BMJ Supportive & Palliative Care最新文献

Objective: To explore the role of religious practices in palliative care and their impact on the quality of life among inpatients at Ocean Road Cancer Institute.

Methods: A quantitative cross-sectional study was conducted, using structured surveys to gather data from 150 inpatients receiving palliative care. The WHO Quality of Life-BREF (WHOQOL-BREF) tool was used to measure quality of life, alongside data on the usage of religious practices.

Results: The findings reveal that most of the participants (90%) expressed a need for religious practices, predominantly prayer. Notably, access to these practices positively correlated with improved perceptions of well-being, despite a considerable portion of patients reporting a poor quality of life (84.7%).

Conclusion: The study's findings highlight the importance of incorporating religious practices into palliative care, particularly in low-resource settings like Tanzania, to provide culturally sensitive, holistic support for patients with cancer.

Objective: This study aims to investigate the safety and feasibility of early oral feeding in patients with gastric cancer after gastrectomy.

Methods: A total of 135 patients with gastric cancer who would receive gastrectomy were enrolled in the study, with 61 in early oral feeding group and 74 in control group. Outcomes included nutrient intake, nutritional status, gastrointestinal functions and symptoms, pain, physical activity time, clinical outcomes and inflammation markers.

Results: In comparison with control group, patients in early oral feeding group had significantly higher compliance rates of oral energy and protein intake, lower needs of parenteral nutrition and shorter postoperative oral feeding start time during hospitalisation. Moreover, the compliance rate of oral protein intake at 1 week after discharge was higher in patients with gastric cancer of early oral feeding group compared with control group. The gastrointestinal function was better in early oral feeding group, evidenced by shorter time to the first flatus and dwell time for gastric tube.

Conclusion: This study demonstrated that early oral feeding is safe and can significantly improve oral energy and oral protein intake and gastrointestinal functions during hospitalisation in patients with gastric cancer who received gastrectomy, as well as the oral protein intake after discharge.

Trial registration: Chinese Clinical Trial Registry: ChiCTR2300069202.

Introduction: Considering the importance of chronic low back pain in disability in older adults, the present study aimed to investigate the effect of auriculotherapy on pain intensity and functional disability in this group.

Materials and methods: This single-blind clinical trial was conducted on older adults with chronic low back pain in Kashan, Iran, 2019-2020. Seventy eligible older people were allocated to the intervention and sham groups via block randomisation. In the intervention group, pressure was applied using Varcaria seeds on the Shenmen, sympathetic, nerve subcortex and low back points. The visual analogue scale was completed at the beginning (T0), weekly (T1-T4) and 1 month after intervention (T5). Functional disability was assessed using Oswestry Disability Index at T0, T4 and T5. Data were analysed in per-protocol and intention-to-treat designs using repeated measures analysis of variance and analysis of covariance.

Results: There was a significant difference between the two groups regarding disease duration (p=0.012). The interaction effect of time and intervention was significant on pain intensity and functional disability (effect size (ES)=0.858 and ES=0.789, p<0.0001). The pain intensity in the intervention group was significantly lower than in the sham group at T2-T5 (p<0.0001). The functional disability score in the intervention group was significantly lower than in the sham group at T4 and T5 (p<0.0001).

Conclusion: Auriculotherapy can reduce pain intensity and functional disability in older adults with chronic low back pain; it can be used as a complementary medicine in care programmes for older adults with chronic low back pain.

Objectives: While single-session mindful breathing shows symptom reduction in palliative care, data on multi-session efficacy is lacking. This study aimed to determine the effectiveness of multi-session mindful breathing in reducing symptoms among patients with advanced cancer.

Methods: Adult patients with advanced cancer who scored ≥4 in at least two or more symptoms based on the Edmonton Symptom Assessment Scale (ESAS) were recruited from January to March 2020 at the University of Malaya Medical Centre, Malaysia. Participants were randomly assigned to receive either four daily sessions of 30 min mindful breathing and standard care (intervention) or standard care alone (control). The outcome measured was the change in the ESAS score after each session.

