A portable automatic cough analyser in the ambulatory assessment of cough

<p>Abstract</p> <p>Background</p> <p>Cough is one of the main symptoms of advanced lung disease. However, the efficacy of currently available treatment remains unsatisfactory. Research into the new antitussives requires an objective assessment of cough.</p> <p>Methods</p> <p>The aim of the study was to test the feasibility of a new automatic portable cough analyser and assess the correlation between subjective and objective evaluations of cough in 13 patients with chronic cough. The patients' individual histories, a cough symptom score and a numeric cough scale (1-10) were used as a subjective evaluation of cough and a computerized audio-timed recorder was used to measure the frequency of coughing.</p> <p>Results</p> <p>The pre-clinical validation has shown that an automated cough analyser is an accurate and reliable tool for the ambulatory assessment of chronic cough. In the clinical part of the experiment for the daytime, subjective cough scoring correlated with the number of all cough incidents recorded by the cough analyser (r = 0.63; p = 0.022) and the number of cough incidents per hour (r = 0.60; p = 0.03). However, there was no relation between cough score and the time spent coughing per hour (r = 0.48; p = 0.1). As assessed for the night-time period, no correlation was found between subjective cough scoring and the number of incidents per hour (r = 0.29; p = 0.34) or time spent coughing (r = 0.26; p = 0.4).</p> <p>Conclusion</p> <p>An automated cough analyser seems to be a feasible tool for the ambulatory monitoring of cough. There is a moderate correlation between subjective and objective assessments of cough during the daytime, whereas the discrepancy in the evaluation of night-time coughing might suggest that subjective analysis is unreliable.</p

Reading numbers aloud as a tool for the evaluation of breathlessness in Polish cancer patients

Background: The aim of the study was to verify the usefulness of the test of reading numbers aloud(ReNA) in the assessment of the intensity of dyspnoea at rest or on minimal exertion in Polish patients with advanced cancer. Material and methods: The study group included patients with advanced cancer who were breathless at rest or on minimal exertion. A modified Borg scale, a numeric rating scale (NRS) and a visual analogue scale(VAS) to assess breathlessness and peak expiratory flow (PEF) were performed. Patients then read aloud from a page containing a grid of numbers as quickly and clearly as they could for 60 seconds. It was intended to repeat the reading five times. The maximal amount of numbers read during the test (NNmax) and the maximal numbers read per breath (NN/Bmax) were noted. Results: Thirty-one patients with evidence of cancer participated in the study. However, for statistical analysis we included 28 patients (17 males, mean age 64.1 &#177; SD = 8.8) who were able to read numbers aloud at least once. The mean value for the modified Borg scale was 4.07 &#177; 1.89, NRS 5.75 &#177; 2.37 and VAS 5.11 &#177; 2.34. The average value for PEF was 183.26 &#177; 89.97. Twelve patients (42.86%) were unable to complete all five readings due to tiredness and fatigue. The mean value for the NNmax was 50.39 &#177; 29.93 and for NN/Bmax was 2.92 &#177; 2.45. No correlation was observed between the results for NRS, VAS or PEF and NNmax or NN/Bmax. Only the modified Borg scale correlated moderately with NNmax and NN/Bmax (R = &#8211;0.52 and R = &#8211;0.44, respectively). Conclusion: The ReNA seems to be a useful tool for assessing the intensity of dyspnoea at rest or on minimal exertion in Polish patients with advanced cancer. However, fatigue and tiredness due to the reading were a problem for almost half of the advanced cancer patients, who were unable to complete the whole test. Adv. Pall. Med. 2010; 9, 3: 73&#8211;80Background: The aim of the study was to verify the usefulness of the test of reading numbers aloud(ReNA) in the assessment of the intensity of dyspnoea at rest or on minimal exertion in Polish patients with advanced cancer. Material and methods: The study group included patients with advanced cancer who were breathless at rest or on minimal exertion. A modified Borg scale, a numeric rating scale(NRS) and a visual analogue scale(VAS) to assess breathlessness and peak expiratory flow (PEF) were performed. Patients then read aloud from a page containing a grid of numbers as quickly and clearly as they could for 60 seconds. It was intended to repeat the reading five times. The maximal amount of numbers read during the test (NNmax) and the maximal numbers read per breath (NN/Bmax) were noted. Results: Thirty-one patients with evidence of cancer participated in the study. However, for statistical analysis we included 28 patients (17 males, mean age 64.1 &#177; SD = 8.8) who were able to read numbers aloud at least once. The mean value for the modified Borg scale was 4.07 &#177; 1.89, NRS 5.75 &#177; 2.37 and VAS 5.11 &#177; 2.34. The average value for PEF was 183.26 &#177; 89.97. Twelve patients (42.86%) were unable to complete all five readings due to tiredness and fatigue. The mean value for the NNmax was 50.39 &#177; 29.93 and for NN/Bmax was 2.92 &#177; 2.45. No correlation was observed between the results for NRS, VAS or PEF and NNmax or NN/Bmax. Only the modified Borg scale correlated moderately with NNmax and NN/Bmax (R = &#8211;0.52 and R = &#8211;0.44, respectively). Conclusion: The ReNA seems to be a useful tool for assessing the intensity of dyspnoea at rest or on minimal exertion in Polish patients with advanced cancer. However, fatigue and tiredness due to the reading were a problem for almost half of the advanced cancer patients, who were unable to complete the whole test. Adv. Pall. Med. 2010; 9, 3: 73&#8211;8

