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2.
J Bras Nefrol ; 42(2 suppl 1): 44-46, 2020 Aug 26.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32877499

RESUMO

INTRODUCTION: Palliative care is an approach aimed at relieving suffering, controlling symptoms and seeking to improve quality of life. It must be offered in conjunction with standard treatment for any disease that threatens the continuation of life, such as a Covid-19 infection. DISCUSSION: The bioethical principles and strategies used by palliative medicine can assist nephrologists in the care of patients with renal dysfunction, who face the difficulties of isolation at the beginning and follow-up of dialysis in outpatient treatment, and those who are at risk for a more serious disease progress. Some of them: - a Shared decision making, which enables the patient and family to participate as facilitators in the systematization of the team's reasoning, in addition to respecting the principle of autonomy; - Symptom Management: which should be a priority to ensure relief of suffering even in times of social isolation; - Communication skills: making it possible to alleviate suffering in announcing bad news or complex decisions through communication techniques;; - Bereavement assistance: which in acute situations such as the pandemic, causing unexpected losses, the importance of sympathy from healthcare professionals becomes even greater. CONCLUSION: The principles of palliative care are essential to face the challenges of a planet-wide crisis, which raises human suffering in all dimensions, and which requires the construction of strategies that can keep patients assisted, comfortable and with measures proportional to their clinical condition and preferences.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Cuidados Paliativos/métodos , Pneumonia Viral/epidemiologia , Terapia de Substituição Renal/normas , Luto , Comunicação , Tomada de Decisão Compartilhada , Humanos , Nefrologia/normas , Pandemias , Terapia de Substituição Renal/métodos , Avaliação de Sintomas/métodos
3.
Pediatr Clin North Am ; 67(5): 945-962, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32888691

RESUMO

Hypoplastic left heart syndrome (HLHS) is a complex form of congenital heart disease defined by anatomic and functional inadequacy of the left side of the heart with nonviability of the left ventricle to perform systemic perfusion. Lethal if not treated, a strategy for survival currently is well established, with continuing improvement in outcomes over the past 30 years. Prenatal diagnosis, good newborn care, improved surgical skills, specialized postoperative care, and unique strategies for interstage monitoring all have contributed to increasing likelihood of survival. The unique life with a single right ventricle and a Fontan circulation is a focused area of investigation.


Assuntos
Técnica de Fontan/métodos , Ventrículos do Coração/anormalidades , Síndrome do Coração Esquerdo Hipoplásico/diagnóstico , Cuidados Paliativos/métodos , Diagnóstico Pré-Natal/métodos , Feminino , Ventrículos do Coração/fisiopatologia , Humanos , Síndrome do Coração Esquerdo Hipoplásico/fisiopatologia , Síndrome do Coração Esquerdo Hipoplásico/cirurgia , Recém-Nascido , Gravidez
4.
Einstein (Sao Paulo) ; 18: eAO5395, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32935826

RESUMO

OBJECTIVE: To investigate the prevalence of palliative sedation use and related factors. METHODS: An observational study based on data collected via electronic questionnaire comprising 23 close-ended questions and sent to physicians living and working in the state of São Paulo. Demographic data, prevalence and frequency of palliative sedation use, participant's familiarity with the practice and related motivating factors were analyzed. In order to minimize memory bias, questions addressing use frequency and motivating factors were limited to the last year prior to survey completion date. Descriptive statistics were used to summarize data. RESULTS: In total, 20,168 e-mails were sent and 324 valid answers obtained, resulting in 2% adherence. The overall prevalence of palliative sedation use over the course of professional practice was 68%. However, only 48% of respondents reported having used palliative sedation during the last year, primarily to relieve pain (35%). The frequency of use ranged from one to six times (66%) during the study period and the main reason for not using was the lack of eligible patients (64%). Approximately 83% of physicians felt comfortable using palliative sedation but only 26% reported having specific academic training in this field. CONCLUSION: The prevalence of palliative sedation use is high, the primary indication being pain relief. However, frequency of use is low due to lack of eligible patients.


