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Exercise and mind-body therapies for fatigue in breast cancer: evidence mapping from systematic reviews. 运动和身心疗法治疗乳腺癌患者的疲劳:来自系统综述的证据图谱。
IF 1.8 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-12-18 DOI: 10.1136/spcare-2025-005599
Guijun Ke, Siying Tao, Haobing Xu, Zihang Ai, Junwei Huang, Yang Xie, Zuomei Deng

Background: Cancer-related fatigue (CRF) is a common side effect in patients with breast cancer. Various non-pharmacological interventions are employed to alleviate CRF; however, current research lacks evaluations of their efficacy. This study compared the effectiveness of different non-pharmacological interventions on CRF in patients with breast cancer and to provide references for future research and clinical practice.

Methods: We systematically searched multiple databases, including the China National Knowledge Infrastructure (CNKI), Wanfang, VIP Database for Chinese Technical Periodicals (VIP), China Biology Medicine (CBM), PubMed, Web of Science, Cochrane Library and EMBASE, covering the period from the inception of each database to August 2024. The quality of the included studies was assessed via the AMSTAR-2 scale (a measurement tool to assess systematic reviews 2), and evidence mapping was used to summarise the characteristics of included studies.

Results: 52 systematic reviews/meta-analyses were included. The types of non-pharmacological interventions included 34 exercise interventions, 6 multidimensional interventions (a multimodal intervention approach involving three or more non-pharmacological therapies), 4 psychosocial interventions, 2 massage or acupuncture therapies, 2 art therapies, 1 moxibustion, 1 dietary supplement, 1 continuity of care and 1 systemic care. The conclusions of these studies were categorised as 'beneficial' for 41 studies, 'may be beneficial' for 9 studies and 'inconclusive' for 2 studies.

Conclusions: The evidence mapping revealed that exercise interventions are the most widely used and effective interventions for CRF in patients with breast cancer. However, owing to the variety of non-pharmacological interventions and the fact that some of them are less common in studies, more large-sample, high-quality, prospective randomised trials and systematic reviews/meta-analyses involving different interventions are needed to further validate them in the future.

背景:癌症相关性疲劳(CRF)是乳腺癌患者常见的副作用。采用各种非药物干预措施来缓解CRF;然而,目前的研究缺乏对其功效的评估。本研究比较了不同非药物干预措施对乳腺癌患者CRF的影响,为今后的研究和临床实践提供参考。方法:系统检索中国知网(CNKI)、万方、中国科技期刊VIP库(VIP)、中国生物医学(CBM)、PubMed、Web of Science、Cochrane Library、EMBASE等数据库,检索时间从各数据库建立至2024年8月。纳入研究的质量通过AMSTAR-2量表(一种评估系统评价的测量工具2)进行评估,并使用证据图来总结纳入研究的特征。结果:纳入了52项系统综述/荟萃分析。非药物干预类型包括34种运动干预,6种多维干预(涉及三种或更多非药物治疗的多模式干预方法),4种心理社会干预,2种按摩或针灸疗法,2种艺术疗法,1种艾灸,1种膳食补充剂,1种连续性护理和1种全身护理。这些研究的结论被归类为“有益”的研究有41项,“可能有益”的研究有9项,“不确定”的研究有2项。结论:证据图谱显示,运动干预是乳腺癌患者CRF应用最广泛、最有效的干预措施。然而,由于各种各样的非药物干预措施,其中一些在研究中不太常见,需要更多的大样本、高质量、前瞻性随机试验和涉及不同干预措施的系统评价/荟萃分析,以便在未来进一步验证它们。
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引用次数: 0
Beyond religious practices: functional determinants of quality of life in palliative oncology in Tanzania. 超越宗教实践:坦桑尼亚姑息肿瘤学生活质量的功能决定因素。
IF 1.8 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-12-18 DOI: 10.1136/spcare-2025-005877
Sonia Nada Edward Sokoine, Nadia Ahmed
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引用次数: 0
Genomic variation in symptom expression in castrate-resistant prostate cancer. 去势抵抗性前列腺癌症状表达的基因组变异。
IF 1.8 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-12-18 DOI: 10.1136/spcare-2025-005510
Janet Hardy, Ristan Greer, Karyn Foster, Niara Oliveira, Phillip Good, Petra Vayne-Bossert, Adam D Ewing

Objectives: Men with castrate-resistant prostate cancer (CRPC) suffer from symptoms related to both their disease and its treatment with marked variation between individuals with respect to symptom expression. This study aimed to determine whether genetic variation in cytokine expression is associated with symptom severity.

