Refractory angina is a growing challenge for palliative medicine: a systematic review of non-invasive interventions

BackgroundRefractory angina can have a significant effect on quality of life. Non-invasive interventions have been suggested but there are few guidelines on management. Our aim was to systematically review all studies that reported non-invasive interventions for refractory angina and report on their effectiveness and safety.MethodsWe performed a literature search of six databases and a grey literature search. Treatments considered first line or second line according to the European Society of Cardiology were excluded, as were interventions that had undergone review within the last 3 years. Design, setting and outcomes were extracted and quality was assessed. A narrative synthesis was undertaken, including an analysis of adverse effects.Results4476 studies were screened, 14 studies were included in our analysis. Interventions were specialist multidisciplinary programmes, transcutaneous electrical nerve stimulation (TENS), perhexiline, medical optimisation, morphine and intranasal alfentanil. The effects of specialist programmes and perhexiline treatment were mixed. Positive effects were reported with TENS, opioids and medical optimisation, with improvements in symptoms, exercise capacity and quality of life. No major adverse effects were noted in any of the treatments.ConclusionThere are non-invasive treatments for refractory angina that are overlooked by current guidelines. While the quality of these studies varies, positive changes have been reported in symptoms, exercise tolerance and quality of life with few adverse effects. There is a need for further research into these treatments which could be useful within the contexts of cardiology and palliative care.

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Exploring the feasibility of a music-assisted relaxation intervention to assist with the initiation of non-invasive ventilation in people with Motor Neuron Disease

Music and Medicine ◽

10.47513/mmd.v9i2.504 ◽

2017 ◽

Vol 9 (2) ◽

pp. 86

Author(s):

Jeanette Tamplin ◽

Felicity A Baker ◽

Rebecca Davies ◽

Eleanor Bajo ◽

Karen Bolger ◽

...

Keyword(s):

Quality Of Life ◽

Motor Neuron ◽

Motor Neuron Disease ◽

Qualitative Data ◽

Small Sample ◽

Invasive Ventilation ◽

Positive Effects ◽

Non Invasive ◽

Non Invasive Ventilation

Background: Transitioning to non-invasive ventilation (NIV) can cause anxiety in people with Motor Neuron Disease (MND), which may reduce adherence rates. Music therapy has demonstrated positive effects with mechanical (invasive) ventilation.Method: This feasibility study examined the effects of music-assisted relaxation (MAR) on NIV adherence, anxiety, and quality of life for people with MND. Data were collected at baseline, 7-days post, and 3-months post NIV implementation.Results: Of 18 consenting participants, 15 chose the MAR condition. Results suggested that supporting NIV transition within the first 7 days may be advantageous for long-term adherence. No effects were found for anxiety or quality of life. Limitations included small sample size, lack of an adequate control, and possible ceiling effects on the instruments used. Qualitative data indicated most participants considered the relaxing and distracting effects of MAR were useful.Conclusions: In this small sample, we found some demand for and acceptability of a music-based intervention in this setting. Participants reported differing experiences of using MAR, and there were technical and logistical issues regarding timely and accessible provision of a MAR intervention within the treatment trajectory of NIV implementation. Conflicting quantitative and qualitative data support the need for mixed method research in this area.

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Significance of Medicinal Mushrooms in Integrative Oncology: A Narrative Review

Frontiers in Pharmacology ◽

10.3389/fphar.2020.580656 ◽

2020 ◽

Vol 11 ◽

Author(s):

Michael Jeitler ◽

Andreas Michalsen ◽

Daniela Frings ◽

Marisa Hübner ◽

Moritz Fischer ◽

...