Assuntos
Hipnóticos e Sedativos/uso terapêutico , Cuidados Paliativos/estatística & dados numéricos , Assistência Terminal , Planejamento Antecipado de Cuidados/ética , Humanos , Dor , Cuidados Paliativos/ética , Cuidados Paliativos/métodos , Prevalência
6.
JCO Glob Oncol ; 6: 1298-1305, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32795196

RESUMO

PURPOSE: As a result of their immunocompromised status associated with disease and treatment, patients with cancer face a profound threat for higher rates of complications and mortality if they contract the coronavirus disease 2019 infection. Medical oncology communities have developed treatment modifications to balance the risk of contracting the virus with the benefit of improving cancer-related outcomes. METHODS: We systemically examined our community cancer center database to display patterns of change and to unveil factors that have been considered with each decision. We studied a cohort of 282 patients receiving treatment and found that 159 patients (56.4%) had treatment modifications. RESULTS: The incidence of treatment modification was observed in patients undergoing adjuvant and neoadjuvant (41.4%), palliative (62.9%), or injectable endocrine or bone-modulating only (76.0%) treatments. Modifications were applied to regimens with myelosuppressive (56.5%), immunosuppressive (69.2%), and immunomodulating (61.5%) potentials. These modifications also affected intravenous (54.9%) and subcutaneous injectable treatments (62.5%) more than oral treatments (15.8%). Treatment modifications in 112 patients (70.4%) were recommended by providers, and 47 (29.6%) were initiated by patients. The most common strategy of modification was to skip or postpone a scheduled treatment (49%). Among treatment with no modifications, treatment regimens were maintained in patients who tolerated treatment well (37.0%), in treatments with curative intent (22%), and in symptomatic patients who required treatment (14%). CONCLUSION: Our observation and analysis suggested that the primary goal of treatment modification was to decrease potential exposure. The pattern also reflected the negative impact of the pandemic on health care providers who initiated these changes. Providers have to consider individualized recommendations incorporating multiple factors, such as tolerance, potential toxicity, treatment nature and route, and disease severity.


Assuntos
Antineoplásicos/administração & dosagem , Betacoronavirus , Infecções por Coronavirus , Neoplasias/terapia , Pandemias , Pneumonia Viral , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/efeitos adversos , Antineoplásicos/uso terapêutico , Centros Comunitários de Saúde , Feminino , Humanos , Masculino , Oncologia/normas , Pessoa de Meia-Idade , Terapia Neoadjuvante , Neoplasias/patologia , Cidade de Nova Iorque , Cuidados Paliativos/métodos , Aceitação pelo Paciente de Cuidados de Saúde
7.
Am J Hosp Palliat Care ; 37(11): 992-997, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32762477

RESUMO

Telemedicine technology has become essential to healthcare delivery in the COVID-19 era, but concerns remain regarding whether the intimacy and communication that is central to high-quality palliative care will be compromised by the use of this technology. We employed a business model approach to identify the need for system innovation in palliative care, and a quality improvement approach to structure the project. Products from this project included a standard operating procedure for safe use of tablet computers for inpatient palliative care consultations and family visitations; tablet procurement with installation of video telehealth software; and training and education for clinical staff and other stakeholders. We describe a case illustrating the successful use of palliative care telehealth in the care of a COVID-19-positive patient at the end of life. Successful use of video telehealth for palliative care involved overcoming inertia to the development of telehealth infrastructure and learning clinical video telehealth skills; and engaging front-line care staff and family members who were open to a trial of telehealth for communication. Information gleaned from family about the patient as a person helped bedside staff to tailor care toward aspects meaningful to the patient and family and informed best practices to incorporate intimacy into future palliative video consultations and family visit.


Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Cuidados Paliativos/métodos , Pneumonia Viral/terapia , Telemedicina/métodos , Assistência Terminal/métodos , Família/psicologia , Humanos , Masculino , Pandemias , Melhoria de Qualidade , Visitas a Pacientes
8.
Med Clin North Am ; 104(5): 767-775, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32773044

RESUMO

Goals of care conversations are important but complex for clinicians caring for older adults. Although clinicians tend to focus on specific medical interventions, these conversations are more successful if they begin with gaining a shared understanding of the medical conditions and possible outcomes, followed by discussion of values and goals. Although training in the medical setting is incomplete, there are many published and online resources that can help clinicians gain these valuable skills.