Need for palliation in patients with the severe COPD - a questionnaire study

Background. Traditionally in Poland, palliative medicine and hospice care is focused on patients with malignant diseases. COPD patients, however, also express the need for palliation of symptoms and end-ofthe life support The aim of this study was to assess the opinion of severe and very severe COPD patients on their most distressing chronic symptoms, social activity and the need for additional palliative support. Material and methods. 26 patients with advanced COPD, staged according to GOLD criteria answered the short questionnaire concerning symptoms, social activities and the need for additional palliative care. Results. All patients suffered chronic symptoms despite of intensive treatment, the majority of them limited social live and all patients expressed the need for additional palliative support. Conclusions. Polish pulmonologists and palliative medicine doctors should join the international discussion aiming on the definition of end-of-the life needs of patients with chronic, life-limiting diseases and evaluation of the potential benefits by addition of palliative care.Background. Traditionally in Poland, palliative medicine and hospice care is focused on patients with malignant diseases. COPD patients, however, also express the need for palliation of symptoms and end-ofthe life support The aim of this study was to assess the opinion of severe and very severe COPD patients on their most distressing chronic symptoms, social activity and the need for additional palliative support. Material and methods. 26 patients with advanced COPD, staged according to GOLD criteria answered the short questionnaire concerning symptoms, social activities and the need for additional palliative care. Results. All patients suffered chronic symptoms despite of intensive treatment, the majority of them limited social live and all patients expressed the need for additional palliative support. Conclusions. Polish pulmonologists and palliative medicine doctors should join the international discussion aiming on the definition of end-of-the life needs of patients with chronic, life-limiting diseases and evaluation of the potential benefits by addition of palliative care

A patient with intractable pain on high dose opioid therapy. Could we manage not to escalate the opioid dose?

Prolonged opioid treatment reveals problems, like opioid tolerance and opioid induced hyperalgesia. On every stage of disease it should be remembered to use procedures that can have opioid dose sparing effect. We describe a patient with severe mixed neuropathic and nociceptive pain who despite complex medication embracing high dose of morphine suffered from untractable pain. He responded to opioid antagonist with sequential opioid rotation and a simple minimally invasive procedure.Prolonged opioid treatment reveals problems, like opioid tolerance and opioid induced hyperalgesia. On every stage of disease it should be remembered to use procedures that can have opioid dose sparing effect. We describe a patient with severe mixed neuropathic and nociceptive pain who despite complex medication embracing high dose of morphine suffered from untractable pain. He responded to opioid antagonist with sequential opioid rotation and a simple minimally invasive procedure

