Palliative Sedation for Children at End of Life: a Retrospective Cohort Study

Abstract Background: Palliative sedation is consciously reducing the patient's consciousness to alleviate the refractory symptoms. However, studies on palliative sedation for children are scarce. We aimed to survey the symptom control and risks for children with sedative therapy in end of life.Method: This study was a single center retrospective cohort study. Children who died in the Department of Palliative Medicine were divided into palliative sedation (Group A) and non-palliative sedation group (Group B). The symptoms relief, survival time, and last hospitalization time were compared between two groups. Results: From January 2012 to November 2019, 41 children died in department of palliative care. 24 children were sedated (Group A), meanwhile 17 children were not (Group B). The symptoms in Group A were more complex than Group B (p =0.013). Overall symptom relief in Group A was higher than that in Group B (24/24, 10/15 p =0.041). Pain relief rates（7/7, 20/21 p =0.714）, maximum/pre-death opioid dose [30(20, 77.5), 18(9, 45) p =0.175, 30(20, 60), 18(9, 45) p =0.208]and pain intensity difference [5(4,6.5), 4(2,6) p =0.315] were not statistically significant difference in both group. After diagnosis, the survival time of the Group A was longer than the Group B (p =0.047). However, the length of hospitalization before death was similar in two groups (p =0.385).Conclusion: Palliative sedation controls complicated, painful symptoms at the end of life and does not shorten the hospitalization time in children.

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Palliative Sedation in COVID-19 End-of-Life Care. Retrospective Cohort Study

Medicina ◽

10.3390/medicina57090873 ◽

2021 ◽

Vol 57 (9) ◽

pp. 873

Author(s):

Jose-Manuel Ramos-Rincon ◽

Oscar Moreno-Perez ◽

Nazaret Gomez-Martinez ◽

Manuel Priego-Valladares ◽

Eduardo Climent-Grana ◽

...

Keyword(s):

Cohort Study ◽

End Of Life ◽

Median Time ◽

Retrospective Cohort Study ◽

End Of Life Care ◽

Retrospective Cohort ◽

Palliative Sedation ◽

University Hospital ◽

Life Care ◽

Butyl Bromide

Background and Objectives: Descriptions of end-of-life in COVID-19 are limited to small cross-sectional studies. We aimed to assess end-of-life care in inpatients with COVID-19 at Alicante General University Hospital (ALC) and compare differences according to palliative and non-palliative sedation. Material and Methods: This was a retrospective cohort study in inpatients included in the ALC COVID-19 Registry (PCR-RT or antigen-confirmed cases) who died during conventional admission from 1 March to 15 December 2020. We evaluated differences among deceased cases according to administration of palliative sedation. Results: Of 747 patients evaluated, 101 died (13.5%). Sixty-eight (67.3%) died in acute medical wards, and 30 (44.1%) received palliative sedation. The median age of patients with palliative sedation was 85 years; 44% were women, and 30% of cases were nosocomial. Patients with nosocomial acquisition received more palliative sedation than those infected in the community (81.8% [9/11] vs 36.8% [21/57], p = 0.006), and patients admitted with an altered mental state received it less (20% [6/23] vs. 53.3% [24/45], p = 0.032). The median time from admission to starting palliative sedation was 8.5 days (interquartile range [IQR] 3.0–14.5). The main symptoms leading to palliative sedation were dyspnea at rest (90%), pain (60%), and delirium/agitation (36.7%). The median time from palliative sedation to death was 21.8 h (IQR 10.4–41.1). Morphine was used in all palliative sedation perfusions: the main regimen was morphine + hyoscine butyl bromide + midazolam (43.3%). Conclusions: End-of-life palliative sedation in patients with COVID-19 was initiated quite late. Clinicians should anticipate the need for palliative sedation in these patients and recognize the breathlessness, pain, and agitation/delirium that foreshadow death.

