Symptom burden in malignant and non-malignant disease on admission to a palliative care unit.

BACKGROUND: There is increasing recognition that patients with non-malignant diseases have comparable physical and psychosocial symptom burden to patients with cancer. There is currently limited data directly comparing symptom burden between these patient groups. OBJECTIVE: To investigate differences in symptom burden between patients with malignant and non-malignant conditions admitted to a palliative care unit (PCU). METHOD: A cross-sectional study involving 186 patients admitted to a PCU was undertaken. Patients were dichotomised into malignant or non-malignant disease categories. Symptom burden at admission was assessed using the Symptom Assessment Scale and Palliative Care Problem Severity Score. Group differences in symptoms were analysed using univariate and multivariate approaches. RESULTS: One hundred patients (53.8%) had cancer, with upper gastrointestinal the most common type (18.0%). Among the 86 patients with non-malignant disease, neurological conditions were most prevalent (40.7%). Patients admitted with non-malignant diseases were older, more functionally impaired and more likely to be deteriorating or terminal. A malignant diagnosis was associated with a higher likelihood of clinician-assessed pain, patient-assessed pain, fatigue, psychological/spiritual symptoms and other symptoms. However, when adjusted for confounders, disease category ceased to be a significant predictor of symptom burden. Younger patients experienced worse pain and patients in terminal phase experienced less symptom burden. CONCLUSION: Symptom burden was similar between patients with malignant and non-malignant disease after adjustment for confounders. Further research is needed to understand the palliative care needs of patients with non-malignant disease.

Decontamination options for indoor surfaces contaminated with realistic fentanyl preparations.

The significant increase in illegal use of the synthetic opioid fentanyl is leading to unintentional overdose fatalities. Spills of fentanyl where it is abused or prepared for illegal distribution can result in persistent contamination of areas. Remediation can be attempted through physical removal but may benefit greatly from application of decontamination solutions that provide in-situ degradation of fentanyl. This work investigates the efficacy of decontamination technologies for degradation of fentanyl-HCl on indoor surfaces. Decontamination studies were conducted to evaluate the oxidative degradation of fentanyl based on percarbonate, hydrogen peroxide, peracetic acid, and chlorine (bleach) chemistries. This study utilized an experimental design relevant to field operations to provide direct information to first or hazardous materials responders and providers of environmental fentanyl remediation services, who may otherwise rely on unverified approaches. Across a range of nonporous indoor surfaces, results suggest that water (with or without detergent) spraying alone can physically remove 70-90% of fentanyl (with all fentanyl recovered in runoff). In nearly all cases, the spray application of peracetic acid or acetified bleach oxidants resulted in statistically significant degradation of fentanyl (>95% reduction), with noticeably lower efficacy for other oxidants (e.g., pH neutral bleach and OxiClean™). The decontamination efficacy was significantly reduced upon the addition of cutting agents that competed for oxidant demand.

Surface decontamination for blister agents Lewisite, sulfur mustard and agent yellow, a Lewisite and sulfur mustard mixture.

Sulfur mustard (HD) and Lewisite (L) are blister agents that have a high potential for terrorist use; Agent Yellow (HL) is the eutectic mixture of HD and L. Bench-scale testing was used to determine the residual amount of these chemical warfare agents remaining on three building materials (wood, metal and glass) after application of various decontaminants (household bleach, full strength and dilute; hydrogen peroxide 3% solution; and EasyDECON(®) DF200). All decontaminants reduced the amount of L recovered from coupons. Application of dilute bleach showed little or no difference compared to natural attenuation in the amount of HD recovered from coupons. Full-strength bleach was the most effective of four decontaminants at reducing the amount of HD from coupons. Hydrogen peroxide (3% solution) and DF200 did decrease the amount of HD recovered from coupons more than natural attenuation (except DF200 against HD on metal), but substantial amounts of HD remained on some materials. Toxic HD by-products were generated by hydrogen peroxide treatment. The effectiveness of decontaminants was found to depend on agent, material, and decontaminant. Increased decontaminant reaction time (60min rather than 30min) did not significantly increase effectiveness.