Fatal course of Churg-Strauss disease

Churg-Strauss syndrome (CSS) is an allergic vasculitis, which is commonly characterized by asthma and allergic rhinitis, eosinophila and eosinophillic infiltration of organs. Approximately 60-90% of patients with CSS are long-term survivors. We presented the case of fatal case of the disease complicated by pulmonary embolism, arrhythmia, and eventually - cerebral bleeding.Churg-Strauss syndrome (CSS) is an allergic vasculitis, which is commonly characterized by asthma and allergic rhinitis, eosinophila and eosinophillic infiltration of organs. Approximately 60-90% of patients with CSS are long-term survivors. We presented the case of fatal case of the disease complicated by pulmonary embolism, arrhythmia, and eventually - cerebral bleeding

The last months of lung cancer patients&#8217; lives, in the memory of their relatives. A qualitative study based on in-depth interviews with family members

Background. The aim of the study was to assess how family members remember the final months of their loved ones 2&#8211;8 years after their death. We focused particularly on their recognition of the patients&#8217; physical, psychosocial and spiritual needs. Methods. The family members of 45 non small-cell lung cancer patients who died up to 7 years after radical surgical treatment were telephoned and asked to meet the research team. Only 20 of them agreed to talk about the dying and death of their relatives; for the rest the issue was still too painful. During the meeting with two researchers, participants were asked to comment freely on the points of the Assessment of Dying in Lung Cancer Patients questionnaire. Results. Almost all the relatives interviewed in our study were able to recognize the beginning of the terminal phase. They connected the beginning of dying with the deterioration of the physical and/or psychological status of patients, such as the exacerbation of weakness and/or other symptoms or with clearly distinguished incidents such as cancer recurrence or hip fracture. The majority were able to define the length of this phase as being several months (median = 3, range 1&#8211;11 months). The most common physical symptoms mentioned by the relatives interviewed were, in sequential order: pain (n = 13) and fatigue (n = 13), anorexia (n = 9), dyspnoea (n = 7) and cachexia (n = 7). Of the 20 decedents, 18 regularly received painkillers at least at some period during their final months. Apart from medicines prescribed by the doctors, 9 patients were treated with &#8220;anticancer&#8221; herbs, or homeopathy, or by bioenergotherapy. From the relatives&#8217; perspectives, the main approach was focused on the physical aspects of care while there was a lack of psychological and social support, the latter often causing severe financial burden. Most relatives believed that chaplains are the main source of spiritual comfort and there was easy access to such a service both in their parish and in the hospice or hospitals. Conclusion. Our study showed that the families remembered feelings of loneliness and helplessness when confronted with the psychological suffering of their loved ones and the financial burdens caused by the caregivers. Professionals involved in palliative care should acknowledge that holistic care requires sensitivity, not only to the physical but also to the psychosocial and spiritual aspects of end-of-life care.Background. The aim of the study was to assess how family members remember the final months of their loved ones 2&#8211;8 years after their death. We focused particularly on their recognition of the patients&#8217; physical, psychosocial and spiritual needs. Methods. The family members of 45 non small-cell lung cancer patients who died up to 7 years after radical surgical treatment were telephoned and asked to meet the research team. Only 20 of them agreed to talk about the dying and death of their relatives; for the rest the issue was still too painful. During the meeting with two researchers, participants were asked to comment freely on the points of the Assessment of Dying in Lung Cancer Patients questionnaire. Results. Almost all the relatives interviewed in our study were able to recognize the beginning of the terminal phase. They connected the beginning of dying with the deterioration of the physical and/or psychological status of patients, such as the exacerbation of weakness and/or other symptoms or with clearly distinguished incidents such as cancer recurrence or hip fracture. The majority were able to define the length of this phase as being several months (median = 3, range 1&#8211;11 months). The most common physical symptoms mentioned by the relatives interviewed were, in sequential order: pain (n = 13) and fatigue (n = 13), anorexia (n = 9), dyspnoea (n = 7) and cachexia (n = 7). Of the 20 decedents, 18 regularly received painkillers at least at some period during their final months. Apart from medicines prescribed by the doctors, 9 patients were treated with &#8220;anticancer&#8221; herbs, or homeopathy, or by bioenergotherapy. From the relatives&#8217; perspectives, the main approach was focused on the physical aspects of care while there was a lack of psychological and social support, the latter often causing severe financial burden. Most relatives believed that chaplains are the main source of spiritual comfort and there was easy access to such a service both in their parish and in the hospice or hospitals. Conclusion. Our study showed that the families remembered feelings of loneliness and helplessness when confronted with the psychological suffering of their loved ones and the financial burdens caused by the caregivers. Professionals involved in palliative care should acknowledge that holistic care requires sensitivity, not only to the physical but also to the psychosocial and spiritual aspects of end-of-life care