Assuntos
Tomada de Decisão Compartilhada , Cuidados Paliativos , Planejamento de Assistência ao Paciente , Idoso , Competência Clínica , Humanos , Cuidados Paliativos/ética , Cuidados Paliativos/métodos , Cuidados Paliativos/psicologia , Planejamento de Assistência ao Paciente/ética , Planejamento de Assistência ao Paciente/normas , Relações Médico-Paciente
9.
Croat Med J ; 61(3): 215-222, 2020 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-32643337

RESUMO

AIM: To evaluate the efficacy of radiation therapy in alleviating pain and improving the quality of life (QoL) with validated questionnaires in patients with painful bone metastases (BoM). METHODS: This prospective, observational study recruited 167 patients with painful BoM who were treated with palliative radiotherapy (PRT) from February 2015 to February 2018. After the first clinical assessment, the patients filled out specific questionnaires and underwent a fast radiotherapy treatment within 48 hours. The patients were followed up for eight weeks. RESULTS: The median age was 66.30 years. The most common primary cancer was lung cancer (31.1%). The most often prescribed scheme was 8 Gy in one fraction (70%). The patients experienced significant pain response and improved QoL compared with baseline, especially in the first two weeks after radiation. Overall, reduced pain and drug score were reported at two weeks of PRT in 68 (51.5%) and 37 (28%) of patients, respectively. CONCLUSIONS: PRT is an effective treatment option for patients with painful BoM.


Assuntos
Neoplasias Ósseas/radioterapia , Dor do Câncer/radioterapia , Qualidade de Vida/psicologia , Radioterapia Conformacional , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Ósseas/psicologia , Neoplasias Ósseas/secundário , Dor do Câncer/psicologia , Fracionamento da Dose de Radiação , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Cuidados Paliativos/métodos , Estudos Prospectivos , Dosagem Radioterapêutica , Inquéritos e Questionários , Resultado do Tratamento , Adulto Jovem
10.
Age Ageing ; 49(4): 516-522, 2020 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-32725209

RESUMO

Older people are particularly affected by the COVID-19 outbreak because of their vulnerability as well as the complexity of health organisations, particularly in the often-compartmentalised interactions between community, hospital and nursing home actors. In this endemic situation, with massive flows of patients requiring holistic management including specific and intensive care, the appropriate assessment of each patient's level of care and the organisation of specific networks is essential. To that end, we propose here a territorial organisation of health care, favouring communication between all actors. This organisation of care is based on three key points: To use the basis of territorial organisation of health by facilitating the link between hospital settings and geriatric sectors at the regional level.To connect private, medico-social and hospital actors through a dedicated centralised unit for evaluation, geriatric coordination of care and decision support. A geriatrician coordinates this multidisciplinary unit. It includes an emergency room doctor, a supervisor from the medical regulation centre (Centre 15), an infectious disease physician, a medical hygienist and a palliative care specialist.To organise an ad hoc follow-up channel, including the necessary resources for the different levels of care required, according to the resources of the territorial network, and the creation of a specific COVID geriatric palliative care service. This organisation meets the urgent health needs of all stakeholders, facilitating its deployment and allows the sustainable implementation of a coordinated geriatric management dynamic between the stakeholders on the territory.


Assuntos
Infecções por Coronavirus , Avaliação Geriátrica/métodos , Serviços de Saúde para Idosos , Pandemias , Administração dos Cuidados ao Paciente , Pneumonia Viral , Programas Médicos Regionais/organização & administração , Idoso , Betacoronavirus/isolamento & purificação , Redes Comunitárias/organização & administração , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , França/epidemiologia , Alocação de Recursos para a Atenção à Saúde/tendências , Serviços de Saúde para Idosos/ética , Serviços de Saúde para Idosos/organização & administração , Serviços de Saúde para Idosos/tendências , Humanos , Inovação Organizacional , Cuidados Paliativos/métodos , Pandemias/prevenção & controle , Administração dos Cuidados ao Paciente/ética , Administração dos Cuidados ao Paciente/organização & administração , Administração dos Cuidados ao Paciente/tendências , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Web Semântica , Participação dos Interessados
11.
Am J Hosp Palliat Care ; 37(11): 980-984, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32691604

RESUMO

As the spread of the novel coronavirus disease 2019 (COVID-19) continues worldwide, health care systems are facing increased demand with concurrent health care provider shortages. This increase in patient demand and potential for provider shortages is particularly apparent for palliative medicine, where there are already shortages in the provision of this care. In response to the developing pandemic, our Geriatrics and Palliative (GAP) Medicine team formulated a 2-team approach which includes triage algorithms for palliative consults as well as acute symptomatic management for both patients diagnosed with or under investigation (PUI) for COVID-19. These algorithms provided a delineated set of guidelines to triage patients in need of palliative services and included provisions for acute symptoms management and the protection of both the patient care team and the families of patients with COVID-19. These guidelines helped with streamlining care in times of crisis, providing care to those in need, supporting frontline staff with primary-level palliative care, and minimizing the GAP team's risk of infection and burnout during the rapidly changing pandemic response.


Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Cuidados Paliativos/métodos , Pandemias , Planejamento de Assistência ao Paciente , Pneumonia Viral/terapia , Triagem/métodos , Algoritmos , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Acesso aos Serviços de Saúde , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Cuidados Paliativos/normas , Pandemias/prevenção & controle , Planejamento de Assistência ao Paciente/normas , Equipe de Assistência ao Paciente , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle
12.
Am J Hosp Palliat Care ; 37(11): 988-991, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32705889

RESUMO

OBJECTIVES: A vital component of the coronavirus response is care of the dying COVID-19 patient. We document the demographics, symptoms experienced, medications required, effectiveness observed, and challenges to high-quality holistic palliative care in 31 patients. This will aid colleagues in primary and secondary care settings anticipate common symptoms and formulate management plans. METHODS: A retrospective survey was conducted of patients referred to the hospital palliative care service in a tertiary hospital, south east of England between March 21 and April 26, 2020. Patients included had a confirmed laboratory diagnosis of COVID-19 via reverse transcription polymerase chain reaction nasopharyngeal swab for SARS-Cov-2 or radiological evidence of COVID-19. RESULTS: The thirty-one patients included were predominantly male (77%), elderly (median [interquartile range]: 84 [76-89]), and had multiple (4 [3-5]) comorbidities. Referral was made in the last 2 [1-3] days of life. Common symptoms were breathlessness (84%) and delirium (77%). Fifty-eight percent of patients received at least 1 "as required" dose of an opioid or midazolam in the 24 hours before death. Sixty percent of patients needed a continuous subcutaneous infusion and the median morphine dose was 10 mg S/C per 24 hours and midazolam 10 mg S/C per 24 hours. Nineteen percent of our cohort had a loved one or relative present when dying. CONCLUSION: We provide additional data to the internationally reported pool examining death arising from infection with SARS-CoV-19. The majority of patients had symptoms controlled with low doses of morphine and midazolam, and death was rapid. The impact of low visitation during dying needs exploring.


Assuntos
Infecções por Coronavirus/terapia , Cuidados Paliativos , Pneumonia Viral/terapia , Visitas a Pacientes , Idoso , Idoso de 80 Anos ou mais , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/prevenção & controle , Feminino , Humanos , Masculino , Cuidados Paliativos/métodos , Pandemias/prevenção & controle , Pneumonia Viral/mortalidade , Pneumonia Viral/prevenção & controle , Estudos Retrospectivos , Inquéritos e Questionários
13.
Am J Hosp Palliat Care ; 37(11): 985-987, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32720520

RESUMO

CONTEXT: The coronavirus disease 2019 (COVID-19) pandemic laid bare the immediate need for primary palliative care education for many clinicians. Primary care clinicians in our health system reported an urgent need for support in advance care planning and end-of-life symptom management for their vulnerable patients. This article describes the design and dissemination of palliative care education for primary care clinicians using an established curriculum development method. OBJECTIVES: To develop a succinct and practical palliative care toolkit for use by primary care clinicians during the COVID-19 pandemic, focused on 2 key elements: (i) advance care planning communication skills based on the narrative 3-Act Model and (ii) comfort care symptom management at the end of life. RESULTS: The toolkit was finalized through an iterative process involving a team of end-users and experts in palliative care and primary care, including social work, pharmacy, nursing, and medicine. The modules were formatted into an easily navigable, smartphone-friendly document to be used at point of care. The toolkit was disseminated to our institution's primary care network with practices spanning our state. Early feedback has been positive. CONCLUSION: While we had been focused primarily on the inpatient setting, our palliative care team at Johns Hopkins Bayview Medical Center pivoted existing infrastructure and curriculum development expertise to meet the expressed needs of our primary care colleagues during the COVID-19 pandemic. Through collaboration with an interprofessional team including end-users, we designed and disseminated a concise palliative care toolkit within 6 weeks.