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Liposomal Doxorubicin in Aggressive B Cell Lymphoma Has Similar Efficacy to the Conventional Formulation: Results from a Retrospective Cohort Study

Blood ◽

10.1182/blood.v126.23.5106.5106 ◽

2015 ◽

Vol 126 (23) ◽

pp. 5106-5106 ◽

Cited By ~ 1

Author(s):

Evelyn Acuña Cruz ◽

Jimena Cannata Ortiz ◽

Ana García-Noblejas ◽

Adrian Alegre ◽

Reyes Arranz Sáez

Keyword(s):

Cohort Study ◽

Board Of Directors ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Liposomal Doxorubicin ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Advisory Committees ◽

Group A ◽

Group B

Abstract Introduction: Anthracyclines plays a key role in the treatment of Diffuse Large B cell Lymphoma (DLBCL). There is a great concern about its cardiotoxicity, especially among elderly patients with raising age and related morbidities. Liposomal doxorubicin (LD) has proven to be efficacious and less cardiotoxic in combinations of neo-adjuvant chemotherapy regimes through phase II and III studies in breast cancer. There are some phase II studies in DLBCL but to our knowledge, controlled randomized studies are pending. Aim: To analyze the efficacy and toxicity of LD (Myocet¨) in DLBCL patients with cardiovascular/cardiopathy risk, in comparison with a control population who received the standard therapy during the same period of time. Methods: We conducted a retrospective cohort study in patients with de novo DLBCL treated with standard immunochemotherapy, comparing conventional Doxorubicin vs LD. Selection of a 3.3 vs 1 ratio was used to increase statistic power. Criteria to indicate LD therapy were any of the following: left heart ejection fraction < 50%, cardiovascular risk factors or prior history of cardiopathy. Overall response (OR), complete/uncertain response (CR/CRu), progression free survival (PFS) and overall survivall (OS) were analyzed. Toxicity was evaluated with CTCAE v.4.0. and the used statistical package was SPSS v18.0. Results: 78 patients (pts) treated between March 2006 and June 2012 were selected: 60 pts in the control group (group A) and 18 in the study arm (group B). Their characteristics are shown in table 1. Homogeneity was observed, except in LVEF < 50%, older age and hypertension in group B. Efficacy: 69 pts were evaluable for response, with similar OR rate and CR+CRu in both groups (see table 2). Response was consolidated in 17 pts: 22% in group A and 40% in group B. With a median follow up of 4.3 years for surviving pts (0.74 yrs - 8 yrs), actuarial OS and PFS for the whole series were 64% ±SD 13% and 55% ±SD 7%, respectively, without significant differences between both arms (OS: 64% vs 77%; p=0,7 and 56% vs 55%; p=0,9). Toxicity: Hematological toxicity was 43% vs 11%, grade 3 neutropenia 43% vs 6% and febrile neutropenia 37% vs 11%, all significantly different and favoring group B. These differences were probably due to the systematical use of Peg- GSF in group B. Four (5%) cardiac events were observed in group B: 1 heart failure and 3 arrhythmias. Currently, 16 (21%) pts have died, 11 due to lymphoma, 4 due to infection grade 5 during induction treatment and 1 suicide. Conclusion: In this study, the association of LD to immunochemotherapy showed the same efficacy as conventional Doxorubicin in fragile patients, without increased toxicity. Acknowledgment: We are grateful to TEVA for their contribution with the CRO for the statistical analysis. Disclosures Alegre: Celgene Corporation: Membership on an entity's Board of Directors or advisory committees; Janssen: Membership on an entity's Board of Directors or advisory committees; Amgen: Membership on an entity's Board of Directors or advisory committees.

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Comment on Ramos-Rincon et al. Palliative Sedation in COVID-19 End-of-Life Care. Retrospective Cohort Study. Medicina 2021, 57, 873

Medicina ◽

10.3390/medicina58010082 ◽

2022 ◽

Vol 58 (1) ◽

pp. 82 ◽

Cited By ~ 1

Author(s):

Robert Geoffrey Twycross ◽

Aaron Kee Yee Wong ◽

Bella Vivat

Keyword(s):

Cohort Study ◽

End Of Life ◽

Retrospective Cohort Study ◽

End Of Life Care ◽

Retrospective Cohort ◽

Palliative Sedation ◽

University Hospital ◽

Life Care ◽

Medical Wards

We read with interest the article by Ramos-Rincon and colleagues about patients with COVID-19 dying in acute medical wards in a Spanish University hospital [...]

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Analysis of discordance between AMH and AFC in IVF patients: a retrospective cohort study

10.21203/rs.3.rs-763045/v1 ◽

2021 ◽

Author(s):

Yannan Chen ◽

Xiaoling Gu ◽

Xi Guan ◽

Minyan Yu ◽

Shuping Zhong ◽

...

