toxic ingestion and suicide attempt. The patient chewed and ingested two illegally purchased transdermal fentanyl patches. In th

Multidisciplinary supportive care in systemic light chain amyloidosis.

The immunoglobulin light-chain amyloidosis is a multisystemic disease which manifests by damage to the vital organs by light chain-derived amyloid fibril. Traditionally, the treatment has been directed to the underlying plasma cell clone with or without high dose chemotherapy followed by autologous stem cell transplantation using melphalan based conditioning. Now with the approval of highly tolerable anti-CD38 monoclonal antibody daratumumab based anti-plasma cell therapy in 2021, high rates of hematologic complete responses are possible even in patients who are otherwise deemed not a candidat

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… can be useful, amitriptyline and nortriptyline should be avoided due to anti-cholinergic side effects Malnutrition | Adequate calorie and protein intake is important, all patients should have a nutritional plan Constipation | Metoclopramide can improve motility, stool softener both useful, osmotic laxatives … Constipation can also be managed by homogenized meals, sodium docusate, senna, and occasional judicious use of osmotic laxative. Severe fecal impaction can be treated with fluoroscopy-guided stool decompression or manual disimpaction. …

Удельное микробное соотношение в кишечном микробиоме связано с множественным склерозом.

Гут микробиота дисбиоз связан с множественным склерозом (MS), однако причинно-следственная связь между конкретными кишечными бактериями и патогенезом MS остается слабой. Поэтому мы описали микробиом стула людей с MS (PwMS) и здоровым управлением (HC) с использованием метагеномической последовательности дробовика. PwMS продемонстрировал отличный микробиом по сравнению с HC, при этом виды Crevotella copri (PC) и Blautia были движущими силами микробных сообществ в HC и PwMS, соответственно. В результате применения к мышам видов MS-ding Blautia (Blautia Wexlerae; BW) повысились уровни кишечных мар

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… The exclusion criteria included a) active pregnancy, b) history of bariatric surgery, c) active chronic illness such as inflammatory bowel disease, Celiac disease, etc., and d) use of antibiotics or laxatives. All PwMS were either on DMT or not on treatment for at least 3 mo before enrollment. … Subjects were asked to provide fecal samples at least 4 wk after their last dose of oral antibiotics or laxatives and at least 3 mo after their last colonoscopy. Demographics and clinical characteristics of all participants providing stool samples at enrollment are provided in Table 1 . …

A Randomised Controlled Phase II Trial of the Combination of XELOX with Thalidomide for the First-line Treatment of Metastatic Colorectal Cancer.

ObjectiveTo evaluate the efficacy and safety of the combination of XELOX regimen (oxaliplatin plus capecitabine) with thalidomide for the first-line treatment of metastatic colorectal cancer (MCRC).MethodsAll of the 89 patients with MCRC who fulfilled eligibility criteria were randomly assigned to treatment group (n=44) and control group (n=45). The treatment group received a combination of XELOX with thalidomide and the control group received XELOX alone. Each patient received at least 2 cycles of treatment (1 cycle=21 d). The primary endpoint was progression-free survival (PFS) and the secon

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… The rate of constipation was higher in thalidomide group compared with the control group, but that could be alleviated by adjusting the diet of the patient or orally administrating laxatives, and that didn’t lead to chemotherapy interruption. …