Pharmacological treatments for fatigue associated with palliative care: executive summary of a Cochrane Collaboration systematic review

Abstract Background In palliative care patients, fatigue can be severely debilitating and is often not counteracted with rest, thereby impacting daily activity and quality of life. Further complicating issues are the multidimensionality, subjective nature and lack of a consensus definition of fatigue. The review aimed to evaluate the efficacy of pharmacological treatments for fatigue in palliative care, with a focus on patients at an advanced stage of disease, including patients with cancer and other chronic diseases

Democratic directionality for transformative food systems research

Effective interfaces of knowledge and policy are critical for food system transformation. Here, an expert group assembled to explore research needs towards a safe and just food system put forward principles to guide relations between society, science, knowledge, policy and politics

Audiobooks from terminally ill parent for their children – a qualitative evaluation

Background!#!Improving the quality of life is one of the main objectives of palliative care. Biographical approaches are often used in combination with leaving a legacy in a range of different interventions such as Dignity Therapy or Life Review. This study presents an evaluation of audiobook biographies for palliative care patients with young children.!##!Methods!#!Young parents diagnosed with a life-limiting disease could participate and create an audiobook for their young children. The audiobook itself was recorded over several days and edited by qualified radio journalists. After providing informed consent participants were interviewed twice over the course of the intervention regarding expectations, concerns, motivation, and experiences. Interviews and notes were transcribed verbatim and were analyzed using content analysis. The contents of the audiobooks are not part of the evaluation.!##!Results!#!The data were collected from February 2017 till September 2020. Fifty-four patients with ninety-six children at a mean age of 7 years were included and created an audiobook. The main theme of all interviews were the children. Within this field identified main topics were legacy, motivation, usage, benefit, aims, difficulties and worries in descending order. All patients would recommend the intervention.!##!Conclusion!#!Creating an audiobook as a legacy to their children seemed to help the diseased parents to cope with their limited life span

Evidence of Heterosynaptic LTD in the Human Nociceptive System : Superficial Skin Neuromodulation Using a Matrix Electrode Reduces Deep Pain Sensitivity

Long term depression (LTD) is a neuronal learning mechanism after low frequency stimulation (LFS). This study compares two types of electrodes (concentric vs. matrix) and stimulation frequencies (4 and 30 Hz) to examine homo- and heterosynaptic effects indirectly depicted from the somatosensory profile of healthy subjects. Both electrodes were compared in a prospective, randomized, controlled cross-over study using 4 Hz as the conditioning LFS compared to 30 Hz (intended sham condition). Quantitative sensory testing (QST) was used to examine 13 thermal and mechanical detection and pain thresholds. Sixteen healthy volunteers (10 women, age 31.0 ± 12.7 years) were examined. Depending on the electrodes and frequencies used a divergent pattern of sensory minus signs occurred. Using LFS the concentric electrode increased thermal thresholds, while the matrix electrode rather increased mechanical including deep pain thresholds. Findings after cutaneous neuromodulation using LFS and a matrix electrode are consistent with the concept of heterosynaptic LTD in the human nociceptive system, where deep pain sensitivity was reduced after superficial stimulation of intraepidermal nerve fibres. Cutaneous neuromodulation using LFS and a matrix electrode may be a useful tool to influence deep pain sensitivity in a variety of chronic pain syndromes

Meaning in life of terminally ill parents with minor children compared to palliative care patients – a quantitative analysis using SMiLE

Background: Caring for terminally ill patients with minor children can be very stressful. The perceived quality of life is significantly influenced by the Meaning in Life (MiL). No studies were found that focus on the prioritized special needs of this patient group. Objectives: The aim is to compare and contrast terminally ill parents with minor children and palliative care patients in Germany, in order to provide appropriate support beyond medical, nursing or therapeutic interventions. Methods: Terminally ill parents diagnosed were surveyed using a validated instrument ‘Schedule for Meaning in Life Evaluation (SMiLE)’. The study listed various areas that contribute to the MiL, followed by an evaluation of their importance and satisfaction levels. The researchers then compared these findings with data collected from palliative care patients. Results: In Germany, 54 patients, mostly female and with a mean age of 43, were included in this study between February 2017 and September 2020. The median age of the 96 children during the survey phase was 7 years. The comparison group consists of 100 palliative care patients in Germany; mostly aged 50 years and older. For terminally ill patients most important areas were in decreasing order family (100%), social relations (80%), leisure time (61%), nature/animals (39%) and home/garden (30%). Although the overall indices are close between both groups, there are significant and highly correlated differences between them. Parents felt limited by their illness in being a mother or father, as they wanted to be. Conclusion: The involvement with SMiLE led patients to consider their coping resources. The areas relevant to terminally ill parents differed from those relevant to palliative care patients. All participants identified family as the most important factor for MiL. The results suggest that evaluating MiL can serve as a coping strategy and help terminally ill parents with minor children

