Remote and rural palliative care

As this chapter explores the role of the rural nurse in the provision of palliative care, it is worthwhile to spend a little time explaining the role and context of rural nursing practice, and how the context of practice impacts upon the scope of services that rural nurses can access to meet the needs of the terminally ill client. Following this, the chapter will focus on accessibility and delivery of palliative care services from the clients' and rural nurses' perspectives. The chapter will conclude that, for palliation to be successful in rural areas, more attention has to be paid to the skilling of rural nurses. Further, the very diversity of rural communities means that, for a rural palliative care service to be successful, this diversity must be recognised and taken into consideration in planning service delivery

Pain management skills of regional nurses caring for older people with dementia: a needs analysis

An exploratory survey of the pain management education needs of 197 nurses working with older people with dementia was undertaken in a regional area of Queensland, Australia. The analysis indicated that nurses in this setting might not have the knowledge base to manage pain effectively; and that respondents have essentially negative perceptions of the availability and appropriateness of current pain management education programs. Consistent with non-metropolitan nurses generally, respondents expressed a preference for pain management education that had a significant face-to-face component allied with ongoing mentorship and support on completion of the program. The obstacles to attending such programs were also typical of the problems facing regional and rural nurses throughout Australia. These were identified as inability to pay for courses; lack of information on what is available; distance to travel to education; and a perceived lack of employer support due to an inability to replace those staff attending education. Positive aspects include the degree to which participants were responsive and interested in dementia pain management and their access to, and acceptance of, non-medical pain therapies. The findings suggest a definite need for a dementia pain management program for aged care nurses, specifically tailored to their needs and to the constraints of the regional practice setting

Compliance, normality, and the patient on peritoneal dialysis

Monitoring and enhancing patient compliance with peritoneal dialysis (PD) is a recurring and problematic theme in the renal literature. A growing body of literature also argues that a failure to understand the patient's perspective of compliance may be contributing to these problems. The aim of this study was to understand the concept of compliance with PD from the patient's perspective. Using the case study approach recommended by Stake (1995), five patients on PD consented to in-depth interviews that explored the meaning of compliance in the context of PD treatment and lifestyle regimens recommended by health professionals. Participants also discussed factors that influenced their choices to follow, disregard, or refine these regimens. Results indicate that health professionals acting in alignment with individual patient needs and wishes, and demonstrating an awareness of the constraints under which patients operate and the strengths they bring to their treatment, may be the most significant issues to consider with respect to definitions of PD compliance and the development of related compliance interventions. Aspects of compliance that promoted relative normality were also important to the participants in this study and tended to result in greater concordance with health professionals' advice

Chemotherapy-induced nausea and vomiting: A narrative review to inform dietetics practice

Chemotherapy-induced nausea and vomiting (CINV) are common nutrition-impact symptoms experienced by cancer patients. They exert a detrimental effect on dietary intake, risk of malnutrition and quality of life. While CINV are primarily managed with medication, dietitians play an important role in the management of CINV-related complications such as reduced dietary intake. This review discusses the burden of nausea and vomiting which cancer patients can experience, including its effect on quality of life, nutrition status, and treatment outcomes. Implications for dietetic practice include the need to explore the nature of reported symptoms, identify predisposing risk factors, and to consider the use of a variety of interventions that are individualised to the patient’s symptoms. There are little clinical data regarding effective dietetic interventions for nausea and vomiting. In summary, this review discusses dietetic-related issues surrounding CINV including the pathophysiology, risk factors, prevalence, and both pharmacological and dietetic treatment options

Characteristics of patients with haematological and breast cancer (1996–2009) who died of heart failure-related causes after cancer therapy

