RESUMEN
BACKGROUND: In the SARS-CoV-2 pandemic, general and specialist Palliative Care (PC) plays an essential role in health care, contributing to symptom control, psycho-social support, and providing support in complex decision making. Numbers of COVID-19 related deaths have recently increased demanding more palliative care input. Also, the pandemic impacts on palliative care for non-COVID-19 patients. Strategies on the care for seriously ill and dying people in pandemic times are lacking. Therefore, the program 'Palliative care in Pandemics' (PallPan) aims to develop and consent a national pandemic plan for the care of seriously ill and dying adults and their informal carers in pandemics including (a) guidance for generalist and specialist palliative care of patients with and without SARS-CoV-2 infections on the micro, meso and macro level, (b) collection and development of information material for an online platform, and (c) identification of variables and research questions on palliative care in pandemics for the national pandemic cohort network (NAPKON). METHODS: Mixed-methods project including ten work packages conducting (online) surveys and qualitative interviews to explore and describe i) experiences and burden of patients (with/without SARS-CoV-2 infection) and their relatives, ii) experiences, challenges and potential solutions of health care professionals, stakeholders and decision makers during the SARS-CoV-2 pandemic. The work package results inform the development of a consensus-based guidance. In addition, best practice examples and relevant literature will be collected and variables for data collection identified. DISCUSSION: For a future "pandemic preparedness" national and international recommendations and concepts for the care of severely ill and dying people are necessary considering both generalist and specialist palliative care in the home care and inpatient setting.
Asunto(s)
COVID-19 , Pandemias , Adulto , Alemania , Humanos , Cuidados Paliativos , SARS-CoV-2RESUMEN
Quantitative sensory testing (QST) is a standardized and formalized clinical sensitivity test. Testing describes a subjective (psychophysical) method that entails a cooperation of the person to be examined. Within its framework, calibrated stimuli are applied to capture perception and pain thresholds, thus providing information on the presence of sensory plus or minus signs. The presented QST battery imitates natural thermal or mechanical stimuli. The aim is to acquire symptom patterns of sensory loss (for the functioning of the thick and thin nerve fibers) as well as a gain of function (hyperalgesia, allodynia, hyperpathia) with a simultaneous detection of cutaneous and deep tissue sensibility. Most of the tested QST parameters are normally distributed only after a logarithmic transformation (secondary normal distribution)-except the number of paradoxical heat sensations, of cold and heat pain thresholds, and vibration detection thresholds. A complete QST profile can be measured within 1 h. QST is suitable not only for clinical trials but also in practice as a diagnostic method to characterize the function of the somatosensory system-from the peripheral nerve fiber receptor to the projection pathways to the brain.
Asunto(s)
Hiperalgesia , Umbral del Dolor , Humanos , Dolor , Dimensión del Dolor , Umbral Sensorial , Sensación TérmicaRESUMEN
BACKGROUND: There is currently a lack of studies that evaluate the effects of matrix electrode neuromodulation on acute pain. In this prospective and randomized cross-over study, we investigated the efficacy of 4 Hz-matrix stimulation on venipuncture-induced pain in 30 healthy subjects. METHODS: We compared two conditions of neurostimulation: in EC1 (experimental condition 1), we performed venipuncture during stimulation, with 2.5 min of prestimulation with 600 stimuli; in EC2 (experimental condition 2), the length of stimulation was 5 min, at 1200 stimuli, with subsequent venipuncture. A group with no stimulation was used as control condition. RESULTS: The EC2 group did not only show a 77% reduction in puncture pain when compared to the control group (p < 0.001; effect size [ES] d = 1.45), but also had a significant effect compared with EC1 (p < 0.001; ES d = 1.33). EC1, on the other hand, did not demonstrate a significant difference to the control group. The status of the veins was evaluated based on visibility and did not differ significantly between the conditions. CONCLUSION: The results of this study showed for the first time that pre-emptive matrix stimulation could be an effective way to reduce acute pain. The duration of stimulation seems to play a key role in the effectiveness of the neurophysiological mechanism of action. Matrix stimulation is a therapeutic intervention with very few side effects, which could, in the future, expand our pain-management options for the treatment of acute pain.
