scholarly journals Pharmacological Prophylaxis of Venous Thromboembolism in Terminally Ill Patients: A Need or Futility?

2021 ◽  
Vol 34 (13) ◽  
Author(s):  
Laura Serranito ◽  
Paulo Reis-Pina
Keyword(s):  
Thrombotic Event ◽  
Terminally Ill ◽  
Stage Iv ◽  
Underlying Disease ◽  
Pharmacological Prophylaxis ◽  
Oncological Patients ◽  
Relief Of Suffering ◽  
Life Itself ◽  
Subcutaneous Enoxaparin

The aim of this case is to clarify the need to maintain the terminally ill oncological patients who have had a thrombotic event in the course of their underlying disease under antithrombotic therapy. This case addresses a 63-year-old man with stage IV gastric antrum adenocarcinoma, completely bed-ridden and anticoagulated with subcutaneous enoxaparin for more than a year, following deep venous thrombosis of the left lower limb. After reviewing the literature, it was found that, for end-of-life patients, anticoagulation seems to have little benefit as the main objective is not the extension of life itself, but rather the preservation of the best quality of life through practices that are well established in the relief of suffering.

Improving the quality of life of terminally ill oncological patients: the example of palliative care at Hospice Villa Speranza

2013 ◽  
Vol 9 (6) ◽  
pp. 771-776 ◽  
Author(s):  
Adriana Turriziani ◽  
Gennaro Attanasio ◽  
Santina Cogliandolo ◽  
Francesco Scarcella ◽  
Luisa Sangalli ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Terminally Ill ◽  
Oncological Patients

scholarly journals Performance Evaluation of IMERG GPM Products during Tropical Storm Imelda

Atmosphere ◽  
2021 ◽  
Vol 12 (6) ◽  
pp. 687
Author(s):  
Salman Sakib ◽  
Dawit Ghebreyesus ◽  
Hatim O. Sharif
Keyword(s):  
Stage Iv ◽  
Tropical Storm ◽  
Average Correlation ◽  
Acceptable Range ◽  
Precipitation Estimates ◽  
Overall Performance ◽  
Early Late ◽  
Statistical Metrics ◽  
Better Than

Tropical Storm Imelda struck the southeast coastal regions of Texas from 17–19 September, 2019, and delivered precipitation above 500 mm over about 6000 km2. The performance of the three IMERG (Early-, Late-, and Final-run) GPM satellite-based precipitation products was evaluated against Stage-IV radar precipitation estimates. Basic and probabilistic statistical metrics, such as CC, RSME, RBIAS, POD, FAR, CSI, and PSS were employed to assess the performance of the IMERG products. The products captured the event adequately, with a fairly high POD value of 0.9. The best product (Early-run) showed an average correlation coefficient of 0.60. The algorithm used to produce the Final-run improved the quality of the data by removing systematic errors that occurred in the near-real-time products. Less than 5 mm RMSE error was experienced in over three-quarters (ranging from 73% to 76%) of the area by all three IMERG products in estimating the Tropical Storm Imelda. The Early-run product showed a much better RBIAS relatively to the Final-run product. The overall performance was poor, as areas with an acceptable range of RBIAS (i.e., between −10% and 10%) in all the three IMERG products were only 16% to 17% of the total area. Overall, the Early-run product was found to be better than Late- and Final-run.

scholarly journals Effectiveness of ovarian suspension in preventing postoperative ovarian adhesions in patients with severe pelvic endometriosis—a case-control study

2019 ◽  
Vol 16 (1) ◽  
Author(s):  
Zahra Dehbashi ◽  
Shaheen Khazali ◽  
Fateme Davari Tanha ◽  
Farnaz Mottahedian ◽  
Mahsa Ghajarzadeh ◽  
...  
Keyword(s):  
Pregnancy Rate ◽  
Transvaginal Ultrasound ◽  
Stage Iv ◽  
Clinical Pregnancy ◽  
Reproductive Age ◽  
Deep Infiltrating Endometriosis ◽  
Pelvic Endometriosis ◽  
Double Blind ◽  
Entire Study

