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Chronic pain evaluation in breast cancer patients using the Self-Report Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS): a single center cross-sectional retrospective study 使用利兹神经病理性症状和体征自我评估(S-LANSS)评估乳腺癌患者的慢性疼痛:一项单中心横断面回顾性研究
Q4 Medicine Pub Date : 2023-07-13 DOI: 10.5603/pmpi.a2023.0027
Dhiraj Daga, N. S. Shah, Sanchit Jain, Gaurav Sharma, Harsh Goel, Sooyun Tavolacci, Boski Gupta, Kiran Gulia, Tabish H Khan, Darksha Usmani, Akash Gujral, Naoshad Muhammad, Sandeep Mittan, Poonam Banthia
Background: Breast cancer is the most common cancer in India, and the number of survivors has increased over the last few years. Pain is one of the most common symptoms during cancer treatment due to either the disease itself or adverse effects of treatment. The available data suggests that breast cancer patients have a high prevalence of neuropathic pain. Patients and methods: A cross sectional observational study was done at the Department of Radiation Oncology, between November 2021 to June 2022. The patients were admitted and screened for participation, non-metastatic post operative breast cancer on regular follow up for 2 years after their last chemotherapy or radiotherapy and not having any chronic neuropathy disease and the Self-Report Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) pain scale was used to assess the neuropathy pain status of patients. Patients’ demographics, clinical characteristics, and treatment of surgery, radiation therapy, and chemotherapy were collected and the comparison of the pain score between the patients was analysed. Results: Total of 149 patients were included in the study. S-LANSS score was calculated in the study population and more than 61% of participants reported a score equal or greater than 12, suggesting a predominant neuropathic pain component. Autonomic dysfunction, thermal pain, and allodynia were more prevalent in patients who underwent mastectomies compared to breast-conserving surgery. Whereas the dysesthesia and autonomic dysfunction score was higher in only the anthracycline group. Conclusions: The most important index for quality of life in cancer patients is the presence of persistent chronic pain and it is important to classify it accordingly in order to provide the best management. Using the S-LANSS score, the pattern of neuropathic pain can be determined early which leads to early intervention.
背景:乳腺癌是印度最常见的癌症,在过去几年中,幸存者人数有所增加。疼痛是癌症治疗期间最常见的症状之一,其原因可能是疾病本身,也可能是治疗的不良反应。现有数据表明,乳腺癌患者的神经性疼痛发生率很高。患者和方法2021 年 11 月至 2022 年 6 月期间,放射肿瘤科开展了一项横断面观察研究。研究采用利兹神经病理性症状和体征自评量表(S-LANSS)评估患者的神经病理性疼痛状况。收集患者的人口统计学资料、临床特征以及手术、放疗和化疗治疗情况,并对患者的疼痛评分进行比较分析。研究结果研究共纳入 149 名患者。研究人员计算了S-LANSS评分,61%以上的参与者报告评分等于或大于12分,表明神经病理性疼痛成分占主导地位。与保乳手术相比,接受乳房切除术的患者更容易出现自主神经功能障碍、热痛和异感症。而只有蒽环类药物组患者的痛觉障碍和自主神经功能障碍评分较高。结论癌症患者生活质量的最重要指标是是否存在持续性慢性疼痛,因此必须对其进行相应的分类,以便提供最佳的治疗方案。使用 S-LANSS 评分可以及早确定神经病理性疼痛的模式,从而进行早期干预。
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引用次数: 0
The effect of hippocampal sparing during prophylactic cranial irradiation on the preservation of neurocognitive functions in patients with small cell lung cancer: a preliminary study 小细胞肺癌患者在预防性颅脑照射期间保留海马体对神经认知功能的影响:一项初步研究
Q4 Medicine Pub Date : 2023-07-12 DOI: 10.5603/pmpi.a2023.0021
Karolina Loga, Bartosz Wójcik, Anna Stanisławek, A. Papis-Ubych, Jacek Fijuth, L. Gottwald
Background: Prophylactic cerebral irradiation (PCI) is the standard of care for patients with limited small cell lung cancer (SCLC). Cerebral irradiation is associated with the deterioration of the quality of life in terms of cognitive function, in which the hippocampus plays a critical role. Protection of the hippocampus during PCI aims to reduce the adverse effects of ionizing radiation on neurocognitive function, which may be important for optimal quality of life. To date, subjective psychological tests have been used as a methodical assessment of cognitive function in patients after PCI