Asunto(s)
Dolor Agudo , Terapia por Estimulación Eléctrica , Manejo del Dolor , Dolor Agudo/terapia , Estudios Cruzados , Humanos , Estudios ProspectivosRESUMEN
Palliative medicine focuses on relieving burdening symptoms to improve quality of life. The most common symptoms are physical weakness, pain, loss of appetite, nausea as well as dyspnea, itching and depression. Frequently, good symptom control can be achieved using the most effective drug combination therapy or non-medicinal interventions. This article specifically addresses the physical symptoms dyspnea, itching and the psychological symptom depression.
Asunto(s)
Trastorno Depresivo/etiología , Disnea/etiología , Cuidados Paliativos/métodos , Prurigo/etiología , Trastorno Depresivo/terapia , Disnea/terapia , Humanos , Evaluación de Resultado en la Atención de Salud , Prurigo/terapiaRESUMEN
To date, no studies investigating titration with oral transmucosal fentanyl for the dose-finding of transdermal fentanyl treatment have been published. In an open randomized study 60 patients with chronic malignant (n = 39) or nonmalignant pain (n = 21), who required opioid therapy according to step three of the guidelines of the World Health Organization (WHO), were investigated. In two groups of 30 patients each titration with immediate release morphine (IRM) or oral transmucosal fentanyl citrate (OTFC) was undertaken. For measurement purposes the Brief Pain Inventory (BPI) and Minimal Documentation System (MIDOS) were used. After a 24-h titration phase, in which patients documented the intensity of pain, nausea, and tiredness, treatment with transdermal fentanyl was evaluated over a 10-day period by means of the necessary dose adaptation (responder ≤ 1 dose adaptation; conversion formula 1:1 [OTFC group] vs 100:1 [IRM group]).The pain reduction over the first 24 h (titration phase) did not differ significantly between the groups. The number of responders (17 OTFC vs. 21 IRM) over the 10-day period did not show any difference either. In both groups there was a significant reduction in pain intensity (p < 0.001). Over the course of the study, there were significantly more drop-outs because of adverse effects in the OTFC group than in the IRM group (8 vs 1, p = 0.028).Oral transmucosal fentanyl citrate can be applied for the titration of transdermal fentanyl, but it does not show any clinically relevant advantage. For example, the risk of side effects-induced drop-outs was greater in the present study. Whether the unnecessary opioid switching to treat chronic pain and breakthrough pain is advantageous with regard to minimizing conversion errors cannot be definitively answered within the scope of this study.
Asunto(s)
Dolor en Cáncer/tratamiento farmacológico , Dolor Crónico/tratamiento farmacológico , Fentanilo/administración & dosificación , Cuidados Paliativos/métodos , Administración Bucal , Administración Cutánea , Adulto , Anciano , Relación Dosis-Respuesta a Droga , Femenino , Fentanilo/efectos adversos , Humanos , Masculino , Persona de Mediana Edad , Morfina/administración & dosificación , Morfina/efectos adversos , Dimensión del DolorRESUMEN
An online survey of chief neurological consultants was conducted to find out how they judged the demand for and access to palliative and hospice care (PHC) structures for their neurological patients (NP) as well as their collaboration with PHC structures. 110 of 881 chief consultants who were contacted participated in the survey. About 10â% of their NP were considered suitable for PHC. They estimated that 9â% of the deceased had died from their underlying neurological disease. The integration of PHC structures into the management of various neurological diseases was considered worthwhile but 51.9â-â78.5â% indicated that there was no or little collaboration with PHC structures. 12â% of the participants were trained in palliative care (PC). To guarantee an adequate PHC also for NP, PHC knowledge should be integrated into the curriculum and training of neurologists and the PC community should further extend its services to NP, adapting their knowledge and structures to these patients' special needs.
