Pub Date : 2005-05-01DOI: 10.1177/104990910502200316
{"title":"Call for manuscripts","authors":"","doi":"10.1177/104990910502200316","DOIUrl":"https://doi.org/10.1177/104990910502200316","url":null,"abstract":"","PeriodicalId":7716,"journal":{"name":"American Journal of Hospice and Palliative Medicine®","volume":"1 1","pages":"239 - 239"},"PeriodicalIF":0.0,"publicationDate":"2005-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90931427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2005-03-01DOI: 10.1177/104990910502200216
John W. Barnhill
Multiple causes of abdominal pain occur in HIV/AIDS. Common ones include: • Gastrointestinal tract (GIT) spasm related to gastroenteritis • Pancreatitis (especially in patients on NRTIs) • Intra-abdominal lymphadenopathy (TB, lymphoma) • Kaposi’s sarcoma of the GIT (look for skin or mucosal lesions) • Sclerosing cholangitis (sometimes resulting in hepatitis and cholecystitis) • Gynaecological related pain (severe pelvic inflammatory disease, tuboovarian or pelvic abscesses) • Non-HIV-related causes (common surgical conditions like appendicitis) • Cytomegalovirus (CMV) • Herpetic ulcers
{"title":"Book Review: A Clinical Guide to Supportive and Palliative Care for HIV/AIDS","authors":"John W. Barnhill","doi":"10.1177/104990910502200216","DOIUrl":"https://doi.org/10.1177/104990910502200216","url":null,"abstract":"Multiple causes of abdominal pain occur in HIV/AIDS. Common ones include: • Gastrointestinal tract (GIT) spasm related to gastroenteritis • Pancreatitis (especially in patients on NRTIs) • Intra-abdominal lymphadenopathy (TB, lymphoma) • Kaposi’s sarcoma of the GIT (look for skin or mucosal lesions) • Sclerosing cholangitis (sometimes resulting in hepatitis and cholecystitis) • Gynaecological related pain (severe pelvic inflammatory disease, tuboovarian or pelvic abscesses) • Non-HIV-related causes (common surgical conditions like appendicitis) • Cytomegalovirus (CMV) • Herpetic ulcers","PeriodicalId":7716,"journal":{"name":"American Journal of Hospice and Palliative Medicine®","volume":"207 1","pages":"158 - 160"},"PeriodicalIF":0.0,"publicationDate":"2005-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73742147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2005-03-01DOI: 10.1177/104990910502200201
In late December 2004, the Food and Drug Administration (FDA) approved ziconotide intrathecal (IT) infusion (Prialt®), Elan Corporation, Dublin, Ireland), for the management of severe pain in patients for whom IT therapy is warranted and who are intolerant or refractory to other treatment. Ziconotide is the first approved drug in a new class of nonopioid analgesics called N-type calcium channel blockers (NCCBs). A synthetic equivalent of a naturally occurring conopeptide found in a marine snail known as Conus magus, ziconotide selectively blocks calcium channels on nerves that ordinarily transmit pain signals to the brain. FDA approval was based on treatment of more than 1,200 patients and three phase-III clinical trials that evaluated its safety and efficacy in patients with severe chronic pain. The trials included a variety of subjects, including patients with pain related to failed back surgery, cancer, AIDS, and nonmalignant causes. Adverse side effects were mild to moderate and included dizziness, ataxia, confusion, and abnormal gait. For a fact sheet and prescribing information, visit Elan’s Web site at www.prialt.com. (Source: Medscape Medical News, January 15, 2005.)
{"title":"Hospice news","authors":"","doi":"10.1177/104990910502200201","DOIUrl":"https://doi.org/10.1177/104990910502200201","url":null,"abstract":"In late December 2004, the Food and Drug Administration (FDA) approved ziconotide intrathecal (IT) infusion (Prialt®), Elan Corporation, Dublin, Ireland), for the management of severe pain in patients for whom IT therapy is warranted and who are intolerant or refractory to other treatment. Ziconotide is the first approved drug in a new class of nonopioid analgesics called N-type calcium channel blockers (NCCBs). A synthetic equivalent of a naturally occurring conopeptide found in a marine snail known as Conus magus, ziconotide selectively blocks calcium channels on nerves that ordinarily transmit pain signals to the brain. FDA approval was based on treatment of more than 1,200 patients and three phase-III clinical trials that evaluated its safety and efficacy in patients with severe chronic pain. The trials included a variety of subjects, including patients with pain related to failed back surgery, cancer, AIDS, and nonmalignant causes. Adverse side effects were mild to moderate and included dizziness, ataxia, confusion, and abnormal gait. For a fact sheet and prescribing information, visit Elan’s Web site at www.prialt.com. (Source: Medscape Medical News, January 15, 2005.)","PeriodicalId":7716,"journal":{"name":"American Journal of Hospice and Palliative Medicine®","volume":"22 1","pages":"87 - 89"},"PeriodicalIF":0.0,"publicationDate":"2005-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79548886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2005-01-01DOI: 10.1177/104990910502200102
