[Early palliative care for the management of breathlessness in pulmonary diseases]. / Prise en charge palliative précoce de la dyspnée dans les maladies pulmonaires.

Dyspnoea in chronic respiratory disease is a very frequent symptom with a significant impact on quality of life (QoL). The aim of palliative care is to improve and maintain the QoL of patients with life-threatening diseases and its early implementation is now recommended in many evolving pulmonary diseases. The effectiveness of symptomatic treatments to relieve refractory breathlessness (morphine, oxygen supply, hypnosis, pulmonary rehabilitation) is often limited. These measures are more effective if offered early in the holistic management of the patient. This article illustrates and describes, with the help of a clinical situation, these treatments options and the collaborations established between the palliative care and pneumology divisions.

La dyspnée en lien avec une maladie respiratoire chronique est un symptôme très fréquent avec un impact important sur la qualité de vie (QoL). Les soins palliatifs ont pour objectif d'améliorer la QoL et les symptômes des personnes atteintes de maladies potentiellement mortelles et sont recommandés dans la prise en charge usuelle de nombreuses pathologies pulmonaires évolutives. Les traitements symptomatiques de la dyspnée réfractaire (morphine, oxygène, hypnose, réadaptation respiratoire) ont souvent un effet limité. Ces mesures sont d'autant plus efficaces si elles sont proposées précocement dans la prise en charge holistique du patient. Cet article illustre et décrit, à partir d'une situation clinique, ces modalités thérapeutiques et les collaborations établies entre les soins palliatifs et la pneumologie.

University hospital center for palliative and supportive care.

The Center for Palliative Care and Supportive Care opened in 2019 with the aim of contributing to the implementation of general palliative care in all departments of the Geneva University Hospitals. Built with the aim of supporting care professionals in the management of patients with palliative trajectories and enhancing their professional skills, depending on their specialisation, the centre has laid out recommendations for the palliative management of people with a life-limiting disease. The results of the centre's actions, carried out in collaboration with these professionals, are encouraging and show a growing use of the recommended tools for the evaluation and management of patients in general palliative care.

[Palliative sedation in a hospital unit]. / Sédation palliative en unité hospitalière.

A person at the end of life may present uncomfortable symptoms becoming refractory to an adequate treatment. In this case, the initiation of palliative sedation is indicated. Most sedated inpatients die outside a specialized palliative care unit. Palliative sedation must be initiated and adapted according to the best clinical practices. This article describes the processes associated with palliative sedation in a hospital unit.

Une personne en fin de vie peut présenter des symptômes inconfortables devenant réfractaires à un traitement adéquat. Dans ce cas, l'instauration d'une sédation palliative est indiquée. La majorité des patients hospitalisés et sédatés décèdent en dehors d'une unité spécialisée de soins palliatifs. La sédation palliative doit pouvoir être introduite et adaptée selon les règles de bonnes pratiques. Cet article traite des processus liés à la sédation palliative en unité hospitalière.

Identifying the palliative care needs of frail, older, housebound patients in the community: A cross-sectional study.

BACKGROUND: The early introduction of palliative care can have a positive impact on the quality of life of patients suffering from life-limiting diseases. However, the palliative care needs of older, frail, housebound patients are still mostly unknown, as is the impact of frailty on the importance of these needs. OBJECTIVES: To identify the palliative care needs of frail, older, housebound patients in the community. METHODS: We conducted a cross-sectional observational study. This study took place in a single primary care center and included patients who were ≥65 years old, housebound, followed by the Geriatric Community Unit of the Geneva University Hospitals. RESULTS: Seventy-one patients completed the study. Most patients were female (56.9%), and mean age (SD) was 81.1 (±7.9). The Edmonton Symptom Assessment Scale mean (SD) score was higher in frail patients as opposed to vulnerable patients for tiredness (p = 0.016), drowsiness (p = 0.0196), loss of appetite (p = 0.0124), and impaired feeling of well-being (p = 0.0132). There was no difference in spiritual well-being, measured by the spiritual scale subgroup of the Functional Assessment of the Chronic Illness Therapy-Spiritual Well-Being scale (FACIT-sp) between frail and vulnerable participants, although scores in both groups were low. Caregivers were mainly spouses (45%) and daughters (27.5%) with a mean (SD) age of 70.7 (±13.6). The overall carer-burden measured by the Mini-Zarit was low. SIGNIFICANCE OF RESULTS: Older, frail, housebound patients have specific needs that differ from non-frail patients and should guide future palliative care provision. How and when palliative care should be provided to this population remains to be determined.

Recurrent Persistent Hiccups on Opioid Treatment: A Case Report and Literature Review.