Asunto(s)
Actitud del Personal de Salud , Prestación Integrada de Atención de Salud/organización & administración , Cuidados Paliativos al Final de la Vida/organización & administración , Enfermedades del Sistema Nervioso/terapia , Cuidados Paliativos/organización & administración , Ejecutivos Médicos , Derivación y Consulta , Adulto , Anciano , Causas de Muerte , Competencia Clínica , Educación , Alemania , Accesibilidad a los Servicios de Salud/organización & administración , Necesidades y Demandas de Servicios de Salud/organización & administración , Humanos , Comunicación Interdisciplinaria , Colaboración Intersectorial , Persona de Mediana Edad , Enfermedades del Sistema Nervioso/mortalidad , Enfermedades del Sistema Nervioso/psicología , Grupo de Atención al Paciente/organización & administración , Sociedades MédicasRESUMEN
Cancer pain and pain associated with non-neoplastic diseases can be associated with pain mechanisms, such as a peripheral or central sensitization or deafferentation. The clarification allows indirect conclusions about the underlying mechanisms based on clinical signs, such as allodynia or hyperalgesia. Non-opioid analgesics are the basis of cancer pain therapy according to the World Health Organization (WHO) pain ladder. In the case of severe cancer pain, treatment can be escalated directly from level 1 to level 3. Opioids are highly effective for the treatment of cancer pain even with a neuropathic component, which can occur in up to 40 % of cases as amixed pain syndrome. Coanalgesics represent a valuable therapeutic adjunct for better pain control and can address treatment of comorbidities, such as anxiety, depression and sleep disorders. When liver and/or renal function is reduced, the dosage of many drugs has to be adapted. Treatment of multimorbid or critically ill patients with opioids and antidepressants/anticonvulsants requires consideration of numerous possible pharmacodynamic and pharmacokinetic interactions.
Asunto(s)
Analgésicos Opioides/administración & dosificación , Analgésicos/administración & dosificación , Dolor en Cáncer/tratamiento farmacológico , Dolor Crónico/tratamiento farmacológico , Manejo del Dolor/métodos , Cuidados Paliativos/métodos , Anticonvulsivantes/administración & dosificación , Antidepresivos/administración & dosificación , Dolor en Cáncer/prevención & control , Enfermedad Crónica , Dolor Crónico/prevención & control , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Combinación de Medicamentos , Monitoreo de Drogas/métodos , Medicina Basada en la Evidencia , Alemania , Humanos , Dimensión del Dolor/efectos de los fármacos , Resultado del TratamientoRESUMEN
In Germany, approximately half a million people suffer from cancer pain, which is one of the most common first symptoms of tumor disease in 20-40% of the patients. The prevalence increases during the course of the disease to approximately 90% among patients in a palliative care unit. Treatment in the field of cancer pain is often provided by interdisciplinary teams of different pain or palliative care services. Due to the high availability of opioids and also, in European comparison, of a high number of specialized services in hospice and palliative care provision, Germany plays a special role next to Great Britain. There is a great need for the further development of the coordination and networking of these services within Germany, which is regulated by the Hospice and Palliative Act. The cross-sectional curricula QB 13 (palliative medicine) and QB 14 (pain medicine) were implemented in German medical faculties in order to improve integration of cancer pain management into the teaching of medical students. Research in the area of cancer pain addresses clinical topics such as the availability of opioids, but also basic research including genetic variability as a predictor for the efficacy of opioids and the neurobiology of cancer pain.
Asunto(s)
Dolor en Cáncer/terapia , Manejo del Dolor/métodos , Cuidados Paliativos/métodos , Analgésicos Opioides/uso terapéutico , Dolor en Cáncer/psicología , Terapia Combinada/métodos , Comparación Transcultural , Europa (Continente) , Alemania , Investigación sobre Servicios de Salud , Cuidados Paliativos al Final de la Vida/métodos , Humanos , Comunicación Interdisciplinaria , Colaboración Intersectorial , Sociedades Médicas , Investigación Biomédica TraslacionalRESUMEN
Quantitative sensory testing (QST) is a standardized and formalized set of clinical sensitivity tests based on subjective (psychophysical) methods, which depends on the cooperation of the subject being investigated. Calibrated stimuli are used to measure the perception and pain thresholds, which provide information on the presence of sensory plus or minus signs. The QST equipment presented mimics natural thermal or mechanical stimuli. The rationale is to test for patterns of functional sensory loss or gain by simultaneous assessment of both cutaneous and deep pain sensitivity. The majority of QST parameters are normally distributed only after logarithmic transformation (i.e. secondary normalization). With QST a complete somatosensory profile can be obtained within 1 h. The QST is a suitable method for characterizing the function of the somatosensory system in clinical trials and also in clinical practice as a diagnostic procedure.