Aims: To describe the characteristics and time to death of patients with breast or haematological cancer who died of heart failure (HF) after cancer therapy. Patients with an index admission for HF who died of HF-related causes (IAHF) and those with no index admission for HF who died of HF-related causes (NIAHF) were compared. Methods and results: We performed a linked data analysis of cancer registry, death registry, and hospital administration records (n = 15 987). Index HF admission must have occurred after cancer diagnosis. Of the 4894 patients who were deceased (30.6% of cohort), 734 died of HF-related causes (50.1% female) of which 279 (38.0%) had at least one IAHF (41.9% female) post-cancer diagnosis. Median age was 71 years [interquartile range (IQR) 62–78] for IAHF and 66 years (IQR 56–74) for NIAHF. There were fewer chemotherapy separations for IAHF patients (median = 4, IQR 2–9) compared with NIAHF patients (median = 6, IQR 2–12). Of the IAHF patients, 71% had died within 1 year of the index HF admission. There was no significant difference in HF-related mortality in IAHF patients compared with NIAHF (HR, 1.10, 95% CI, 0.94–1.29, P = 0.225). Conclusions: The profile of IAHF patients who died of HF-related causes after cancer treatment matched the current profile of HF in the general population (over half were aged ≥70 years). However, NIAHF were younger (62% were aged ≤69 years), female patients with breast cancer that died of HF-related causes before hospital admission for HF-related causes—a group that may have been undiagnosed or undertreated until death

Supplemental prophylactic intervention for chemotherapy-induced nausea and emesis (spice) trial: Protocol for a multi-centre double-blind placebo-controlled randomized trial

Aim: There is significant recent interest in the role of ginger root (Zingiber officinale) as an adjuvant therapy for chemotherapy‐induced nausea. The supplemental prophylactic intervention for chemotherapy‐induced nausea and emesis (SPICE) trial aims to assess the efficacy by reduced incidence and severity of chemotherapy‐induced nausea and vomiting, and enhanced quality of life, safety and cost effectiveness of a standardised adjuvant ginger root supplement in adults undergoing single‐day moderate‐to‐highly emetogenic chemotherapy. Methods: Multisite, double‐blind, placebo‐controlled randomised trial with two parallel arms and 1:1 allocation. The target sample size is n = 300. The intervention comprises four capsules of ginger root (totalling 60 mg of active gingerols/day), commencing the day of chemotherapy and continuing for five days during chemotherapy cycles 1 to 3. The primary outcome is chemotherapy‐induced nausea‐related quality of life. Secondary outcomes include nutrition status; anticipatory, acute and delayed nausea and vomiting; fatigue; depression and anxiety; global quality of life; health service use and costs; adverse events; and adherence. Results: During the five‐month recruitment period from October 2017 to April 2018 at site A only, a total of n = 33 participants (n = 18 female) have been enrolled in the SPICE trial. Recruitment is expected to commence at Site B in May 2018. Conclusions: The trial is designed to meet research gaps and could provide evidence to recommend specific dosing regimens as an adjuvant for chemotherapy‐induced nausea and vomiting prevention and management.No Full Tex

Screening for overweight using mid-upper arm circumference (MUAC) among children younger than two years in the Eastern Cape, South Africa

Background: The relationship between overweight and under-nutrition, particularly in resource-poor settings, poses practical challenges for targeting nutrition interventions. Current anthropometric indicators including weight for length (WLZ) recommended by the WHO may be challenging in community settings. Objectives: The aim of this study was to assess whether MUAC can accurately identify children aged younger than two years with overweight and obesity. Method: A descriptive, cross-sectional study was used to collect data from a non-probability sample of 397 young South African children from October 2015 to February 2016. MUAC cut-off values were tested using a receiver operating characteristic and area under the curve (AUC). Results: The prevalence of overweight (WLZ > +2) and obesity (WLZ > +3) was 11% (n = 44) and 5% (21) respectively. A MUAC cut-off value for identifying male children 6 to 24 months old with overweight was determined at 16.5 cm (85% sensitivity, 71.4% specificity, AUC = 0.821) and female children at 16.5 cm (100% sensitivity, 76.6% specificity, AUC = 0.938). Conclusions: MUAC may be an appropriate tool for identifying children younger than two years old with overweight and obesity. The predicted MUAC cut-off values were able to identify infants and young children with overweight accurately

Efficacy of ginger (Zingiber officinale) in ameliorating chemotherapy-induced nausea and vomiting and chemotherapy-related outcomes: a systematic review update and meta-analysis

