Research in palliative care

2015 ◽  
Author(s):  
Stein Kaasa ◽  
Karen Forbes
Keyword(s):  
Palliative Care ◽  
Clinical Trials ◽  
Translational Research ◽  
Advanced Disease ◽  
Research Governance ◽  
Evidence Based ◽  
Controlled Clinical Trials ◽  
Wide Range

Research in palliative care is essential for maintaining standards and advancing knowledge and improving practice. It is challenging, sometimes daunting, often frustrating, but always exciting and rewarding when a study is successfully completed, whether the outcome is positive or negative. This chapter discusses a wide range of topics that will help those who are new to research to get started, to proceed and complete it, and contribute to improving outcomes for patients with advanced disease. Topics include, among others, collaborative and translational research, research governance, controlled clinical trials, evidence-based palliative care, and trial planning (including methodology, randomization, statistical considerations, protocol, access to patients, finance, administration, monitoring, and publication).

Trends in randomized controlled trials in ENT: a 30-year review

1997 ◽  
Vol 111 (7) ◽  
pp. 611-613 ◽  
Author(s):  
K. W. Ah-See ◽  
N. C. Molony ◽  
A. G. D. Maran
Keyword(s):  
Clinical Trials ◽  
Clinical Practice ◽  
Randomized Controlled Trials ◽  
Gold Standard ◽  
Controlled Trials ◽  
Evidence Based ◽  
Controlled Clinical Trials ◽  
Medline Search ◽  
Randomized Controlled Clinical Trials ◽  
Randomized Controlled

AbstractThere is a growth in the demand for clinical practice to be evidence based. Recent years have seen a rise in the number of randomized controlled clinical trials (RCTS). Such trials while acknowledged as the gold standard for evidence can be difficult to perform in surgical specialities. We have recently identified a low proportion of RCTS in the otolaryngology literature. Our aim was to identify any trend in the number of published RCTS within the ENT literature over a 30-year period and to identify which areas of our speciality lend themselves to this form of study design. A Medline search of 10 prominent journals published between 1966 and 1995 was performed. Two hundred and ninety-six RCTS were identified. Only five were published before 1980. Two hundred (71 per cent) of RCTS were in the areas of otology and rhinology. An encouraging trend is seen in RCTS within ENT literature.

Occupational therapy in palliative care

2021 ◽  
pp. 206-212
Author(s):  
Maria Denise Pessoa Silva ◽  
Fiona Rolls ◽  
Lynne White ◽  
Tamsin Longley ◽  
Jane Murphy ◽  
...  
Keyword(s):  
Palliative Care ◽  
Occupational Therapy ◽  
Occupational Therapist ◽  
Evidence Based ◽  
Shortness Of Breath ◽  
Functional Impairments ◽  
Functional Difficulties ◽  
Wide Range ◽  
Care At Home

Occupational therapy in palliative care aims to help patients achieve their optimum independence for as long as possible in activities that are important to them. There is a wide range of difficulties and symptoms experienced by palliative patients with which occupational therapy can intervene, which may include physical disabilities and functional impairments, extreme fatigue, anxiety, shortness of breath, and cognitive deficits. This chapter describes the broad range of areas in which the occupational therapist works in palliative care together with the multidisciplinary team. They take a key role in assessing and treating functional difficulties, organizing and facilitating safe discharge and care at home, with the aim of achieving best quality of life and avoiding admission to hospital whenever possible. The occupational therapist analyses and assesses specific problems and provides a treatment programme or solution to help the patient remain as independent as possible, using clinical reasoning and evidence-based practice.

Caregiver burden and distress

2021 ◽  
pp. 303-310
Author(s):  
Rinat Nissim ◽  
Sarah Hales ◽  
Gary Rodin
Keyword(s):  
Palliative Care ◽  
Family Caregivers ◽  
Personal Growth ◽  
Advanced Disease ◽  
Supporting Evidence ◽  
Care Providers ◽  
Wide Range ◽  
Care Family ◽  
The Common ◽  
Physical Challenges