背景:预防性脑照射(PCI)是局限性小细胞肺癌(SCLC)患者的标准治疗方法。脑辐照与认知功能方面的生活质量下降有关,而海马在认知功能方面起着至关重要的作用。在 PCI 期间保护海马体的目的是减少电离辐射对神经认知功能的不利影响,这对优化生活质量可能非常重要。迄今为止,主观心理测试一直被用作 PCI 术后患者认知功能的评估方法
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引用次数: 0
Non-pharmacological methods of treating depression in elderly are effective and not toxic: a minireview 治疗老年抑郁症的非药物方法有效且无毒:小视角
Q4 Medicine Pub Date : 2023-07-12 DOI: 10.5603/pmpi.a2023.0026
Mateusz Kalita, Zbigniew Żylicz
Psychological depression is a frequent disorder still underdiagnosed and untreated in elderly. It is treated like something that belongs to the last phase of life. Depression is known to compromise quality of life near death. Pharmacological therapy is not always possible in this group because of frequent adverse effects and interactions with other drugs used and limited time until death. Beside pharmacological therapy there are many non-toxic non pharmacological therapies, more suitable for this population. These therapies, like cognitive behavioral therapy or mindfulness meditation therapy as well as many other are confirmed to be effective and safe in this population. Some of these therapies are suitable for the patients who are cognitively impaired.
心理抑郁症是一种常见疾病,在老年人中仍未得到充分诊断和治疗。它被视为属于生命最后阶段的疾病。众所周知,抑郁症会影响临近死亡时的生活质量。由于经常出现不良反应和与其他药物的相互作用,以及死亡前的时间有限,因此药物治疗并不总是适用于这一群体。除了药物治疗,还有许多无毒的非药物疗法更适合这类人群。这些疗法,如认知行为疗法或正念冥想疗法以及许多其他疗法,已被证实对这类人群有效且安全。其中一些疗法适合认知能力受损的患者。
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引用次数: 0
Lessons learned from self-efficacy of healthcare professionals for advance care planning 从医护人员预先护理规划的自我效能中汲取的经验教训
Q4 Medicine Pub Date : 2023-07-10 DOI: 10.5603/pmpi.a2023.0024
V. Tripodoro, María Stella Di Gennaro, Julia Fila, Verónica Inés Veloso, Celeste Quiroga, Cristina Lasmarías Martínez
Background: Advance care planning (ACP) is a reflective, deliberative, and structured process based on dialogue and free agreement between the person concerned and healthcare professionals. Argentina has no national ACP program or systematic approach for patients diagnosed with advanced chronic disease. Healthcare providers who treat these patients highlight some main obstacles in initiating the ACP process. Perceived self-efficacy is one of the main predictors of success in learning processes and promotes the acquisition of new behaviours and positive results in implementing ACP. We aimed to sensitise professionals and explore their self-efficacy for ACP before specific training. Participants and methods: This exploratory, prospective, descriptive study used the self-efficacy ACP-SEs scale already validated in Argentina. We surveyed 236 healthcare professionals (n 125 physicians/n 111 non-physicians) before specific training courses (2019–2021). Results: Participants’ experience, training needs, and practices. Most respondents were females (43 years old). Non-physicians (n 111) were 40 nurses, 32 psychologists, 16 social workers, 15 physiotherapists, and 8 other health backgrounds. Over 50% had 5–20 years of professional and primary care experience. When comparing professions, half of the physicians increased by up to 5.23 points higher on the self-efficacy scale than non-physicians. Most participants had no personal advance directives and neither helped a relative nor a patient sign a document. Half of the participants had previously undergone training. Half of the professionals who had done ACP significantly increased their value on the scale by up to 7.5 points more than those who did not. Differences between physicians and non-physicians revealed areas of improvement involving communication skills, roles and tasks, and legal issues. Conclusions: Healthcare providers' skills improve with experience and require training to increase self-efficacy. Our findings should encourage tailor-made training programs in the future. One of the goals of this study was to spark discussions before specific training courses and develop appropriate teaching methods based on perceived self-efficacy in Argentina.