Methods: An exploratory prospective, longitudinal consecutive patient cohort study was undertaken across two Queensland sites. Patient characteristics including tumour burden and current treatment were collected at baseline. Symptom severity was assessed 3-4 weekly for up to 6 assessments, with blood taken for genetic analysis once only during the study. Cytokine gene variants of each participant were assessed using a panel of single nucleotide polymorphisms (SNPs) most described in the literature.

Results: Of the 66 participants, 27/66 (41%) had a low, and 39/66 (59%) a high tumour burden. Symptom severity was not related to tumour burden or patient characteristics. Of the 142 SNPs analysed from 62 participants, 15 SNPs from 7 genes were significantly associated with symptom severity. After Benjamini-Hochberg adjustment, SNPs rs2069772 from Interleukin-2 (IL2) and rs230494 from Nuclear Factor kappa-light-chain-enhancer of activated B cells (NFKb) remained significant.

Conclusion: Although multiple factors can influence symptom severity, genetic variation may play a part. The early identification of men likely to develop severe symptoms during the course of their prostate cancer could theoretically enable symptoms to be managed more aggressively from an early stage. These preliminary findings need to be replicated in a larger cohort of men with CRPC.

目的:患有去势抵抗性前列腺癌(CRPC)的男性患有与其疾病及其治疗相关的症状,个体之间在症状表达方面存在显着差异。本研究旨在确定细胞因子表达的遗传变异是否与症状严重程度相关。方法:一项探索性前瞻性、纵向连续患者队列研究在昆士兰州的两个地点进行。在基线时收集患者特征,包括肿瘤负荷和当前治疗。每周评估3-4次症状严重程度,最多评估6次,在研究期间仅采血进行一次遗传分析。使用文献中描述最多的单核苷酸多态性(SNPs)来评估每个参与者的细胞因子基因变异。结果:在66名参与者中,27/66(41%)的肿瘤负担低,39/66(59%)的肿瘤负担高。症状严重程度与肿瘤负荷或患者特征无关。在62名参与者分析的142个snp中,来自7个基因的15个snp与症状严重程度显著相关。benjamin - hochberg调节后,来自白细胞介素-2 (IL2)的rs2069772和来自活化B细胞核因子kappa轻链增强子(NFKb)的rs230494的snp仍然显著。结论:虽然多种因素影响症状的严重程度,但遗传变异可能起一定作用。在前列腺癌的发展过程中,早期识别可能出现严重症状的男性,理论上可以使症状在早期得到更积极的控制。这些初步发现需要在更大的CRPC男性队列中得到验证。
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引用次数: 0
Nutritional status and paediatric anthracycline early cardiotoxicity. 营养状况与儿科蒽环类药物早期心脏毒性。
IF 1.8 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-12-18 DOI: 10.1136/spcare-2025-005798
Radnyi Mande, Maya Prasad, Rajul Gala, Badira C Parambil, Ram Mohan, Pallavi Rane, Girish Chinnaswamy

Objectives: To evaluate the incidence, pattern and risk factors of early cardiotoxicity and to assess the impact of undernutrition in children with Wilms tumour (WT) and hepatoblastoma receiving anthracycline-based therapy.

Methods: In this retrospective cohort study, 137 children treated between 2017 and 2022 were analysed. Cardiac function was monitored by serial echocardiography, and nutritional status was assessed using WHO and Pediatric Hematology-Oncology Association of Central America (AHOPCA) criteria. Multivariable logistic regression was performed to identify factors associated with early cardiac dysfunction.

Results: The incidence of early cardiotoxicity was 11.7%. Majority of patients who developed cardiotoxicity were asymptomatic. Undernutrition, assessed by WHO and AHOPCA criteria, was highly prevalent and significantly associated with cardiac dysfunction. Most affected patients showed recovery with medical management.

