PC-FACS
2019; Elsevier BV; Volume: 59; Issue: 1 Linguagem: Inglês
10.1016/j.jpainsymman.2019.11.002
ISSN1873-6513
Autores Tópico(s)Diet and metabolism studies
ResumoPC-FACS (Fast Article Critical Summaries for Clinicians in Palliative Care) provides hospice and palliative care clinicians with concise summaries of the most important findings from more than 100 medical and scientific journals. If you have colleagues who would benefit from receiving PCFACS, please encourage them to join the AAHPM at aahpm.org. Comments from readers are welcomed at [email protected]. PC-FACS (Fast Article Critical Summaries for Clinicians in Palliative Care) provides hospice and palliative care clinicians with concise summaries of the most important findings from more than 100 medical and scientific journals. If you have colleagues who would benefit from receiving PCFACS, please encourage them to join the AAHPM at aahpm.org. Comments from readers are welcomed at [email protected]. Effect of Nalbuphine on Pain Liang RJ, Lai YH, Kao YT, Yang TH, Chen YL, Wang HJ. A novel finding of nalbuphine-6 glucuronide, an active opiate metabolite, possessing potent antinociceptive effects: synthesis and biological evaluation. Eur J Med Chem. 2019;178:544-551. Validating Medical Records Mirarchi FL, Juhasz K, Cooney TE, et al. TRIAD XII: are patients aware of and agree with DNR or POLST orders in their medical records. J Patient Saf. 2019;15(3):230-237. Racial Disparities in EOL Care Mayeda DP, Ward KT. Methods for overcoming barriers in palliative care for ethnic/racial minorities: a systematic review [published online ahead of print July 26]. Palliat Support Care. 2019:1-10. https://doi.org/10.1017/S1478951519000403. Adverse Events During Transition Kapoor A, Field T, Handler S, et al. Adverse events in long-term care residents transitioning from hospital back to nursing home [published online ahead of print July 22]. JAMA Intern Med. 2019. https://doi.org/10.1001/jamainternmed.2019.2005. Disease-Specific Advance Care Planning Fritz L, Zwinkels H, Koekkoek JAF, et al. Advance care planning in glioblastoma patients: development of a disease-specific ACP program [published online ahead of print June 26]. Support Care Cancer. 2019. https://doi.org/10.1007/s00520-019-04916-9. QOL of Patients in Locked-In State Kuzma-Kozakiewicz M, Andersen PM, Ciecwierska K, et al. An observational study on quality of life and preferences to sustain life in locked-in state. Neurology. 2019;93(10):e938-e945. Cannabinoid Use in Cancer Patients Chang YD, Jung JW, Oberoi-Jassal R, et al. Edmonton Symptom Assessment Scale and clinical characteristics associated with cannabinoid use in oncology supportive care outpatients. J Natl Compr Canc Netw. 2019;17(9):1059-1064. Rave Reviews Nalbuphine, a semisynthetic opioid, is equipotent to morphine in relieving moderate to severe pain and has no serious side effects.1 What are the antinociceptive effects of fully synthesized nalbuphine metabolites? This pharmacodynamic study synthesized nalbuphine metabolites, nalbuphine-3-glucuronide (N3G), and nalbuphine-6-glucuronide (N6G) and assessed their analgesic effects in rats. Paw pressure (Randall-Selitto) and cold-ethanol tail-flick (CET) tests were conducted to evaluate analgesic response after nalbuphine, N3G, or N6G intracisternal and intraperitoneal administrations. Antinociception was evaluated by calculating area under the time course curve (AUC; trapezoidal method) and duration spent at >50% maximum possible analgesia (%MPA=[(Test-Baseline)/(Cutoff-Baseline)]x100%). Animals (n=6/group) were tested at 15, 30, and 45 minutes premedication to obtain an average baseline of aversive time latency and CET latency (each animal its own control). Tail-flick latency was measured over 2.5 hours (15-minute intervals) postadministration. Analysis used one-factor ANOVA with Tukey's test. In intracisternal administration, N6G exerted