Abstract Background Endometriosis can exert obvious negative effects on women’s quality of life. Excisional surgery is among the most effective treatments for severe pelvic endometriosis. The prevalence of severe pelvic adhesions following a laparoscopic examination of severe endometriosis varies between 50 and 100%. Temporary intraoperative ovarian suspension is a method for the reduction of adhesions is in the treatment of severe pelvic endometriosis. Given the importance and the prevalence of endometriosis and its complications, we conducted the present study to determine more effective adhesion-reducing methods with a view to improving the quality of the treatments provided. Methods The present prospective double-blind randomized clinical trial was conducted on 50 women of reproductive age (≥ 19 years) diagnosed with severe pelvic endometriosis on transvaginal ultrasound scans and vaginal examinations at Yas Hospital between 2014 and 2017. Women with severe endometriosis (stage III, stage IV, and deep infiltrating endometriosis) requiring an extensive bilateral dissection of the pelvic walls and the rectovaginal space, with preserved uterus and ovaries, were included in the study. The preoperative severity of ovarian adhesions was assessed in terms of ovarian motility, measured through a combination of gentle pressures applied with the vaginal probe and abdominal pressures applied with the examiner’s free hand. A table of random numbers was used to choose which ovary to suspend. The entire study population received standard general anesthesia. In the laparoscopic examination of the cases with severe endometriosis, both ovaries were routinely suspended to the anterior abdominal wall with PROLENE sutures. At the end of the surgery, one of the ovaries was kept suspended for 7 days, whereas the other ovarian suspension suture was cut. At 3 months postoperatively, all the patients underwent ultrasound scans for the assessment of ovarian motility and adhesions. The severity of pelvic pain was defined according to a visual analog score. After surgery, infertile women were followed for 2-4 years, and were contacted regarding the infertility treatment. Chemical and clinical pregnancy rates was compered between the two groups. Results Three months after laparoscopy, the adhesions were mild in 41 (82%) patients and moderate in 9 (18%) on the suspended side, and mild in 12 (24%) patients and moderate in 38 (76%) on the control side (P < 0.001). The mean dysmenorrhea score was 6.8 ± 1.5 before surgery and 4.5 ± 1.4 after surgery (P < 0.001). The chemical pregnancy rate and clinical pregnancy rate were not different in the suspended and control groups (P = 0. 62, P = 0.64). Conclusions The reduction in adhesions via ovarian suspension surgery promises reductions in the complications of endometriosis.

scholarly journals To hydrate or not to hydrate? The effect of hydration on survival, symptoms and quality of dying among terminally ill cancer patients

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Chien-Yi Wu ◽  
Ping-Jen Chen ◽  
Tzu-Lin Ho ◽  
Wen-Yuan Lin ◽  
Shao-Yi Cheng
Keyword(s):  
Cancer Patients ◽  
Proportional Hazards Model ◽  
Clinical Symptoms ◽  
Terminally Ill ◽  
Good Death ◽  
Artificial Nutrition ◽  
Symptom Improvement ◽  
Terminally Ill Cancer Patients ◽  
Quality Of Dying

Abstract Background Artificial nutrition and hydration do not prolong survival or improve clinical symptoms of terminally ill cancer patients. Nonetheless, little is known about the effect of artificial hydration (AH) alone on patients’ survival, symptoms or quality of dying. This study explored the relationship between AH and survival, symptoms and quality of dying among terminally ill cancer patients. Methods A pilot prospective, observational study was conducted in the palliative care units of three tertiary hospitals in Taiwan between October 2016 and December 2017. A total of 100 patients were included and classified into the hydration and non-hydration group using 400 mL of fluid per day as the cut-off point. The quality of dying was measured by the Good Death Scale (GDS). Multivariate analyses using Cox’s proportional hazards model were used to assess the survival status of patients, the Wilcoxon rank-sum test for within-group analyses and the Mann-Whitney U test for between-groups analyses to evaluate changes in symptoms between day 0 and 7 in both groups. Logistic regression analysis was used to assess the predictors of a good death. Results There were no differences in survival (p = 0.337) or symptom improvement between the hydration and non-hydration group, however, patients with AH had higher GDS scores. Conclusions AH did not prolong survival nor significantly improve dehydration symptoms of terminally ill cancer patients but it may influence the quality of dying. Communication with patients and their families on the effect of AH may help them better prepared for the end-of-life experience.

scholarly journals POS1494-HPR THE COLLABORATION OF RHEUMATOLOGY-DERMATOLOGY IN THE EVALUATION OF RHEUMATIC DISEASES PATIENTS: EXPERIENCE IN A UNIVERSITY HOSPITAL