Conclusions: Undernourished children receiving anthracycline therapy for WT and hepatoblastoma are at increased risk of early cardiotoxicity. Routine nutritional assessment, early intervention and close cardiac monitoring may help mitigate acute cardiac toxicity in this vulnerable population.

目的:评估早期心脏毒性的发生率、模式和危险因素,并评估营养不良对接受蒽环类药物治疗的Wilms肿瘤(WT)和肝母细胞瘤儿童的影响。方法:在这项回顾性队列研究中,对2017年至2022年期间接受治疗的137名儿童进行了分析。通过连续超声心动图监测心功能,并使用世卫组织和中美洲儿童血液肿瘤学协会(AHOPCA)标准评估营养状况。采用多变量logistic回归来确定与早期心功能障碍相关的因素。结果:早期心脏毒性发生率为11.7%。大多数出现心脏毒性的患者无症状。根据WHO和AHOPCA标准评估,营养不良非常普遍,并与心功能障碍显著相关。多数患者经治疗后康复。结论:营养不良的儿童接受蒽环类药物治疗WT和肝母细胞瘤的早期心脏毒性风险增加。常规营养评估、早期干预和密切的心脏监测可能有助于减轻这一弱势群体的急性心脏毒性。
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引用次数: 0
Rituals in palliative care: an integrative review. 姑息治疗中的仪式:一项综合综述。
IF 1.8 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-12-18 DOI: 10.1136/spcare-2025-005717
Chrystabel Butler, David Kissane, Natasha Michael

Background: Rituals are a universal phenomenon in human culture, which act to support and process transitions and challenges. The objective of this integrative review was to synthesise the evidence for the types of rituals, whether traditional, religious or idiosyncratic, that are used by people witnessing or experiencing the dying process, as well as the specific elements and impacts of such activities.

Methods: This review used methodology proposed by Whittemore and Knafl9 and searched the following databases: Web of Science, Medline, PubMed, CINAHL and EMBASE. Articles were limited to qualitative and quantitative studies in English with keywords in the title or abstract and no limits on year of publication. Of the 482 studies identified, 34 were included and categorised as rituals conducted for patients, staff or patients and staff together. Data analysis involved deductive content analysis and a narrative approach to summarise the synthesised results.

Results: Two distinct ritual patterns that differed in purpose and impacts were identified: rituals within coherent religious or cultural frameworks and personally-derived idiosyncratic rituals. Traditional religious and cultural rituals supported passage from life to death and affirmed identity and belonging, while idiosyncratic rituals affirmed individuality and provided psychosocial and physiological support.

Conclusion: Rituals continue to be defined ambiguously and evolve organically to signify the significance of death. Rituals support a 'good death' as unification with a divine force or through honouring values of individualism, humanism and existentialism. The level of impact of rituals depends on conscious use of collectively understood symbolism for context and participants.

背景:仪式是人类文化中的一种普遍现象,它支持和处理过渡和挑战。这项综合综述的目的是综合各种仪式的证据,无论是传统的、宗教的还是特殊的,这些仪式是见证或经历死亡过程的人所使用的,以及这些活动的具体因素和影响。方法:采用Whittemore和Knafl9提出的方法,检索Web of Science、Medline、PubMed、CINAHL和EMBASE数据库。文章仅限于定性和定量的英文研究,标题或摘要中有关键词,没有出版年份的限制。在已确定的482项研究中,有34项被纳入并归类为为患者,工作人员或患者和工作人员一起进行的仪式。数据分析包括演绎内容分析和总结综合结果的叙述方法。结果:确定了两种不同目的和影响的不同仪式模式:在连贯的宗教或文化框架内的仪式和个人衍生的特殊仪式。传统的宗教和文化仪式支持从生到死,肯定身份和归属感,而特殊的仪式肯定个性,提供社会心理和生理支持。结论:仪式的定义仍然是模糊的,并且有机地演变以表示死亡的意义。仪式支持“善终”,将其视为与神圣力量的统一,或通过尊重个人主义、人文主义和存在主义的价值观。仪式的影响程度取决于有意识地使用集体理解的上下文和参与者的象征主义。
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引用次数: 0
Nursing home resident deaths in a tertiary care hospital. 在三级护理医院的养老院居民死亡。
IF 1.8 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-12-18 DOI: 10.1136/spcare-2025-005965
Nicole Cairns, Therese Hayden, Jeanette Lacey, Ellen Sweeney, Orlaith Finucane, John Richard Attia

Objectives: To investigate why residents of residential aged care homes (RACH) are transferred to hospital for end-of-life care (EoLC).