Keyword(s):

Quality Of Life ◽

Adverse Effects ◽

Cancer Patients ◽

Cancer Care ◽

Controlled Clinical Trial ◽

Medicinal Mushrooms ◽

Positive Effects ◽

Randomized Controlled ◽

Study Results

Medicinal mushrooms are widely used in East Asia for the treatment of various diseases, especially in complementary cancer care. While there is a growing interest in medicinal mushrooms in Western countries and an increasing number of pre-clinical studies indicate distinct anti-cancer and regenerative properties, little is known about their potential relevance for clinical practice. This review aims to provide an overview of the clinical evidence, significance and potential role of medicinal mushrooms in complementary cancer care. Scientific databases for (randomized) controlled clinical trials evaluating whole spectrum formulations of medicinal mushrooms (mushroom powder and mushroom extracts) in cancer patients during and/or after conventional oncological treatment were searched. Eight studies met our inclusion criteria (eight randomized controlled trials, one controlled clinical trial). The medicinal mushrooms investigated were Agaricus sylvaticus (two trials), Agaricus blazei murill (two trials), Antrodia cinnamomea (one trial), Coriolus versicolor (one trial) and Ganoderma lucidum (three trials); all were compared to placebo and administered orally. A variety of cancer entities, outcomes and treatment durations were observed. Study results suggested beneficial effects of medicinal mushrooms, particularly quality of life and reduction of adverse effects of conventional therapies. Also, positive effects on antitumor activity and immunomodulation were reported, e.g., an increased activity of natural killer cells. In addition, results might suggest a longer survival of cancer patients receiving mushroom preparations, although in most studies this was not significant when compared to placebo. Adverse events of treatment with medicinal mushrooms were poorly reported; gastrointestinal reactions and a decrease in platelet cell count occurred in some cases. The methodological quality of most studies was generally unsatisfying and most results were insufficiently reported in several respects. Medicinal mushrooms may have a therapeutic potential for cancer patients during and after conventional oncological care with regards to quality of life, reduction of adverse effects of conventional care and possibly other surrogate parameters like immune function. There is an urgent need to investigate the safety and possible interactions of medicinal mushrooms. High-quality clinical research is warranted in order to clarify the potential of medicinal mushrooms in cancer therapy.

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375 Does epidural spinal cord stimulation improve heart efficiency and quality of life in patients with refractory angina pectoris and chronic heart failure? Preliminary report

European Journal of Heart Failure Supplements ◽

10.1016/s1567-4215(07)60243-4 ◽

2007 ◽

Vol 6 (1) ◽

pp. 86-87

Author(s):

W DYRLA ◽

M KUCH ◽

M BARCZEWSKA ◽

W MAKSYMOWICZ ◽

L KOSTANA ◽

...

Keyword(s):

Quality Of Life ◽

Heart Failure ◽

Spinal Cord ◽

Chronic Heart Failure ◽

Angina Pectoris ◽

Preliminary Report ◽

Refractory Angina ◽

Epidural Spinal Cord Stimulation ◽

Refractory Angina Pectoris

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A Comparison of the Effect of Two Types of Whole Body Vibration Platforms on Fibromyalgia. A Randomized Controlled Trial

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18063007 ◽

2021 ◽

Vol 18 (6) ◽

pp. 3007

Author(s):

José Antonio Mingorance ◽

Pedro Montoya ◽

José García Vivas Miranda ◽

Inmaculada Riquelme

Keyword(s):

Quality Of Life ◽

Motor Function ◽

Whole Body Vibration ◽

Whole Body ◽

Control Group ◽

Body Vibration ◽

Positive Effects ◽

Therapy Program

Whole body vibration has been proven to improve the health status of patients with fibromyalgia, providing an activation of the neuromuscular spindles, which are responsible for muscle contraction. The present study aimed to compare the effectiveness of two types of whole body vibrating platforms (vertical and rotational) during a 12-week training program. Sixty fibromyalgia patients (90% were women) were randomly assigned to one of the following groups: group A (n = 20), who performed the vibration training with a vertical platform; group B (n = 20), who did rotational platform training; or a control group C (n = 20), who did not do any training. Sensitivity measures (pressure pain and vibration thresholds), quality of life (Quality of Life Index), motor function tasks (Berg Scale, six-minute walking test, isometric back muscle strength), and static and dynamic balance (Romberg test and gait analysis) were assessed before, immediately after, and three months after the therapy program. Although both types of vibration appeared to have beneficial effects with respect to the control group, the training was more effective with the rotational than with vertical platform in some parameters, such as vibration thresholds (p < 0.001), motor function tasks (p < 0.001), mediolateral sway (p < 0.001), and gait speed (p < 0.05). Nevertheless, improvements disappeared in the follow-up in both types of vibration. Our study points out greater benefits with the use of rotational rather than vertical whole body vibration. The use of the rotational modality is recommended in the standard therapy program for patients with fibromyalgia. Due to the fact that the positive effects of both types of vibration disappeared during the follow-up, continuous or intermittent use is recommended.