Asunto(s)
Percepción del Dolor , Umbral del Dolor , Psicofísica/métodos , Umbral Diferencial , Humanos , Hiperalgesia/diagnósticoRESUMEN
INTRODUCTION: Itch can be reduced by pain. Activation of sleeping nociceptors (CMi) is a crucial mechanism for the peripheral component of intense and long-lasting pain. Thus, activation of CMi might be especially effective in itch reduction. Electrical stimulation using sinusoidal pulses activates CMi with tolerable pain intensity, whereas short rectangular pulses with low intensity do not. In humans, histaminergic itch is mediated by histamine-sensitive CMi, whereas other pruritogens activate polymodal nociceptors (CM). METHODS: In a psychophysical approach in a balanced crossover repeated-measures design in healthy volunteers, we activated nociceptors by two different electrical stimulation paradigms via a matrix electrode: 4 Hz sinusoidal pulses that activate C-nociceptors including CMi or 4 Hz rectangular stimuli to activate nociceptors excluding CMi. After 5-min stimulation, itch was induced by either histamine iontophoresis or application of cowhage spicules. Itch ratings were assessed via a numerical rating scale (NRS). RESULTS: Electrical 4 Hz sine wave stimulation (0.1 mA) with low pain ratings of 1.5 (NRS; 0-10) induced an axon reflex erythema (3 cm2 ), indicating activation of CMi, whereas rectangular 0.2 ms pulses (average 0.91 mA) with the same pain rating did not. Both electrical stimulation paradigms reduced itch magnitude over time evoked by either histamine or cowhage to a similar extent. Peak maximum itch evoked by histamine was reduced by both stimulation paradigms, but not cowhage maximum itch. DISCUSSION: Since electrical stimulation with the rectangular pulse paradigm reduces itch to a similar extent as the sine wave stimulation paradigm, the input of CMi is not necessarily required for itch suppression. The input of A-fibres and polymodal nociceptors, similarly, as also achieved by scratching, seems to be sufficient for both forms of chemically evoked itch. SIGNIFICANCE: Since activation of CMi does not provide additional benefit for itch suppression, spinal pain pathways transmitted via CM versus CMi have differential effects on itch-processing circuits. This is important knowledge for using electrical matrix stimulation as itch suppressor since activation of sleeping nociceptors either requires significantly painful stimulation paradigms or specialized stimulation paradigms as sinusoidal pulses. An alternative approach using half-sine wave pulses with low pain intensity activating specifically polymodal nociceptors to suppress itch via matrix electrode stimulation may be considered.
Asunto(s)
Dolor Crónico , Nociceptores , Humanos , Piel , Histamina/efectos adversos , Prurito/inducido químicamente , Prurito/terapia , Estimulación EléctricaAsunto(s)
Dolor en Cáncer/terapia , Oncología Médica/normas , Neoplasias/complicaciones , Manejo del Dolor/normas , Adulto , Analgésicos Opioides/normas , Analgésicos Opioides/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Dolor Irruptivo/diagnóstico , Dolor Irruptivo/epidemiología , Dolor Irruptivo/etiología , Dolor Irruptivo/terapia , Dolor en Cáncer/diagnóstico , Dolor en Cáncer/epidemiología , Dolor en Cáncer/etiología , Supervivientes de Cáncer , Europa (Continente) , Humanos , Oncología Médica/métodos , Estadificación de Neoplasias , Neoplasias/diagnóstico , Neoplasias/patología , Neoplasias/terapia , Manejo del Dolor/métodos , Dimensión del Dolor/métodos , Dimensión del Dolor/normas , Dolor Asociado a Procedimientos Médicos/diagnóstico , Dolor Asociado a Procedimientos Médicos/epidemiología , Dolor Asociado a Procedimientos Médicos/etiología , Dolor Asociado a Procedimientos Médicos/terapia , Prevalencia , Sociedades Médicas/normas , Cuidado Terminal/métodos , Cuidado Terminal/normas , Resultado del TratamientoRESUMEN
Palliative care patients do not only suffer from cancer pain but also from painful muscle spasticity due to multiple sclerosis, amyotrophic lateral sclerosis, after stroke or due to dementia if damage of the pyramidal motor system is present. Centrally active muscle relaxants can be helpful also when used as coanalgesics for cancer pain. In addition to opioids other coanalgesics, such as tricyclic antidepressants or serotonin/noradrenalin reuptake inhibitors as well as anticonvulsants (sodium channel and calcium channel blockers) can be helpful if neuropathic cancer pain is present. Idiopathic Parkinsonism or multiple system atrophy leads more to a painful rigor and pain control should be supported here by optimal adjustment of L-DOPA or DOPA agonist therapy. However, pain treatment should always address the psychological, social and spiritual demands of the patient.