Methods: We audited electronic health records at one tertiary referral centre hospital (New South Wales, Australia) from 1 June 2021 to 30 May 2023.

Results: Over a 2 year period, there were 2535 presentations to the emergency department (ED) from RACH, of which 45% were transferred back to RACH, 9% died in ED and 46% were admitted to hospital. Only 17% of those admitted were referred to palliative care, with an average delay of 3 days. The most common reasons for admission were falls, shortness of breath and sepsis. Most patients were in extremis at the time of referral, with an average time to death of 3 days; this was the most common barrier to returning patients to RACH (48%). In other cases (30%), the desired place of care was hospital or there was an urgent reason for admission, for example, fracture requiring surgery.

Conclusions: Once RACH patients are admitted to hospital for EoLC, there is little time to influence the trajectory of care. Future efforts should focus on supporting care in RACH and providing EoLC in situ.

目的:探讨居家安老院(RACH)居民转院接受临终关怀(EoLC)的原因。方法:我们审核了一家三级转诊中心医院(澳大利亚新南威尔士州)从2021年6月1日至2023年5月30日的电子健康记录。结果:在2年的时间里,从RACH到急诊科(ED)就诊的2535例,其中45%转回RACH, 9%死于ED, 46%住院。只有17%的入院患者被转介到姑息治疗,平均延迟3天。最常见的入院原因是跌倒、呼吸短促和败血症。大多数患者在转诊时处于危急状态,平均死亡时间为3天;这是患者返回RACH最常见的障碍(48%)。在其他情况下(30%),期望的护理地点是医院或有紧急入院原因,例如骨折需要手术。结论:一旦RACH患者因EoLC入院,几乎没有时间影响护理轨迹。未来的努力应侧重于支持RACH的护理和就地提供EoLC。
{"title":"Nursing home resident deaths in a tertiary care hospital.","authors":"Nicole Cairns, Therese Hayden, Jeanette Lacey, Ellen Sweeney, Orlaith Finucane, John Richard Attia","doi":"10.1136/spcare-2025-005965","DOIUrl":"https://doi.org/10.1136/spcare-2025-005965","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate why residents of residential aged care homes (RACH) are transferred to hospital for end-of-life care (EoLC).</p><p><strong>Methods: </strong>We audited electronic health records at one tertiary referral centre hospital (New South Wales, Australia) from 1 June 2021 to 30 May 2023.</p><p><strong>Results: </strong>Over a 2 year period, there were 2535 presentations to the emergency department (ED) from RACH, of which 45% were transferred back to RACH, 9% died in ED and 46% were admitted to hospital. Only 17% of those admitted were referred to palliative care, with an average delay of 3 days. The most common reasons for admission were falls, shortness of breath and sepsis. Most patients were in extremis at the time of referral, with an average time to death of 3 days; this was the most common barrier to returning patients to RACH (48%). In other cases (30%), the desired place of care was hospital or there was an urgent reason for admission, for example, fracture requiring surgery.</p><p><strong>Conclusions: </strong>Once RACH patients are admitted to hospital for EoLC, there is little time to influence the trajectory of care. Future efforts should focus on supporting care in RACH and providing EoLC in situ.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145780276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Invasive procedures for hiccups: a national single healthcare system study. 打嗝的侵入性治疗:一项国家单一医疗保健系统研究。
IF 1.8 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-12-17 DOI: 10.1136/spcare-2025-005897
Elizabeth Cathcart-Rake, Christopher J Ehret, Ryan S D'Souza, Michael R Moynagh, Nav S Buttar, Aminah Jatoi

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.

