Current opinion in supportive and palliative care
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Curr Opin Support Palliat Care · Sep 2015
ReviewThe role of airflow for the relief of chronic refractory breathlessness.
Chronic refractory breathlessness is a major cause of suffering to people with advanced stage cardiorespiratory and some neurodegenerative diseases. It is a frightening, distressing and disabling symptom that imposes significant burdens on family members. Evidence is mounting for the role of facial or nasal airflow for the relief of chronic refractory breathlessness in those patients with mild hypoxaemia or normoxaemia. Airflow can be delivered from a cylinder of compressed medical air via face mask or nasal cannulae or a hand-held fan. The hand-held fan offers patients a simple, low-cost, self-management strategy that is not associated with any known risks. Therefore, it is timely and relevant to review the research available for the efficacy and appropriateness of facial or nasal airflow. ⋯ The hand-held fan should be considered as one of the first interventions to try in management plans for patients who present with mild hypoxaemia or normoxaemia and chronic refractory breathlessness at rest or on minimal exertion. Emerging evidence indicates that airflow from the hand-held fan may also have an important role with exertion-induced breathlessness, decreasing distress and speeding recovery time after exercise, thereby helping patients self-manage their symptoms during everyday general activity and plan for crises of breathlessness, secure in the knowledge that they have a tangible, easily portable device to try in any circumstances.
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Curr Opin Support Palliat Care · Sep 2015
ReviewNonopioid medication for the relief of refractory breathlessness.
To provide an overview of recent evidence relating to nonopioid medication for the treatment of refractory breathlessness. ⋯ Based on this review, there is insufficient evidence to support the routine use of nonopioid medication in the treatment of refractory breathlessness.
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Curr Opin Support Palliat Care · Sep 2015
ReviewManagement of respiratory symptoms in paediatric palliative care.
Respiratory symptoms in children with life-limiting and life-threatening conditions are common, distressing and have a lasting impact, yet there is a paucity of evidence to guide clinicians in their management. This article makes a series of recommendations for the management of the most frequent and distressing respiratory symptoms encountered in paediatrics (dyspnoea, cough, haemoptysis and retained secretions) with attention to the evidence from research. ⋯ In the absence of well designed paediatric studies we need to judiciously apply what we can extrapolate from adult studies to each child we are treating; selecting interventions and approaches carefully, adjusting them when there is no evidence of individual benefit.
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Curr Opin Support Palliat Care · Jun 2015
ReviewNausea and vomiting induced by gastrointestinal radiation therapy: current status and future directions.
Radiation therapy-induced nausea and vomiting (RINV) are common and troublesome symptoms among patients receiving radiation therapy for gastrointestinal cancers. Their impact on function, quality of life and, ultimately, cancer control warrant a review of their incidence, underlying mechanisms, treatments and research themes. ⋯ Optimal supportive care strategies for RINV following radiation therapy for gastrointestinal cancers are lacking, and will not be known until future research answers the many open questions regarding the mechanisms underlying RINV, the true incidence and impact of these symptoms among patients and the best way to predict and mitigate them.
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Curr Opin Support Palliat Care · Jun 2015
ReviewEmerging targets and therapeutic approaches for the treatment of osteoarthritis pain.
Osteoarthritis is a complex and often painful disease that is inadequately controlled with current analgesics. This review discusses emerging targets and therapeutic approaches that may lead to the development of better analgesics. ⋯ Identification of new targets will inform and guide future research, aiding the development of more effective analgesics. Future clinical trial designs should implement sensory phenotyping of patients, as an inclusion or stratification criterion, in order to establish an individualized, mechanism-based treatment of osteoarthritis pain.