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Eugen Bleuler and evidence-based psychiatry
Not so much a pioneer of EVIDENCE BASE MEDICINE as a visionary for evidence-based psychiatry Stam and Vermeulen1 argue persuasively that Eugen Bleuler (1857–1939) is an unrecognised proponent of evidence-based medicine.2 Bleuler saw the self-absorbed, wish-fulfilling, magical thinking they describe as a fundamental symptom of schizophrenia.3 Rather than suggesting doctors were ill, Bleuler was highlighting the dangers of a medical rigidity of thought and perceptions of infallibility. Bleuler was of course correct that many remedies of the day were unproven and likely to be ineffective or even dangerous, and that thei...
Source: Journal of Neurology, Neurosurgery and Psychiatry - May 7, 2013 Category: Neurosurgery Authors: Lawrie, S. M. Tags: Genetics, End of life decisions (palliative care), Child and adolescent psychiatry, Psychotic disorders (incl schizophrenia), Urological surgery Editorial commentaries Source Type: research
Primary and Secondary Leiomyosarcoma of the Oral and Perioral Region—Clinicopathological and Immunohistochemical Analysis of a Rare Entity With a Review of the Literature
Conclusion: Lung and cervical lymph node metastases often occur in LMS of the head and neck. Presurgical staging, including gynecologic examination, whole-body computed tomography, and sometimes positron-emission or computed tomography, to rule out LMS metastasis is mandatory. Surgical resection of the tumor should be given top priority. Lack of p16 reactivity may have a prognostic value for LMS because it was related to a trend toward poorer survival.
Source: Journal of Oral and Maxillofacial Surgery - February 22, 2013 Category: ENT & OMF Authors: Anja Schütz, Ralf Smeets, Oliver Driemel, Samer George Hakim, Hartwig Kosmehl, Henning Hanken, Andreas Kolk Tags: Surgical Oncology and Reconstruction Source Type: research
Chemoembolization and Radioembolization for Hepatocellular Carcinoma
Hepatocellular carcinoma (HCC) continues to represent a major worldwide problem. Although treatments such as resection, transplantation, and ablation may provide a chance for a cure, these options are often precluded because of advanced disease presentation. Palliative treatments include transarterial embolization and systemic therapies. This review will summarize the state of the science for embolic therapies in HCC (conventional and drug-eluting chemoembolization, radioembolization) as well as discuss related topics including HCC staging, assessment of response, and ongoing clinical trials.
Source: Clinical Gastroenterology and Hepatology - January 28, 2013 Category: Gastroenterology Authors: Riad Salem, Robert J. Lewandowski Tags: Perspectives in Clinical Gastroenterology and Hepatology Source Type: research
Catheterization‐based intervention in low birth weight infants less than 2.5 kg with acute and long‐term outcome
ConclusionInterventional catheterization is feasible with low procedural morbidity and mortality in high risk infants < 2.5 kg. Catheterization primarily serves as a palliative procedure to stabilize infants for definitive treatment. Balloon valvuloplasty may be effective for isolated valvar pulmonary stenosis in infants < 2.5 kg. © 2013 Wiley Periodicals, Inc.
Source: Catheterization and Cardiovascular Interventions - July 1, 2013 Category: Cardiovascular & Thoracic Surgery Authors: Daisuke Kobayashi, Salaam Sallaam, Sanjeev Aggarwal, Harinder R. Singh, Daniel R. Turner, Thomas J. Forbes, Srinath T. Gowda Tags: Pediatric and Congenital Heart Disease Source Type: research
Ataxia and epilepsy due to a rare autosomal mitochondrial disease
We report a case of a twenty three year old female presenting with status epilepticus due to a rare mutation in a nuclear gene causing mitochondrial dysfunction. She had previously been investigated for an inherited ataxia without a definitive diagnosis being made. She presented as an emergency with focal seizures that rapidly evolved into intractable status epilepticus. Despite prolonged, aggressive treatment in Intensive Care Unit, she remained encephalopathic with persisting seizures. Her younger sister who also has milder symptoms with ataxia visited our hospital on the day of acute admission and revealed some useful i...