目的:在极少数情况下,打嗝可引起发病,如睡眠剥夺、误吸甚至死亡。有时,姑息性侵入性手术被考虑。这项研究验证了侵入性手术可以提供打嗝缓解和可接受的安全性的假设。方法:使用多站点电子医疗数据对1995年1月至2022年1月间接受有创手术治疗打嗝的成年患者进行评估。打嗝缓解被定义为手术后该体征/症状的严重程度或频率的改善。结果:共有69例患者接受了一次或多次有创手术治疗打嗝(总共144次)。59例(86%)为男性。最常见的初始手术是膈神经阻滞(n=10),然后是食管扩张(n=9)。只有31名患者(45%)在第一次手术后表现出打嗝缓解。近一半(32例)患者(46%)接受了不止一次手术(2例接受了9次手术)。在这些后续治疗中,有35例得到缓解。144例手术中出现了5个不良事件:食管切除术后心房颤动、心脏装置移除后血肿、开颅后声带不动、迷走神经操作后声带不动、迷走神经减压后脑脊液漏。结论:侵入性手术可以缓解打嗝并具有可接受的安全性。然而,这些方法似乎只能缓解大约一半患者的打嗝,有时只是暂时的。
{"title":"Invasive procedures for hiccups: a national single healthcare system study.","authors":"Elizabeth Cathcart-Rake, Christopher J Ehret, Ryan S D'Souza, Michael R Moynagh, Nav S Buttar, Aminah Jatoi","doi":"10.1136/spcare-2025-005897","DOIUrl":"https://doi.org/10.1136/spcare-2025-005897","url":null,"abstract":"<p><strong>Objectives: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145773507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Corneal reflex: novel strong prognostic marker for imminent death. 角膜反射:即将死亡的新的强有力的预后标记。
IF 1.8 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-12-17 DOI: 10.1136/spcare-2025-005889
Se-Il Go, Gyeong-Won Lee, Byeong Sun Moon, Jung Woo Choi, Seong-Je Kim, Jung Hun Kang

Objectives: This study aimed to evaluate the prognostic significance of the corneal reflex in predicting death within 24 hours among terminally ill patients with cancer.

Methods: This prospective observational study was conducted with patients with advanced cancer admitted to the hospice centre of Gyeongsang National University Hospital who were in the phase of impending death. Corneal reflex and other end-of-life signs were assessed three times daily by trained nurses using standardised criteria. Mixed-effects logistic regression was used to identify predictors of death within 24 hours, and diagnostic performance was examined for 24-96 hours.

Results: A total of 665 observations was analysed. Absence of corneal reflex was strongly associated with death within 24 hours (OR 5.48, p<0.001), with a 24-hour mortality rate of 70.7%. It showed high specificity (85.0%) and positive predictive value (70.7%). Even among patients with a Richmond Agitation-Sedation Scale score of -4 or -5, absence of the corneal reflex remained a significant predictor of 24-hour mortality (71.2% vs 37.1%, p<0.001). Other significant predictors included peripheral cyanosis, oxygen desaturation and low blood pressure.

Conclusions: Absence of corneal reflex is a specific and clinically useful sign of imminent death within 24 hours in terminally ill patients with cancer, supporting its application in end-of-life prognostication and decision-making.