Hiccups are a rare but potentially debilitating side effect of opioid treatment, with only a handful of reported cases in the medical literature. The pathophysiological mechanism linking opioids and hiccups is unknown, and a lack of evidence exists concerning the optimal management of the condition. We report on a 64-year-old man diagnosed with advanced renal cancer and painful osteolytic metastases, presenting persistent hiccups while on opioid treatment. Hiccups recurred after multiple challenges with codeine, morphine and hydromorphone on separate occasions. Hiccups ceased only after opioid discontinuation, although various pharmacological treatments were tried to shorten the duration of hiccups. Eventually, fentanyl was introduced and was well tolerated by the patient, without any recurrence of hiccups. The chronological correlation between opioid initiation and the onset of hiccups, as well as opioid discontinuation and the termination of hiccups leads to the conclusion that a causal role of codeine, morphine and hydromorphone in this occurrence is likely. Individual susceptibility probably plays a central role in the development of opioid-related hiccups. Opioid rotation is a promising strategy in the management of opioid-related hiccups, particularly when the mere discontinuation of the opioid is not a viable option, such as in the oncology and palliative care field.

Palliative care provision for people living with heart failure: The Geneva model.

As life expectancy rises and the survival rate after acute cardiovascular events improves, the number of people living and dying with chronic heart failure is increasing. People suffering from chronic ischemic and non-ischemic heart disease may experience a significant limitation of their quality of life which can be addressed by palliative care. Although international guidelines recommend the implementation of integrated palliative care for patients with heart failure, models of care are scarce and are often limited to patients at the end of life. In this paper, we describe the implementation of a model designed to improve the early integration of palliative care for patients with heart failure. This model has enabled patients to access palliative care when they normally would not have and given them the opportunity to plan their care in line with their values and preferences. However, the effectiveness of this interdisciplinary model of care on patients' quality of life and symptom burden still requires evaluation.

[Improving access to palliative care for patients with heart failure: advances and challenges]. / Améliorer l'accès aux soins palliatifs pour les patients atteints d'insuffisance cardiaque chronique - Avancées et défis.

Following the therapeutic progress of the last decades, patients suffering from chronic heart failure (HF) are living longer than ever before. However, recovery from a HF syndrome remains rare and patients more often have to live with chronic HF which considerably impacts their quality of life. For several years, national and international cardiology societies have recommended the early integration of palliative care for HF patients. Although the impact of palliative care on the quality of life, depression and general symptom management of patients with HF has now been clearly established, its implementation is still scarce. The objective of this review is to highlight recommendations and models of care for the implementation of palliative care for patients with HF.

Grâce aux progrès thérapeutiques des dernières décennies, les personnes atteintes d'insuffisance cardiaque (IC) ont une espérance de vie qui augmente. Cependant, la guérison du syndrome d'IC reste rare et le plus souvent les patients vivent avec une IC chronique ayant un impact considérable sur leur qualité de vie. Depuis de nombreuses années, les recommandations nationales et internationales de cardiologie préconisent une prise en charge palliative intégrée et précoce de ces patients. Bien que son impact sur la qualité de vie, la dépression et la gestion globale des symptômes des patients souffrant d'IC soit maintenant clairement démontré, son implémentation dans la pratique reste insuffisante. L'objectif de cet article est de mettre en lumière les recommandations et modèles de prise en charge palliative pour les patients souffrant d'IC.

Decrease in pain perception during acute SARS-CoV-2 infection: a case series.

ABSTRACT: Many reports have described pain appearance or an increase of chronic pain concomitant to severe acute respiratory syndrome coronavirus 2 infection. Here, we describe the cases of 3 patients with chronic cancer pain, in which COVID-19 was associated with a dramatic reduction or disappearance of pain. Pain reappeared after recovery from COVID-19. Neurological imaging and pathological findings, when available, were inconclusive. To the best of our knowledge, this is the first case series reporting an acute reduction in pain perception in COVID-19. We believe further investigation is mandatory because it could shed new light on the mechanisms of pain perception and modulation.

Breathlessness and COVID-19: A Call for Research.

Breathlessness, also known as dyspnoea, is a debilitating and frequent symptom. Several reports have highlighted the lack of dyspnoea in a subgroup of patients suffering from COVID-19, sometimes referred to as "silent" or "happy hyp-oxaemia." Reports have also mentioned the absence of a clear relationship between the clinical severity of the disease and levels of breathlessness reported by patients. The cerebral complications of COVID-19 have been largely demonstrated with a high prevalence of an acute encephalopathy that could possibly affect the processing of afferent signals or top-down modulation of breathlessness signals. In this review, we aim to highlight the mechanisms involved in breathlessness and summarize the pathophysiology of COVID-19 and its known effects on the brain-lung interaction. We then offer hypotheses for the alteration of breathlessness perception in COVID-19 patients and suggest ways of further researching this phenomenon.