potent antinociceptive effects, with 2.8- and 3.5-times higher AUC values than nalbuphine in the Randall-Selitto and CET tests, respectively. However, N3G showed scarce biological activity in the pain tests. The pain relief durations expressed as elapsed times corresponding to the percent analgesic effect >50% MPA were longer with N6G than with nalbuphine or N3G in both pain tests. In intraperitoneal administration, nalbuphine exerted analgesic effects, but N3G and N6G produced no antinociceptive responses. In addition, the pain-relieving durations of nalbuphine in terms of time elapses >50% MPA were <10 minutes in both tests. The highly water-soluble property of N6G likely restricts its antinociceptive effects via common-route administration. All P 28 indicates clinically relevant depression). There was no association of low quality of life/depression with time since diagnosis (r<0.03) or progression (r<0.3). The 5 patients with ALSFRS-R=0 (no extremity movement abilities and anarthria) reported positive quality of life and no depression. Information-seeking increased with time since diagnosis only (r=0.60) but no other association of coping strategies (Motor Neuron Disease Coping Scale) and clinical measures was found (r<0.3). Seventeen out of 19 would again select invasive ventilation/PEG. Patients had a median=4.5 (Q=2–7.25) wish for hastened death (Schedule of Attitudes Toward Hastened Death; range=0–20, ≥10 indicates clinically significant wish). Lastly, caregivers overestimated depressiveness (U=78, P=0.004) and underestimated quality of life (U=136, P=0.20). For many healthy individuals, LIS is feared to be the worst possible outcome. Despite severe physical limitations, some patients with LIS have been able to adapt to the condition and maintain a positive sense of well-being. They would again choose life-sustaining treatments and report a low desire for hastened death. Psychosocial adaptation to allow for successful coping by readjusting expectations, reframing what is important in life, and looking at things from a different perspective all helped patients maintain good quality of life. In contrast, their caregivers underestimated quality of life and overestimated depression. Contrary to public opinion, severe physical limitation does not necessarily correlate with poor quality of life. Rather, deliberate reappraisals can increase a patient's sense of well-being. Ritika Oberoi-Jassal, MD HMDC, Department of Geriatrics, James A. Haley Veterans Affairs, Tampa, FL Kuzma-Kozakiewicz M, Andersen PM, Ciecwierska K, et al. An observational study on quality of life and preferences to sustain life in locked-in state. Neurology. 2019;93(10):e938-e945. 1.Plum F, Posner JB. The Diagnosis of Stupor and Coma. Philadelphia, PA: F. A. Davis Company; 1966.2.Cedarbaum JM, Stambler N, Malta E, et al. The ALSFRS-R: a revised ALS functional rating scale that incorporates assessments of respiratory function: BDNF ALS Study Group (Phase III). J Neurol Sci. 1999;169(1-2):13-21.3.O'Boyle C, McGee H, Hickey A, et al; Royal College of Surgeons in Ireland. The schedule for the evaluation of individual quality of life (SEIQoL). Administration manual. epubs.rcsi.ie/psycholrep/39. Published 1993.4.Hammer EM, Hacker S, Hautzinger M, Meyer TD, Kübler A. Validity of the ALS Depression Inventory (ADI-12): a new screening instrument for depressive disorders in patients with amyotrophic lateral sclerosis. J Affect Disord. 