Asunto(s)
Analgésicos Opioides/uso terapéutico , Manejo del Dolor/métodos , Manejo del Dolor/tendencias , Dimensión del Dolor/métodos , Dimensión del Dolor/tendencias , Cuidados Paliativos/métodos , Cuidados Paliativos/tendencias , HumanosRESUMEN
BACKGROUND: The therapy of tiredness, weakness and fatigue in palliative care patients is of growing interest. Glucocorticoids and androgens are habitually mentioned drugs for treatment. In this review evidence for glucocorticoids and androgens for these indications in palliative care patients are presented. MATERIALS AND METHODS: A systematic search of PubMed and Embase for studies on glucocorticoids and androgens for fatigue, asthenia, sedation, tiredness, weakness, exhaustion, cachexia, drowsiness and wasting in palliative care was carried out in August 2011. Furthermore, the Cochrane Library, references from the literature and leading textbooks were also searched. Study information was entered in a standardized extraction sheet. By a categorization of studies five endpoints were distinguished: fatigue, strength/weakness, tiredness, well being/quality of life and energy/activity/performance. RESULTS: A total of 11 controlled studies with glucocorticoids and 13 controlled studies with androgens were included. In addition four uncontrolled studies, two case series and two surveys with glucocorticoids as well as six uncontrolled studies and one case series with androgen treatment were analyzed. All controlled trials of glucocorticoids were performed in cancer patients and all but one controlled trial of androgens in patients with HIV/AIDS. Glucocorticoids improved quality of life but results for changes of fatigue and weakness were inconsistent. Tiredness and energy were not improved. Androgens had a positive effect on fatigue and quality of life and showed variable effects on weakness. Androgens did not improve energy. Side effects were frequently documented but only rarely resulted in discontinuation of therapy. CONCLUSION: With the existing evidence no general recommendation for glucocorticoid and androgen use in tiredness and weakness in palliative care patients can be given; however, glucocorticoids in cancer patients and androgens in HIV positive-patients can be used in an individual trial for improving patient quality of life. The use in patients suffering from other disease entities should be evaluated in randomized controlled trials with a similar setting. The English full text version of this article will be available in SpringerLink as of November 2012 (under "Supplemental").
Asunto(s)
Fatiga/tratamiento farmacológico , Glucocorticoides/uso terapéutico , Letargia/tratamiento farmacológico , Cuidados Paliativos/métodos , Caquexia/tratamiento farmacológico , Caquexia/psicología , Ensayos Clínicos Controlados como Asunto , Medicina Basada en la Evidencia , Fatiga/psicología , Glucocorticoides/efectos adversos , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/psicología , Humanos , Letargia/psicología , Neoplasias/tratamiento farmacológico , Neoplasias/psicología , Cuidados Paliativos/psicología , Calidad de Vida/psicología , Síndrome Debilitante/tratamiento farmacológico , Síndrome Debilitante/psicologíaRESUMEN
The Drug Commission of the German Medical Association has decided to develop treatment guidelines for palliative care. A series of systematic reviews was commissioned to evaluate the evidence for interventions of common symptoms that burden patients and care givers. A common methodology for all reviews is described in this paper. The methodology was based on the work of the European Palliative Care Research Collaborative. Standardized search strategies were identified in PubMed and Embase and these templates were then adapted by the authors of the reviews according to their needs. The template included the target group (patients and disease entities), indications (symptoms) and interventions (medicines and classes of medicines). Target groups included search terms on palliative or hospice care, cancer, neurodegenerative diseases, HIV/AIDS as well as cardiac and pulmonary failure. The number of relevant hits was surveyed in the first 40 hits in some exemplary searches. This was used for fine tuning the search templates and to optimize the search strategy in order to achieve the highest possible yield with the minimum possible effort. The review series was performed using this search strategy. Every review graded the quality of the included evidence following categories of the Drug Commission of the German Medical Association. Based on these results and recommendations the treatment guidelines will be formulated which will offer concise and evidence-based guidelines for general palliative medicine, offering primary care givers guidance for adequate palliative care in severely ill and dying patients. The English full text version of this article will be available in SpringerLink as of November 2012 (under "Supplemental").