Pharmacological treatments for fatigue associated with palliative care

BACKGROUND: This review updates the original review, 'Pharmacological treatments for fatigue associated with palliative care' and also incorporates the review 'Drug therapy for the management of cancer-related fatigue'.In healthy individuals, fatigue is a protective response to physical or mental stress, often relieved by rest. By contrast, in palliative care patients' fatigue can be severely debilitating and is often not counteracted with rest, thereby impacting daily activity and quality of life. Fatigue frequently occurs in patients with advanced disease (e.g. cancer-related fatigue) and modalities used to treat cancer can often contribute. Further complicating issues are the multidimensionality, subjective nature and lack of a consensus definition of fatigue. The pathophysiology is not fully understood and evidence-based treatment approaches are needed. OBJECTIVES: To evaluate the efficacy of pharmacological treatments for fatigue in palliative care, with a focus on patients at an advanced stage of disease, including patients with cancer and other chronic diseases. SEARCH METHODS: For this update, we searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PsycINFO and EMBASE, and a selection of cancer journals up to 28 April 2014. We searched the references of identified articles and contacted authors to obtain unreported data. To validate the search strategy we selected sentinel references. SELECTION CRITERIA: We considered randomised controlled trials (RCTs) concerning adult palliative care with a focus on pharmacological treatment of fatigue compared to placebo, application of two drugs, usual care or a non-pharmacological intervention. The primary outcome had to be non-specific fatigue (or related terms such as asthenia). We did not include studies on fatigue related to antineoplastic treatment (e.g. chemotherapy, radiotherapy, surgical intervention). We also included secondary outcomes that were assessed in fatigue-related studies (e.g. exhaustion, tiredness). DATA COLLECTION AND ANALYSIS: Two review authors (MM and MC) independently assessed trial quality and extracted data. We screened the search results and included studies if they met the selection criteria. If we identified two or more studies that investigated a specific drug with the same dose in a population with the same disease and using the same assessment instrument or scale, we conducted meta-analysis. In addition, we compared the type of drug investigated in specific populations, as well as the frequent adverse effects of fatigue treatment, by creating overview tables. MAIN RESULTS: For this update, we screened 1645 publications of which 45 met the inclusion criteria (20 additional studies to the previous reviews). In total, we analysed data from 18 drugs and 4696 participants. There was a very high degree of statistical and clinical heterogeneity in the trials and we discuss the reasons for this in the review. There were some sources of potential bias in the included studies, including a lack of description of the methods of blinding and allocation concealment, and the small size of the study populations. We included studies investigating pemoline and modafinil in participants with multiple sclerosis (MS)-associated fatigue and methylphenidate in patients suffering from advanced cancer and fatigue in meta-analysis. Treatment results pointed to weak and inconclusive evidence for the efficacy of amantadine, pemoline and modafinil in multiple sclerosis and for carnitine and donepezil in cancer-related fatigue. Methylphenidate and pemoline seem to be effective in patients with HIV, but this is based only on one study per intervention, with only a moderate number of participants in each study. Meta-analysis shows an estimated superior effect for methylphenidate in cancer-related fatigue (standardised mean difference (SMD) 0.49, 95% confidence interval (CI) 0.15 to 0.83). Therapeutic effects could not be described for dexamphetamine, paroxetine or testosterone. There were a variety of results for the secondary outcomes in some studies. Most studies had low participant numbers and were heterogeneous. In general, adverse reactions were mild and had little or no impact. AUTHORS' CONCLUSIONS: Based on limited evidence, we cannot recommend a specific drug for the treatment of fatigue in palliative care patients. Fatigue research in palliative care seems to focus on modafinil and methylphenidate, which may be beneficial for the treatment of fatigue associated with palliative care although further research about their efficacy is needed. Dexamethasone, methylprednisolone, acetylsalicylic acid, armodafinil, amantadine and L-carnitine should be further examined. Consensus is needed regarding fatigue outcome parameters for clinical trials

Schematic drawing of the distribution of current density.