2008;109(1-2):213-219. There is emerging interest in the use of cannabinoids for treating various medical conditions.1 How does cannabinoid use affect patients' cancer-related clinical characteristics? This retrospective review explored associations between cannabinoid use and cancer-related clinical characteristics in a cancer population. Patients in the supportive care outpatient clinic at Moffitt Cancer Center (2015-2016) completed tetrahydrocannabinol (THC) urine drug tests (UDTs) as well as same-day Edmonton Symptom Assessment Scale (ESAS) and cannabinoid history questionnaires. The ESAS (11-point rating from 0–10 [symptom absence to worst intensity]) scored previous-24-hour symptom severity, and ESAS characteristics were compared among patients with positive vs. negative test results. The Kolmogorov-Smirnov method, multiple logistic regression, and Levene's, Mann-Whitney U, chi-square, and Fisher exact tests were used. Patients (n=332; 21% gynecologic, 15% gastrointestinal cancer) were 43% male and 52% age 50–69 years. Twenty-three percent had positive UDT results for THC. Differences were seen between THC-positive and THC-negative patients for age (median=52 [lower quartile=44; upper quartile=56] vs. 58 [48; 67] years; P<.001), male sex (54% vs. 40%; P=.034), and past/current cannabinoid use (66% vs. 26%; P<.001). THC-positive (vs. THC-negative) patients had higher scores for pain (7 [lower quartile=5; upper quartile=8] vs. 5 [3; 7]; P=.001), nausea (1 [0; 3] vs. 0 [0; 3]; P=.049), appetite (4 [2; 7] vs. 3 [0; 5.75]; P=.015), overall well-being (5.5 [4; 7] vs. 5 [3; 6]; P=.002), spiritual well-being (5 [2; 6] vs. 3 [1; 3]; P=.015), insomnia (7 [5; 9] vs. 4 [2; 7]; P<.001), and total ESAS (52 [34; 66] vs. 44 [29; 54]; P=.001). There exists tremendous public interest and widespread use of medical cannabis among patients with cancer.2 In this retrospective review, researchers at the NCI-Designated Cancer Center have analyzed charts of patients in an outpatient supportive care clinic. Almost one-fourth of the patients' UDTs were positive for THC metabolites, which is consistent with prior research. These patients were more likely to be young and male and reported more frequent cannabis use. Interestingly, the patients also self-reported a higher severity of pain, nausea, insomnia, and worse overall and spiritual well-being compared with patients whose urine was negative for THC. Many potential reasons could explain the findings; however, it seems likely that it was the inadequate control of symptoms that led to the use of cannabis. Therefore, inquiring about the use and motivations behind cannabis use seems crucial for palliative care clinicians taking care of patients with cancer. Use of medical cannabis among cancer patients may be related to suboptimal symptom control. Marcin Chwistek, MD FAAHPM, Fox Chase Cancer Center, Philadelphia, PA Chang YD, Jung JW, Oberoi-Jassal R, et al. Edmonton Symptom Assessment Scale and clinical characteristics associated with cannabinoid use in oncology supportive care outpatients. J Natl Compr Canc Netw. 2019;17(9):1059-1064. 1.Albright VA, Johnson EO. Emerging topics and innovative methodologies in cannabis research. Subst Abuse. 2018;12:1178221818774264.2.Martell K, Fairchild A, LeGerrier B, et al Rates of cannabis use in patients with cancer. Curr Oncol. 2018;25(3):219-225. Rave Reviews Jordan M, Keefer PM, Lee YA, et al. Top ten tips palliative care clinicians should know about caring for children. J Palliat Med. 2018;21(12):1783-1789. Given the paucity of palliative care pediatricians, many “adult” clinicians will find themselves caring for children at some point. This eminently practical article highlights some of the major differences between adult and pediatric palliative care, with helpful advice about how to care for children. Marsac ML, Kindler C, Weiss D, Ragsdale L. Let's talk about it: supporting family communication during end-of-life care of pediatric patients. J Palliat Med. 2018;21(6):862-878. In pediatrics, we care for the child as well as the family. This is a fabulous overview of how to support parents of seriously ill patients in communicating openly and honestly with their children. Kolmar A, Hueckel RM, Kamal A, Dickerman M. Top ten tips palliative care clinicians should know about caring for children in neonatal and pediatric intensive care units. J Palliat