Assuntos
Assistência Ambulatorial/métodos , Betacoronavirus , Infecções por Coronavirus/terapia , Cuidados Paliativos/métodos , Pandemias , Pneumonia Viral/terapia , Planejamento Antecipado de Cuidados , Comunicação , Humanos
14.
Cancer Treat Rev ; 89: 102069, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32717621

RESUMO

BACKGROUND: Salivary duct carcinoma (SDC) is an aggressive subtype of salivary gland cancer. Approximately half of SDC patients will develop recurrences or metastases. Therapeutic palliative therapy is therefore often needed. The majority of SDC tumors expresses the androgen receptor (AR) and one-third expresses human epidermal growth factor receptor 2 (HER2), both are potential therapeutic targets. The aim of this paper is to systematically review and summarize the evidence on systemic palliative therapy for SDC and to provide treatment recommendations. MATERIALS AND METHODS: Electronic libraries were systematically searched with a broad search strategy to identify studies where SDC patients received systemic therapy. Due to the rarity of SDC no restrictions were placed on study designs. RESULTS: The search resulted in 2014 articles of which 153 were full-text analyzed. Forty-five studies were included in the analysis, which included in total 256 SDC patients receiving systemic therapy. Two phase 2 trials primarily including SDC patients were identified. The majority of the studies were case series or case reports, resulting in an overall low quality of available evidence. Based on studies including ≥ 5 SDC patients, objective responses to HER2 targeting agents were observed in 60-70%, to AR pathway agents in 18-53% and to chemotherapy in 10-50%. CONCLUSION: For AR or HER2 positive SDC, agents targeting these pathways are the cornerstone for palliative treatment. Regarding chemotherapy, the combination of carboplatin combined with a taxane is best studied. Regarding other targeted agents and immunotherapy evidence is anecdotal, limiting formulation of treatment recommendations for these antineoplastic agents.


Assuntos
Carcinoma Ductal/tratamento farmacológico , Recidiva Local de Neoplasia/tratamento farmacológico , Ductos Salivares/patologia , Neoplasias das Glândulas Salivares/tratamento farmacológico , Carcinoma Ductal/metabolismo , Carcinoma Ductal/patologia , Ensaios Clínicos como Assunto , Humanos , Metástase Neoplásica , Recidiva Local de Neoplasia/metabolismo , Recidiva Local de Neoplasia/patologia , Cuidados Paliativos/métodos , Receptor ErbB-2/metabolismo , Ductos Salivares/metabolismo , Neoplasias das Glândulas Salivares/metabolismo , Neoplasias das Glândulas Salivares/patologia
15.
J Cancer Res Clin Oncol ; 146(10): 2575-2587, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32715436

RESUMO

BACKGROUND: Limited treatment options are available in chemotherapy-refractory metastatic colorectal cancer (mCRC). The objective was to conduct a systematic literature review (SLR) and exploratory network meta-analysis (NMA) to compare the tolerability and effectiveness of SIRT with Y-90 resin microspheres, regorafenib, TAS-102 (trifluridine/tipiracil), and best supportive care (BSC) as third-line treatment in patients with mCRC. METHODS: An SLR was conducted to identify studies comparing two or more of the treatments and reporting overall survival (OS), progression-free survival, tumor response, or adverse event (AE) incidence. An exploratory NMA was conducted to compare hazard ratios (HRs) for OS using Markov chain Monte Carlo (MCMC) techniques. RESULTS: Seven studies were identified in the SLR: two double-blind randomized-controlled trials (RCT) for each drug, one open-label RCT, and two non-randomized comparative studies for SIRT. Patient selection criteria differed between studies, with SIRT studies including patients with liver-dominant colorectal metastases. Nausea and vomiting were more frequent with TAS-102 than regorafenib or SIRT; diarrhea was more common with TAS-102 and regorafenib than SIRT. The exploratory NMA suggested that all active treatments improved OS, with HRs of 0.48 (95% CrI 0.30-0.78) for SIRT with Y-90 resin microspheres, 0.63 (0.38-1.03) for TAS-102, and 0.67 (0.40-1.08) for regorafenib each compared to BSC. CONCLUSIONS: Regorafenib, TAS-102 and SIRT using Y-90 resin microspheres are more effective than BSC in third-line treatment of mCRC; however, study heterogeneity made comparisons between active treatments challenging. SIRT is a viable treatment for third-line mCRC and its favorable AE profile should be considered in the therapeutic decision-making process.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Braquiterapia/métodos , Neoplasias Colorretais/dietoterapia , Neoplasias Colorretais/radioterapia , Compostos de Fenilureia/uso terapêutico , Piridinas/uso terapêutico , Pirrolidinas/uso terapêutico , Trifluridina/uso terapêutico , Uracila/análogos & derivados , Radioisótopos de Ítrio/administração & dosagem , Método Duplo-Cego , Combinação de Medicamentos , Humanos , Microesferas , Metástase Neoplásica , Metanálise em Rede , Cuidados Paliativos/métodos , Compostos de Fenilureia/administração & dosagem , Intervalo Livre de Progressão , Piridinas/administração & dosagem , Pirrolidinas/administração & dosagem , Ensaios Clínicos Controlados Aleatórios como Assunto , Trifluridina/administração & dosagem , Uracila/administração & dosagem , Uracila/uso terapêutico
16.
Eur Respir J ; 56(3)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32675211