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1031.1-1032
Author(s):  
G. Figueroa-Parra ◽  
A. Moreno-Salinas ◽  
C. M. Gamboa-Alonso ◽  
M. A. Villarreal-Alarcón ◽  
D. Á. Galarza-Delgado
Keyword(s):  
Quality Of Care ◽  
Rheumatic Diseases ◽  
Lupus Erythematosus ◽  
Direct Interaction ◽  
Final Diagnosis ◽  
Underlying Disease ◽  
University Hospital ◽  
Rheumatology Clinic ◽  
Important Interaction

Background:Dermatological manifestations are not rare in patients with rheumatic diseases (RD). Multidisciplinary management and direct interaction between these disciplines are essential. According to Dermatology-Rheumatology clinics, most diagnoses evaluated are systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA), with dermatitis being the most common manifestation. It is important to be aware that skin problems in RD patients are not always related to the underlying condition(1). Nowadays, there is significant evidence to support the manifold advantages of the joint dermatology-rheumatology clinics, including improved quality of care for patients and multidisciplinary training for new physicians(2). This ongoing trend is intended to highlight the important interaction between specialties that treat overlapping conditions, and it has been incorporated in academic health centers to give a comprehensive approach to patients.Objectives:Our purpose was to describe the collaboration between the Rheumatology and Dermatology services during the evaluation of RD patients.Methods:An observational, retrospective study was performed in the Rheumatology Service of the University Hospital “Dr. Jose Eleuterio Gonzalez” in Monterrey, Mexico, between March 2019 and February 2020. All the patients with a Rheumatology or Dermatology consultation requested were included (hospitalized and outpatients). Demographic (age, gender, baseline diagnosis), the reason for consultation, specialty requested, type of treatment, final diagnoses, and agreement in final diagnosis were registered. Results are shown in descriptive statistics.Results:One hundred and seventy-four patients were included, 142 (81.6%) patients from the outpatient clinic and 32 (18.4%) patients hospitalized. The mean age was 45.1 (SD±15.8) years, 135 (77.6%) were females, 54 (31%) patients were under initial diagnosis evaluation, 30 (17.2%) had RA, 25 (14.4%) patients had SLE, 15 (8.6%) patients had psoriatic arthritis, 12 (6.9%) patients had systemic sclerosis, 6 (3.4%) patients had dermatomyositis. The main reasons for consultation in hospitalized patients were acute lupus (15.6%), subacute lupus (12.5%), purpura (12.5%), cutaneous vasculitis (9.4%), urticarial dermatitis (9.4%), dermatomyositis (6.3%) and others (34.3%). The consultation requested was: 156 (89.7%) to Dermatology and 18 (10.3%) to Rheumatology. The type of treatment prescribed was topic/local in 37 (21.3%) patients, systemic in 25 (14.4%) and both in 92 (52.9%) patients. The final diagnoses were related to the underlying disease in 102 (77%) patients and unrelated in 40 (23%) patients. The agreement between initial clinical suspicion and final diagnoses reached 75.9% between Rheumatology and Dermatology services. Figure 1.Conclusion:The collaboration between Rheumatology and Dermatology services are very important. Most of the patients were under initial evaluation. All the rheumatologists and dermatologists should be aware of the interdependence from both specialties to give the best quality of care to the patients.References:[1]Samycia M, McCourt C, Shojania K, Au S. Experiences From a Combined Dermatology and Rheumatology Clinic: A Retrospective Review. J Cutan Med Surg. 2016;20(5):486-489. doi:10.1177/1203475416649138.[2]Theodorakopoulou E, Dalamaga M, Katsimbri P, Boumpas DT, Papadavid E. How does the joint dermatology-rheumatology clinic benefit both patients and dermatologists?. Dermatol Ther. 2020;33(3):e13283. doi:10.1111/dth.13283Figure 1.Disclosure of Interests:None declared

Clinical phenotype, fibrinogen supplementation and health-related quality of life in patients with afibrinogenemia

Blood ◽  
2021 ◽  
Author(s):  
Alessandro Casini ◽  
Sylvia von Mackensen ◽  
Cristina Santoro ◽  
Claudia Djambas Khayat ◽  
Meriem Belhani ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Family Relationships ◽  
Thrombotic Event ◽  
Young Patients ◽  
Severe Bleeding ◽  
Health Related Quality ◽  
Cross Sectional ◽  
Related Quality ◽  
Health Related