Results: 80 patients were recruited and randomised equally into the intervention and control groups. The demographic and clinical characteristics between the two groups were not statistically different. For the intervention group, there were statistically significant reductions in the total ESAS scores following all four sessions of 30 min mindful breathing (n₁=40: z₁=-5.09, p<0.001; z₂=-3.77, p<0.001; z₃=-4.38, p<0.001; z₄=-3.27, p<0.05). For the control group, statistically significant reductions in the total ESAS scores were seen only after sessions 1 and 3 (n₂=40: z₁=-4.04, p<0.001; z₃=-4.53, p<0.001).

Conclusions: Our result provides evidence that four daily sessions of 30 min mindful breathing may be effective in reducing multiple symptoms rapidly in patients with advanced cancer.

Trial registration number: NCT05910541.

Objectives: End-of-life decisions in intensive care units (ICUs) are complex, influenced by patient severity, treatment efficacy and resource constraints. This study assessed the predictive value of delta-Sequential Organ Failure Assessment (SOFA) scores on days 2, 3 and 5, both independently and combined with Simplified Acute Physiology Score (SAPS) 3, for in-hospital mortality.

Methods: A retrospective cohort study analysed ICU patients with stays of≥5 days from 2018 to 2020. Clinical data included SAPS 3 and SOFA scores at admission, 48 hours and on days 3 and 5, alongside mortality outcomes. Logistic regression and discriminant analysis identified mortality predictors and evaluated model performance.

Results: Among 200 patients, 26% died in hospital. Non-survivors had significantly higher SAPS 3 scores (mean 51.9±11.9 vs 45.6±11.9 in survivors, p=0.001) and worsening SOFA scores, particularly on days 3 and 5. Combining SAPS 3 with delta-SOFA on day 5 produced an area under the receiver operating characteristic (AUROC) of 0.71 (95% CI: 0.63 to 0.79), indicating moderate predictive ability.

Conclusions: Integrating the delta-SOFA score on day 5 with SAPS 3 improves in-hospital mortality predictions during prolonged ICU stays. Findings suggest early treatment limitations within 48 hours may be premature, as patient responses evolve and shared decision-making becomes more feasible over time.

Purpose: This study examines the relationship between specific problem categories endorsed by patients with cancer seeking psycho-oncology services and their levels of distress and depression. Additionally, we investigate the potential associations between demographic and clinical characteristics and the endorsement of specific problem categories.

Methods: A non-randomised interventional study was conducted with adult patients referred for psycho-oncology services. Patients attended 1-2 psycho-oncology sessions, completing the distress thermometer, problem checklist and Patient Health Questionnaire at the start of each visit and repeated the distress thermometer at visit end. Analyses evaluated the associations between problem checklist categories and levels of distress and depression.

Results: Patients who endorsed a higher problem load, regardless of problem category, endorsed higher levels of distress and depression. Notably, younger patients, non-white patients and patients with breast cancer endorsed higher problem loads.

Conclusion: The findings emphasise the importance of addressing problem load as a contributor to distress and depression among patients with cancer. While problem load was associated with patient characteristics, further investigation is needed to understand how these characteristics may influence distress and depression directly. Interventions should focus on reducing problem load to improve psychological well-being.

Purple urine bag syndrome is an uncommon condition that occurs in patients with long-standing indwelling urinary catheters, due to urinary tract infection (UTI) by bacteria producing sulfatase or phosphatase enzymes. This results in the formation of the pigments indigo (blue) and indirubin (red), together providing a purple appearance to urine. Management includes a change of catheter and appropriate antibiotics. Although prognosis is usually favourable, rare incidences of complications like Fournier's gangrene have been reported.We report three patients who developed purple urine bag syndrome: a man in his late 50s, a woman in her early 30s and a woman in her early 70s, who were on home-based care with regular home visits by the specialist palliative care team. None of them had any other signs or symptoms suggestive of UTIs. Their urinary catheters and collection bags were changed and proper catheter care was reinforced. All three patients were given antibiotics based on urine culture and sensitivity results. Following the same, urine colour reverted to normal in all patients and none of them had any recurrence.We would like to underline the importance of identifying purple urine bag syndrome as an indicator of underlying UTI, especially in palliative care settings, where patients may not manifest the classical signs and symptoms of UTI. We also would like to highlight the importance of patient and caregiver education on proper catheter care for prevention.