Caregivers of patients with advanced disease can be seen as both care providers and as receivers of care. Family caregivers frequently face a wide range of their own psychological, spiritual, social, financial, and physical challenges, which may increase in duration due to longer survival and more ambulatory and home care of patients with advanced disease. While support for family caregivers is an integral component of quality palliative care, such support is often unavailable and there is a dearth of evidence-based interventions for caregivers. This chapter will provide an overview of the common issues faced by family caregivers of adults in palliative care, the factors that contribute to or exacerbate these problems, the interventions designed to address them and their supporting evidence, and the potential for personal growth in caregivers. Gaps in clinical practice and research are identified and future directions for clinical attention and research are discussed.

scholarly journals Bevacizumab for pediatric radiation necrosis

2020 ◽  
Vol 7 (4) ◽  
pp. 409-414 ◽  
Author(s):  
Lorena V Baroni ◽  
Daniel Alderete ◽  
Palma Solano-Paez ◽  
Carlos Rugilo ◽  
Candela Freytes ◽  
...  
Keyword(s):  
Monoclonal Antibody ◽  
Clinical Trials ◽  
Radiation Necrosis ◽  
Treatment Options ◽  
Mass Effect ◽  
Pediatric Brain Tumors ◽  
Controlled Clinical Trials ◽  
Wide Range ◽  
Fluid Attenuated Inversion Recovery ◽  
Pediatric Brain

Abstract Background Radiation necrosis is a frequent complication occurring after the treatment of pediatric brain tumors; however, treatment options remain a challenge. Bevacizumab is an anti-VEGF monoclonal antibody that has been shown in small adult cohorts to confer a benefit, specifically a reduction in steroid usage, but its use in children has not been well described. Methods We describe our experience with bevacizumab use for symptomatic radiation necrosis at 5 institutions including patients treated after both initial irradiation and reirradiation. Results We identified 26 patients treated with bevacizumab for symptomatic radiation necrosis, with a wide range of underlying diagnoses. The average age at diagnosis of radiation necrosis was 10.7 years, with a median time between the last dose of radiation and the presentation of radiation necrosis of 3.8 months (range, 0.6-110 months). Overall, we observed that 13 of 26 patients (50%) had an objective clinical improvement, with only 1 patient suffering from significant hypertension. Radiological improvement, defined as reduced T2/fluid-attenuated inversion recovery signal and mass effect, was observed in 50% of patients; however, this did not completely overlap with clinical response. Both early and late radiation necrosis responded equally well to bevacizumab therapy. Overall, bevacizumab was very well tolerated, permitting a reduction of corticosteroid dose and/or duration in the majority of patients. Conclusions Bevacizumab appears to be effective and well-tolerated in children as treatment for symptomatic radiation necrosis and warrants more robust study in the context of controlled clinical trials.

Advances in Periodontology

2000 ◽  
Vol os7 (4) ◽  
pp. 149-152 ◽  
Author(s):  
Maurizio S Tonetti
Keyword(s):  
Clinical Trials ◽  
Soft Tissue ◽  
Periodontal Diseases ◽  
Evidence Based ◽  
Controlled Clinical Trials ◽  
Soft Tissue Management ◽  
Research Findings ◽  
Randomised Controlled ◽  
Periodontal Plastic Surgery ◽  
Implant Treatment

Advances in periodontal science and practice over the last decade have radically changed the understanding of periodontal diseases and have opened new, exciting prospects for both medical and surgical therapy of periodontal diseases. Establishment of the aetiology and pathogenesis of periodontitis, understanding of the unique genetic and environmental susceptibility profile of affected subjects, and recognition of the systemic implications of periodontal infections are the key research findings. The use of randomised, controlled, clinical trials has allowed the development of evidence-based periodontology. Adjunctive antimicrobial therapy, regenerative periodontal surgery, periodontal plastic surgery, bone regeneration surgery in the light of implant treatment, and advanced soft tissue management at implant sites have radically changed practice.

scholarly journals Problems in Clinical Trial Design in Multiple Sclerosis

2002 ◽  
Vol 4 (3) ◽  
pp. 125-138 ◽  
Author(s):  
Jeffrey I. Greenstein
Keyword(s):  
Multiple Sclerosis ◽  
Clinical Trials ◽  
Outcome Measures ◽  
Trial Design ◽  
Clinical Trial Design ◽  
Evidence Based ◽  
Controlled Clinical Trials ◽  
Cognitive Components ◽  
Basic Understanding ◽  
Clinical Measures

