scholarly journals Palliative care physicians’ perspectives of management for terminally ill cancer patients with death rattle: a nationwide survey

2020 ◽  
Vol 50 (7) ◽  
pp. 830-833
Author(s):  
Ryo Matsunuma ◽  
Kozue Suzuki ◽  
Yoshinobu Matsuda ◽  
Masanori Mori ◽  
Hiroaki Watanabe ◽  
...  
Keyword(s):  
Palliative Care ◽  
Nationwide Survey ◽  
Self Report ◽  
Anticholinergic Agent ◽  
Pharmacological Management ◽  
Terminally Ill Cancer Patients ◽  
Scopolamine Hydrobromide ◽  
Death Rattle

Abstract Death rattle occurs during the last days of life, and relatives of those afflicted frequently report that it is very distressful. However, there is no effective treatment for it. The purpose of this study was to investigate the perceptions of Japanese palliative care physicians in clinical practice in Japan. We conducted a nationwide survey of 268 physicians via an anonymous, self-report questionnaire. We assessed pharmacological and non-pharmacological management and anticholinergic agent choice. One hundred eighty-nine physicians (70.5%) returned the questionnaires. Fifty-five participants (29.1%) treating patients with Type-1 (real death rattle) and 36 participants (19%) treating patients with Type-2 (pseudo-death rattle) death rattle reported that they would frequently administer an anticholinergic agent. One-fourth would administer scopolamine butylbromide or scopolamine hydrobromide. In conclusion, more Japanese palliative care physicians thought that anticholinergic agents might be effective for treating Type-1 death rattle rather than Type-2. Further clinical trials of these agents are needed.

A Comparison of Impulsive and Instrumental Subgroups of Batterers

1998 ◽  
Vol 13 (3) ◽  
pp. 217-230 ◽  
Author(s):  
Roger G. Tweed ◽  
Donald G. Dutton
Keyword(s):  
Attachment Style ◽  
Physical Violence ◽  
Self Report ◽  
Group Type ◽  
Millon Clinical Multiaxial Inventory ◽  
Preoccupied Attachment ◽  
Abusive Men ◽  
Trauma Scores

Previous research on subtypes of batterers has revealed at least two distinct types of batterers. One group (Type 1) demonstrates suppressed physiological responding during conflicts with their wives, tends to use violence in nonintimate relationships and manifests Millon Clinical Multiaxial Inventory (MCMI-II) scale elevations on the Antisocial and Aggressive-Sadistic scales. The second group (Type 2) manifests violence in the intimate relationship only and reports dysphoria. The current study extends our knowledge of these two groups by using a cluster analysis to assess personality disorder and relating the results to each group’s attachment style, anger, trauma scores, and scores on a self-report of Borderline Personality Organization (BPO). An instrumental group (Type 1) showed an Antisocial-Narcissistic-Aggressive profile on the MCMI-II and reported more severe physical violence. An impulsive group (Type 2) showed a mixed profile on the MCMI-II with Passive-Aggressive, Borderline, and Avoidant elevations, high scores on a self-report of BPO, higher chronic anger, and Fearful attachment. Both types of abusive men reported a Preoccupied attachment style, but only the Impulsive men reported an accompanying Fearful attachment style.

scholarly journals Approach to patients with refractory coeliac disease

F1000Research ◽  
2016 ◽  
Vol 5 ◽  
pp. 2544 ◽  
Author(s):  
Ikram Nasr ◽  
Iman Nasr ◽  
Hannah Campling ◽  
Paul J. Ciclitira
Keyword(s):  
T Cell ◽  
Coeliac Disease ◽  
Cell Receptor ◽  
Management Approach ◽  
Pharmacological Management ◽  
Strict Adherence ◽  
Epithelial Lymphocyte ◽  
Refractory Coeliac Disease

Refractory coeliac disease (RCD) is a recognised complication, albeit very rare, of coeliac disease (CD). This condition is described when individuals with CD continue to experience enteropathy and subsequent or ongoing malabsorption despite strict adherence to a diet devoid of gluten for at least 12 months and when all other causes mimicking this condition are excluded. Depending on the T-cell morphology and T-cell receptor (TCR) clonality at the β/γ loci, RCD can be subdivided into type 1 (normal intra-epithelial lymphocyte morphology, polyclonal TCR population) and type 2 (aberrant IELs with clonal TCR). It is important to differentiate between the two types as type 1 has an 80% survival rate and is managed with strict nutritional and pharmacological management. RCD type 2 on the other hand has a 5-year mortality of 50% and can be complicated by ulcerative jejunitis or enteropathy-associated T-cell lymphoma (EATL). Management of RCD type 2 has challenged many experts, and different treatment approaches have been adopted with variable results. Some of these treatments include immunomodulation with azathioprine and steroids, methotrexate, cyclosporine, alemtuzumab (an anti CD-52 monoclonal antibody), and cladribine or fludarabine sometimes with autologous stem cell transplantation. In this article, we summarise the management approach to patients with RCD type 2.

scholarly journals Practice and Perceived Importance of Advance Care Planning and Difficulties in Providing Palliative Care in Geriatric Health Service Facilities in Japan: A Nationwide Survey