Research published in the November issue of the Journal of the National Cancer Institute reported that oncologists can safely give breast cancer patients radiation treatment and taxane drugs without increasing the risk of radiation pneumonitis. Radiation pneumonitis is an interstitial pulmonary inflammation that can develop in as many as 5 to 15 percent of patients with thoracic radiation treatment. Acute radiation pneumonitis occurs within one to six months following treatment. Symptoms can include low-grade fever, cough, and fullness in the chest. Severe reactions can result in dyspnea, pleuritic chest pain, hemoptysis, acute respiratory distress, and death. Fibrosis can occur without previous pneumonitis, but once pneumonitis occurs, fibrosis is almost certain to take place. The radiographic hallmark of radiation pneumonitis is a diffuse infiltrate corresponding to a previous radiation treatment field. According to a study conducted by Dr. Tse-Kuan Yu and colleagues at the University of Texas M. D. Anderson Cancer Center, new techniques for administering radiation therapy have made radiation-related pneumonitis much less common. However, there have been some recent reports that linked taxane chemotherapy in the increased risk of radiation-induced injury when used in conjunction with radiation treatment. The research team conducted a randomized study comparing paclitaxel-FAC (5-flurouracil, doxorubicin, and cyclophosphamide) with FAC alone in breast cancer patients, some of whom also underwent radiation therapy. The researchers analyzed these data to determine whether patients given the taxane drug had an increased risk of radiation-induced pneumonitis. The results of the study showed that patients with breast cancer treated with sequential paclitaxel, FAC, and radiation therapy appeared to have a very low rate of clinically relevant radiation pneumonitis that was no different from that of patients treated with FAC alone. In total, 5 percent of the 100 patients given paclitaxel developed pneumonitis compared with 4.5 percent of the 89 patients given FAC only. In the studies that found an increased risk, paclitaxel had been given just before or during radiation therapy. In the current study, patients received radiation three to four months after the end of paclitaxel treatment. The research team concluded that the risk of radiation pneumonitis should not be a determining factor in whether to use radiotherapy in conjunction with taxane drugs for breast cancer treatment. They agree that further research is necessary to explore the association between the risk of radiation pneumonitis and the combination of paclitaxel chemotherapy and radiation therapy. (Source: J Natl Cancer Inst. 2004; 96(22): 1676-1681.)
发表在《美国国家癌症研究所杂志》11月刊上的研究报告称，肿瘤学家可以安全地给乳腺癌患者进行放射治疗和紫杉烷类药物，而不会增加患放射性肺炎的风险。放射性肺炎是一种间质性肺部炎症，在接受胸部放射治疗的患者中可发展为5%至15%。急性放射性肺炎在治疗后一至六个月内发生。症状包括低烧、咳嗽和胸胀。严重的反应可导致呼吸困难、胸膜炎性胸痛、咯血、急性呼吸窘迫和死亡。以前没有肺炎也可以发生纤维化，但一旦发生肺炎，几乎肯定会发生纤维化。放射性肺炎的影像学标志是弥漫性浸润，与以前的放射治疗区相对应。根据德克萨斯大学安德森癌症中心(University of Texas m.d. Anderson Cancer Center)余子宽博士(Tse-Kuan Yu)及其同事进行的一项研究，放射治疗的新技术已经使辐射相关肺炎的发病率大大降低。然而，最近有一些报告表明，紫杉烷化疗与放射治疗联合使用时，会增加辐射诱发损伤的风险。研究小组进行了一项随机研究，比较了紫杉醇-FAC(5-氟尿嘧啶、阿霉素和环磷酰胺)和单独FAC治疗乳腺癌患者，其中一些患者也接受了放疗。研究人员分析了这些数据，以确定服用紫杉烷类药物的患者患放射性肺炎的风险是否增加。研究结果显示，序贯紫杉醇、FAC和放射治疗的乳腺癌患者出现临床相关放射性肺炎的发生率非常低，与单独接受FAC治疗的患者没有区别。总的来说，100名接受紫杉醇治疗的患者中有5%发生肺炎，而89名仅接受FAC治疗的患者中有4.5%发生肺炎。在发现风险增加的研究中，紫杉醇是在放射治疗之前或期间服用的。在目前的研究中，患者在紫杉醇治疗结束后三到四个月接受放疗。研究小组得出结论，放射性肺炎的风险不应成为是否使用放疗联合紫杉烷类药物治疗乳腺癌的决定性因素。他们一致认为，有必要进一步研究放射性肺炎风险与紫杉醇化疗和放疗联合使用之间的关系。(资料来源:J Natl Cancer institute, 2004;96(22): 1676 - 1681。)
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Pub Date : 2005-01-01DOI: 10.1177/104990910502200116
S. Baumrucker, G. Carter, Matt Stolick, Marie L Eloi-Stiven, Maria, Melissa S. Tobias, Madelon Finkel, Luisa, Lopez-Luciano, Vansantha, Kondamudi, M. Delarosa, M. Webb, Gary, Doolittle, E. Melton
