BMJ Supportive & Palliative Care最新文献

Background: Chronic low back pain (CLBP) remains a prevalent and debilitating condition with significant social and economic impact. Due to limitations associated with pharmacological therapies, there is increasing interest in non-pharmacological approaches such as Tui Na manual therapy. This systematic review aimed to evaluate the effectiveness of Tui Na therapy in reducing pain and improving function in CLBP.

Methods: A comprehensive literature search was conducted across PubMed, Cochrane Library, EMBASE, Medline, Scopus, Web of Science and Google Scholar from inception to 30 April 2025, identifying randomised controlled trials and quasi-experimental studies evaluating Tui Na or Chuna interventions in adults (≥18 years) with chronic specific or non-specific low back pain (duration ≥12 weeks). Studies were included if they reported outcomes on pain intensity and functional status. Risk of bias was assessed using the Cochrane RoB 2.0 tool, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework was used to assess the quality of evidence.

Results: Five studies involving 618 participants were included. Tui Na (or Chuna) therapy significantly reduced pain intensity (mean Visual Analogue Scale/Numerical Rating Scale reduction: 2.5-3.1 points) and improved functional outcomes (mean Oswestry Disability Index reduction: 10-15 points) compared with control or conventional care. Improvements were consistent across both specific and non-specific CLBP subgroups. No serious adverse events were reported; mild side effects were rare and self-limiting.

Conclusion: This review provides evidence that Tui Na and Chuna manual therapies are effective in alleviating pain and improving function in adults with CLBP. Given their favourable safety profile and consistent clinical benefits, these therapies may serve as valuable components of integrative pain management strategies.

Introduction: The majority of observational studies approved that regular consumption of vitamin E would decrease the risk of cardiovascular events. However, a great number of randomised trials do not support this idea and dismiss the beneficial effect of vitamin E in reducing heart disease risk factors.

Methods: To test this hypothesis and identify whether vitamin E supplementation can reduce the risks of cardiovascular diseases, we organised a systematic review to reach out relevant articles. Insert the authors' criteria for inclusion and exclusion of studies; 58 papers were remained in the review.

Results: Some of the studies revealed a significant role of vitamin E in preventing CVD, while almost all of the trials suggested no beneficial impact of vitamin E on cardiovascular outcomes. Thus, there is a need for further studies to be conducted in the field.

Conclusion: It is recommended to critically review the results of randomised trials based on a wide range of different parameters, including the form of vitamin E, the duration and dosage of vitamin E consumption, and the synergetic effects of vitamin E with other antioxidants or medication. The intervention studies also need to be considered in terms of specific clinical settings and be improved through successful study designs.

Objectives: Bone metastases are common in advanced cancers. In patients with impending pathologic fractures, prophylactic fixation can improve quality of life. Postoperative radiotherapy (RT) is the standard of care for bone metastases; however, preoperative RT may be beneficial in some patients. We evaluated outcomes in patients treated with preoperative RT for bone metastases.

Methods: We performed a retrospective review of 10 patients with bone metastases treated with preoperative RT. Descriptive statistics were used to characterise the cohort, and the Kaplan-Meier method was used to estimate time to subsequent palliative RT treatment and overall survival.

Results: 10 patients were included in the analysis. Preoperative RT was used for various reasons, including for continuation of systemic therapy (20%), to reduce the RT field (20%) and due to medical comorbidities delaying surgery (20%). The median time from completion of RT to surgery was 13 days (IQR 7-21). The majority of patients (90%) had no postoperative complications. No patients had radiographic evidence of local disease recurrence at a median of 13 months.

Conclusions: Patients treated with preoperative RT do well with minimal operative complications and improvement in reported pain. A randomised clinical trial is warranted to compare outcomes for preoperative and postoperative RT for palliation of bone metastasis requiring orthopaedic intervention.

Objectives: On rare occasions, hiccups can cause morbidity, such as sleep deprivation, aspiration and even death. At times, palliative invasive procedures are considered. This study tested the hypothesis that invasive procedures can provide hiccup palliation with an acceptable safety profile.

Methods: Multi-site electronic medical data were used to assess adult patients who underwent an invasive procedure for hiccups between January 1995 and January 2022. Hiccup palliation was defined as documented improvement in severity or frequency of this sign/symptom after the procedure.

Results: A total of 69 patients underwent one or more invasive procedures for hiccups (144 total procedures). Fifty-nine patients (86%) were men. The most frequent initial procedure was a phrenic nerve block (n=10) followed by oesophageal dilation (n=9). Only 31 patients (45%) manifested hiccup palliation after their first procedure. Nearly half, or 32 patients (46%), underwent more than one procedure (2 underwent nine procedures). Of these subsequent procedures, 35 resulted in palliation. Five adverse events arose from 144 procedures: post-esophagectomy atrial fibrillation, haematoma after cardiac device removal, vocal cord immobility after craniotomy, vocal cord immobility after vagal nerve manipulation, and a cerebral spinal leak after vagal nerve decompression.

