scholarly journals Pharmacological strategies used to manage symptoms of patients dying of COVID-19: A rapid systematic review

2021 ◽  
pp. 026921632110132
Author(s):  
Laura Heath ◽  
Matthew Carey ◽  
Aoife C Lowney ◽  
Eli Harriss ◽  
Mary Miller
Keyword(s):  
Systematic Review ◽  
Palliative Care ◽  
Holistic Approach ◽  
Narrative Synthesis ◽  
Inclusion Criteria ◽  
Pharmacological Interventions ◽  
Pharmacological Management ◽  
Subcutaneous Infusion ◽  
Advanced Search ◽  
Continuous Subcutaneous Infusion

Background: COVID-19 has tragically resulted in over 2.5 million deaths globally. Despite this, there is a lack of research on how to care for patients dying of COVID-19, specifically pharmacological management of symptoms. Aim: The aim was to determine the dose ranges of pharmacological interventions commonly used to manage symptoms in adult patients dying of COVID-19, establish how effectiveness of these interventions was measured, and whether the pharmacological interventions were effective. Design: This was a rapid systematic review with narrative synthesis of evidence, prospectively registered on PROSPERO (ID: CRD42020210892). Data sources: We searched MEDLINE, EMBASE, CINAHL via the NICE Evidence Health Databases Advanced Search interface; medRxiv; the Cochrane COVID-19 Study Register; and Google Scholar with no date limits. We included primary studies which documented care of patients dying of COVID-19 under the care of a specialist palliative care team. Results: Seven studies, documenting the care of 493 patients met the inclusion criteria. Approximately two thirds of patients required a continuous subcutaneous infusion with median doses of 15 mg morphine and 10 mg midazolam in the last 24 h of life. Four studies described effectiveness by retrospective review of documentation. One study detailed the effectiveness of individual medications. Conclusions: A higher proportion of patients required continuous subcutaneous infusion than is typically encountered in palliative care. Doses of medications required to manage symptoms were generally modest. There was no evidence of a standardised yet holistic approach to measure effectiveness of these medications and this needs to be urgently addressed.

Consumer and carer leadership in palliative care academia and practice: A systematic review with narrative synthesis

2019 ◽  
Vol 33 (8) ◽  
pp. 959-968 ◽  
Author(s):  
Brett Scholz ◽  
Alan Bevan ◽  
Ekavi Georgousopoulou ◽  
Aileen Collier ◽  
Imogen Mitchell
Keyword(s):  
Systematic Review ◽  
Decision Making ◽  
Palliative Care ◽  
Service Planning ◽  
Data Sources ◽  
Health Policies ◽  
Narrative Synthesis ◽  
Inclusion Criteria ◽  
Systemic Decision Making ◽  
Synthesis Approach

Background: Contemporary health policies call for consumers to be part of all aspects of service planning, implementation, delivery and evaluation. The extent to which consumers are part of the systemic decision-making levels of palliative care appears to vary between and within services and organisations. Aim: The aim of this systematic review is to develop understandings about consumer and carer leadership in palliative care. Design: A systematic, narrative synthesis approach was adopted due to the heterogeneity of included studies. The review was registered on PROSPERO prospectively (PROSPERO 2018 CRD42018111625). Data sources: PubMed, Scopus and PsycINFO were searched for all studies published in English specifically focusing on consumers’ leadership in palliative care organisations and systems. Articles were appraised for quality using a modified JBI-QARI tool. Results: Eleven studies met the inclusion criteria and quality assessment. Consumers are currently involved in leadership of palliative care teaching, research and services. Findings highlight the benefits of consumer leadership in palliative care including more relevant, higher-quality services, teaching and research. Across the included studies, it was not clear the extent to which consumer leaders had influence in relation to setting agendas across the palliative care sector. Conclusion: The findings suggest that more could be done to support consumer leadership within palliative care. Academics and clinicians might improve the relevance of their work if they are able to more meaningfully partner with consumers in systemic roles in palliative care.

scholarly journals Continuous subcutaneous infusion for pain control in dying patients: experiences from a tertiary palliative care center

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Per Fürst ◽  
Staffan Lundström ◽  
Pål Klepstad ◽  
Peter Strang
Keyword(s):  
Palliative Care ◽  
Adverse Effects ◽  
Pain Control ◽  
Performance Status ◽  
Infusion Pump ◽  
Eastern Cooperative Oncology Group ◽  
Moderate Increase ◽  
Subcutaneous Infusion ◽  
Dying Patients ◽  
Continuous Subcutaneous Infusion

