Subcutaneous pantoprazole in an elderly, palliative care patient

2019 ◽  
pp. bmjspcare-2019-001916
Author(s):  
Hugues Michelon ◽  
Hélène Souchu ◽  
Bénédicte Chauvron-Defilippi ◽  
Anne Lecoeur ◽  
Maryvonne Villart ◽  
...  
Keyword(s):  
Palliative Care ◽  
Linitis Plastica ◽  
Care Patient ◽  
Intravenous Route ◽  
Published Data ◽  
Clinical Safety ◽  
Off Label ◽  
Improve Patient ◽  
Efficiency Data ◽  
Interesting Alternative

Proton pump inhibitors (PPIs) have become the agents of choice for acid-related diseases. In some clinical situations, PPI therapy by oral or intravenous route may be difficult especially among elderly and patients in palliative care. Off-label PPI subcutaneous injection could be the last alternative to improve patient relief, despite limited published data. We report a case of linitis plastica, peritoneal carcinomatosis and occlusive syndrome who suffered from painful regurgitations which rapidly improved after subcutaneous pantoprazole. No related adverse effects were observed during PPI therapy. Despite some limitations, this report suggests that off-label subcutaneous pantoprazole could be an interesting alternative route when intravenous infusion may be difficult or harmful for elderly and patients in palliative care. Nevertheless, clinical safety and efficiency data on larger populations are needed to validate this use in such population.

scholarly journals Therapeutic Use of Botulinum Neurotoxins in Dermatology: Systematic Review

Toxins ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 120
Author(s):  
Emanuela Martina ◽  
Federico Diotallevi ◽  
Giulia Radi ◽  
Anna Campanati ◽  
Annamaria Offidani
Keyword(s):  
Systematic Review ◽  
Skin Diseases ◽  
Meta Analysis ◽  
Published Data ◽  
Efficacy And Safety ◽  
Botulinum Toxins ◽  
Epidermolysis Bullosa Simplex ◽  
Off Label ◽  
Facial Erythema ◽  
Notalgia Paresthetica

Botulinum toxin is a superfamily of neurotoxins produced by the bacterium Clostridium Botulinum with well-established efficacy and safety profile in focal idiopathic hyperhidrosis. Recently, botulinum toxins have also been used in many other skin diseases, in off label regimen. The objective of this manuscript is to review and analyze the main therapeutic applications of botulinum toxins in skin diseases. A systematic review of the published data was conducted, following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Botulinum toxins present several label and off-label indications of interest for dermatologists. The best-reported evidence concerns focal idiopathic hyperhidrosis, Raynaud phenomenon, suppurative hidradenitis, Hailey–Hailey disease, epidermolysis bullosa simplex Weber–Cockayne type, Darier’s disease, pachyonychia congenita, aquagenic keratoderma, alopecia, psoriasis, notalgia paresthetica, facial erythema and flushing, and oily skin. Further clinical trials are still needed to better understand the real efficacy and safety of these applications and to standardize injection and doses protocols for off label applications.

scholarly journals MODERN METHODS OF TREATMENT IN PALLIATIVE CARE

2019 ◽  
Vol 72 (7) ◽  
pp. 1229-1235
Author(s):  
Ewa Kucharska ◽  
Aleksandra Kucharska ◽  
Aleksander Sieroń ◽  
Mariusz Nowakowski ◽  
Karolina Sieroń
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Hospice Care ◽  
Clinical Symptoms ◽  
Care Patient ◽  
Unique Type ◽  
Modern Methods ◽  
High Dynamics ◽  
Methods Of Treatment

The palliative care patient is definitely a unique type of patient. Due to the complexity of the symptoms requires a holistic therapeutic approach. Modern methods of treatment in palliative and hospice care underline an important role of physio, kinesiotherapy and pharmacological treatment coexistence. The rehabilitation reduces clinical symptoms, accompanying the basic disease and increases the quality of life of palliative patients and their families. It becomes an inseparable element of treatment, both in outpatient care as well as in stationary care and home care. Due to the high dynamics onset of cancer in the group of geriatric patients there is a need for a broader analysis of the topic. The goal of palliative care is to achieve the best possible quality of life for patients and their families.