How do relatives remember the dying of lung cancer patients after 2-8 years? A qualitative study based on in-depth interviews with family members

Background. The aim of our study was to assess how relatives remember the dying of lung cancer patients several years after their death. Methods. The family members of 45 non small-cell lung cancer patients who died up to 7 years after radical surgical treatment were telephoned and asked to meet the research team. Only 20 of them agreed to talk about the dying and death of their relatives; for the rest the issue was still too painful. During the meeting with 2 researchers, participants were asked to comment freely on the points of the Assessment of Dying in Lung Cancer Patients questionnaire and to score the Quality of Dying Apgar. Results. Family members of 15 of the patients stated recognizing the dying of their loved one. They concluded this on the basis of exacerbation of symptoms, "typical" appearance, change in behaviour or particular words the patient said to them. The median score of the quality of dying was 6.5/10 (range 3-9). Lower scoring was observed for patients who died in hospital, without the family present at the moment of death and with uncontrolled symptoms. Only 5 of the relatives assessed pain and other symptom control as satisfactory. Other family members remembered pain (n = 9), dyspnoea (n = 8), delirium (n = 4) and other symptoms as disturbing the dying in a severe or moderate way. Three relatives assessed that their loved one's dying was not "dignified", mostly due to the severe physical suffering, the nursing being crucially remiss at the hospital and the patient's being alone at the moment of death. All family members were able to describe the healthcare professionals' attitudes and even repeat the statements they heard from them. Conclusion. We have demonstrated that several years after death many of the words and the behaviour of the dying patients were still alive in their relatives' memories. The family members remember how the healthcare professionals behaved and what they said to them. While caring for dying people, we should bear in mind that the way in which we behave may either give strength to the family or destroy their peace of mind for many years.Background. The aim of our study was to assess how relatives remember the dying of lung cancer patients several years after their death. Methods. The family members of 45 non small-cell lung cancer patients who died up to 7 years after radical surgical treatment were telephoned and asked to meet the research team. Only 20 of them agreed to talk about the dying and death of their relatives; for the rest the issue was still too painful. During the meeting with 2 researchers, participants were asked to comment freely on the points of the Assessment of Dying in Lung Cancer Patients questionnaire and to score the Quality of Dying Apgar. Results. Family members of 15 of the patients stated recognizing the dying of their loved one. They concluded this on the basis of exacerbation of symptoms, "typical" appearance, change in behaviour or particular words the patient said to them. The median score of the quality of dying was 6.5/10 (range 3-9). Lower scoring was observed for patients who died in hospital, without the family present at the moment of death and with uncontrolled symptoms. Only 5 of the relatives assessed pain and other symptom control as satisfactory. Other family members remembered pain (n = 9), dyspnoea (n = 8), delirium (n = 4) and other symptoms as disturbing the dying in a severe or moderate way. Three relatives assessed that their loved one's dying was not "dignified", mostly due to the severe physical suffering, the nursing being crucially remiss at the hospital and the patient's being alone at the moment of death. All family members were able to describe the healthcare professionals' attitudes and even repeat the statements they heard from them. Conclusion. We have demonstrated that several years after death many of the words and the behaviour of the dying patients were still alive in their relatives' memories. The family members remember how the healthcare professionals behaved and what they said to them. While caring for dying people, we should bear in mind that the way in which we behave may either give strength to the family or destroy their peace of mind for many years