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Cannabis and Canabidinoids on the Inflammatory Bowel Diseases: Going Beyond Misuse

International Journal of Molecular Sciences ◽

10.3390/ijms21082940 ◽

2020 ◽

Vol 21 (8) ◽

pp. 2940

Author(s):

Antonelly Cassio Alves de Carvalho ◽

Gabriela Achete de Souza ◽

Samylla Vaz de Marqui ◽

Élen Landgraf Guiguer ◽

Adriano Cressoni Araújo ◽

...

Keyword(s):

Quality Of Life ◽

Inflammatory Bowel Diseases ◽

Literature Search ◽

Cannabis Sativa ◽

Antioxidant Properties ◽

Number Of Patients ◽

Bowel Diseases ◽

Inflammatory Bowel ◽

Anti Inflammatory

Inflammatory bowel diseases (IBD) are characterized by a chronic and recurrent gastrointestinal condition, including mainly ulcerative colitis (UC) and Crohn’s disease (CD). Cannabis sativa (CS) is widely used for medicinal, recreational, and religious purposes. The most studied compound of CS is tetrahydrocannabinol (THC) and cannabidiol (CBD). Besides many relevant therapeutic roles such as anti-inflammatory and antioxidant properties, there is still much controversy about the consumption of this plant since the misuse can lead to serious health problems. Because of these reasons, the aim of this review is to investigate the effects of CS on the treatment of UC and CD. The literature search was performed in PubMed/Medline, PMC, EMBASE, and Cochrane databases. The use of CS leads to the improvement of UC and CD scores and quality of life. The medical use of CS is on the rise. Although the literature shows relevant antioxidant and anti-inflammatory effects that could improve UC and CD scores, it is still not possible to establish a treatment criterion since the studies have no standardization regarding the variety and part of the plant that is used, route of administration and doses. Therefore, we suggest caution in the use of CS in the therapeutic approach of IBD until clinical trials with standardization and a relevant number of patients are performed.

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Elderly and drugs: risks and necessity of rational use

Brazilian Journal of Pharmaceutical Sciences ◽

10.1590/s1984-82502010000400003 ◽

2010 ◽

Vol 46 (4) ◽

pp. 617-632 ◽

Cited By ~ 9

Author(s):

André de Oliveira Baldoni ◽

Farah Maria Drumond Chequer ◽

Elisa Raquel Anastácio Ferraz ◽

Danielle Palma de Oliveira ◽

Leonardo Régis Leira Pereira ◽

...

Keyword(s):

Quality Of Life ◽

Adverse Effects ◽

Elderly Population ◽

Adverse Drug Events ◽

The Elderly ◽

External Factors ◽

Access To Information ◽

Inappropriate Use ◽

The World

In recent decades, the world has undergone a demographic transformation with a rapid growth of the elderly population, resulting in an increased demand for funds to maintain their health and drug consumption. Pharmacokinetic and pharmacodynamic changes occurring in the elderly can interfere directly in the adverse effects of drugs and increase the risk of intoxication. In addition, there are external factors interfering with the pharmacotherapy of the elderly, such as inappropriate use and the lack of access to information. Many therapeutic classes of drugs should be used with caution or avoided in the elderly population, such as anti-inflammatory and some anti-hypertensive drugs, diuretics and digitalis. If not managed carefully, these medicines can affect the safety and quality of life in the elderly. Thus, the aim of this review was to identify drugs that should be used with caution in elderly patients in order to avoid intoxication and/or adverse drug events.

