Journal of palliative medicine
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Review Meta Analysis
Fan Therapy for the Relief of Dyspnea in Adults with Advanced Disease and Terminal Illness: A Meta-Analysis of Randomized Controlled Trials.
Background: Dyspnea is one of the most common symptoms in patients with advanced disease and terminal illness, associated with poorer quality of life. The efficacy of fan therapy to palliate dyspnea is inconsistent and unclear. Objective: The aim of this meta-analysis was to evaluate the efficacy of fan therapy for the relief of dyspnea in adults with advanced disease and terminal illness. Design: The CENTRAL, MEDLINE, EMBASE, CINAHL, and PsycINFO were searched to retrieve all randomized controlled trials examining the benefits of fan therapy for the relief of dyspnea in patients at the advanced stages of illness. Risk of bias was assessed according to the Cochrane Collaboration standard scheme. Results: Five studies involving 198 adults were identified. ⋯ Long-term application of fan therapy for at least one month was not related to changes of dyspnea severity (MDs, 0.10; 95% CI, -1.14 to 1.35; p = 0.870). However, significant heterogeneity and low quality of the included trials limit applicability of the results in general practice. No difference was found in activity performance, respiratory rate and SpO2, changes in other symptom intensities, and adverse events. Conclusion: Current trials provided low-quality evidence for a significant short-term effect after fan therapy in the relief of dyspnea and no beneficial effect in the long-term application in adults with advanced disease and terminal illness.
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Background: Chemotherapy-induced peripheral neuropathy is characterized by pain, numbness, and tingling in the hands and feet and by diminished quality of life. Multiple previous studies, mostly preclinical, suggest that poly (ADP-ribose) polymerase (PARP) inhibitors may help with these symptoms. Objective: To assess the relationship between PARP inhibition and prevention/palliation of peripheral neuropathy in a clinical setting. Design: Meta-analysis of placebo-controlled clinical trials with PARP inhibitors. Setting/Subjects: We conducted 9 literature searches that included PubMed and other sources to compile fully published placebo-controlled clinical trials that tested PARP inhibitors and that reported on peripheral neuropathy. Measurements: The relative risks for neuropathy of all grades based on PARP inhibition were calculated for each trial. Each trial was weighted by its respective sample size. ⋯ Four included a concomitant PARP inhibitor (either olaparib or veliparib) and paclitaxel, a neuropathy-causing chemotherapy agent; the remaining trial evaluated long-term monotherapy with olaparib. The pooled overall relative risk for the development of neuropathy with PARP inhibition was 1.06 (95% confidence interval: 1-1.4). Conclusions: PARP inhibition does not appear to reduce the risk of chemotherapy-induced peripheral neuropathy. Whether PARP inhibitors may palliate (rather than prevent) neuropathy remains an area in need of further investigation.
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Internationally, use of lidocaine infusions to treat cancer pain varies by center. Existing systematic reviews do not adequately inform use of lidocaine in cancer pain. ⋯ Based on the current available evidence, lidocaine infusion could be considered in refractory cancer pain where agents with level 1 evidence are ineffective. Further research is necessary to understand the protocol and population in which lidocaine may improve cancer pain and capitalize on the promising opportunities identified.
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Review Meta Analysis
Psychotherapy Targeting Depression and Anxiety for Use in Palliative Care: A Meta-Analysis.
Research on the effectiveness of evidence-based practices in the treatment of depression and anxiety with palliative care populations is primarily limited to individuals having specific conditions such as cancer. ⋯ Findings suggest that psychotherapy for individuals with serious illnesses appropriate for palliative care can mitigate symptoms of depression and anxiety and improve quality of life. Methodological reporting and quality of research designs in studies of psychotherapy for palliative patient populations could be improved. Future research is needed with a broader range of patient populations.
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Due to large number of deaths occurring in nursing home (NH) settings, along with reports of pain and suffering, there is great need for improvements in the provision of end-of-life (EOL) care in NHs. ⋯ Findings provide support for the importance of a relational community and culture change within NHs for positive EOL experiences, in addition to providing a model to guide future research priorities.