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Antral Follicle ◽

Antral Follicle Count ◽

Entire Study ◽

Therapeutic Regime ◽

Significant Difference ◽

Group A ◽

Group B

Abstract Background Both anti-Mullerian hormone (AMH) and antral follicle count (AFC) predict ovarian reserve independently and have been shown to correlate well. However, it is quite common to encounter discordance between the two clinical indices. This objective of this study is to speculate which condition is favorable to patients and to decide what best to be done in cases of such discordance. Methods This retrospective cohort study analyzed the medical records of 714 women undergoing the first IVF cycle at the Center for Reproductive Medicine, the Affiliated Hospital of Nantong University, Nantong, Jiangsu between January 2017 and December 2020. All patients had their essential characteristics, baseline FSH, Estradiol, PRL, LH, Testosterone, CA125, AMH, and AFC recorded. Patients were classified into three groups according to whether their AMH and AFC values were in the lower quartile, upper quartile, or in between, namely Group A (Concordance, concordant in AMH and AFC), Group B (HTP, AMH concentration higher than predicted according to AFC) and Group C (LTP, AMH concentration lower than predicted according to AFC). SPSS 25.0 software package (SPSS, Inc., Chicago, IL, USA) was used for statistical analysis. Results The entire study population has a good concordance between AMH and AFC. 240 women (33.61%) had discordant AMH and AFC values, and the proportion in Group B(HTP) and Group C(LTP) seemed similar (16.67% VS 16.94%). The three cohorts had similar age, infertile duration, FSH, Estradiol, PRL, LH, Testosterone, and CA125 levels. BMI progressively increased from Group B to Group A and to Group C. The ratio of patients, who had completely mature oocytes (COM), rapidly decreased from Group C to Group A and to Group B. Although no significant difference in CMO rate was observed among Group A, B, and C when stratified according to BMI, CMO rate was the highest (72.31%) when BMI < 18.5 kg/m2 in all BMI categories. Conclusions Our analysis demonstrated a high frequency of clinical discordance between AMH and AFC in women undergoing IVF therapeutic regime. Patients’ BMI and completely mature oocytes ratio are significantly different among distinct grouping based on their AMH and AFC partition.

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Effects of Unsuppressed Endogenous Insulin On Pharmacokinetics And/Or Pharmacodynamics of Study Insulin In The Healthy: A Retrospective Cohort Study

10.21203/rs.3.rs-841778/v1 ◽

2021 ◽

Author(s):

Hui Liu ◽

Hongling Yu ◽

Lisi Sun ◽

Jingtao Qiao ◽

Jiaqi Li ◽

...

Keyword(s):

Cohort Study ◽

Blood Glucose ◽

Human Insulin ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

C Peptide ◽

Endogenous Insulin ◽

Significant Difference ◽

Group A ◽

Group B

Abstract Background: C-peptide, a marker of endogenous insulin, should be consistently inhibited during euglycemic clamping, while an elevated postdosing C-peptide (CPpostdosing) is not an occasional phenomenon. This study aimed to describe the effects of insufficient suppression of endogenous insulin on estimates of the pharmacokinetics and pharmacodynamics of subcutaneously injected insulin. Methods: This was a retrospective cohort study that included 33 males who underwent a manual euglycemic clamp with a subcutaneous injection of insulin aspart (IAsp). Time-profiles of whole blood glucose, human insulin, glucose infusion rate (GIR), and C-peptide were recorded. The subjects were divided into two groups at a ratio of 2:1: group A [(CPpostdosing)max＞CPbaseline], group B [(CPpostdosing)max≤CPbaseline]. The endogenous insulin was approximately equal to the measured value of human insulin or calculated from the C-peptide. Results: The basal glucose, CPbaseline, basal human insulin, HOMA-IR, IAsp dose, and demographic statistics were all comparable between the two groups except the ‘clamped’ glucose. The ‘clamped’ glucose was 99.7±7.1% (group A) and 94.9±5.1% (group B) of baseline. After correction for ‘clamped’ glucose, AUCGIR,0-8h was higher in group A (P＜0.05) under comparable IAsp exposure. AUCendogenous insulin,0-8h calculated from C-peptide was different from that measured from human insulin in group A (P＜0.05), whereas no significant difference between these measures was observed in group B. Conclusions: Blood glucose should be controlled below baseline to ensure the inhibition of endogenous insulin. Unsuppressed endogenous insulin may contribute to observed GIR, and the endogenous-insulin-corrected pharmacokinetics estimated by C-peptide may be inaccurate with insufficient endogenous insulin suppression.