<p>Both (<b>A</b>) a concentric electrode and (<b>B</b>) a matrix array electrode induce high current densities distributed within superficial layers of the skin predominately activating intracutaneous nerve fibres.</p

Monitoring des Asiatisch-Pazifischen Forschungsraums (APRA) : Schwerpunkt Indien : 3. Bericht (2021)

Der asiatisch-pazifische Raum hat sich bei Wissenschaft, Forschung und Innovation in den letzten Jahren sehr dynamisch entwickelt. Daraus ergeben sich für Deutschland sowohl wissenschaftlich als auch wirtschaftlich große Chancen. Teilweise besteht bereits heute eine intensive Zusammenarbeit in Wissenschaft und Technologie, in einigen Fällen sind diese Austauschbeziehungen aber noch weniger ausgeprägt oder im Verlauf des vergangenen Jahrzehnts der Dynamik in der Region nicht gefolgt. Hieraus ergeben sich für Deutschland neue Rahmenbedingungen, die eine Anpassung der Wissenschafts-, Forschungs- oder auch Innovationspolitik erforderlich machen könnten. Um relevante Entwicklungsdynamiken in der APRA-Region erfassen und mit jenen in etablierten Wissenschafts- und Innovationsnationen vergleichen zu können, ist daher eine kontinuierliche Beobachtung der Entwicklungen notwendig. Im Sinne einer evidenzbasierten Politik ist es für eine Vielzahl von Entscheidungsträgern unumgänglich, umfassende quantitative und qualitative Informationen zur Bewertung der Situation zur Verfügung zu haben. Dies ist einerseits notwendig, um das Erstarken möglicher Wettbewerber frühzeitig zu erkennen, andererseits, und wichtiger, um Möglichkeiten zum Ausbau bestehender und zur Initiierung neuer Partnerschaften identifizieren zu können. Das Bundesministerium für Bildung und Forschung (BMBF) beobachtet die dynamische Entwicklung von Wissenschaft, Forschung und Innovation im Asiatisch-Pazifischen Forschungsraum bereits seit mehreren Jahren, um das eigene Handeln adäquat auf neue Entwicklungen abstimmen zu können. In diese Aktivitäten ordnet sich auch das Projekt „Monitoring des Asiatisch-Pazifischen Forschungsraums“, in dessen Rahmen bereits zwei ausführliche Berichte vorgelegt wurden. Dieser dritte Bericht aktualisiert einerseits zentrale Betrachtungen der vorangehenden Publikationen, erweitert sie andererseits aber auch um zusätzliche, ergänzende Analysen.Bundesministerium für Bildung und Forschun

A systematic review on the role of vitamins, minerals, proteins, and other supplements for the treatment of cachexia in cancer: a European Palliative Care Research Centre cachexia project

We provide a systematic review to support the European Palliative Care Research Collaboration development of clinical guidelines for cancer patients suffering from cachexia. CENTRAL, MEDLINE, PsycINFO, ClinicalTrials.gov, and a selection of cancer journals have been searched up until 15 April 2016. The systematic literature research yielded 4214 publications with 21 of these included in the final evaluation. Regarding minerals, our search identified only one study examining the use of magnesium with no effect on weight loss. As far as vitamins are concerned, vitamin E in combination with omega-3 fatty acids displayed an effect on survival in a single study, vitamin D showed improvement of muscle weakness in prostate cancer patients, and vitamin C supplementation led to an improvement of various quality of life aspects in a sample with a variety of cancer diagnoses. For proteins, a combination therapy of β-hydroxy-β-methylbutyrate (HMB), arginine, and glutamine showed an increase in lean body mass after 4 weeks in a study of advanced solid tumour patients, whereas the same combination did not show a benefit on lean body mass in a large sample of advanced lung and other cancer patients after 8 weeks. L-carnitine led to an increase of body mass index and an increase in overall survival in advanced pancreatic cancer patients. Adverse effects of food supplementation were rare and showed mild intensity. There is not enough solid evidence for the use of minerals, vitamins, proteins, or other supplements in cancer. No serious adverse effects have been reported with dietary supplementation

Factor analysis of VARIMAX rotated QST data after 4 Hz matrix array stimulation.

<p>All mechanical pain thresholds (MPT, MPS, WUR, PPT) show significant loadings on factor 1 “mechanical pain” (x-axis). Thermal pain thresholds show significant loadings on factor 2 “thermal pain” (y-axis), while thermal and mechanical detection thresholds take an intermediate position, indicating that 4 Hz stimulation differentially effects different peripheral and central sensory channels to the brain.</p