Med. 2019;22(9):1149-1153. The longer an adult stays in the intensive care unit (ICU), the worse their prognosis; however, in pediatrics (especially neonatology), it's exactly the opposite. This article helps guide clinicians through the unique worlds of the pediatric and neonatal ICUs, equipping them with necessary tools to care for critically ill children. PC-FACS Feedback We appreciate your feedback. Help us help you-send your comments to [email protected]. PC-FACS was created in 2005 by Founding Editor-in-Chief Amy P. Abernethy, MD, PhD, FACP, FAAHPM. The Academy is deeply grateful to Dr. Abernethy for creating this important publication and for her many contributions to the field of hospice and palliative medicine. PC-FACS is edited by Editor-in-Chief, Mellar P. Davis, MD, FCCP, FAAHPM, of the Geisinger Health System, and Associate Editor-in-Chief, Robert M. Arnold, MD, FAAHPM, of the University of Pittsburgh Medical Center. All critical summaries are written by Jeff Fortin, MD. AAHPM thanks the following PC-FACS Editorial Board members for their review of the critical summaries and preparation of the commentaries: Editorial Leadership Mellar P. Davis, MD FCCP FAAHPM, Editor in Chief Robert M. Arnold, MD FAAHPM, Associate Editor in Chief Basic Science Rony Dev, DO MS, Senior Section Editor Kenneth Cornetta, MD Regina Mackey, MD Rosene Pirrello, RPh Jacob Strand, MD Bioethics, Humanities, and Spirituality Jessica A. Moore, DHCE MA, Senior Section Editor Timothy Mark Corbett, MD MA HMCD FAAHPM Gregory Phelps, MD MPH MAHCM Beth Popp, MD HMDC FAAHPM FACP Erin Zahradnik, MD Diversity, Equity, and Inclusion Ronit Elk, PhD, Senior Section Editor Elizabeth Chuang, MD MPH Jane Loitman, MD MBA FAAHPM Mona Patel, DO Mei-Ean Yeow, MN Geriatrics and Care Transitions Eric Widera, MD FAAHPM, Senior Section Editor Ahsan Azhar, MBBS MD FACP Dashima Carthen, MD Catherine Bree Johnston, MD MPH Laura Patel, MD Hospice, Hospice and Palliative Medicine Interface, and Regulatory Issues Christopher Jones, MD MBA HMDC FAAHPM, Senior Section Editor Kyle Neale, DO Nina O'Connor, MD FAAHPM Alan Roth, DO FAAFP FAAHPM Renato Samala, MD FACP Pediatrics Robert C. Macauley, MD FAAP FAAHPM, Senior Section Editor Regina Okhuysen-Cawley, MD Sue Sreedhar Rachel Thienprayoon, MD Megan Thorvilson, MD MDiv Psychosocial Abby R. Rosenberg, MD MS FAAP, Senior Section Editor Kate Aberger, MD Dan Handel, MD Ritika Oberoi-Jassal, MD Laura Porter, PhD Symptom Assessment and Management Marcin Chwistek, MD FAAHPM, Senior Section Editor Dulce Crus-Oliver, MD Giovanni Elia, MD FAAHPM Jennifer Pruskowski, PharmD BCPS BCGP CPE Sara Martin, MD Medical Writers Jeff M. Fortin, PhD (September 2016-present) Lana Christian, MS (August 2015-August 2016) Moses Sandrof (October 2014-July 2015) Jane Wheeler (July 2005-September 2014) AAHPM Staff Laura Davis, CAE, Director, Marketing and Membership Allison Lundberg, Manager, Marketing and Membership Andie Bernard, Managing Editor AAHPM Publications Committee Joanne Wolfe, MD, Chair The views expressed herein are those of the individual authors and are not necessarily those of the Academy. Information included herein is not medical advice and is not intended to replace the judgment of a practitioner with respect to particular patients, procedures or practices. To the extent permissible under applicable laws, the Academy disclaims responsibility for any injury and / or damage to persons or property as a result of any actual or alleged libelous statements, infringement of intellectual property or other proprietary or privacy rights, or from use or operation of any ideas, instructions, procedures, products or methods contained in this publication. American Academy of Hospice and Palliative Medicine 8735 W. Higgins Road, Suite 300 Chicago, IL 60631, USA Phone: 847-375-4712 Fax: 877-734-8671 E-mail: Website: www.aahpm.org
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