Annals of palliative medicine
-
Non-small cell lung cancer (NSCLC) is the most common and deadly malignancy in the United States. A significant portion of these individuals can present with or later develop metastatic NSCLC (mNSCLC). These patients typically do not survive more than two to three years after diagnosis despite the use of systemic therapies; however, there are individuals with low burden mNSCLC (oligometastatic disease) who can potentially be cured with the use of aggressive local therapies-such as stereotactic ablative radiotherapy (SAbR)-in conjunction with or without systemic therapy. ⋯ The combination of immunotherapy and SAbR likely represents one of the most effective while still tolerable therapies in this patient population. There are other subtypes of oligometastatic disease, including oligoprogressive disease which are amenable to SAbR. The current literature supports the use of SAbR in this population to increase the time of a patient's current systemic therapy; however, there are prospective studies evaluating the efficacy of treatment on progression free survival (PFS).
-
Randomized Controlled Trial
Efficacy and safety of ultrasound-guided above-knee lateral approach for popliteal sciatic nerve block in surgeries below the knee: a randomized controlled trial.
Ultrasound guidance has become a standard method for detection of nerve structures in regional anesthesia. During ultrasound-guided blockade, to identify anatomical structures is crucial but can be challenging. In clinical practice, we find a wide difference in the visibility score of the sciatic nerve (SN) through different approaches. This study aimed to compare SNB through the anterior and above-knee lateral approach in terms of identification ease, performance efficacy, and safety. ⋯ Based on the visibility score, the above-knee lateral approach allowed easy SN identification and safe SNB. Using the ultrasound-guided above-knee lateral approach for SNB in below-knee surgeries could be a reliable choice.
-
The effectiveness of Tai Chi for chronic obstructive pulmonary disease (COPD) so far is unclear. The present systematic review aimed to determine the influence of Tai Chi among people with COPD. ⋯ Tai Chi may have the potential to reduce dyspnoea, enhance exercise capacity, and improve the quality of life in COPD patients. People with COPD may obtain benefit from practicing Tai Chi.
-
Palliative care and advance care planning are important components of diabetes and other chronic disease management plans. Most people with diabetes do not have conversations about palliative/end of life (EOL) care or advance care directives; often because diabetes clinicians are reluctant to discuss these issues. Guidelines for conversations and decision aids can assist shared decision-making for both clinicians and patients. The aim was to co-design information with older people with diabetes, families and clinicians to facilitate conversations about palliative and EOL care and to identify the language (words) people with diabetes, families and diabetes clinicians use to discuss death and dying. ⋯ Co-design with key end-users improved relevance to these groups. Diabetes clinicians prefer to use euphemisms for death and would benefit from education and strategies to help them initiate conversations about EOL diabetes care.
-
Observational Study
Perioperative pulmonary aspiration and regurgitation without aspiration in adults: a retrospective observational study of 166,491 anesthesia records.
Pulmonary aspiration (PA) of gastric contents is a rare but serious perioperative complication. Recent studies focused on pediatric patients, but over a decade has passed since the latest incidence and outcome in adult population have been reported. Patients who experienced regurgitation without aspiration were rarely mentioned. Besides, our department proposed a modified rapid sequence induction (RSI) protocol in 2018 and its preventive effect remained to be examined. ⋯ The incidence of pulmonary aspiration and regurgitation without aspiration was low, especially in elective cases. Regurgitation during anesthesia induction had mostly developed aspiration. Further evaluation of the effect of modified RSI protocol needs a large sample size.