{"title":"2004 Cumulative Subject Index","authors":"S. Baumrucker, G. Carter, Matt Stolick, Marie L Eloi-Stiven, Maria, Melissa S. Tobias, Madelon Finkel, Luisa, Lopez-Luciano, Vansantha, Kondamudi, M. Delarosa, M. Webb, Gary, Doolittle, E. Melton","doi":"10.1177/104990910502200116","DOIUrl":"https://doi.org/10.1177/104990910502200116","url":null,"abstract":"","PeriodicalId":7716,"journal":{"name":"American Journal of Hospice and Palliative Medicine®","volume":"25 1","pages":"74 - 78"},"PeriodicalIF":0.0,"publicationDate":"2005-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79686178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2005-01-01DOI: 10.1177/104990910502200115
J. Chibnall, P. Duckro, T. Kannan, Seema Mishra, A. Singhal
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Pub Date : 2004-11-01DOI: 10.1177/104990910402100603
Research published in the September 2004 issue of the Journal of Pain and Symptom Management reports that patients enrolled in hospice care cost Medicare less. The study, “Medicare Cost in Matched Hospice and NonHospice Cohorts,” also revealed that hospice patients lived longer, on average, than similar patients who did not choose hospice care. Commissioned by the National Hospice and Palliative Care Organization (NHPCO) and conducted by the actuarial firm of Milliman, USA, the study’s goal was to identify cost differences between patients who elect and do not elect to receive Medicare-paid hospice benefits. According to the research, the majority of patients with 16 of the most common terminal diagnoses who choose hospice care cost Medicare less. Cost savings range from $1,115 for rectal cancer patients to $8,879 for congestive heart failure patients. Researchers also found that, on average, hospice patients lived longer. These life spans range from 20 days for patients with a diagnosis of gallbladder cancer to 69 days for those with breast cancer. “With almost 30 percent of Medicare costs going for all types of care delivered towards the end of life, an understanding of the cost benefits of hospice is important,” said J. Donald Schumacher, president and CEO of NHPCO. “However, discussions relating to costs should never cloud the most important issue— hospice provides the highest quality of compassionate care for patients and families.” A significant factor in this study is the unique methodology used to work towards eliminating selection bias. Selection bias has been a recognized problem in previous studies contrasting hospice versus nonhospice patients. Medicare health insurance claims and enrollment data were used to measure both costs and time until death, starting from narrowly defined dates. Indicative markers were identified that represented unambiguous points in the end stage of each disease. This study began tracking patients further upstream in a manner that researchers suggest addresses many selection bias concerns. The data source was Medicare health insurance claims and enrollment data from 5 percent Sample Beneficiary Standard Analytic Files for years 1998, 1999, and 2000. This 5 percent sample is created by the Centers for Medicare & Medicaid Services as a statistically representative, longitudinal data set. The research includes 8,700 patients who met the criteria for this study. The article points out that a period of at least two to three months of hospice care may be optimal from both a cost and clinical standpoint. (Source: NHPCO press release, September 21, 2004.)
2004年9月发表在《疼痛与症状管理杂志》上的一项研究报告称，参加临终关怀的病人花费较少的医疗保险费用。这项名为“匹配临终关怀和非临终关怀队列的医疗保险成本”的研究还显示，临终关怀患者的平均寿命比没有选择临终关怀的类似患者更长。受美国国家临终关怀和姑息治疗组织(National Hospice and Palliative Care Organization，简称NHPCO)委托，美国Milliman精算公司进行的这项研究的目标是确定选择和不选择接受医疗保险支付的临终关怀福利的患者之间的成本差异。根据这项研究，大多数患有16种最常见的晚期诊断的患者选择临终关怀的费用更低。节省的费用从直肠癌患者1115美元到充血性心力衰竭患者8879美元不等。研究人员还发现，平均而言，临终关怀病人的寿命更长。这些寿命从诊断为胆囊癌的20天到诊断为乳腺癌的69天不等。NHPCO总裁兼首席执行官j·唐纳德·舒马赫(J. Donald Schumacher)表示:“由于近30%的医疗保险费用用于临终关怀，了解临终关怀的成本效益非常重要。”“然而，有关费用的讨论不应该掩盖最重要的问题——临终关怀为病人和家属提供了最高质量的慈悲关怀。”本研究的一个重要因素是用于消除选择偏差的独特方法。在以往的安宁疗护病人与非安宁疗护病人的对比研究中，选择偏倚是一个公认的问题。医疗保险索赔和登记数据被用来衡量成本和死亡前的时间，从狭义的定义日期开始。确定了指示性标记，代表了每种疾病终末期的明确点。这项研究以一种研究人员提出的解决许多选择偏差问题的方式开始进一步追踪患者。数据来源是1998年、1999年和2000年5%样本受益人标准分析文件中的医疗保险健康保险索赔和登记数据。这5%的样本是由医疗保险和医疗补助服务中心创建的，作为统计代表性的纵向数据集。该研究包括8700名符合本研究标准的患者。文章指出，从成本和临床角度来看，至少两到三个月的临终关怀可能是最佳的。(资料来源:美国国家电力公司2004年9月21日的新闻稿。)
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Pub Date : 2004-11-01DOI: 10.1177/104990910402100615
Francis C. Zanger
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