背景:预先护理计划(ACP)是一个反思、审议和结构化的过程,基于当事人与医疗保健专业人员之间的对话和自由协议。阿根廷没有针对晚期慢性病患者的全国性 ACP 计划或系统方法。为这些患者提供治疗的医护人员强调了启动 ACP 过程的一些主要障碍。自我效能感是预测学习过程成功与否的主要因素之一,它能促进新行为的获得,并在实施 ACP 过程中取得积极成果。我们的目的是在具体培训之前提高专业人员的认识,并探索他们对 ACP 的自我效能感。参与者和方法:这项探索性、前瞻性和描述性研究使用了已在阿根廷验证的 ACP-SEs 自我效能量表。我们在特定培训课程(2019-2021 年)之前对 236 名医疗保健专业人员(n 125 名医生/n 111 名非医生)进行了调查。调查结果显示参与者的经验、培训需求和实践。大多数受访者为女性(43 岁)。非医生(n 111)包括 40 名护士、32 名心理学家、16 名社会工作者、15 名物理治疗师和 8 名其他健康背景的人员。超过 50%的人拥有 5-20 年的专业和初级医疗经验。在进行职业比较时,半数医生的自我效能感比非医生高出 5.23 分。大多数参与者没有个人预嘱,既没有帮助亲属也没有帮助病人签署文件。半数参与者以前接受过培训。半数接受过 ACP 培训的专业人士比未接受过培训的专业人士在量表上的分值显著提高了 7.5 分。医生和非医生之间的差异表明,他们在沟通技巧、角色和任务以及法律问题方面都有所改进。结论:医疗服务提供者的技能会随着经验的积累而提高,需要通过培训来增强自我效能感。我们的研究结果应鼓励今后开展量身定制的培训计划。本研究的目标之一是在具体培训课程前引发讨论,并根据阿根廷人的自我效能感制定适当的教学方法。
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引用次数: 0
Pathophysiology and management of opioid-induced constipation: a narrative review 阿片类药物引起的便秘的病理生理学和治疗:综述
Q4 Medicine Pub Date : 2023-07-07 DOI: 10.5603/pmpi.a2023.0025
Jakub Kobiałka, Bartłomiej Ludwig, Anna Dziekiewicz, Joanna Bystron
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引用次数: 0
Blood transfusions in palliative care: a method to improve quality of life or a double-edged sword? A mini-review 姑息关怀中的输血:改善生活质量的方法还是一把双刃剑?微型综述
Q4 Medicine Pub Date : 2023-07-06 DOI: 10.5603/pmpi.a2023.0023
Martyna Bukała, Zbigniew Żylicz
Blood transfusions are uncommon in the palliative care setting. There are no guidelines to make decisions about blood transfusions in palliative care. Certainly, these decisions cannot be made basing on the hemoglobin level only. Occasionally the issue of blood transfusion is being discussed with the family. Instead of being a bridge to recovery and self-sufficiency of the bone marrow, like non-palliative medicine, blood transfusions are appreciated as buying some quality time for the patient. However, this issue is questionable in the light of available data and experience. Blood transfusion can boost the patient’s energy for days or a week, but it can also have more adverse effects including re-bleeding and unexplained death. Controlled data on this subject are absent. In the discussions on blood transfusions with the patients and their families these aspects should not be forgotten. Blood transfusions remain, not without reason a rare but possible procedure in palliative care.