2017 ◽  
Vol 35 (3) ◽  
pp. 464-472 ◽  
Author(s):  
Shoji Yokoya ◽  
Yoshiyuki Kizawa ◽  
Takami Maeno
Keyword(s):  
Palliative Care ◽  
Health Service ◽  
Advance Care Planning ◽  
Nationwide Survey ◽  
Self Report ◽  
Care Planning ◽  
Care Education ◽  
Perceived Importance ◽  
Advance Care ◽  
Eol Care

Background: The provision of end-of-life (EOL) care by geriatric health service facilities (GHSFs) in Japan is increasing. Advance care planning (ACP) is one of the most important issues to provide quality EOL care. This study aimed to clarify the practice and perceived importance of ACP and the difficulties in providing palliative care in GHSFs. Methods: A self-report questionnaire was mailed to head nurses at 3437 GHSFs nationwide. We asked participants about their practices regarding ACP, their recognition of its importance, and their difficulties in providing palliative care. We also analyzed the relationship between these factors and EOL care education. Results: Among 844 respondents (24.5% response rate), approximately 69% to 81% of head nurses confirmed that GHSF residents and their families understood disease conditions and goals of care. There was a large discrepancy between the actual practice of ACP components and the recognition of their importance (eg, asking residents about existing advance directive [AD; 27.5% practiced it, while 79.6% considered it important]; recommending completion of an AD [18.1% vs 68.4%], and asking for designation of a health-care proxy [30.4% vs 76.8%]). The EOL care education was provided at 517 facilities (61.3%). Head nurses working at EOL care education–providing GHSFs practiced ACP significantly more frequently and had significantly fewer difficulties in providing palliative care. Conclusion: A large discrepancy was found between GHSF nurses’ practice of ACP and their recognition of its importance. Providing EOL care education in GHSFs may increase ACP practices and enhance respect for resident’s preferences concerning EOL care.

scholarly journals Self-Reported Periodontitis and Complications in Type 1 Diabetes Patients: A Brazilian Nationwide Survey

2016 ◽  
Vol 27 (5) ◽  
pp. 599-603 ◽  
Author(s):  
Luciano Santos Oliveira ◽  
◽  
Ronaldo Lira-Junior ◽  
Carlos Marcelo Figueredo ◽  
Marília Brito Gomes ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Diabetes Complications ◽  
Microvascular Complications ◽  
Nationwide Survey ◽  
Self Report ◽  
Systemic Complications ◽  
Blood Pressures ◽  
Public Clinics ◽  
Diabetes Patients

Abstract This study aimed to evaluate the possible association between periodontitis and systemic complications in a Brazilian type 1 diabetes population. A multicentre, sectional study was carried out in 28 public clinics located in 20 Brazilian cities. Data from 3,591 patients were obtained (56.0% females, 57.2% Caucasians), with an average age of 21.2 ± 11.7 years and whose mean duration of type 1 diabetes was 9.6 ± 8.1 years. Periodontitis was evaluated through self-report. Odds ratios (OR) and 95% confidence intervals were calculated to evaluate the association between periodontitis and systemic diabetes complications (chronic micro and macrovascular complications and hospitalizations by hyperglycemia and diabetic ketoacidosis). The prevalence of periodontitis was 4.7% (n=170). Periodontitis patients had mean age of 27.4 ± 12.9. This group was older (p<0.001), exhibited longer diabetes duration (p<0.0001) and had elevated total cholesterol (p<0.05), triglycerides (p<0.001) and lower HDL (p<0.05) values than patients without periodontitis. Systolic and diastolic blood pressures were significantly increased in periodontitis patients (p<0.01). Periodontitis patients had increased odds of microvascular complications (2.43 [1.74-3.40]) and of hospitalizations related to hyperglycemia (2.76 [1.72-4.42]) and ketoacidosis (2.72 [1.53-4.80]). In conclusion, periodontitis was associated to systemic complications in Brazilian type 1 diabetes patients.

GLYBURIDE VERSUS METFORMIN : NEONATAL COMPLICATIONS IN THE PHARMACOLOGICAL MANAGEMENT OF PATIENTS WITH GESTATIONAL DIABETES. SYSTEMATIC REVIEW OF THE LITERATURE.

2021 ◽  
pp. 77-81
Author(s):  
Alexander Garcia Castañeda ◽  
Maria Camila Ruiz ◽  
Carolina Garcia ◽  
Lida Marcela Vega Mesa ◽  
Gennifer Andrea Gomez Toloza ◽  
...  
Keyword(s):  
Gestational Diabetes ◽  
Type I Diabetes ◽  
Progressive Increase ◽  
Type I ◽  
Third Trimester ◽  
Pharmacological Management ◽  
High Blood Glucose ◽  
Blood Glucose Concentrations

Diabetes mellitus can be dened as a group of metabolic disorders characterized by high blood glucose concentrations (1) . In general, type I diabetes is frequently associated with a deciency secondary to the destruction of insulin-producing β cells (2) . Meanwhile, type II diabetes is the result of a progressive increase in insulin resistance with a relative decit of it (3) . On the other hand, gestational diabetes is dened by The American Diabetes Association (ADA) as one that is diagnosed in the second or third trimester that is not clearly type 1 or type 2 diabetes (4) .

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