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536 QUALITY OF LIFE AND FOLLOW-UP AFTER ESOPHAGEAL AND GASTRIC CANCER SURGERY. PROTOCOL FOR DEVELOPING AND TESTING A NEW FOLLOW-UP MODEL

Diseases of the Esophagus ◽

10.1093/dote/doab052.536 ◽

2021 ◽

Vol 34 (Supplement_1) ◽

Author(s):

I Hovdenak Jakobsen ◽

D Kjaer

Keyword(s):

Quality Of Life ◽

Gastric Cancer ◽

Adverse Effects ◽

Prospective Study ◽

Patient Involvement ◽

Complex Interventions ◽

National Implementation ◽

Patient Reported

Abstract Esophageal and gastric cancers are aggressive diseases. Due to extensive treatment, many patients experience adverse effects such as dysphagia, dumping, pain, fatigue, fear of recurrence and depression—all negatively impacting quality of life (QoL). The purpose of this study is to develop and test a follow-up model for patients after surgery for esophageal and gastric cancer. The model targets handling of adverse effects and psychosocial distress, aiming at improving patients’ QoL and functional level. Methods Development of the model follows recognized principles for complex interventions by the Medical Research Counsil. Extensive patient involvement is included in the development process, by means of a national patient advisory board. The assumed effect of the new model will be tested in a national two-part prospective study, executed before and after national implementation of the model, in both parts including approximately200 patients. Participants will be recruited prior to surgery, and follow-up is one year. Patient-reported data will be collected pre-operatively, at 3, 6, 9 and 12 months postoperatively, along with clinical and sociodemographic data. Results Development of the follow-up model after surgery will be completed in august 2020 and inclusion of patients for the prospective study part one, before implementation of the model, will commence summer 2020. Conclusion The perspectives of this study may be crucial for future follow-up of esophageal and gastric cancer patients. First, the extensive patient involvement in developing the model will ensure a patient-centred approach to follow-up. And second, the follow-up studies will provide important and up-to-date knowledge about clinical and patient-reported outcomes in a population-based, national cohort.

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Elucidating the Potential Side Effects of Current Anti- Seizure Drugs for Epilepsy

Current Neuropharmacology ◽

10.2174/1570159x19666210826125341 ◽

2021 ◽

Vol 19 ◽

Author(s):

Enes Akyüz ◽

Mohd. Farooq Shaikh ◽

Betül Köklü ◽

Cansu Ozenen ◽

Alina Arulsamy

Keyword(s):

Quality Of Life ◽

Side Effects ◽

Adverse Effects ◽

Side Effect ◽

First Line ◽

Epileptic Patients ◽

Life Threatening ◽

Visual Problems ◽

Gaba Transmission

: Over the decades, various interventions have been developed and utilized to treat epilepsy. However, majority of epileptic patients are often first prescribed with anti-epileptic drugs (AED), now known as anti-seizure drugs (ASD), as a first line of defense to suppress their seizures and regain their quality of life. ASDs exert their anti-convulsant effects through various mechanisms of action including regulation of ion channels, blocking of glutamate-mediated stimulating neurotransmitter interaction, and enhancing the inhibitory GABA transmission. About one third of epileptic patients are often resistant to anti-convulsant drugs, while others develop numerous side effects which may lead to treatment discontinuation and further deterioration of quality of life. Common side effects of ASDs include headache, nausea and dizziness. However, more adverse effects such as auditory and visual problems, skin problems, liver dysfunction, pancreatitis and kidney disorders may also be witnessed. Some ASDs may even result in life-threatening conditions as well as serious abnormalities, especially in patients with comorbidities and in pregnant women. Nevertheless, some clinicians had observed a reduction in the development of side effects post individualized ASD treatment. This suggest that a careful and well-informed ASD recommendation to patients may be crucial for an effective and side-effect free control of their seizures. Therefore, this review aimed to elucidate the anticonvulsant effects of ASDs as well as their side effect profile, by discussing their mechanism of action and reported adverse effects based on clinical and preclinical studies, thereby providing clinicians with a greater understanding of the safety of current ASDs.

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