[A palliative care approach of patients with chronic obstructive pulmonary disease]. / Prise en charge palliative des patients atteints de bronchopneumopathie chronique obstructive.

Chronic obstructive pulmonary disease (COPD) is a frequent, progressive and lethal disease. As opposed to other chronic illnesses, such as cardio-vascular diseases, the prevalence of COPD is still on the rise. It is now well documented that these patients can present many invalidating symptoms towards the end of their life. The aim of a palliative approach for patients living with advanced COPD is to decrease the impact of symptoms and offer a pluridisciplinary approach so as to maintain the best possible quality of life.

La bronchopneumopathie chronique obstructive (BPCO) est une maladie fréquente, évolutive et mortelle. Contrairement à d'autres maladies chroniques, comme les maladies cardiovasculaires, sa prévalence ne cesse d'augmenter. De plus, il a été démontré que les patients atteints de BPCO peuvent développer une invalidité importante liée à leur maladie dans les années qui précèdent leur décès. L'objectif d'une prise en charge palliative des personnes vivant avec une BPCO avancée est de diminuer l'impact des symptômes et d'offrir un accompagnement pluridisciplinaire, dans le but de leur permettre de maintenir la meilleure qualité de vie possible.

[Vaccination of the elderly: how to communicate better]. / Vaccination de la personne âgée : quelques outils pour mieux communiquer.

Elderly people are high risk patients who need specific and tailored monitoring. Prevention is an important part in taking care of their well-being. The utility and efficacy of vaccination against influenza, diphtheria and tetanus are now indisputable for seniors, but coverage is still insufficient. This article will discuss the reasons for insufficient adherence, assuming that the general practitioner or another unit of the health care system has suggested a vaccination plan to the senior patient. With this goal in mind, we explored the various obstacles that may occur during the communication between physician and patient, be it due to old age (sensory loss), linked to cognitive decline or directly in relationship with the myths and beliefs surrounding vaccination, especially the vaccine against influenza.

Les personnes âgées forment une population à risque qui nécessite un suivi spécifique et adapté. La prévention constitue une partie importante de leur prise en charge. L'utilité et l'efficacité de la vaccination contre la grippe (influenza), la diphtérie et le tétanos ne sont plus à démontrer chez les seniors, cependant la couverture reste sous-optimale. Cet article va discuter les raisons d'une adhérence insuffisante, partant du principe qu'un acteur du système de soins a proposé un plan de vaccination à un senior. Pour ce faire, nous explorons les diverses barrières intervenant dans la communication médecin-malade, que ce soit celles liées au vieillissement (troubles sensoriels), au déclin cognitif ou en lien avec les mythes et croyances entourant la vaccination, en mettant l'accent sur le vaccin contre la grippe.

A role for cytosolic isocitrate dehydrogenase as a negative regulator of glucose signaling for insulin secretion in pancreatic ß-cells.

Cytosolic NADPH may act as one of the signals that couple glucose metabolism to insulin secretion in the pancreatic ß-cell. NADPH levels in the cytoplasm are largely controlled by the cytosolic isoforms of malic enzyme and isocitrate dehydrogenase (IDHc). Some studies have provided evidence for a role of malic enzyme in glucose-induced insulin secretion (GIIS) via pyruvate cycling, but the role of IDHc in ß-cell signaling is unsettled. IDHc is an established component of the isocitrate/α-ketoglutarate shuttle that transfers reducing equivalents (NADPH) from the mitochondrion to the cytosol. This shuttle is energy consuming since it is coupled to nicotinamide nucleotide transhydrogenase that uses the mitochondrial proton gradient to produce mitochondrial NADPH and NAD(+) from NADP(+) and NADH. To determine whether flux through IDHc is positively or negatively linked to GIIS, we performed RNAi knockdown experiments in ß-cells. Reduced IDHc expression in INS 832/13 cells and isolated rat islet ß-cells resulted in enhanced GIIS. This effect was mediated at least in part via the KATP-independent amplification arm of GIIS. IDHc knockdown in INS 832/13 cells did not alter glucose oxidation but it reduced fatty acid oxidation and increased lipogenesis from glucose. Metabolome profiling in INS 832/13 cells showed that IDHc knockdown increased isocitrate and NADP(+) levels. It also increased the cellular contents of several metabolites linked to GIIS, in particular some Krebs cycle intermediates, acetyl-CoA, glutamate, cAMP and ATP. The results identify IDHc as a component of the emerging pathways that negatively regulate GIIS.