Source: Journal of Neurology, Neurosurgery and Psychiatry - October 9, 2013 Category: Neurosurgery Authors: Cheripelli, B. K., Duncan, C. Tags: Genetics, Brain stem / cerebellum, Cranial nerves, Epilepsy and seizures, Muscle disease, Neuromuscular disease, Ophthalmology, Hospice, Drugs: psychiatry, Musculoskeletal syndromes Association of British Neurologists (ABN) joint meeting with the Royal Source Type: research
Acupuncture is an effective treatment for pain and other ms symptoms
This study demonstrates clear benefit from acupuncture as a treatment for pain in MS patients. This result may have been influenced by the patients' expectations of the potential benefits, as they had all sought acupuncture for pain relief. However, the sustained benefit of acupuncture as a treatment for pain was further confirmed by the fact that most patients managed to reduce their analgesia requirements, with some able to stop taking painkillers completely. There was some subjective improvement in mood, mobility and energy levels, and more than half felt their sleep pattern improved. Despite a transient increase in pai...
Source: Journal of Neurology, Neurosurgery and Psychiatry - October 9, 2013 Category: Neurosurgery Authors: Kerr Grieve, J., Flucker, S., O'Riordan, J. Tags: Pain (neurology), Pain (palliative care), Pain (anaesthesia), Drugs: musculoskeletal and joint diseases Association of British Neurologists (ABN) joint meeting with the Royal College of Physicians (RCP), London, 23-24 October 2013 Source Type: research
Length of time from extubation to cardiorespiratory death in neonatal intensive care patients and assessment of suitability for organ donation
Conclusions
This provides a guide for grieving parents on time frames for the interval between extubation and CRD. More accurate postextubation CRD times are required to determine likely potential for postcardiac death organ donation.
Source: Archives of Disease in Childhood - Fetal and Neonatal Edition - December 13, 2013 Category: Perinatology & Neonatology Authors: Saha, S., Kent, A. L. Tags: Child health, Neonatal and paediatric intensive care, Neonatal health, End of life decisions (palliative care), Neonatal intensive care, Artificial and donated transplantation, End of life decisions (ethics) Original articles Source Type: research
A Paradigm Shift: Healing, Quality of Life, and a Professional Choice
We are not human beings having a spiritual experience, but rather spiritual beings having a human experience.—Pierre Teilhard de Chardin In his most recent publication, Dr. Balfour Mount, the father of palliative care in North America, highlights the necessity of a paradigm shift in health care from the diagnostic and therapeutic models to a model of care that also embraces whole person care, a model in which attention to quality of life, healing, and attention to the lived experience of the whole person and their family are foundational. Dr. Mount challenges each of us to consider this paradigm shift as a personal and ...
Source: Journal of Pain and Symptom Management - January 1, 2014 Category: Palliative Care Authors: Cory Ingram Tags: Humanities: Art, Language, and Spirituality in Health Care Source Type: research
Patients With Cirrhosis and Denied Liver Transplants Rarely Receive Adequate Palliative Care or Appropriate Management
Conclusions: Patients with cirrhosis who have been removed from the wait list for LT are infrequently referred for palliative care (∼10% of cases), although a high percentage have pain or nausea. Goals of care and do not resuscitate status are rarely discussed. Improved planning of goals of care and access to palliative services are required for these patients.
Source: Clinical Gastroenterology and Hepatology - August 26, 2013 Category: Gastroenterology Authors: Zafrina Poonja, Amanda Brisebois, Sander Veldhuyzen van Zanten, Puneeta Tandon, Glenda Meeberg, Constantine J. Karvellas Tags: Pancreas, Biliary Tract, and Liver Source Type: research
Toward a common therapeutic framework in castration-resistant prostate cancer: A model for urologic oncology and medical oncology interaction
Conclusion: This approach aims to focus the care on the patient with CRPC rather than on his physicians and promises to improve patient outcomes in this disease state.