Conclusions: Invasive procedures can palliate hiccups with an acceptable safety profile. However, these procedures appear to palliate hiccups in only about half of patients and sometimes do so only transiently.

This study investigated the associations between sedentary behaviour-specifically time spent driving, watching television, and using a computer-and the risk of musculoskeletal diseases and fractures using a Mendelian randomisation (MR) approach. A two-sample MR analysis was conducted based on data from the IEU GWAS database of the UK Biobank. Single-nucleotide polymorphisms significantly associated with sedentary behaviours, musculoskeletal disorders, and fractures were selected as instrumental variables after linkage disequilibrium testing, exclusion of potential confounders, and confirmation of instrument strength (F-statistics >10). Inverse variance weighting was used as the primary analytical method, with weighted median and MR-Egger regression as complementary analyses. Sensitivity analyses included Cochran's Q test, MR-Egger intercept testing, and leave-one-out analysis. Random- and fixed-effects models were applied to synthesise results across different sedentary behaviour domains. The MR analyses identified significant associations between television viewing and ankle fractures (P = 0.0182), television viewing and musculoskeletal and connective tissue diseases (P < 0.001), and heel bone mineral density and ankle fractures (P < 0.001). In contrast, computer use was negatively associated with musculoskeletal and connective tissue diseases (P = 0.0017), suggesting a potential protective effect that warrants further investigation. Overall, these findings indicate that sedentary behaviours have heterogeneous effects on musculoskeletal health. Television viewing was associated with an increased risk of ankle fractures and musculoskeletal diseases, whereas computer use showed an inverse association with musculoskeletal disorders. This study provides genetic evidence for the role of sedentary behaviour in the development of musculoskeletal and fracture-related diseases and may inform targeted prevention and intervention strategies. The study was registered in PROSPERO (CRD42024552384).

Objectives: Sarcopenia, characterised by reduced skeletal muscle mass and strength, is increasingly recognised as a prognostic marker in oncology. Its role in breast cancer and its variation across molecular subtypes remains unclear. This study examined the prognostic value of sarcopenia, defined by Skeletal Muscle Index (SMI), and its association with overall survival (OS) among breast cancer subtypes.

Methods: This retrospective study included 523 women diagnosed with breast cancer at Ege University between January 2014 and January 2015. Clinical, pathological and anthropometric data were collected. Sarcopenia was evaluated using bioelectrical impedance analysis (BIA) with the TANITA SC-330 device to estimate appendicular muscle mass, and defined as SMI <5.5 kg/m². Survival outcomes were analysed using Kaplan-Meier curves and Cox regression models adjusted for age, tumour stage, molecular subtype and body mass index. Subgroup analyses were performed for luminal A, luminal B, HER2-positive and triple-negative breast cancer (TNBC) subtypes.

Results: The mean age was 57.6±13.0 years, and 9.7% were sarcopenic. Sarcopenia was significantly associated with reduced OS (HR: 1.789, p=0.025). While no significant effect was seen in luminal A or B subtypes, sarcopenia predicted markedly worse survival in HER2-positive patients (HR: 11.247, p=0.001) and TNBC patients. Recurrence rates were similar between sarcopenic and non-sarcopenic individuals.

Conclusion: Sarcopenia assessed by BIA is an independent predictor of poor survival in breast cancer, particularly in HER2-positive and TNBC subtypes. Incorporating muscle assessment into routine evaluation may help identify high-risk patients and guide supportive care.

Background: The WHO defines palliative care (PC) as an approach to improving the quality of life for patients and their families. Within this context, palliative psychiatry (PP) emerges. The present study undertakes a scoping review of research on the applicability of PC in people with severe mental disorders.

Methods: Nine online databases were used to identify articles published without time or language restrictions, from which 17 records were selected. These records originated from eight countries and covered eight psychiatric diagnostic groups.

Results: A descriptive synthesis of the eligible studies was conducted, which were then analysed using content analysis techniques. From the thematic analysis, three main themes emerged: general aspects of PP, critical reflections on the application of care and the strategies employed in this field.

Conclusions: Despite the growing definition of PP, the literature remains scarce, with few studies focused on PC for psychiatric disorders, leading to a neglect of such care. There is a significant demand for more empirical research and diverse approaches that include narratives and evaluations from patients and their families.

Trial registration number: The protocol for this review was registered on the Open Science Framework platform under the DOI number: 10.17605/OSF.IO/3ZVN5.