Due to its low prevalence, epidemiologic data on afibrinogenemia are limited and none are available on health-related quality of life (HRQoL). We conducted a cross-sectional international study to characterize the clinical features, the fibrinogen supplementation modalities and their impact on HRQoL in patients with afibrinogenemia. A total of 204 patients (119 adults and 85 children) from 25 countries were included. The bleeding phenotype was severe: 68 (33.3%) patients having at least one bleed per month and 48 (23%) a history of cerebral bleeding. About 35% (n=72) of patients were treated with fibrinogen concentrates or cryoprecipitates as prophylaxis, 18.1% (n=37) received more than one injection per week and 16.6% (n=34) were on home treatment. A thrombotic event was reported in venous and/or arterial territories by 37 (18.1%) patients. Thrombosis occurred even in young patients and recurrence was frequent (7.4%). The total HRQoL was lower in children than in adults. Discomfort linked to treatment and limitations to sports and leisure were the main concerns. Women and children were particularly affected in family relationships. In multivariate analyses, younger age, residence in Asia or Africa and a previous thrombotic event were statistically correlated with a worse HRQoL. In conclusion, our study underlines the severe bleeding and thrombotic phenotype and their impact on HRQoL in afibrinogenemia. The optimal strategy for fibrinogen supplementation needs to be determined.

Fifteen-minute consultation: A structured approach to the management of chronic cough in a child

2017 ◽  
Vol 103 (2) ◽  
pp. 65-70 ◽  
Author(s):  
Cherry Alviani ◽  
Gary Ruiz ◽  
Atul Gupta
Keyword(s):  
Chronic Cough ◽  
Respiratory Infections ◽  
School Attendance ◽  
Underlying Disease ◽  
Acute Respiratory Tract Infection ◽  
Healthy Children ◽  
Foreign Materials ◽  
Structured Approach

Coughing is a primary pulmonary defence mechanism that enhances clearance of secretions and particles from the airways and protects against aspiration of foreign materials. Coughing may affect 30% of children at any given time (1). Many are healthy children but some may have serious underlying disease. Childhood cough accounts for a large number of consultations and 80% of families who are referred to a paediatric respiratory clinic for chronic cough have sought medical advice five times or more (2). The majority of childhood coughs are secondary to an acute respiratory tract infection and will improve once the infection resolves, usually within 1 to 3 weeks. With pre-school children who may experience between 6 and 10 respiratory infections a year differentiating acute recurrent cough from chronic cough is key (Table 1). Chronic cough can significantly impact a family’s quality of life, as it affects the child’s sleep, school attendance and play. Parents experience distress and anxiety, worrying that the cough may lead to long-term chest damage or even death (3). This article aims to guide clinicians through the assessment of the child with a chronic cough. It will discuss identifying causes, use of first line investigations, initiating appropriate management and addressing parental anxiety and exacerbating factors (4,5).

Applying Translational Research in Understanding Complications and Defining Targets for Intervention: Inflammation in PD as a Model

2009 ◽  
Vol 29 (2) ◽  
pp. 135-141
Author(s):  
Roberto Pecoits–Filho
Keyword(s):  
Peritoneal Dialysis ◽  
Patient Care ◽  
Translational Research ◽  
Research Question ◽  
Underlying Disease ◽  
Cardiovascular Complications ◽  
Research Environment ◽  
The Core ◽  
Quality Of Patient Care

The bench-to-bedside approach to translational research is becoming increasingly important to efficiently advance understanding of the mechanisms underlying disease and to improve the quality of patient care. Although this investigation model has been practiced since the early days of the therapy, robust research platforms built to practice translational research have only recently been structured in the field of peritoneal dialysis. Experience with a translational research environment that generated most of the information cited in this overview is the core of this manuscript. The central investigation theme described is how to approach the cardiovascular complications of peritoneal dialysis. The research question was, could the continuous activation of inflammatory pathways be central in this process and represent a relevant target for interventions?

Validity of caregiver-reported hospital admission in a study on the quality of care received by terminally ill cancer patients

2010 ◽  
Vol 63 (1) ◽  
pp. 103-108 ◽  
Author(s):  
F. Chini ◽  
P. Giorgi Rossi ◽  
M. Costantini ◽  
M. Beccaro ◽  
P. Borgia
Keyword(s):  
Quality Of Care ◽  
Hospital Admission ◽  
Cancer Patients ◽  
Terminally Ill ◽  
Terminally Ill Cancer Patients
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