RESUMO

BACKGROUND: Many people are dying from coronavirus disease 2019 (COVID-19), but consensus guidance on palliative care in COVID-19 is lacking. This new life-threatening disease has put healthcare systems under pressure, with the increased need of palliative care provided to many patients by clinicians who have limited prior experience in this field. Therefore, we aimed to make consensus recommendations for palliative care for patients with COVID-19 using the Convergence of Opinion on Recommendations and Evidence (CORE) process. METHODS: We invited 90 international experts to complete an online survey including stating their agreement, or not, with 14 potential recommendations. At least 70% agreement on directionality was needed to provide consensus recommendations. If consensus was not achieved on the first round, a second round was conducted. RESULTS: 68 (75.6%) experts responded in the first round. Most participants were experts in palliative care, respiratory medicine or critical care medicine. In the first round, consensus was achieved on 13 recommendations based upon indirect evidence and clinical experience. In the second round, 58 (85.3%) out of 68 of the first-round experts responded, resulting in consensus for the 14th recommendation. CONCLUSION: This multi-national task force provides consensus recommendations for palliative care for patients with COVID-19 concerning: advance care planning; (pharmacological) palliative treatment of breathlessness; clinician-patient communication; remote clinician-family communication; palliative care involvement in patients with serious COVID-19; spiritual care; psychosocial care; and bereavement care. Future studies are needed to generate empirical evidence for these recommendations.


Assuntos
Planejamento Antecipado de Cuidados/organização & administração , Infecções por Coronavirus , Cuidados Paliativos , Pandemias , Pneumonia Viral , Sistemas de Apoio Psicossocial , Terapia Respiratória/métodos , Comitês Consultivos , Betacoronavirus/isolamento & purificação , Consenso , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/psicologia , Infecções por Coronavirus/terapia , Europa (Continente) , Humanos , Cuidados Paliativos/métodos , Cuidados Paliativos/organização & administração , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/psicologia , Pneumonia Viral/terapia , Índice de Gravidade de Doença
17.
J Gastrointest Cancer ; 51(3): 800-804, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32656628

RESUMO

PURPOSE: Today, the rapid outbreak of COVID-19 is the leading health issue. Patients with cancer are at high risk for the development of morbidities of COVID-19. Hence, oncology centers need to provide organ-based recommendations for optimal management of cancer in the COVID-19 era. METHODS: In this article, we have provided the recommendations on management of locally advanced rectal cancer during the COVID-19 pandemic based on our experience in Shohada-e Tajrish Hospital, Iran. RESULTS: We recommend that patients with locally advanced rectal cancer should be managed in an individualized manner in combination with local conditions related to COVID-19. CONCLUSION: Our recommendation may provide a guide for oncology centers of developing countries for better management of locally advanced rectal cancer.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/prevenção & controle , Oncologia/normas , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Guias de Prática Clínica como Assunto/normas , Neoplasias Retais/terapia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/normas , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Betacoronavirus/isolamento & purificação , Quimioterapia Adjuvante/normas , Tomada de Decisão Clínica , Consenso , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Humanos , Controle de Infecções/normas , Irã (Geográfico)/epidemiologia , Oncologia/métodos , Terapia Neoadjuvante/normas , Estadiamento de Neoplasias , Cuidados Paliativos/métodos , Cuidados Paliativos/normas , Seleção de Pacientes , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Protectomia/normas , Neoplasias Retais/patologia , Reto/patologia , Reto/cirurgia
18.
Anticancer Res ; 40(7): 3897-3903, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32620630