目的:本研究旨在评价角膜反射在预测晚期癌症患者24小时内死亡中的预后意义。方法:这项前瞻性观察研究是在庆尚国立大学医院临终关怀中心收治的处于即将死亡阶段的晚期癌症患者中进行的。角膜反射和其他临终体征由训练有素的护士使用标准化标准每天评估三次。使用混合效应逻辑回归来确定24小时内死亡的预测因素,并在24-96小时内检查诊断性能。结果:共分析665例观察。角膜反射缺失与24小时内死亡密切相关(OR 5.48)。结论:角膜反射缺失是癌症晚期患者24小时内即将死亡的一个特殊且临床有用的信号,支持其在临终预后和决策中的应用。
{"title":"Corneal reflex: novel strong prognostic marker for imminent death.","authors":"Se-Il Go, Gyeong-Won Lee, Byeong Sun Moon, Jung Woo Choi, Seong-Je Kim, Jung Hun Kang","doi":"10.1136/spcare-2025-005889","DOIUrl":"10.1136/spcare-2025-005889","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to evaluate the prognostic significance of the corneal reflex in predicting death within 24 hours among terminally ill patients with cancer.</p><p><strong>Methods: </strong>This prospective observational study was conducted with patients with advanced cancer admitted to the hospice centre of Gyeongsang National University Hospital who were in the phase of impending death. Corneal reflex and other end-of-life signs were assessed three times daily by trained nurses using standardised criteria. Mixed-effects logistic regression was used to identify predictors of death within 24 hours, and diagnostic performance was examined for 24-96 hours.</p><p><strong>Results: </strong>A total of 665 observations was analysed. Absence of corneal reflex was strongly associated with death within 24 hours (OR 5.48, p<0.001), with a 24-hour mortality rate of 70.7%. It showed high specificity (85.0%) and positive predictive value (70.7%). Even among patients with a Richmond Agitation-Sedation Scale score of -4 or -5, absence of the corneal reflex remained a significant predictor of 24-hour mortality (71.2% vs 37.1%, p<0.001). Other significant predictors included peripheral cyanosis, oxygen desaturation and low blood pressure.</p><p><strong>Conclusions: </strong>Absence of corneal reflex is a specific and clinically useful sign of imminent death within 24 hours in terminally ill patients with cancer, supporting its application in end-of-life prognostication and decision-making.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145676425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Death on the table: how do operating room staff experience intraoperative deaths? A narrative synthesis of qualitative evidence. 手术台上的死亡:手术室工作人员如何经历术中死亡?定性证据的叙述性综合。
IF 1.8 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-12-17 DOI: 10.1136/spcare-2025-005766
Jonathan Bayuo, John Akortiakumah, Mary Abboah-Offei, Yakubu Salifu

Background: Intraoperative deaths, though statistically rare, may evoke varied emotions among operating room (OR) staff that remain underrecognized and inadequately addressed.

Aim: To synthesise the qualitative evidence regarding experiences of OR staff following patient death in the OR. A secondary aim is to unpack strategies to support OR staff following an intraoperative death experience.

Design: Narrative review of qualitative studies.

Data sources: Peer-reviewed databases (PubMed, EMBASE, CINAHL, Web of Science, Scopus and Cochrane Review Library) and grey literature sources (such as thesis databases) were extensively searched for peer-reviewed primary studies and non-peer-reviewed literature respectively reporting on intraoperative deaths or deaths occurring in the OR.

Results: Six studies were retained. The synthesis revealed that unexpected OR deaths or those deaths perceived as sudden or preventable evoked more severe and enduring psychological repercussions, marked by guilt, hypervigilance, emotional and moral distress.In contrast, anticipated fatalities, particularly in patients with advanced illness, evoked less intense emotions but did not eliminate emotional tolls. The findings revealed divergent coping mechanisms among OR professionals: surgeons often engaged in meaning-making or employed emotion-focused and problem-focused strategies to process loss. In contrast, anaesthetists described emotional desensitisation over time. Nurses, meanwhile, navigated a pervasive culture of silence.

Conclusion: The emotional toll captured underscores urgent needs for interventions, such as team-based debriefing support, alongside systemic reforms to normalise vulnerability and integrate emotional stewardship into institutional policies.Addressing this is not only ethically imperative but critical to sustaining a resilient workforceand ensuring patient safety in an era of escalating surgical demand.