Abstract Background Continuous subcutaneous infusion (CSCI) via ambulatory infusion pump (AIP) is a valuable method of pain control in palliative care. When using CSCI, low-dose methadone as add-on to other opioids might be an option in complex pain situations. This study aimed to investigate the effects, and adverse effects, of CSCI for pain control in dying patients, with particular interest in methadone use. Methods This was an observational cohort study. Imminently dying patients with pain, admitted to specialized palliative inpatient wards and introduced on CSCI, were monitored daily by staff for symptoms (Integrated Palliative Care Outcome Scale - IPOS), sedation (Richmond Agitation and Sedation Scale – RASS), performance status (Eastern Cooperative Oncology Group - ECOG) and delirium (Confusion Assessment Method - CAM). Results Ninety-three patients with a median survival of 4 days were included. Of the 47 patients who survived ≥3 days, the proportion of patients with severe/overwhelming pain decreased from 45 to 19% (p < 0.001) after starting CSCI, with only a moderate increase in morphine equivalent daily dose of opioids (MEDD). Alertness was marginally decreased (1 point on the 10-point RASS scale, p = 0.001), whereas performance status and prevalence of delirium, regardless of age, remained unchanged. Both patients with methadone as add-on (MET, n = 13) and patients with only other opioids (NMET, n = 34), improved in pain control (p < 0.05 and 0.001, respectively), despite that MET patients had higher pain scores at baseline (p < 0.05) and were on a higher MEDD (240 mg vs.133 mg). No serious adverse effects demanding treatment stop were reported. Conclusions CSCI via AIP is an effective way to reduce pain in dying patients without increased adverse effects. Add-on methadone may be beneficial in patients with severe complex pain.

scholarly journals Specialist palliative care services for older people in primary care: A systematic review using narrative synthesis

2019 ◽  
Vol 34 (1) ◽  
pp. 32-48 ◽  
Author(s):  
Kim de Nooijer ◽  
Yolanda WH Penders ◽  
Lara Pivodic ◽  
Nele J Van Den Noortgate ◽  
Peter Pype ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Palliative Care ◽  
Older People ◽  
Narrative Synthesis ◽  
Specialist Palliative Care ◽  
Family Carers ◽  
Care Services ◽  
Specialist Services ◽  
Palliative Care Services

Background: There is recognition that older people with incurable conditions should have access to specialist palliative care services. However, it remains unclear which activities and outcomes these services entail for older people in primary care and to which patients they are provided. Aim: The aim of this review was to identify the criteria for referral to specialist services; who provides specialist palliative care; through which activities and with which frequency; which outcomes are reported; and which suggestions are made to improve services. Design: Systematic review of the literature and narrative synthesis. Quality appraisal and selection of studies were performed independently by two researchers. Participant characteristics, intervention features, outcome data and suggestions for improvement were retrieved. Data sources: Embase, Medline, Web of Science, Cochrane, Google Scholar, PsycINFO and CINAHL EBSCO databases (until June 2019). Results: Ten eligible articles, three qualitative, three quantitative, three mixed-method and one narrative review, were identified. Referral criteria were mainly based on patient characteristics such as diagnosis. The specialist services involved a variety of activities and outcomes and descriptions were often lacking. Services could be improved regarding the information flow between healthcare professionals, greater in-depth palliative care knowledge for case managers and social workers, identification of a key worker and support for family carers. Conclusion: The limited evidence available shows areas for improvement of the quality of and access to specialist services for older people, such as support for family carers. In addition, this review underscores the need for comprehensive reporting of interventions and the use of consensus-based outcome measures.

scholarly journals Yoga as an Alternative and Complementary Treatment for Patients With Low Back Pain

2012 ◽  
Vol 18 (1) ◽  
pp. 23-28 ◽  
Author(s):  
Manoj Sharma ◽  
Taj Haider
Keyword(s):  
Systematic Review ◽  
Low Back Pain ◽  
Back Pain ◽  
English Language ◽  
Holistic Approach ◽  
The United States ◽  
Low Back ◽  
Inclusion Criteria ◽  
Complementary Treatment ◽  
Study Inclusion