输血在姑息关怀中并不常见。目前还没有关于姑息关怀中输血决定的指南。当然,这些决定不能仅仅依据血红蛋白水平。输血的问题偶尔会与家属进行讨论。输血并不像非姑息治疗那样是通往康复和骨髓自给自足的桥梁,而是为病人争取一些宝贵的时间。然而,从现有的数据和经验来看,这个问题值得商榷。输血可以在数天或一周内增强病人的体力,但也可能产生更多不良影响,包括再次出血和不明原因死亡。目前还没有这方面的对照数据。在与患者及其家属讨论输血问题时,不应忘记这些方面。在姑息治疗中,输血仍然是一种罕见但可行的程序,这并非毫无道理。
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引用次数: 0
Palliative, supportive, and hospice care: current challenges in medical education 缓和、支持和临终关怀:当前医学教育的挑战
Q4 Medicine Pub Date : 2023-06-30 DOI: 10.5603/pmpi.2023.0016
Wojciech Leppert
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引用次数: 0
Accessibility and challenges of perinatal palliative care in Poland 波兰围产期姑息治疗的可及性和挑战
Q4 Medicine Pub Date : 2023-06-30 DOI: 10.5603/pmpi.a2023.0015
Urszula Tataj-Puzyna, Beata Szlendak, Izabela Kaptacz, Dorota Sys, Maria Węgrzynowska, Barbara Baranowska
Introduction: This article examines the legal status and level of accessibility to perinatal palliative care (PPC) in Poland, with a focus on the number of services provided and the number of parents receiving PPC services. Material and methods: The desk research was based on information obtained from the National Health Fund regarding the number of units that signed a contract for the provision of guaranteed PPC services from 2018 to the first half (January–June) of 2022; the number of parents receiving the service from 2018 to 2022; and the number of services provided by a doctor, a psychologist and by primary care midwives (PCMs). In addition, the Map of Health Needs and National Transformation Plan data were used to prepare the data. Results: In Poland, since 2018, PPC services have been provided with public funds under contracts signed with the National Health Fund. Since 2022, these type of services has been provided by 17 centres. Care was provided to 1,860 pregnant women diagnosed with lethal foetal anomaly and to four fathers. There are still voivodeships in which there is a lack of provision of PPC services that are financed from the state budget. Conclusions: In Poland, there is no full accessibility to publicly funded PPC in every voivodeship. The lack of a sufficient number of PPC centres and the lack of a uniform national standard of practice for this type of care — provided in hospices, hospitals and home settings — prevents women from having continuity of professional perinatal care. There is a need to ensure the quality of the services provided and make progress towards the employment of midwives in PPC facilities by service providers to ensure that women receive obstetric care from the moment of an adverse diagnosis, professional preparation for childbirth and the postnatal period.
前言:本文考察了波兰围产期姑息治疗(PPC)的法律地位和可及性水平,重点关注提供的服务数量和接受PPC服务的父母数量。材料和方法:桌面研究基于从国家卫生基金获得的关于2018年至2022年上半年(1月至6月)签署提供有保证的PPC服务合同的单位数量的信息;2018年至2022年接受该服务的家长人数;以及医生、心理学家和初级保健助产士提供的服务数量。此外,还利用卫生需求图和国家转型计划的数据编制了这些数据。结果:在波兰,自2018年以来,根据与国家卫生基金签署的合同,PPC服务由公共资金提供。自2022年以来,17个中心提供了这类服务。向1 860名诊断为致命胎儿畸形的孕妇和4名父亲提供了护理。仍有一些省缺乏由国家预算资助的PPC服务。结论:在波兰,并非每个省都能完全获得公共资助的PPC。由于缺乏足够数量的PPC中心,以及在收容所、医院和家庭环境中提供的这类护理缺乏统一的国家实践标准,妇女无法获得持续的专业围产期护理。有必要确保所提供服务的质量,并在服务提供者在PPC设施中雇用助产士方面取得进展,以确保妇女从不利诊断的那一刻起,从分娩的专业准备到产后,都能得到产科护理。
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引用次数: 0
Spiritual care competence and caring abilities among Polish nurses: a correlation descriptive study 波兰护士精神关怀能力与关怀能力的相关描述性研究
Q4 Medicine Pub Date : 2023-06-29 DOI: 10.5603/pmpi.a2023.0022
Michał Machul, Beata Dobrowolska
Background: Spiritual care is an obligatory aspect of nursing care for a patient at the end of life and play an important role in providing quality nursing care. The aim of this study was to describe level of spiritual care competence and caring abilities of Polish nurses, and to examine the relationship between them. Participants and methods: In the study based on the Caring Ability Inventory (CAI) and the Spiritual Care Competence Scale (SCCS) questionnaires descriptive, correlational, cross-sectional design was adopted. The study involved 451 clinical nurses. Results: Respondents’ overall score of SCCS was high (median = 101.22; mean = 103.00; SD = 17.14) and low in the overall score of CAI (median = 185.44; mean = 185.00; SD = 21.05). The respondents who believe that nurses should assess the patient’s spiritual needs obtained statistically higher scores in all subscales and the overall score of SCCS and CAI. The total score of spiritual care competence was also positively correlated with the level of caring abilities (p < 0.01). The caring abilities and competences to provide spiritual care of Polish nurses correlate, among others, with their age, professional experience, level of education and job satisfaction. Conclusions: The implementation by academic teachers and nursing managers of strategies promoting patient-centred nursing care and humanistic values will contribute to strengthening the caring abilities of nurses and the skills to provide spiritual care to patients especially in the most basic human experience of dying.