The presence of mu-, delta-, and kappa-opioid receptors in human heart tissue

Functional evidence suggests that the stimulation of peripheral and central opioid receptors (ORs) is able to modulate heart function. Moreover, selective stimulation of either cardiac or central ORs evokes preconditioning and, therefore, protects the heart against ischemic injury. However, anatomic evidence for OR subtypes in the human heart is scarce. Human heart tissue obtained during autopsy after sudden death was examined immunohistochemically for mu- (MOR), kappa- (KOR), and delta- (DOR) OR subtypes. MOR and DOR immunoreactivity was found mainly in myocardial cells, as well as on sparse individual nerve fibers. KOR immunoreactivity was identified predominantly in myocardial cells and on intrinsic cardiac adrenergic (ICA) cell-like structures. Double immunofluorescence confocal microscopy revealed that DOR colocalized with the neuronal marker PGP9.5, as well as with the sensory neuron marker calcitonin gene-related peptide (CGRP). CGRP-immunoreactive (IR) fibers were detected either in nerve bundles or as sparse individual fibers containing varicose-like structures. Our findings offer the first hint of an anatomic basis for the existence of OR subtypes in the human heart by demonstrating their presence in CGRP-IR sensory nerve fibers, small cells with an eccentric nucleus resembling ICA cells, and myocardial cells. Taken together, this suggests the role of opioids in both the neural transmission and regulation of myocardial cell function

Funding models in palliative care: lessons from international experience

Background:Funding models influence provision and development of palliative care services. As palliative care integrates into mainstream health care provision, opportunities to develop funding mechanisms arise. However, little has been reported on what funding models exist or how we can learn from them.Aim:To assess national models and methods for financing and reimbursing palliative care.Design:Initial literature scoping yielded limited evidence on the subject as national policy documents are difficult to identify, access and interpret. We undertook expert consultations to appraise national models of palliative care financing in England, Germany, Hungary, Republic of Ireland, New Zealand, The Netherlands, Norway, Poland, Spain, Sweden, Switzerland, the United States and Wales. These represent different levels of service development and a variety of funding mechanisms.Results:Funding mechanisms reflect country-specific context and local variations in care provision. Patterns emerging include the following:Provider payment is rarely linked to population need and often perpetuates existing inequitable patterns in service provision.Funding is frequently characterised as a mixed system of charitable, public and private payers.The basis on which providers are paid for services rarely reflects individual care input or patient needs.Conclusion:Funding mechanisms need to be well understood and used with caution to ensure best practice and minimise perverse incentives. Before we can conduct cross-national comparisons of costs and impact of palliative care, we need to understand the funding and policy context for palliative care in each country of interest

Funding models in palliative care: Lessons from international experience

Background: Funding models influence provision and development of palliative care services. As palliative care integrates into mainstream health care provision, opportunities to develop funding mechanisms arise. However, little has been reported on what funding models exist or how we can learn from them. Aim: To assess national models and methods for financing and reimbursing palliative care. Design: Initial literature scoping yielded limited evidence on the subject as national policy documents are difficult to identify, access and interpret. We undertook expert consultations to appraise national models of palliative care financing in England, Germany, Hungary, Republic of Ireland, New Zealand, The Netherlands, Norway, Poland, Spain, Sweden, Switzerland, the United States and Wales. These represent different levels of service development and a variety of funding mechanisms. Results: Funding mechanisms reflect country-specific context and local variations in care provision. Patterns emerging include the following: Provider payment is rarely linked to population need and often perpetuates existing inequitable patterns in service provision. Funding is frequently characterised as a mixed system of charitable, public and private payers. The basis on which providers are paid for services rarely reflects individual care input or patient needs. Conclusion: Funding mechanisms need to be well understood and used with caution to ensure best practice and minimise perverse incentives. Before we can conduct cross-national comparisons of costs and impact of palliative care, we need to understand the funding and policy context for palliative care in each country of interest