Low back pain is not only a leading cause of disability in the United States but also one of the most expensive to treat. Exercise proves to be inconsistent, and surgery often leads to disease reappearance. Yoga offers a holistic approach to overcome the psychological and physical aspects of low back pain. A systematic review was performed to determine the efficacy of yoga for low back pain. Study inclusion criteria were studies ( a) published in the English language, ( b) published between January 2000 and June 2012, ( c) included any form of yoga as an intervention, ( d) used any quantitative study design, and (5) measured low back pain as an outcome. Of the 13 studies included, 9 demonstrated a reduction in low back pain using yoga as part of the intervention. Limitations include lack of theory-based approaches, unclear definitions of low back pain, and multiple instruments used to measure the outcome.

scholarly journals Non-pharmacological interventions for reducing aggression and violence in serious mental illness: A systematic review and narrative synthesis

2016 ◽  
Vol 34 ◽  
pp. 17-28 ◽  
Author(s):  
J Rampling ◽  
V Furtado ◽  
C Winsper ◽  
S Marwaha ◽  
G Lucca ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mental Illness ◽  
Serious Mental Illness ◽  
Thinking Skills ◽  
Evidence Base ◽  
Primary Diagnosis ◽  
Narrative Synthesis ◽  
Mentally Disordered Offenders ◽  
Pharmacological Interventions ◽  
Manual Search

AbstractBackgroundFor people with mental illness that are violent, a range of interventions have been adopted with the aim of reducing violence outcomes. Many of these interventions have been borrowed from other (offender) populations and their evidence base in a Serious Mental Illness (SMI) population is uncertain.AimsTo aggregate the evidence base for non-pharmacological interventions in reducing violence amongst adults with SMI and PD (Personality Disorder), and to assess the efficacy of these interventions. We chose to focus on distinct interventions rather than on holistic service models where any element responsible for therapeutic change would be difficult to isolate.MethodsWe performed a systematic review and narrative synthesis of non-pharmacological interventions intended to reduce violence in a SMI population and in patients with a primary diagnosis of PD. Five online databases were searched alongside a manual search of seven relevant journals, and expert opinion was sourced. Eligibility of all returned articles was independently assessed by two authors, and quality of studies was appraised via the Cochrane Collaboration Tool for Assessing Risk of Bias.ResultsWe included 23 studies of diverse psychological and practical interventions, with a range of experimental and quasi-experimental study designs that included 7 Randomised Controlled Trials (RCTs). The majority were studies of Mentally Disordered Offenders. The stronger evidence existed for patients with a SMI diagnosis receiving Cognitive Behavioural Therapy or modified Reasoning & Rehabilitation (R&R). For patients with a primary diagnosis of PD, a modified version of R&R appeared tolerable and Enhanced Thinking Skills showed some promise in improving attitudes over the short-term, but studies of Dialectical Behaviour Therapy in this population were compromised by high risk of experimental bias. Little evidence could be found for non-pharmacological, non-psychological interventions.ConclusionsThe evidence for non-pharmacological interventions for reducing violence in this population is not conclusive. Long-term outcomes are lacking and good quality RCTs are required to develop a stronger evidence base.

scholarly journals Communication and support from health-care professionals to families, with dependent children, following the diagnosis of parental life-limiting illness: A systematic review

2016 ◽  
Vol 31 (3) ◽  
pp. 212-222 ◽  
Author(s):  
Rachel Fearnley ◽  
Jason W. Boland
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Literature Review ◽  
Emotional Support ◽  
Health Care Professionals ◽  
Data Sources ◽  
Narrative Synthesis ◽  
Inclusion Criteria ◽  
Dependent Children ◽  
Insufficient Time

Background: Communication between parents and their children about parental life-limiting illness is stressful. Parents want support from health-care professionals; however, the extent of this support is not known. Awareness of family’s needs would help ensure appropriate support. Aim: To find the current literature exploring (1) how parents with a life-limiting illness, who have dependent children, perceive health-care professionals’ communication with them about the illness, diagnosis and treatments, including how social, practical and emotional support is offered to them and (2) how this contributes to the parents’ feelings of supporting their children. Design: A systematic literature review and narrative synthesis. Data sources: Embase, MEDLINE, PsycINFO, CINAHL and ASSIA ProQuest were searched in November 2015 for studies assessing communication between health-care professionals and parents about how to talk with their children about the parent’s illness. Results: There were 1342 records identified, five qualitative studies met the inclusion criteria (55 ill parents, 11 spouses/carers, 26 children and 16 health-care professionals). Parents wanted information from health-care professionals about how to talk to their children about the illness; this was not routinely offered. Children also want to talk with a health-care professional about their parents’ illness. Health-care professionals are concerned that conversations with parents and their children will be too difficult and time-consuming. Conclusion: Parents with a life-limiting illness want support from their health-care professionals about how to communicate with their children about the illness. Their children look to health-care professionals for information about their parent’s illness. Health-care professionals, have an important role but appear reluctant to address these concerns because of fears of insufficient time and expertise.

