Key aspects of psychosocial needs in palliative care - a qualitative analysis within the setting of a palliative care unit in comparison with specialised palliative home care.

BACKGROUND: The number of palliative care patients with complex needs is increasing in developed countries. In addition to physical aspects and symptom control, psychosocial aspects are of great importance for palliative care patients. The aim of this study was to understand which psychosocial aspects are important to patients, relatives and health professionals within the setting of a palliative care unit in comparison with specialised palliative home-care (SPHC). METHODS: We used a qualitative design based on semistructured interviews, which were coded via qualitative content analysis. The study took place in the state of Hesse, Germany, and data collection was conducted in 2017 (interviews from the ELSAH study, which was conducted in a SPHC) and 2018 (supplementary interviews conducted in a palliative care unit). The results from both settings were compared. RESULTS: In the palliative care unit, 10 health professionals, 11 patients and 8 relatives were interviewed. In the outpatient setting, we interviewed 30 health professionals, 14 patients and 14 relatives. We identified four key psychosocial issues related to palliative care that were relevant in both the inpatient and outpatient settings: care planning, patient-centred care, a protected environment with feelings of safety, and psychological well-being. In addition, immediate availability of medical staff, greater relief of the relatives and better accessibility of psychological care were more important in the inpatient setting than in the specialised palliative home care setting. CONCLUSIONS: Knowledge and application of the identified key issues may improve patient-centred palliative care. Accessibility of psychological care and immediate availability of medical staff may be important factors for enhancing psychological well-being in the inpatient palliative care setting. Consideration of the identified key issues may help to develop more collaborative transitions between the palliative care unit and the SPHC and may help to provide palliative care patients and their families with care that is appropriate and feasible for them. TRIAL REGISTRATION: The underlying comparative study of the outpatient setting of specialised palliative home-care (ELSAH) was registered within the German Clinical Trials Register DRKS-ID: DRKS00012421, ( https://drks.de/search/de/trial/DRKS00012421 ) on 19th May 2017.

Polysomnography outcomes following transoral CO2 laser microsurgery in pediatric patients with laryngomalacia.

OBJECTIVE: Laryngomalacia is the most common cause of stridor in newborns and infants. The aim of the contribution was to present objectified data of the outcome of transoral CO(2) laser microsurgery in patients with laryngomalacia utilizing polysomnography (PSG). PATIENTS AND METHODS: This retrospective study comprised 21 patients who were diagnosed to suffer from laryngomalacia. Diagnosis was confirmed by pharyngo-laryngoscopy under spontaneous breathing. If there was evidence for laryngomalacia a transoral CO(2) lasersurgical intervention and/or epiglottopexy was performed in the same session. 8 patients, on whom the following should be focused, received pre- and postoperative PSG which was performed for efficiency control of the applied treatment. RESULTS: All 21 patients underwent invasive treatment for laryngomalacia (lasersurgical division of the aryepiglottic folds: n=13; epiglottopexy: n=5; combined procedure: n=3). All patients were successfully extubated after surgery. In 20/21 cases breathing improved clearly after one single intervention. Stridor disappeared completely in the further course of the disease. In the 8 patients who received pre- and postinterventional PSG, lasersurgical interventions were performed. Statistical analysis of pre- and postoperative PSG revealed that MOAI/h (mixed obstructive apnea index/hour) improved significantly (p=0.016, Wilcoxon-Signed-Rank Test). Also desaturation/hour improved in the postoperative course (p=0.11). CONCLUSION: The presented concept describes an effective and reliable approach for diagnostics and treatment for laryngomalacia. To objectify the success of supraglottoplaty in patients suffering from severe laryngomalacia a pre- and postoperative PSG seems to be useful and advisable. The present results of PSG demonstrate that children with laryngomalacia to benefit from lasersurgical division of the aryepiglottic folds and/or epiglottopexy. This fact is supported by the postoperative improved clinical aspect.

Use of ProSeal laryngeal mask airway in 2114 adult patients: a prospective study.

BACKGROUND: There have been numerous studies published on the ProSeal laryngeal mask airway (PLMA). However, few have investigated its utility in a large practice setting. We sought to gather comprehensive data about the characteristics, efficacy, and safety of its use by a representative group of anesthesiologists working at a teaching center. METHODS: Information was collected on a standardized data collection form. Clinical information obtained included user characteristics, patient characteristics, type and duration of operation, details of airway management and anesthetic technique, details of adverse events, and postoperative status of the patient. RESULTS: Use of the PLMA was documented in 2114 patients by 81 anesthesiologists (57% trainee, 43% staff grade). The insertion success rate was 99% within a maximum of 3 attempts. Mean airway leak pressure was 28 (11-40) cm H(2)O. In 3.2% of cases, the PLMA was abandoned in favor of the endotracheal tube. Ventilation was controlled in 98%. Clinically "relevant" adverse events were recorded in 3.3% of all cases, of which 0.6% were classified as "serious." No long-term adverse sequelae resulted. No signs of aspiration were found in 12 patients with apparent regurgitation of gastric fluid through the drain tube of the PLMA. Five cases of difficult ventilation and 16 cases of difficult endotracheal intubation were successfully managed by the use of the PLMA. CONCLUSION: This study demonstrates that airway management using the PLMA is safe and effective in a general practice setting. The results support the assumption that a correctly positioned PLMA can protect from pulmonary aspiration of regurgitate gastric fluid. The data also support use of the PLMA for the management of the difficult airway.