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Long-Term Visual, Refractive and Topographic Outcomes of KeraRings Combined with Accelerated Transepithelial Crosslinking for Management of Different Grades of Progressive Keratoconus: A Retrospective Cohort Study

The Open Ophthalmology Journal ◽

10.2174/1874364102115010054 ◽

2021 ◽

Vol 15 (1) ◽

pp. 54-69

Author(s):

Mohammed Iqbal ◽

Amr Mounir ◽

Khaled Abd-Elaziz ◽

Omar M. Said

Keyword(s):

Visual Acuity ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Distance Visual Acuity ◽

Uncorrected Distance Visual Acuity ◽

Corrected Distance Visual Acuity ◽

Group A ◽

Group B

Purpose: To evaluate long-term visual, refractive, and topographic outcomes of KeraRings intrastromal implantation combined with accelerated transepithelial cross-linking for management of different stages of progressive keratoconus. Materials and Methods: This retrospective cohort study included 70 eyes of 70 patients with Amsler-Krumeich grades 1 to 4 keratoconus. They were divided into two groups: group-A included 37 eyes with grades 1-2 keratoconus, and group-B included 33 eyes with grades 3-4 keratoconus. Both groups underwent combined Keraring implantation with TCXL treatment. The main outcome measures included the preoperative and postoperative visual acuity, refraction, keratometry readings, and pachymetry. Results: At postoperative month 60, group-B exhibited significantly higher values of all mean uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), sphere/cylinder/spherical equivalent/defocus equivalent (DEQ), and K1/K2/Kaverages/Kmax parameters compared to that of group A. However, group-A exhibited better stability of postoperative improvements. Keratoconus progression (KCP) was greater in group-B (45.5%) than group-A (10.8%). Two eyes revealed segments' migration while one eye showed tunnel vascularization and opacification with segments' migration. Conclusion: The diagnostic criteria of preoperative-KCP are not adequate for the diagnosis of postoperative-KCP following ICRS implantation. UDVA and K average posterior seemed to be more sensitive parameters than K max in documenting early postoperative-KCP. We suggest that deterioration of UDVA≥0.10 log MAR and/or K average posterior ≥0.25 D are highly suspicious of post-ring implantation keratoconus progression (PR-KCP). The occurrence of two of the following parameters: Kmax≥0.50 D, Kaverageanterior≥0.50 D, K average posterior ≥0.25 D, or pachymetry≥1.5% thinning, is diagnostic of PR-KCP. The occurrence of two or more of the following parameters: Kmax≥0.50 D, Kaverageanterior≥0.50 D, Kaverageposterior ≥0.25 D, pachymetry≥ 1.5% thinning or UDVA≥0.10 logMAR, is diagnostic of PR-KCP. We also suggest that Kmax≥0.75 D alone is diagnostic of PR-KCP.

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Reply to Twycross et al. Comment on “Ramos-Rincon et al. Palliative Sedation in COVID-19 End-of-Life Care. Retrospective Cohort Study. Medicina 2021, 57, 873”

Medicina ◽

10.3390/medicina58010083 ◽

2022 ◽

Vol 58 (1) ◽

pp. 83

Author(s):

Jose-Manuel Ramos-Rincon ◽

Manuel Priego-Valladares

Keyword(s):

Cohort Study ◽

End Of Life ◽

Retrospective Cohort Study ◽

End Of Life Care ◽

Retrospective Cohort ◽

Palliative Sedation ◽

Life Care

First of all, we want to thank Twycross, Wong, and Vivat [...]

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Effectiveness of a Gelatin–Thrombin Matrix Sealant (Floseal®) for Reducing Blood Loss During Microendoscopic Decompression Surgery for Lumbar Spinal Canal Stenosis: A Retrospective Cohort Study

Global Spine Journal ◽

10.1177/21925682211008835 ◽

2021 ◽

pp. 219256822110088

Author(s):

Kazunori Nomura ◽

Munehito Yoshida ◽

Motohiro Okada ◽

Yosuke Nakamura ◽

Kenichi Yawatari ◽

...