Tai Chi as an Alternative or Complementary Therapy for Patients With Depression

2012 ◽  
Vol 18 (1) ◽  
pp. 43-49 ◽  
Author(s):  
Manoj Sharma ◽  
Taj Haider
Keyword(s):  
Systematic Review ◽  
Disease Burden ◽  
English Language ◽  
Tai Chi ◽  
Alternative Therapy ◽  
Holistic Approach ◽  
Complementary Therapy ◽  
Assessment Tools ◽  
Inclusion Criteria ◽  
Complementary Treatment

Considering depression ranks high among the contributors to worldwide disease burden and conventional treatments have severe limitations, Tai Chi, due to its holistic approach, is being explored as an alternative therapy. A systematic review was conducted to determine the efficacy of Tai Chi as a treatment option for depression. Inclusion criteria included the following: ( a) studies published in the English language, ( b) studies published between January 2007 and July 2012, ( c) studies that included Tai Chi as a therapy in an intervention, ( d) studies that used any quantitative study design, and ( e) studies that measured depression as an outcome. A total of 11 studies met these criteria. The efficacy of Tai Chi as an alternative and complementary treatment for depression is mixed. Limitations of the reviewed interventions included a mixed usage of instruments, high dropout rates, low sample sizes, and a lack of quality assessment tools for Tai Chi.

scholarly journals Association Between Sarcopenic Obesity and Metabolic Syndrome in Adults: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 16 (2) ◽  
pp. 153-162 ◽  
Author(s):  
Dima Khadra ◽  
Leila Itani ◽  
Yomna Chebaro ◽  
May Obeid ◽  
Miryam Jaber ◽  
...  
Keyword(s):  
Systematic Review ◽  
Metabolic Syndrome ◽  
Relative Risk ◽  
Meta Analysis ◽  
Sarcopenic Obesity ◽  
Narrative Synthesis ◽  
Inclusion Criteria ◽  
Meta Analyses ◽  
Overweight Or Obesity

Background: In the last two decades, a new phenotype termed Sarcopenic Obesity (SO), in which sarcopenia and obesity coexist, has emerged. Objective: The aim of this systematic review and meta-analysis was first to assess the prevalence of Metabolic syndrome (Mets) among individuals with and without SO, and second, to determine if SO may increase the relative risk of Mets. Methods: This study was conducted in adherence to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines and the data were collated by means of metaanalysis and narrative synthesis. Results: Twelve studies including a total of 11,308 adults with overweight or obesity of both genders met the inclusion criteria and were reviewed, revealing two main findings. First, a similar overall prevalence of Mets in individuals with SO (61.49%; 95% CI: 52.19-70.40) when compared to those without SO (56.74%; 95% CI: 47.32-65.93) was identified. Second, the presence of SO appears not to increase the risk of Mets with respect to those without SO (RR = 1.08, 95% CI: 0.99- 1.17, p = 0.07). Conclusion: No higher prevalence of Mets among individuals with SO when compared to those with obesity only, nor a significant association between SO and a higher risk of Mets was found.

Non-pharmacological interventions for managing pain in community-dwelling older adults

2022 ◽  
Vol 27 (1) ◽  
pp. 28-30
Author(s):  
Shiva Tripathi ◽  
Munukutla Venkata ◽  
James Hill ◽  
Joanna Harrison
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Community Dwelling ◽  
Effective Control ◽  
Direct Result ◽  
Pharmacological Interventions ◽  
Pharmacological Management ◽  
Pain Medications ◽  
Community Dwelling Older Adults

Pain is a complex and common issue within older adults. This complexity can be a direct result of comorbidities and the subsequent polypharmacy. The effective control of pain in older adults needs more than just pharmacological management. Non-pharmacological interventions have been demonstrated to be beneficial when combined with pain medications. This commentary critically appraises a systematic review that examines the effectiveness of non-pharmacological interventions for the management of pain in community dwelling older adults.

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