Current opinion in supportive and palliative care
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Curr Opin Support Palliat Care · Jun 2011
ReviewApplicability and generalizability of palliative interventions for dyspnoea: one size fits all, some or none?
Determining which palliative interventions are appropriate within and between groups remains difficult because of the lack of prospective studies and heterogeneity in dyspnoea context, assessment and reporting. This review presents an evolution of dyspnoea theories, summarizes literature published during 2010 concerning intervention effectiveness between conditions and highlights the lag between emerging research evidence and dyspnoea assessments in clinical trials. ⋯ Multiple interventions exist for palliation of dyspnoea in different contexts. The majority of studies assessed emotional and behavioural consequences of dyspnoea rather than dyspnoea sensation (intensity, sensory quality, unpleasantness). As a more detailed understanding of the mechanisms leading to perceptions of dyspnoea evolve, a 'back to basics' strategy for clinical assessment might provide a means of determining which interventions can be generalized or are best suited to various forms of dyspnoea.
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Cancer patients with moderate-to-severe pain require opioids for analgesia. Whereas early guidelines recommend oral morphine as the 'drug of choice', newer synthetic opioids can be given by a reliable and effective nonoral transdermal route. We examine the mode of action of transdermal patches and we review the evidence on two drugs, which are currently available in this formulation - buprenorphine and fentanyl - covering physicochemical characteristics and pharmacokinetics of the patches, clinical efficacy data and adverse effects. ⋯ Transdermal buprenorphine and fentanyl are now established for moderate-to-severe cancer pain. There is still a need for further comparative studies with other opioids, especially for buprenorphine.
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Curr Opin Support Palliat Care · Dec 2010
ReviewDecision making among older people with advanced heart failure as they transition to dependency and death.
This review critically considers recent research, identifying patient experiences of, and preferences for, participation in decision making during the end-of-life transition. ⋯ This review indicates a need to think carefully about how policy recommendations and guidance relating to patient participation in decision making at the end-of-life can be effectively implemented in practice. The need for continuity of involvement from key health workers is identified as very important in this regard. 'Transition' is also considered as a concept that may offer health professionals a different approach for assessment and management of heart failure patients over a longer period and means of integrating heart failure management with palliative care.
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Curr Opin Support Palliat Care · Sep 2010
ReviewScreening for prostate cancer: have we resolved the controversy?
Prostate cancer (PCa) screening has long been a source of controversy. In this review, we discuss the interim results of the European Randomized Study of Screening for Prostate Cancer (ERSPC) and the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. Implications of these studies will also be underlined. ⋯ Despite the effects demonstrated by the ERSPC, there is currently insufficient evidence to introduce a population-based screening programme. The studies evaluating quality of life and cost-efficiency need to be completed with the highest urgency and their results should be considered together with more mature data from the ERSPC to reach an effective implementation of screening on PCa. Meanwhile, we have to improve the screening test, screening protocol and further develop an accurate individualized risk assessment to decrease the rates of overdiagnosis and overtreatment, while the mortality reduction and the detection of clinically relevant PCa should be maintained.