Asunto(s)
Quimioterapia/métodos , Medicina Basada en la Evidencia/métodos , Cuidados Paliativos/métodos , Alemania , Humanos , Guías de Práctica Clínica como Asunto , Atención Primaria de Salud , Evaluación de Síntomas/métodos , Resultado del TratamientoRESUMEN
During the course of cancer progression up to 90% of the patients suffer from pain of nociceptive, neuropathic or mixed nociceptive/neuropathic origin. Psychological, social or existential factors may additionally affect the intensity of pain (concept of "total pain"). The WHO "analgesic ladder" provides a large variety of effective drugs that can be used according to the specific pain type. Parenteral or peridural opioid therapy as well as neurodestructive methods can effectively support the analgesic treatment in selected cases.
Asunto(s)
Neoplasias/complicaciones , Dolor Intratable/terapia , Cuidados Paliativos , Analgésicos/uso terapéutico , Analgésicos Opioides/administración & dosificación , Analgésicos Opioides/uso terapéutico , Anticonvulsivantes/uso terapéutico , Cateterismo , Quimioterapia Combinada , Humanos , Procedimientos Neuroquirúrgicos , Dimensión del Dolor , Dolor Intratable/tratamiento farmacológico , Dolor Intratable/epidemiología , Dolor Intratable/etiología , Cuidado TerminalRESUMEN
During the course of cancer progression up to 90% of the patients suffer from pain of nociceptive, neuropathic or mixed nociceptive/neuropathic origin. Psychological, social or existential factors may additionally affect the intensity of pain (concept of "total pain"). The WHO "analgesic ladder" provides a large variety of effective drugs that can be used according to the specific pain type. Parenteral or peridural opioid therapy as well as neurodestructive methods can effectively support the analgesic treatment in selected cases.
Asunto(s)
Analgésicos/administración & dosificación , Neoplasias/complicaciones , Neoplasias/tratamiento farmacológico , Dolor/complicaciones , Dolor/tratamiento farmacológico , Cuidados Paliativos/métodos , Cuidado Terminal/métodos , Alemania , Humanos , Resultado del TratamientoRESUMEN
BACKGROUND: Palliative care in nursing homes has become an increasing focal point of healthcare in Germany and the evaluation of the specific quality of palliative care in this setting is under discussion. The assessment of quantitative data has the advantage of allowing pre-post comparisons of different interventions and implementation procedures and can therefore be used for evaluation of effectiveness. However, no assessment tool in German is available yet. Recent research on the assessment of healthcare professionals' knowledge indicated that knowing about technical and psychosocial aspects of palliative care is an easily measurable index for the quality of care. In consequence this index will be used as the core of the test instrument. The specific self-efficacy related to palliative care should be additionally included. METHOD: An analysis of the two most common tests of palliative care knowledge by three experts revealed that these instruments were only partly useful in Germany because of differences in the healthcare systems. The experts also criticised that the tests included only a few items concerning psychosocial care and that these items often showed ceiling effects. In addition, the instruments were not suitable for use in nursing homes. For specific self-efficacy only one test is available in Dutch. The items of these three instruments were face validated by 5 experts and new items were generated where needed. The content validity was verified again by five experts with the think-aloud method. Items were validated in 23 calliative care trainers whose expert knowledge served as an external criterion. Items that scored low in this group were eliminated. A second sample of 36 assistant nurses working in nursing homes who took part in a workshop for palliative care was used to assess change sensitivity before and after training. RESULTS: A total of 23 items for the knowledge test and 15 items for specific self-efficacy were selected. The level of difficulty was suitable because an expert group could answer the questions while for assistant nurses the items were sufficiently difficult to show a difference between groups. Items were very sensitive to change after a training course. CONCLUSION: The BPW is the first standardized test instrument for palliative care in the German language. In comparison to the other tests it includes items from the psychosocial domain without demonstrating a ceiling effect for these items. Content and criterion validity were good. Additional tests with larger samples and with other groups of nurses working in other settings would be needed to improve the data on reliability and to extend the validation to other settings.
