scholarly journals Palliative Care Challenges of Patients With Progressive Bulbar Palsy: A Retrospective Case Series of 14 Patients

2021 ◽  
Vol 12 ◽  
Author(s):  
Sarah K. Bublitz ◽  
Christiane Weck ◽  
Andrea Egger-Rainer ◽  
Katharina Lex ◽  
Piret Paal ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Symptom Control ◽  
Case Series ◽  
Symptom Burden ◽  
Oral Secretion ◽  
Retrospective Case ◽  
Bulbar Palsy ◽  
Retrospective Case Series ◽  
High Level

Progressive bulbar palsy (PBP) is a form of motoneuron disease and is widely classified as a subtype of amyotrophic lateral sclerosis (ALS) with a shorter time of survival and female predominance. In this retrospective case series of 14 patients with PBP, we focus on challenges in palliative care for this patient cohort, including symptom control, gastrostomy, non-invasive ventilation, and end-of-life phase. We show that rapid physical decline at the end of life is associated with bronchopulmonary infection and excessive oral secretion leading to a high level of symptom burden. Early and regular advance care planning discussions with a focus on oral secretion management with patients and caregivers are crucial.

Pulmonary Hypertension and Palliative Care: What, When, Where, and Why?

2016 ◽  
Vol 15 (1) ◽  
pp. 26-31 ◽  
Author(s):  
Eric R. Fenstad ◽  
Sara E. Wordingham ◽  
Keith M. Swetz
Keyword(s):  
Palliative Care ◽  
Pulmonary Hypertension ◽  
Treatment Options ◽  
Symptom Control ◽  
Symptom Burden ◽  
Accurate Information ◽  
Goals Of Care ◽  
Total Care ◽  
High Level

Summary: Pulmonary hypertension (PH) can be associated with a high level of symptom burden from the disease as well as its treatment. Involvement of palliative care (PC) services may help facilitate discussion regarding goals of care, prognostic planning, and treatment options focused on improving quality of life (QOL). Background: PC is active total care of a patient whose disease is not fully responsive to curative therapies, with symptom control as the top priority. After a life-limiting diagnosis is made, health care teams and patients determine prognosis, whether cure is attainable or reasonable, what treatment options are available, risks and benefits of associated treatments, and how treatment or nontreatment will impact QOL and survival. QOL is often the focus of palliative interventions, with the goal to minimize symptoms and empower patients with accurate information to help affirm life and meet objectives of care. Implications for clinicians: PC can begin at the onset of symptoms in a disease that cannot be cured. Early PC may help facilitate discussion regarding goals of care when patient expectations are discordant with prognosis. While PC is a responsibility of all clinicians, subspecialist assistance can be helpful when a clinical decline occurs, in the setting of uncertainty, when patients are removed from the transplant list, or when long-term QOL issues are present. Conclusion: Communication with patients who have PH can be delicate and requires an understanding of the disease's process, trajectory, and prognosis. PC teams possess communication skills that may benefit patients and providers with QOL optimization, delivery of difficult news, advanced care planning, and shared decision-making.

Management of isoniazid-monoresistant tuberculosis (Hr-TB) in Queensland, Australia: a retrospective case series

2020 ◽  
Vol 173 ◽  
pp. 106163
Author(s):  
Malcolm Wilson ◽  
Bridget O'Connor ◽  
Nicholas Matigian ◽  
Geoffrey Eather
Keyword(s):  
Case Series ◽  
Retrospective Case ◽  
Retrospective Case Series

Non-vascularized fibular autograft for resistant humeral diaphyseal nonunion: Retrospective case series

2021 ◽  
pp. 102843
Author(s):  
Ahmed Fathy Sadek ◽  
Ezzat Hassan Fouly ◽  
Ahmad Fouad Abdelbaki Allam ◽  
Alaa Zenhom Mahmoud
Keyword(s):  
Case Series ◽  
Retrospective Case ◽  
Retrospective Case Series ◽  
Fibular Autograft

scholarly journals Paediatric admissions to a district general hospital adult intensive care unit over a six year period: A single centre retrospective case series, with review of practitioner confidence and competence in paediatric critical care

2021 ◽  
pp. 175114372110121
Author(s):  
Stephen A Spencer ◽  
Joanna S Gumley ◽  
Marcin Pachucki
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Case Series ◽  
Critically Ill Children ◽  
Single Centre ◽  
Retrospective Case ◽  
Retrospective Case Series ◽  
Paediatric Critical Care ◽  
Doctors And Nurses

Background Critically ill children presenting to district general hospitals (DGH) are admitted to adult intensive care units (AICUs) for stabilisation prior to transfer to paediatric intensive care units (PICUs). Current training in PICU for adult intensive care physicians is only three months. This single centre retrospective case series examines the case mix of children presenting to a DGH AICU and a multidisciplinary survey assesses confidence and previous experience, highlighting continued training needs for DGH AICU staff. Methods all paediatric admissions to AICU and paediatric retrievals were reviewed over a 6-year period (2014-2019). Cases were identified from the Electronic Patient Record (EPR) and from data provided by the regional paediatric retrieval service. A questionnaire survey was sent to AICU doctors and nurses to assess confidence and competence in paediatric critical care. Results Between 2014-2019, 284 children were managed by AICU. In total 35% of cases were <1 y, 48% of cases were <2 y and 64% of cases were <5 y, and 166/284 (58%) children were retrieved. Retrieval reduced with increasing age (OR 0.49 [0.40-0.60], p < 0.0001). The survey had an 82% response rate, and highlighted that only 13% of AICU nurses and 50% of doctors had received prior PICU training. Conclusion At least one critically unwell child presents to the AICU each week. Assessment, stabilisation and management of critically unwell children are vital skills for DGH AICU staff, but confidence and competence are lacking. Formalised strategies are required to develop and maintain paediatric competencies for AICU doctors and nurses.

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