No gender-related bias in COPD diagnosis and treatment in Sweden: a randomised, controlled, case-based trial.

Introduction:COPD is a major cause of morbidity and mortality. The prevalence, morbidity and mortality of COPD among females have increased. Previous studies indicate a possible gender bias in the diagnosis and management of COPD. The present study aims to determine if there is gender bias in the management of COPD in Sweden.Methods:This was a double-blind, randomised (1:1), controlled, parallel-group, web-based trial using the hypothetical case scenario of a former smoker (40 pack-years and quit smoking 3 years ago) who was male or female. The participants were blind to the randomisation and the purpose of the trial. The case progressively revealed more information with associated questions on how the physician would manage the patient. Study participants chose from a list of tests and treatments at each step of the case scenario.Results:In total, 134 physicians were randomised to a male (n=62) or a female (n=72) case. There was no difference in initial diagnosis (61 (98%) male cases and 70 (97%) female cases diagnosed with COPD) and planned diagnostic procedures between the male and female cases. Spirometry was chosen by all the physicians as one of the requested diagnostic tests. The management of the hypothetical COPD case did not differ by sex of the responding physician.Conclusion:In Sweden, diagnosis and management of a hypothetical patient with COPD did not differ by the gender of the patient or physician

Comparability of the Australian National Cancer Symptom Trials (CST) Group's Study Populations to National Referrals to Non-CST Specialist Palliative Care Services Participating in the Palliative Care Outcomes Collaboration

Using the results of Phase III studies in clinical practice depends on how representative study participants are of the clinical population to whom the results will be applied. The closer the characteristics between the subgroup who participate in a clinical trial and the whole population, the easier it is for clinicians to apply the results directly to the patient that he/she is treating. Trial participation is generally more happenstance than a systematic sampling of a population and is limited by eligibility criteria that do not reflect the entire clinical population. Phase III study populations tend to be younger with fewer comorbidities and not represent the gender and ethnicity of the target population, limiting generalizability of results. When moving from Phase III studies to Phase IV postmarketing studies, there will be differences in the populations prescribed the medications and the outcomes achieved, highlighting the gap between gold-standard evidence from Phase III randomized studies and the application of that evidence in real-world practice. Palliative care services are referral based, yet there are no standard national or international referral criteria. As such, the populations served by specialist palliative care services are ill defined, complicating the problem of defining a representative population even further. Key characteristics have been suggested to aid generalizability of research findings in palliative care, although these are poorly reported. In palliative care, large-scale Phase III, symptom control effectiveness studies are being conducted successfully. This includes the work of the Australian National Cancer Symptom Trials (CST) group. Can the findings from these studies be generalized to the broader palliative cancer care population in the same health system? The aim of this analysis was to compare key demographic factors between participants with cancer in these Phase III studies and people referred to nontrial specialist palliative care services using standard prospective data collection. The null hypothesis was that there was no difference between participants\u27 characteristics

Harms From Haloperidol for Symptom Management in Palliative Care—a Post Hoc Pooled Analysis of Three Randomized Controlled Studies and Two Consecutive Cohort Studies

Symptom control for people with cancer improves quality of life. Haloperidol is a key drug in palliative care and is frequently used for the treatment of delirium, nausea, and vomiting.1 Haloperidol, a butyrophenone, is a more potent D2 receptor antagonist than other antiemetics, such as prochlorperazine, olanzapine, or chlorpromazine. The adverse events associated with haloperidol are like those of the phenothiazines, except that haloperidol potentially causes less sedation and hypotension. However, haloperidol is more strongly associated with extrapyramidal symptoms especially compared with newer drugs such as quetiapine or risperidone, and patients with Parkinson disease or Lewy body dementia may be more sensitive to its adverse events.2 Haloperidol is inexpensive and has several routes of administration. Only a few studies focus on patients with life-limiting illnesses. The aim of this study was to determine whether the doses of haloperidol used in palliative care cause immediate and short-term harms and, if so, what is their severity

The Prospective Evaluation of the Net Effect of Red Blood Cell Transfusions in Routine Provision of Palliative Care

© Copyright 2017, Mary Ann Liebert, Inc. 2017. Background: Red Blood Cell (RBC) transfusions are commonly used in palliative care. RBCs are a finite resource, transfusions carry risks, and the net effect (benefits and harms) is poorly defined for people with life-limiting illnesses. Objective: To examine the indications and effects of RBC transfusion in palliative care patients. Design: This international, multisite, prospective consecutive cohort study. Setting/Subjects: Palliative care patients undergoing RBC transfusion. Measurements: Target symptoms (fatigue, breathlessness, generalized weakness, or dizziness) were assessed before transfusion and at day 7 by treating clinicians, using National Cancer Center Institute Common Terminology Criteria for Adverse Events. Assessment of harms was made at day 2. Results: One hundred and one transfusions with day 7 follow-up were collected. Median age was 72.0 (interquartile range 61.5-83.0) years, 58% men, and mean Australia-modified Karnofsky Performance Status (AKPS) of 48 (standard deviation [SD] 17). A mean 2.1 (SD 0.6) unit was tranfused. The target symptoms were fatigue (61%), breathlessness (16%), generalized weakness (12%), dizziness (6%), or other (5%). Forty-nine percent of transfusions improved the primary target symptom, and 78% of transfusions improved at least one of the target symptoms. Harms were infrequent and mild. An AKPS of 40%-50% was associated with higher chances of symptomatic benefit in the target symptom; however, no other predictors of response were identified. Conclusions: In the largest prospective consecutive case series to date, clinicians generally reported benefit, with minimal harms. Ongoing work is required to define the optimal patient-and clinician-reported hematological and functional outcome measures to optimize the use of donor blood and to minimize transfusion-Associated risk