Journal of pain and symptom management
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J Pain Symptom Manage · Oct 2014
Autonomic dysfunction in cancer cachexia coincides with large fiber polyneuropathy.
Cancer cachexia occurs in most patients suffering from solid malignancies. Recent works suggest paraneoplastic mechanisms. Empirical studies also found autonomic dysfunction in cancer patients, but comprehensive evaluation of the peripheral nervous system is lacking. ⋯ Large fiber polyneuropathy coincides with autonomic dysfunction in cachectic cancer patients. Our findings suggest a relevant role of sympathetic impairment in cancer cachexia.
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J Pain Symptom Manage · Oct 2014
Review Case ReportsPatients who lack capacity and lack surrogates: can they enroll in hospice?
Patients who lack capacity and lack surrogates are among the most vulnerable patients we care for in palliative care. In the case we present here, we have considered how to make end-of-life decisions for a patient who lacks both capacity and surrogates, who has a terminal illness, and who is not a candidate for disease-modifying treatments. We first define and characterize this population of patients through a review of the literature and then explore some decision-making quandaries that are encountered at the end of life. Finally, we make recommendations on how best to proceed with decision making for this vulnerable population.
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J Pain Symptom Manage · Oct 2014
Multicenter Study Controlled Clinical TrialImpact of a clinical pharmacist-led guidance team on cancer pain therapy in China: a prospective multicenter cohort study.
Cancer treatment capacity in China is severely limited relative to the enormous size of the population; and many aspects of treatment, such as opioid protocols for pain control, are not standardized. To improve the quality of drug treatment, clinical pharmacists are taking a more active role in patient care. ⋯ The CPGTs significantly improved standardization, efficiency, and efficacy of cancer pain therapy in China. In a country where clinical pharmacy is still developing, this is a valuable service model that may enhance cancer treatment capacity and efficacy while promoting recognition of the clinical pharmacy profession.
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J Pain Symptom Manage · Oct 2014
Observational StudyVariations in vital signs in the last days of life in patients with advanced cancer.
Few studies have examined variation in vital signs in the last days of life. ⋯ Blood pressure and oxygen saturation decreased in the last days of life. Clinicians and families cannot rely on vital sign changes alone to rule in or rule out impending death. Our findings do not support routine vital signs monitoring of patients who are imminently dying.