Disease-modifying therapies in advanced cancer

2021 ◽  
pp. 800-807
Author(s):  
Olav Dajani ◽  
Karin Jordan
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Side Effects ◽  
Well Being ◽  
Patient Comfort ◽  
Optimal Care ◽  
Disease Modifying ◽  
Critical Components ◽  
Improve Patient

In many situations, anticancer therapies may be critical components when optimizing patient comfort, function, quality of life, and duration of survival. Optimal care requires the integration of oncological and palliative care and it is very important for palliative care clinicians to be familiar with oncological approaches to improve patient well-being, and also the limitations of such approaches. This integrative role requires that palliative care clinicians have a basic literacy regarding anticancer therapies and the expectations and side effects of their treatments. Together with anticancer therapies, medical oncology should encompass patient-centred care by providing supportive and palliative interventions at all stages of the disease, from the time of diagnosis.

Cultural Issues in Palliative Care

2018 ◽  
Author(s):  
Sriram Yennurajalingam
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Cultural Differences ◽  
End Of Life Care ◽  
Life Care ◽  
Care Providers ◽  
Cultural Issues ◽  
Medical Interpreter ◽  
Improve Patient

Culture play a significant role in the care of patients receiving Palliative care. Understanding and managing cultural differences in end-of-life care is important as misunderstanding can result in under-treatment and unnecessary suffering for the patient and their care providers. Therefore better understanding can improve patient–physician communication and potentially improve patients’ quality of life, coping, and facilitate patients to make informed decisions and set appropriate priorities with regard to treatment and end-of-life care. This chapter discusses key cultural issues in palliative care, including the concepts of nondisclosure, the importance of the use of a medical interpreter, and the importance of an interdisciplinary team.

scholarly journals Guidance for switching from off-label antipsychotics to pimavanserin for Parkinson’s disease psychosis: an expert consensus

CNS Spectrums ◽  
2018 ◽  
Vol 23 (6) ◽  
pp. 402-413 ◽  
Author(s):  
Kevin J. Black ◽  
Henry Nasrallah ◽  
Stuart Isaacson ◽  
Mark Stacy ◽  
Rajesh Pahwa ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Case Series ◽  
Published Data ◽  
Consensus Recommendation ◽  
Clinical Reason ◽  
Rebound Effects ◽  
Off Label ◽  
Receptor Interactions ◽  
Daily Dose

Patients with Parkinson’s disease psychosis (PDP) are often treated with an atypical antipsychotic, especially quetiapine or clozapine, but side effects, lack of sufficient efficacy, or both may motivate a switch to pimavanserin, the first medication approved for management of PDP. How best to implement a switch to pimavanserin has not been clear, as there are no controlled trials or case series in the literature to provide guidance. An abrupt switch may interrupt partially effective treatment or potentially trigger rebound effects from antipsychotic withdrawal, whereas cross-taper involves potential drug interactions. A panel of experts drew from published data, their experience treating PDP, lessons from switching antipsychotic drugs in other populations, and the pharmacology of the relevant drugs, to establish consensus recommendations. The panel concluded that patients with PDP can be safely and effectively switched from atypical antipsychotics used off label in PDP to the recently approved pimavanserin by considering each agent’s pharmacokinetics and pharmacodynamics, receptor interactions, and the clinical reason for switching (efficacy or adverse events). Final recommendations are that such a switch should aim to maintain adequate 5-HT2A antagonism during the switch, thus providing a stable transition so that efficacy is maintained. Specifically, the consensus recommendation is to add pimavanserin at the full recommended daily dose (34 mg) for 2–6 weeks in most patients before beginning to taper and discontinue quetiapine or clozapine over several days to weeks. Further details are provided for this recommendation, as well as for special clinical circumstances where switching may need to proceed more rapidly.