Historically, it has been difficult to demonstrate the effectiveness of treatments for multiple sclerosis (MS) because of the variability in the course of the disease, the lack of well-defined, reliable clinical measures, and the pervasiveness of poorly controlled clinical trials. Hence, to interpret the results of clinical trials in MS and make evidence-based decisions regarding treatment for their patients, neurologists should have a basic understanding of appropriate outcome measures and the necessary controls of a well-designed study. This paper reviews the controls required to test the efficacy of agents for the treatment of MS and offers examples of poorly controlled clinical trials to illustrate the problems in interpreting data without such controls. In addition, the outcome measures that should be used to assess the efficacy of treatments on the physical, inflammatory, and cognitive components of the disease are discussed. (Int J MS Care. 2002; 4: 125–131, 136–137)

Searching for Acupuncture Trials: Which Database?

1995 ◽  
Vol 13 (2) ◽  
pp. 97-99 ◽  
Author(s):  
Adrian White ◽  
Karl-Ludwig Resch ◽  
Edzard Ernst
Keyword(s):  
Clinical Trials ◽  
Science Citation Index ◽  
Literature Search ◽  
Citation Index ◽  
Information Service ◽  
British Library ◽  
Evidence Based ◽  
Controlled Clinical Trials ◽  
Relevant Reference ◽  
Based Medicine

Evidence based medicine depends on sensitive, precise and informative searches for references to controlled clinical trials. Five databases: Medline, Centralised Information Service for Complementary Medicine (CISCOM), Science Citation Index (SCI), British Library and Embase, were compared for their effectiveness as literature search tools by conducting test searches for acupuncture trials in a single sample year, 1992. CISCOM showed the greatest sensitivity, followed by Medline and SCI; all three usually provided abstracts, but CISCOM did not provide authors’ addresses. Other databases had features that might make them useful for particular purposes. SCI, British Library and Embase covered a different range of journals from Medline, including acupuncture specialist journals, but of these three only SCI contained an additional relevant reference; it also had the advantages of secondary references and associated correspondence. Indexing of Medline appeared to be more effective for acupuncture than for some other complementary and orthodox medical subjects. It was concluded that the CISCOM search was the most sensitive, and that Medline and SCI had other benefits which were significant.

Palliative care clinical trials: how nurses are contributing to integrated, evidence-based care

2011 ◽  
Vol 17 (5) ◽  
pp. 224-230
Author(s):  
A Hosie ◽  
B Fazekas ◽  
T Shelby-James ◽  
E Mills ◽  
N Byfieldt ◽  
...  
Keyword(s):  
Palliative Care ◽  
Clinical Trials ◽  
Evidence Based ◽  
Evidence Based Care

Psychopharmacologic Strategies for the Treatment of Aggression in Juveniles

CNS Spectrums ◽  
2003 ◽  
Vol 8 (4) ◽  
pp. 298-308 ◽  
Author(s):  
Hans Steiner ◽  
Kirti Saxena ◽  
Kiki Chang
Keyword(s):  
Bipolar Disorder ◽  
Posttraumatic Stress Disorder ◽  
Clinical Trials ◽  
Cognitive Impairment ◽  
Stress Disorder ◽  
Complex Relationship ◽  
Controlled Clinical Trials ◽  
Oppositional Defiant ◽  
Wide Range ◽  
Specific Medication

ABSTRACTMaladaptive aggression in youth is one of the most common and troublesome reasons for referrals to child psychiatrists. It has a complex relationship with psychopathology. There are several syndromes, which are primary disturbances of clustered maladaptive aggression, most notably oppositional defiant disorder and conduct disorder. However, problems with aggression also appear in a wide range of other disturbances, such as bipolar disorder, posttraumatic stress disorder, and mood disorders. Additionally, aggression is normative, serves an adaptive purpose and can be situationally induced. These complexities need to be carefully addressed before targeting maladaptive aggression psychopharmacologically. We summarize the literature on the psychopharmacology of maladaptive aggression in youth, focusing on disorders without cognitive impairment. We delineate the subtypes of aggression which are most likely to respond to medication (reactive-affective-defensive-impulsive in their acute and chronic form) and conclude with a discussion of specific medication strategies which are supported by controlled clinical trials and clinical experience.

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