背景:术中死亡虽然在统计上罕见,但可能引起手术室(OR)工作人员的各种情绪,这些情绪仍未得到充分认识和解决。目的:综合关于病人死亡后手术室工作人员经历的定性证据。第二个目的是解开策略,以支持手术室工作人员在术中死亡的经验。设计:定性研究的叙述性回顾。数据来源:广泛检索同行评议数据库(PubMed、EMBASE、CINAHL、Web of Science、Scopus和Cochrane综述库)和灰色文献来源(如论文数据库),分别报道术中死亡或手术室死亡的同行评议的初步研究和非同行评议的文献。结果:6项研究被保留。综合表明,意外死亡或被认为是突然或可预防的死亡引起了更严重和持久的心理影响,其特征是内疚、过度警惕、情感和道德上的痛苦。相比之下,预期的死亡,特别是在晚期疾病患者中,引起的情绪不那么强烈,但并没有消除情绪上的损失。研究结果揭示了手术室专业人员的不同应对机制:外科医生经常参与意义创造或采用以情绪为中心和以问题为中心的策略来处理损失。相比之下,麻醉师描述了随着时间的推移情绪脱敏。与此同时,护士们在一种普遍的沉默文化中穿行。结论:捕捉到的情绪损失强调了干预措施的迫切需要,例如基于团队的汇报支持,以及系统性改革,使脆弱性正常化,并将情绪管理纳入制度政策。解决这一问题不仅在道德上势在必行,而且对于在手术需求不断上升的时代维持一支有弹性的工作队伍和确保患者安全至关重要。
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引用次数: 0
Multidisciplinary and eHealth care approaches for cancer patients' families: nationwide bereavement survey. 癌症患者家属的多学科和电子保健方法:全国丧亲调查。
IF 1.8 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-12-17 DOI: 10.1136/spcare-2025-005876
Masayuki Toishi, Yusuke Takagi, Kana Kano, Maho Aoyama, Tatsuya Morita, Satoru Tsuneto, Masanori Mori, Mitsunori Miyashita

Objectives: Families of patients with cancer often experience significant psychological distress, yet family care remains insufficiently addressed in current healthcare systems. This study aimed to investigate the acceptability of alternative care delivery methods among families of patients with cancer to seek insights into feasible and sustainable approaches to family-inclusive cancer care.

Methods: A cross-sectional survey of bereaved family members was conducted as part of the nationwide Japan Hospice and Palliative Care Evaluation Study 5. The survey assessed the prevalence of unmet family-care needs, acceptability of care provided by various professionals through different communication modalities and eHealth literacy using the eHealth Literacy Scale.

Results: Participation was accepted by 498 bereaved family members. Among these respondents, 36% accepted asynchronous (text-based/AI-automated) communication for at least one aspect of family care. Acceptance rates were: video calls (85%), telephone (60%), text-based methods (34%) and AI-automated messages (12%). A substantial majority (79%) accepted care from professionals other than physicians and nurses. Acceptance increased with younger age and higher eHealth literacy. Significant unmet needs were identified, including information about high-volume cancer centres (45%) and consultation regarding patients' emotional distress (43%).

Conclusions: Multidisciplinary involvement and electronic communication methods were promising alternatives for delivering family care, particularly among younger families or those with higher eHealth literacy. Willingness to adopt AI-based support was relatively low, highlighting cultural and psychological barriers to AI adoption in Japan. The approaches could potentially help address family unmet needs while optimising the use of limited healthcare resources in palliative cancer care settings.

目的:癌症患者的家庭经常经历显著的心理困扰,但家庭护理仍然没有充分解决在目前的医疗保健系统。本研究旨在探讨癌症患者家庭对替代护理方式的接受程度,以寻求可行和可持续的家庭包容性癌症护理方法。方法:以日本临终关怀与缓和疗护评估研究5为研究对象,对丧亲家属进行横断面调查。调查评估了未满足家庭护理需求的普遍程度、各种专业人员通过不同的沟通方式提供的护理的可接受性以及使用电子卫生素养量表的电子卫生素养。结果:498名丧偶家属接受参与。在这些受访者中,36%的人在家庭护理的至少一个方面接受异步(基于文本/人工智能自动化)通信。接受率为:视频通话(85%)、电话(60%)、基于文本的方法(34%)和人工智能自动消息(12%)。绝大多数(79%)接受医生和护士以外的专业人员的护理。接受度随着年龄的增长和电子健康素养的提高而增加。确定了大量未满足的需求,包括关于高容量癌症中心的信息(45%)和关于患者情绪困扰的咨询(43%)。结论:多学科参与和电子通信方法是提供家庭护理的有希望的替代方法,特别是在年轻家庭或具有较高电子卫生素养的家庭中。日本采用人工智能支持的意愿相对较低,这凸显了日本采用人工智能的文化和心理障碍。这些方法可能有助于解决家庭未满足的需求,同时优化在姑息性癌症护理环境中有限的医疗资源的使用。
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引用次数: 0
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BMJ Supportive & Palliative Care
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