Administration of label and off-label drugs by the subcutaneous route in palliative care: an observational cohort study

2020 ◽  
pp. bmjspcare-2020-002185
Author(s):  
Jesper Jørgen Jensen ◽  
Per Sjøgren
Keyword(s):  
Palliative Care ◽  
Drug Administration ◽  
Subcutaneous Administration ◽  
Drug Discontinuation ◽  
Subcutaneous Route ◽  
Scientific Publications ◽  
Prospective Data ◽  
Off Label ◽  
Injectable Drugs ◽  
Observational Cohort

BackgroundThe marketing authorisation for many injectable drugs used in palliative care does not cover the frequently preferred subcutaneous route. Consequently, subcutaneous off-label drug administration is often practised.AimTo assess the use, safety and tolerability of subcutaneous label and subcutaneous off-label drug administration in a Danish hospice.Material and methodsRetrospective data from hospice inpatient records registered with subcutaneous drug administration. Prospective data of subcutaneous drug administration registered to hospice inpatients over a period of 2 months.ResultsDrugs were administered subcutaneously to 90% of patients in both studied cohorts. Thirty different drugs were administered subcutaneously. Ten (33%) drugs were authorised for subcutaneous administration, 14 (47%) for intramuscular and 6 (20%) for intravenous administration only. A search in major palliative literature and scientific publications revealed that 11 of the 20 subcutaneous off-labelled drugs were administered with little to no support from these sources. In seven patients, 11 adverse drug reactions (ADRs) were registered. ADRs were all minor local reactions and led to drug discontinuation in two patients only.ConclusionSubcutaneous drug administration was frequently used in the hospice. Two-thirds of the drugs were administered subcutaneously off-label. The findings of only a few and minor ADRs indicate that the drugs identified in this study, although often subcutaneously off-label and with little support from palliative literature, were administered with acceptable safety and tolerability. Off-label treatment practised in the clinic should be identified, reported and serve as inspiration for future scientific research and incentives for extension of marketing authorisations.

Caring for the caregiver: factors associated with the quality of life of family caregivers to palliative care patients

2015 ◽  
Vol 3 (3) ◽  
pp. 352
Author(s):  
Macarena Quesada ◽  
Manuel Madrigal ◽  
Aurelio Luna ◽  
Maria D Perez-Carceles
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Family Caregivers ◽  
Care Patient ◽  
Terminal Phase ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Factors Associated ◽  
The Impact

Purpose: The aim was to investigate the factors associated with the quality of life (QoL) of family caregivers to palliative care patients. Methods: A cross-sectional survey was conducted of 125 family caregivers of patients in the terminal phase of their illness and included in palliative care programs. Data were collected using WHOQOL-BREF, the socio-demographic characteristics of both caregiver and patient, clinical questions and information about caregiving. Results: The QoL of caregivers was lower than that of the national average for healthy people. Significantly lower QoL scores were obtained in the case of caregivers if they were women, over 55 years, uneducated, unemployed or the patient’s spouse. Cancer diagnosis and patients who were dependent for their Activities of Daily Living also lower caregiver QoL. The factors associated with higher caregiver QoL in each domain differed: being employed in the physical domain (OR:3.3; 95% CI:1.47-7.4), the patient receiving palliative care in hospital in the psychological domain (OR:3.05; 95% CI:1.19-7.7), a higher level of caregiver´s education in the social domain (OR:3.3; 95% CI:1.4-9.8) and caregivers between 45-55 years in the environmental domain (OR:5.4; 95% CI:1.6-9.2).Conclusion: Family caregivers of palliative care patients are highly burdened during caregiving. Characteristics of the patient and caregiver and the conditions under which care is performed, significantly affect QoL. We consider it essential to increase health professionals’ awareness of the importance of the role of the caregiver in providing services to the terminally ill, given the impact of the caregiver’s QoL on the QoL of the palliative care patient and its importance for the delivery of person-centered care at the end of life.    