RESUMO

BACKGROUND/AIM: Previous studies have shown discrepancies between patient's desired and actual death place. As planning of family support and involvement of palliative home care teams seem to improve the chance to meet patients preferences, geographical availability of specialized palliative home care could influence place of death. PATIENTS AND METHODS: Data of patients diagnosed and deceased between January 2011 until December 2014 with lung, brain, colorectal, breast and prostate cancer was collected from Swedish national registers and multiple regression analyses were performed. RESULTS: Patients with lung, brain, colorectal, and prostate cancer who resided in rural municipalities had a higher likelihood of dying at home than dying in hospital settings, compared to those who lived in urban areas. CONCLUSION: Patients in Sweden, with the exception of breast cancer patients, have a higher likelihood of home death than inpatient hospital death when residing in rural areas compared to when residing in urban areas.


Assuntos
Serviços de Assistência Domiciliar/estatística & dados numéricos , Neoplasias/mortalidade , Neoplasias/terapia , Cuidados Paliativos/estatística & dados numéricos , Humanos , Cuidados Paliativos/métodos , Preferência do Paciente , Sistema de Registros , População Rural/estatística & dados numéricos , Suécia/epidemiologia , Assistência Terminal/métodos , Assistência Terminal/estatística & dados numéricos , População Urbana/estatística & dados numéricos
19.
Pediatr Blood Cancer ; 67 Suppl 3: e28324, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32614139

RESUMO

Traditional and complementary medicine (T&CM) strategies are commonly used by pediatric cancer patients. Nutritional approaches to T&CM include bioactive compounds, supplements, and herbs as well as dietary approaches. Pediatric cancer patients and their families commonly request and use nutritional T&CM strategies. We review the potential risks and benefits of nutritional T&CM use in pediatric cancer care and provide an overview of some commonly used and requested supplements, including probiotics, antioxidants, cannabinoids, vitamins, turmeric, mistletoe, Carica papaya, and others. We also discuss the role of specific diets such as the ketogenic diet, caloric restriction diets, whole-food diets, and immune modulating diets. There is a growing body of evidence to support the use of some T&CM agents for the supportive care of children with cancer. However, further study is needed into these agents and approaches. Open communication with families about T&CM use is critical.


Assuntos
Neoplasias/terapia , Apoio Nutricional/métodos , Cuidados Paliativos/métodos , Criança , Suplementos Nutricionais , Humanos , Neoplasias/dietoterapia , Pediatria/métodos , Prebióticos/administração & dosagem , Probióticos/administração & dosagem , Ensaios Clínicos Controlados Aleatórios como Assunto , Vitaminas/administração & dosagem
20.
Am J Hosp Palliat Care ; 37(10): 869-872, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32638632

RESUMO

BACKGROUND: With the highest number of cases in the world as of April 13, 2020, New York City (NYC) became the epicenter of the global coronavirus disease 2019 (COVID-19) pandemic. The data regarding palliative team involvement in patients with COVID-19, however, remains scarce. We aimed to investigate outcomes of palliative team involvement for the patients with COVID-19 in NYC. METHODS: Consecutive 225 patients with confirmed COVID-19 requiring hospitalization in our urban academic medical center in NYC were analyzed. Patients were divided into 2 groups, those with a palliative care consult (palliative group: 14.2% [n = 32]) versus those with no palliative care consult (no palliative group: 85.8% [n = 193]). RESULTS: The palliative group was older and had more comorbidities. During the hospital course, the palliative group had more intensive care unit stays, rapid response team activations, and more use of vasopressors (P < .05). Patients with palliative care had higher rates of invasive mechanical ventilation than those without (46.9% vs 10.4%, P < .001). Cardiopulmonary resuscitation was performed in 12 patients (6.5% vs 5.2%, P = .77) and death rate was 100% in both subsets. Notably, initial code status was not different between the 2 groups, however, code status at discharge was significantly different between them (P < .001). The rate of full code decreased by 70% in the palliative group and by 47.5% in the no palliative care group from admission to the time of death. CONCLUSIONS: Critically ill patients hospitalized for COVID-19 benefit from palliative team consults by helping to clarify advanced directives and minimize futile resuscitative efforts.


Assuntos
Infecções por Coronavirus/terapia , Cuidados Paliativos , Pneumonia Viral/terapia , Diretivas Antecipadas , Idoso , Idoso de 80 Anos ou mais , Reanimação Cardiopulmonar/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque , Cuidados Paliativos/métodos , Pandemias , Equipe de Assistência ao Paciente , Resultado do Tratamento
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