Source: Urologic Oncology: Seminars and Original Investigations - December 9, 2013 Category: Urology & Nephrology Authors: Ralph de Vere White, Primo N. Lara Tags: News and Topics Source Type: research
Inhaled nebulized and intranasal opioids for the relief of breathlessness
Purpose of reviewInhaled nebulized and intranasal opioid administration is available with a proven short onset of action for the relief of pain. As breathlessness episodes are short, these routes of administration seem to be attractive for breathlessness management. This review describes the recent studies evaluating the effectiveness of inhaled nebulized and intranasal application of opioids for patients suffering from refractory breathlessness.
Recent findingsSince 2012, one systematic review and three primary studies have been identified. The systematic review summarized five studies including seventy patients testing n...
Source: Current Opinion in Supportive and Palliative Care - September 1, 2014 Category: Palliative Care Tags: RESPIRATORY PROBLEMS: Edited by David C. Currow and Amy P. Abernethy Source Type: research
Breathlessness in motor neurone disease: a review of the current strategies and gaps in the evidence
Purpose of reviewThis review on breathlessness and motor neurone disease (MND) is important, as palliative care teams are increasingly becoming involved in the complex care of these patients at an earlier stage in their illness. Subtle cognitive and behavioural changes with MND may make management more challenging. Breathlessness is a distressing symptom, impacting on both patients and carers. Assessment and expectant management of breathlessness improves the quality of life (QoL) and may minimize hospital admission.
Recent findingsLow-dose opioids improve the sensation of breathlessness, with minimal side-effects. It is w...
Source: Current Opinion in Supportive and Palliative Care - September 1, 2014 Category: Palliative Care Tags: RESPIRATORY PROBLEMS: Edited by David C. Currow and Amy P. Abernethy Source Type: research
The assessment and management of cancer cachexia: hypogonadism and hypermetabolism among supportive and palliative care patients
Purpose of reviewTo update the healthcare providers on the potential contribution of increased basal metabolic rate, hypermetabolism, and low testosterone in the development of weight loss in cancer patients.
Recent findingsCancer cachexia, the loss of skeletal muscle with or without the loss of fat, is a multifactorial syndrome. A wide variation in the frequency of hypermetabolism exists in cancer patients and can only be accurately identified by an indirect calorimeter. The frequency of hypermetabolism increases depending on the histology and stage of tumor, associated with the presence of an acute inflammatory response,...
Source: Current Opinion in Supportive and Palliative Care - September 1, 2014 Category: Palliative Care Tags: GENERAL SUPPORTIVE AND PALLIATIVE CARE: Edited by Eduardo Bruera Source Type: research
Delirium diagnosis, screening and management
Purpose of reviewOur review focuses on recent developments across many settings regarding the diagnosis, screening and management of delirium, so as to inform these aspects in the context of palliative and supportive care.
Recent findingsDelirium diagnostic criteria have been updated in the long-awaited Diagnostic Statistical Manual of Mental Disorders, fifth edition. Studies suggest that poor recognition of delirium relates to its clinical characteristics, inadequate interprofessional communication and lack of systematic screening. Validation studies are published for cognitive and observational tools to screen for deliri...
Source: Current Opinion in Supportive and Palliative Care - September 1, 2014 Category: Palliative Care Tags: GENERAL SUPPORTIVE AND PALLIATIVE CARE: Edited by Eduardo Bruera Source Type: research
Supportive and palliative care for patients with chronic mental illness including dementia
Purpose of reviewPeople with preexisting mental illness are known to have difficulty accessing healthcare services including palliative care and people with dementia have similar issues accessing palliative care.
Recent findingsThe review addressed the time period from January 2013 to March 2014. There were few articles addressing issues for palliative and supportive care for patients with preexisting mental health issues. The main factor that would improve care is interdisciplinary working between mental healthcare teams and palliative care teams. In contrast, there were many published articles on the palliative and suppo...
Source: Current Opinion in Supportive and Palliative Care - September 1, 2014 Category: Palliative Care Tags: GENERAL SUPPORTIVE AND PALLIATIVE CARE: Edited by Eduardo Bruera Source Type: research