Keyword(s):

Cohort Study ◽

Blood Loss ◽

Retrospective Cohort ◽

Spinal Canal Stenosis ◽

Lumbar Spinal Canal Stenosis ◽

Canal Stenosis ◽

Postoperative Drainage ◽

Group A ◽

Group B ◽

Lumbar Spinal

Study Design: Retrospective cohort study. Objectives: To investigate the effectiveness and safety of a gelatin–thrombin matrix sealant (GTMS) during microendoscopic laminectomy (MEL) for lumbar spinal canal stenosis (LSCS). Methods: This study included 158 LSCS cases on hemostasis-affecting medication who underwent MEL by a single surgeon between September 2016 and August 2020. Patients were divided into 2 groups depending on whether GTMS was used (37 cases, Group A) or not (121 cases, Group B). Perioperative data related to bleeding or postoperative spinal epidural hematoma (PSEH) was investigated. Clinical outcomes were evaluated using the Japanese Orthopedic Association (JOA) score for low back pain. Results: The mean intraoperative blood loss per level was greater in Group A (26.0 ± 20.3 g) than in Group B (13.6 ± 9.0 g), whereas the postoperative drainage volume was smaller in Group A (79.1 ± 42.5 g) than in Group B (97.3 ± 55.6 g). No revision surgeries for PSEH were required in Group A, while 2 (1.7%) revisions were required in Group B ( P = .957). The median JOA score improved significantly from the preoperative period to 1-year postoperatively in both Group A and B (total score, 16.0-23.5 and 17.0-25.0 points, respectively). Conclusions: The use of GTMS during MEL for LSCS may be associated with a reduction in postoperative drainage volume. The revision rate for PSEH was not affected significantly by the use of GTMS. Clinical outcomes (represented by the JOA score) were significantly improved after the surgery, regardless of GTMS use during MEL.

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Relationship between vaginal group B streptococcus colonization in the early stage of pregnancy and preterm birth: a retrospective cohort study

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03624-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Sho Tano ◽

Takuji Ueno ◽

Michinori Mayama ◽

Takuma Yamada ◽

Takehiko Takeda ◽

...

Keyword(s):

Cohort Study ◽

Preterm Birth ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Early Stage ◽

Group B Streptococcus ◽

Multivariable Logistic Regression Analysis ◽

Simple Method ◽

Group B ◽

Singleton Pregnancies

Abstract Background Although infection and inflammation within the genital tract during pregnancy is considered a major risk factor for spontaneous preterm birth (PTB), there are few studies on association between vaginal microorganisms in the early stage of pregnancy and PTB. The aim of this study was to investigate relationship between vaginal Group B streptococcus (GBS) colonization, a leading cause of infection during pregnancy, in the early stage of pregnancy and PTB. Methods This single-center, retrospective cohort study utilized data from 2009 to 2017 obtained at TOYOTA Memorial Hospital. Women with singleton pregnancies who underwent vaginal culture around 14 weeks of gestation during their routine prenatal check-up were included. Vaginal sampling for Gram staining and culture was performed regardless of symptoms. GBS colonization was defined as positive for GBS latex agglutination assay. Statistical analysis was performed to determine the factors associated with PTB. Results Overall 1079 singleton pregnancies were included. GBS (5.7%) and Candida albicans (5.5%) were the most frequently observed microorganisms. The incidence of PTB (before 34 and before 37 weeks of gestation) were significantly higher in the GBS-positive group than in the GBS-negative group (6.6% vs 0.5%, p = 0.001 and 9.8% vs 4.3%, p = 0.047). Our multivariable logistic regression analysis revealed that GBS colonization was a factor associated with PTB before 34 and before 37 weeks of gestation (Odds ratio [OR] 15.17; 95% confidence interval [CI] 3.73–61.74), and OR 2.42; 95%CI 1.01–5.91, respectively). Conclusions The present study found that vaginal GBS colonization in the early stage of pregnancy was associated with PTB. Our study indicates that patients at a high risk for PTB can be extracted by a simple method using conventional culture method.

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