An assessement of the quality of life in patients with chronic lymphoedema treated by complex decongestive therapy/CDT

Background. Lymphoedema is an accumulation of protein-rich fluid in the interstitial space. Long-lasting lymphoedema leads to chronic inflammation, fibrosis and tissue damage. Lymphoedema seriously affects a patient's body image, daily activities and mobility. At present, there is no curative treatment: the aim of lymphoedema management is long-term symptom control and an improvement in the health-related quality of life (HRQoL). Aim. The aim of this study was to assess the following: - the effect of complex decongestive therapy (CDT) on the quality of life of lymphoedema patients; - the effect of CDT on clinical symptom relief; - changes in HRQoL domains as defined in the SF-12 questionnaire. Methods. 30 patients were enrolled into a treatment group in a Lymphoedema Clinic. We assessed physical symptoms such as pain, heaviness, mobility, the fitting of clothes and body presentation at the beginning of the study, again after two weeks of intensive treatment and then after 4 months of maintenance therapy. Patients completed the SF-12 questionnaire at the beginning and at the end of the study. Results. The research revealed that complex intensive therapy significantly improves both physical and mental aspects of HRQoL. No correlation between HRQoL improvement and limb volume reduction has been found. CDT and the intensive phase of treatment in particular improved the fit of clothes and limb presentation, relieved pain and heaviness, and also improved limb mobility.Background. Lymphoedema is an accumulation of protein-rich fluid in the interstitial space. Long-lasting lymphoedema leads to chronic inflammation, fibrosis and tissue damage. Lymphoedema seriously affects a patient's body image, daily activities and mobility. At present, there is no curative treatment: the aim of lymphoedema management is long-term symptom control and an improvement in the health-related quality of life (HRQoL). Aim. The aim of this study was to assess the following: - the effect of complex decongestive therapy (CDT) on the quality of life of lymphoedema patients; - the effect of CDT on clinical symptom relief; - changes in HRQoL domains as defined in the SF-12 questionnaire. Methods. 30 patients were enrolled into a treatment group in a Lymphoedema Clinic. We assessed physical symptoms such as pain, heaviness, mobility, the fitting of clothes and body presentation at the beginning of the study, again after two weeks of intensive treatment and then after 4 months of maintenance therapy. Patients completed the SF-12 questionnaire at the beginning and at the end of the study. Results. The research revealed that complex intensive therapy significantly improves both physical and mental aspects of HRQoL. No correlation between HRQoL improvement and limb volume reduction has been found. CDT and the intensive phase of treatment in particular improved the fit of clothes and limb presentation, relieved pain and heaviness, and also improved limb mobility

To feed or not to feed in palliative medicine

The problem of malnutrition concerns most patients in the advanced stages of cancer. Nutrition and food are synonymous with the continuation of life for patients and their families and friends. In this paper, the methods of oral, enteral and parenteral nutrition are discussed, together with their advantages and the controversies connected with them and their effects on survival time and the quality of life.The problem of malnutrition concerns most patients in the advanced stages of cancer. Nutrition and food are synonymous with the continuation of life for patients and their families and friends. In this paper, the methods of oral, enteral and parenteral nutrition are discussed, together with their advantages and the controversies connected with them and their effects on survival time and the quality of life

Opioids in clinical practice

The treatment of pain improves quality of life. Opioids are commonly prescribed painkillers. The side effectsof opioids depend on the route of administration, dosage, drug metabolism, comorbid diseases and thepatient’s general condition. Despite many beneficial effects, opioids can lead to increased mortality in heartfailure, myocardial infarction, pulmonary oedema, and COPD. This article reviews specific uses of opioidmedications. Opioids induce immunosuppression, and may undergo drug-drug interactions, especiallyduring polytherapy or polypragmasia

Occurrence and Severity of Pain in Patients with Venous Leg Ulcers: A 12-Week Longitudinal Study

Background: The aim of the study was to analyze the dynamics of pain severity and its predictors in a group of patients with chronic venous leg ulcers. Methods: A 12-week longitudinal study included 754 patients with chronic venous leg ulcers. Subjective severity of pain was measured at weekly intervals with an 11-point visual analogue scale (VAS). Results: A significant decrease in VAS scores has been observed throughout the entire analyzed period. Higher severity of pain during follow-up was independently predicted by the presence of pus and/or unpleasant smell from the ulceration during the first visit, as well as by the occurrence of posterior and/or circumferential ulcers. The presence of ulcer redness during the first visit was associated with lesser pain severity; also, a significant interaction effect between the ulceration redness and warmth was observed. Conclusions: Implementation of complex holistic care may contribute to a substantial decrease in the occurrence and severity of pain in a patient with venous leg ulcers. Pain control seems to depend primarily on clinical parameters and topography of venous ulcers. The predictors of pain severity identified in this study might be considered during the planning of tailored care for patients with venous leg ulcers

Midazolam and hydroxymidazolam plasma concentrations can be monitored with selected biochemical and physiological parameters of palliative care patients

Rationale &amp; objective: Midazolam is one of top three drugs used in palliative care. Its use increases in the last days of hospice patients’ lives while safe dosage can be challenging. Equations currently used to estimate glomerular filtration rate, e.g: the Cockroft-Gault (eGFRCR) and the Modification of Diet in Renal Disease (eGFRMDRD) ones, do not generate precise calculations, especially in palliative patients exhibiting variations in body parameters. Our aim was to seek new relationships between mean midazolam (Mavg) and alfahydroxymidazolam (OH-Mavg) concentrations in plasma, and selected biochemical and physiological parameters of palliative patients, to enable optimal midazolam pharmacotherapy. Study design, participants and interventions: The pilot study included 11 Caucasians, aged 42–95, with advanced cancer disease, receiving midazolam in a hospice in-patient unit. We tested correlations among Mavg, BMI, eGFRMDRD, midazolam clearance (CL), OH-Mavg, bilirubin (Bil) and blood creatinine concentration (Cr). F test and leave-one out (LOO) validation was applied to verify the correlations’ significance and predictive ability. Results: We found ten statistically significant (p < 0.05) correlations related to midazolam pharmacokinetics and physiological factors. We formulated two equations with high degree of predictive ability, based on the eGFRMDRD→CL and the (Bil + BMI × Ln(Cr))→Mavg-(OH-Mavg) correlations.The limitations of the study mainly revolve around its pilot nature and the need to continue testing the results on a bigger population.No funding to disclose. Conclusions: The significance of correlations corresponding to the arithmetic expressions confirms that Bil, BMI, Ln(Cr) analyzed simultaneously report a series of processes on which midazolam metabolism depends. Two of ten correlations proposed came close to meet all LOO validation criteria. Current findings can help optimize midazolam treatment in palliative therapy

Opioidy w praktyce klinicznej

Leczenie bólu przyczynia się do poprawy jakości życia. Opioidy są powszechnie przepisywanymi lekami przeciwbólowymi. Działania niepożądane stosowania opioidów zależą od drogi podania, dawkowania, metabolizmu leków, chorób współistniejących i ogólnego stanu pacjenta. Pomimo wielu korzystnych efektów, opioidy mogą prowadzić do zwiększonej śmiertelności w przypadku wystąpienia niewydolności serca, zawału serca, obrzęku płuc i POChP. W niniejszym artykule omówiono poszczególne zastosowania leków opioidowych. Opioidy wywołują immunosupresję i mogą wchodzić w interakcje lekowe, zwłaszcza podczas politerapii lub polipragmazji