Asunto(s)
Competencia Clínica , Comparación Transcultural , Evaluación Educacional/estadística & datos numéricos , Hogares para Ancianos , Casas de Salud , Personal de Enfermería/educación , Indicadores de Calidad de la Atención de Salud , Curriculum , Educación Continua en Enfermería , Enfermería Geriátrica/educación , Alemania , Humanos , Asistentes de Enfermería/educación , Psicometría/estadística & datos numéricos , Reproducibilidad de los Resultados , Autoeficacia , Encuestas y Cuestionarios , TraducciónRESUMEN
BACKGROUND: This feasibility study addresses the applicability of matrix electrodes for the reduction of ongoing pain in cancer patients via low-frequency electrical stimulation (LFS). METHODS: Low-frequency matrix stimulation (4 Hz) was applied to the skin within the 'Head's zones' referring to the tumour localization of cancer pain patients. Pain at baseline was compared to a 3-day treatment interval consisting of 5 min of matrix stimulation in the morning and evening followed by a 3-day follow-up period without therapy. Main outcome parameters included numeric rating scale values (rating scale 0-100), painDETECT, HADS, and German pain questionnaire, as well as the opioid intake, calculated as the oral morphine equivalent (OME). RESULTS: Twenty patients with cancer pain (aged 64.4 ± 10.3; 9 women) were examined. In the majority of patients, the pain was classified as nociceptive. The mean pain reduction achieved by matrix therapy was 30%, under stable daily controlled-release opioid doses between 177 and 184 mg/day (OME). Seventeen patients (85%) were responders, defined by a pain reduction of at least 30%, while four responders experienced a pain reduction of over 50%. The only side effect was short-term erythema. CONCLUSION: Findings are consistent with the concept of synaptic long-term depression in cancer pain induced after conditioning LFS. Despite the short, but well-tolerated, treatment duration of 2 × 5 min/day, effects persisted throughout the 3-day follow-up. SIGNIFICANCE: Cutaneous neuromodulation using LFS via a matrix electrode has been shown to be a safe intervention for effectively reducing cancer pain in palliative care patients.
Asunto(s)
Dolor en Cáncer/terapia , Terapia por Estimulación Eléctrica/métodos , Anciano , Analgésicos Opioides/uso terapéutico , Dolor en Cáncer/tratamiento farmacológico , Terapia por Estimulación Eléctrica/efectos adversos , Estudios de Factibilidad , Femenino , Humanos , Depresión Sináptica a Largo Plazo , Masculino , Persona de Mediana Edad , Dimensión del Dolor/métodos , Resultado del TratamientoRESUMEN
Dysarthria is a frequent symptom in cerebral ischaemia. However, speech characteristics of these patients have not previously been investigated in relation to lesion site in a prospective study. We investigated the auditory perceptual features in 62 consecutive patients with dysarthria due to a single, non-space-occupying cerebral infarction confirmed by MRI. Standardized speech samples of all patients were stored within 72 h after stroke onset using a digital tape recorder. Speech samples were assessed independently by two experienced speech therapists, who were unaware of the clinical and neuroradiological findings, using an interval scale ranging from 0 to 6. Separately assessed were features of articulation, phonation, prosody, and the global severity for a total of 31 items. Extracerebellar infarctions (85.5%) were located in the lower motor cortex (14.5%), striatocapsular region (46.8%) and base of the pons (24.2%). Isolated cerebellar infarctions were present in 14.5% of patients. There was a strong correlation between the findings of both examiners, showing identical scores, or only minor differences (<1 on the assessment scale) for 80% of all items. The average severity of dysarthria was 2.9 +/- 1.3. Articulatory abnormalities were the predominant deviation characteristics, affecting in particular the production of consonants. However, phonatory and prosodic abnormalities were also frequently observed speech characteristics. As revealed by factor analysis of speech characteristics the total severity of dysarthria was mainly influenced by the impairment of articulation. Speech parameters describing characteristics of articulation and prosody showed significant side-to-side and area differences, while this effect was lacking for any voice parameter. Left cerebral lesions showed a more severe overall impairment of speech and articulation, independent of lesion topography. Thirty-eight of 62 patients were available for follow-up. Speech evaluation showed normal speech within weeks in 15 out of 38 patients (39.5%). In the other 23 patients overall severity of dysarthria was mild. This is the first prospective study which describes speech characteristics of dysarthria due to acute unilateral cerebral infarctions. We could demonstrate that dysarthria in extracerebellar infarctions was more frequently caused by left-sided lesions and that the severity of dysarthria was more pronounced in left-sided lesions independent from lesion topography. All extracerebellar lesions were located along the course of the cortico-bulbar tract fibres. Compatible with a common pathophysiological basis of dysarthria in these patients, none of the 31 speech items differed significantly between subcortical and brainstem lesions.