APRN Palliative Care Externship: Potential impact on oncology nursing palliative care delivery.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 149-149
Author(s):  
Constance Dahlin ◽  
Patrick J. Coyne ◽  
Brian Cassel
Keyword(s):  
Palliative Care ◽  
Patient Care ◽  
Care Delivery ◽  
Improve Patient Care ◽  
Rural Practice ◽  
Oncology Nursing ◽  
Advanced Practice ◽  
Care Providers ◽  
Positive Effects ◽  
Improve Patient

149 Background: Understanding primary palliative care is essential for advanced practice nurses, no matter where they practice. Limitations resulting from the variability of APRN state practice acts, financial considerations, and expenses, challenge post-graduate education for APRNs. With the shortage of health care providers, it is necessary to consider innovative programs to offer this education. Although there are many palliative educational opportunities, there are few abilities to translate the education into practice. Few are focused on the APRN, particularly for community and rural practice where many oncology patients are located and receive care. Methods: The APRN Externship selected 48 externs who completed the week long course. Topics includes pain and symptom assessment and management; fostering communication skills; building understanding of community resources such as hospice, palliative care, and home care; incorporating palliative care into an oncology practice, introducing concepts of business and finance in palliative care; and developing of safe practice with policy, procedure, and guideline development with a focus on rural providers. Externs complete pre course and post course testing along with completing goals to improve patient care. Results: Through an IRB approved process, utilizing both quantitative and qualitative evaluation, we followed the effect of the externship on externs. Externs performed both pre-course as well as 1 month and 6 month post-course testing. They also completed a report on achievement of clinical goals to improve patient care delivery. Conclusions: APRN Palliative Externs reported positive effects from the externship experience to clinical practice. The qualitative and quantitative data has demonstrated sustained effect towards improving palliative care within advanced practice nursing. The APRN palliative externship model could serve as a model to promote better palliative care education for oncology APRNs thereby improving palliative care delivery within oncology nursing.

Early integration of palliative care in Ontario cancer settings.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18234-e18234
Author(s):  
Frances Catriona Wright
Keyword(s):  
Palliative Care ◽  
Positive Impact ◽  
Primary Care Patient ◽  
Life Quality ◽  
Central Nervous System Disease ◽  
Pilot Project ◽  
Care Patient ◽  
Baseline Survey ◽  
Provider Education ◽  
Early Integration

e18234 Background: Introducing palliative care early in the cancer journey results in a better life quality, less aggressive care and possibly longer survival compared to patients receiving standard care. The INTEGRATE project aimed to identify and manage patients who may benefit from palliative care earlier in their cancer treatment. This pilot project assessed whether multidisciplinary forums (Multidisciplinary Cancer Conferences, Clinics and Diagnostic Assessment Programs ) could be used to identify patients using the UK Gold Standards Framework Surprise Question (SQ) “Would you be surprised if this person died within the next year?” Methods: Cancer centres volunteered to pilot test the efficacy of the SQ at multidisciplinary forums and implement a palliative model of care. A survey was completed at 3 different points during the project to measure provider comfort in providing palliative care. All sites received primary level palliative care education. Patient and caregiver experience were assessed using interviews and a validated survey. Identified patients received Advance Care Planning (ACP), symptom management, referrals and standardized reporting to primary care. Patient level data was collected. Results: 3 academic and 1 non-academic cancer centres used the SQ in multidisciplinary forums to identify patients in the Lung, Gastrointestinal and Central Nervous System disease sites between February '15-August '16. A baseline survey showed over 50% of providers had no palliative care training. 157 providers received education and at the end of the project providers had increased comfort & confidence in delivering palliative care. Analyses show that 933 patients were identified using the SQ, from which 78% had ACP initiated and 83% are receiving community palliative care services Conclusions: Multidisciplinary forums appear to be excellent for identifying patients who may benefit from a palliative approach to care. Inter-professional provider education and organized approaches to linking patients to community resources, had a positive impact on provider willingness to address end-of-life and palliative issues. Patients & caregivers report positive experiences of care, but different levels of ‘readiness’ to have the ACP discussions.

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