Background: Ginger has been proposed as an adjuvant treatment for chemotherapy-induced nausea and vomiting. Objective: The aim of this systematic review with meta-analyses is to evaluate, in adult cancer patients receiving chemotherapy, the effects of ginger supplementation dose and duration on the incidence, duration, and severity of chemotherapy-induced nausea and vomiting and outcomes related to chemotherapy-induced nausea and vomiting (eg, quality of life and fatigue), compared with placebo or standard antiemetic medication. Method: Five electronic databases were searched from database inception to April 2018. The quality of evidence was appraised with the Cochrane Risk of Bias tool and Grading of Recommendations, Assessment, Development, and Evaluation level. Data were pooled using Revman software. Results: Eighteen articles were analyzed. The likelihood of acute vomiting was reduced by 60% with ginger supplementation ≤1 g/day for duration >3 days, compared with control groups (odds ratio 0.4, 95% CI 0.17 to 0.81; P=0.01; n=3 studies; n=3 interventions; n=301 participants; I2=20%; Grading of Recommendations, Assessment, Development, and Evaluation level: Moderate). The likelihood of fatigue was reduced by 80% with ginger supplementation of any dose for duration 2=0%; Grading of Recommendations, Assessment, Development, and Evaluation level: Low). No statistically significant association was found between ginger and likelihood of overall or delayed vomiting, likelihood or severity of nausea, or other outcomes related to chemotherapy-induced nausea and vomiting. Conclusions: Ginger supplementation might benefit chemotherapy-induced vomiting as well as fatigue. Due to clinical heterogeneity, this systematic review update found no association between ginger and chemotherapy-induced nausea and other chemotherapy-induced nausea and vomiting-related outcomes. The results of this systematic review and meta-analysis provide a rationale for further research with stronger study designs, adequate sample sizes, standardized ginger products, and validated outcome measures to confirm efficacy of ginger supplementation and optimal dosing regimens.</p

Reforming Restrictive Housing: The 2018 ASCA-Liman Nationwide Survey of Time-in-Cell

Reforming Restrictive Housing: The 2018 ASCA-Liman Nationwide Survey of Time-in-Cell is the fourth in a series of research projects co-authored by the Association of State Correctional Administrators (ASCA) and the Arthur Liman Center at Yale Law School. These monographs provide a unique, longitudinal, nationwide database. The topic is “restrictive housing,” often termed “solitary confinement,” and defined as separating prisoners from the general population and holding them in cells for an average of 22 hours or more per day for 15 continuous days or more. The 2018 monograph is based on survey responses from 43 prison systems that held 80.6% of the U.S. prison population. They reported that 49,197 individuals—4.5% of the people in their custody—were in restrictive housing. Extrapolating, we estimate that some 61,000 individuals were in isolation in U.S. prisons. This number does not include people in most jails or juvenile, military, or immigration facilities. Two areas of special concern are the impact of mental illness and the length of time individuals spend in restrictive housing. Correctional systems use a variety of definitions for serious mental illness. Using their own descriptions, jurisdictions counted more than 4,000 prisoners identified as seriously mentally ill and in restrictive housing. Within the 36 jurisdictions that reported on the length of time people had been in segregation, most people were held for a year or less. Twenty-five jurisdictions counted more than 3,500 individuals held more than three years. Reforming Restrictive Housing details policy changes tracking the impact of the 2016 American Correctional Association’s (ACA) Restrictive Housing Performance Based Standards. The ACA Standards call for limiting the use of isolation for pregnant women, juveniles, and seriously mentally ill individuals. This monograph also compares the responses of the 40 prison systems that answered the ASCA-Liman surveys in both 2015 and 2017. See ASCA-Liman, Aiming to Reduce Time-in-Cell (Nov. 2016), SSRN No. 2874492. The number in restrictive housing was reported to have decreased from 56,000 in 2015 to 47,000 in 2017. Looking at specific states, in more than two dozen systems, the numbers in segregation decreased. In 11 systems, the numbers went up. A related monograph, Working to Limit Restrictive Housing: Efforts in Four Jurisdictions to Make Changes, details the work of four correctional administrations to limit—and in one state abolish—holding people in cells 22 hours a day for 15 days or more