背景:精神关怀是临终病人护理中必不可少的一个方面,在提供高质量的护理中起着重要作用。本研究的目的是描述波兰护士的精神关怀能力和关怀能力的水平,并检查他们之间的关系。对象与方法:本研究以关怀能力量表(CAI)和精神关怀能力量表(SCCS)问卷为基础,采用描述性、相关性、横断面设计。该研究涉及451名临床护士。结果:被调查者的SCCS总分较高(中位数= 101.22;平均值= 103.00;SD = 17.14), CAI总分较低(中位数= 185.44;平均值= 185.00;Sd = 21.05)。认为护士应评估患者精神需求的被调查者在各分量表和SCCS、CAI总分中得分均较高。精神关怀能力总分与关怀能力水平也呈显著正相关(p <0.01)。波兰护士提供精神护理的护理能力和能力与其年龄、专业经验、教育水平和工作满意度有关。结论:学术教师和护理管理者实施以患者为中心的护理策略和人文价值观,有助于提高护士的护理能力和为患者提供精神关怀的技能,特别是在最基本的人类临终体验中。
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引用次数: 0
Visitation policies at palliative care units and stationary hospices during COVID-19 pandemic: a literature review COVID-19大流行期间姑息治疗单位和固定临终关怀医院的探视政策:文献综述
Q4 Medicine Pub Date : 2023-05-08 DOI: 10.5603/pmpi.a2023.0019
Filip Lebiedziński, Kacper Wilczkowski, Jan Getek, Leszek Pawłowski
Background: The COVID-19 pandemic has significantly affected the ability of relatives and friends to accompany patients. Medical facilities have taken measures to limit or prohibit direct contact in proportion to the epidemic risk while respecting the integral healthcare component of relatives’ participation in the therapeutic process. New challenges have also arisen in specialized palliative care units, where the family plays a key role in providing support and comfort to patients with advanced illness, especially at the end of life. This review aims to explore visitation policies in palliative care settings during the COVID-19 pandemic. Patients and methods: PubMed, SCOPUS and Web of Science (WoS) were reviewed using iteratively selected keywords (visiting policy AND palliative care AND COVID-19) to identify visiting policies in specialist palliative care settings. Results: The presence of relatives and their direct participation in inpatient palliative care have been significantly reduced or completely excluded. Several units have established specific visiting policies designed to prevent patients, staff and visiting relatives from acquiring the infection. The rules included obligatory personal protective equipment, limiting the duration of visits and the number of permitted guests, as well as allowing only visitors that had been vaccinated against COVID-19. To mitigate the harm caused by the restrictions, new means of remote contact such as video calls through teleconferencing platforms have been introduced or expanded. Conclusions: Delving into solutions facilitating contact between relatives and patients, implemented in inpatient palliative care units during the COVID-19 pandemic may serve to identify and establish model solutions for managing similar scenarios in the future.
背景:新冠肺炎疫情严重影响了亲友陪伴患者的能力。医疗机构已采取措施,根据流行病的危险程度限制或禁止直接接触,同时尊重亲属参与治疗过程的整体保健组成部分。在专门的姑息治疗病房也出现了新的挑战,在那里,家庭在向晚期疾病患者提供支持和安慰方面发挥着关键作用,特别是在生命末期。本综述旨在探讨COVID-19大流行期间姑息治疗机构的探视政策。患者和方法:使用迭代选择的关键词(就诊政策、姑息治疗和COVID-19)对PubMed、SCOPUS和Web of Science (WoS)进行综述,以确定专科姑息治疗机构的就诊政策。结果:亲属的存在及其直接参与住院姑息治疗已显著减少或完全排除。一些单位制定了具体的探视政策,旨在防止病人、工作人员和探视亲属感染这种病毒。这些规定包括强制性的个人防护装备,限制访问时间和允许的访客人数,以及只允许接种了COVID-19疫苗的访客。为了减轻这些限制造成的危害,已经引入或扩大了新的远程联系手段,如通过电话会议平台进行视频通话。结论:深入研究在2019冠状病毒病大流行期间在姑息治疗住院病房实施的促进亲属和患者接触的解决方案,可能有助于确定和建立未来管理类似情况的示范解决方案。
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引用次数: 0
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Palliative Medicine in Practice
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