PDF superior Delirium in Patients With Cancer.pdf

Delirium in Patients With Cancer.pdf

Delirium in Patients With Cancer.pdf

Comparison of the number of precipitating factors per episode of delirium is summarized in Table 2. The me- dian (range) number of precipitating factors per epi- sode of delirium was 3 (1-6) for reversed and nonre- versed delirium. The distribution of precipitating factors for the first episodes of reversed and nonreversed de- lirium is represented in Table 3 . The application of stan- dardized criteria resulted in a probable classification in 98 (77.8%) of 126 factors associated with reversed de- lirium and 60 (58.8%) of 102 factors associated with nonreversed delirium (P = .96). The 13 nonopioid drug factors associated with reversed delirium included meth- ylphenidate hydrochloride and methotrimeprazine, each in 3 instances; anticholinergics in 2 instances; and se- lective serotonin reuptake inhibitors, theophylline, tri- cyclics, benzodiazepines, and haloperidol decanoate in 1 each. The 21 metabolic factors associated with nonre- versible episodes consisted of hepatic impairment in 8 instances, refractory hypercalcemia in 5, and hypona- tremia and renal insufficiency in 4 each. In reversed epi- sodes, a higher proportion of precipitating factors was present in the case of opioids (P = .01), nonopioid psy- choactive medications (P = .01), and dehydration (P = .007). In nonreversed episodes, a higher propor- tion of precipitating factors was present in the case of res- piratory infection (P = .045), pulmonary cancer disease (P = .001), and metabolic factors (P = .01).
Mostrar más

9 Lee mas

TítuloCirculating miR 200c and miR 141 and outcomes in patients with breast cancer

TítuloCirculating miR 200c and miR 141 and outcomes in patients with breast cancer

In summary, the results of our pilot study indicate that miR-200c and miR-141 levels are deregulated in the blood of BC patients. Based on the differences between cases and healthy controls, the blood miR-200c assay holds promise as a detection marker in BC. Moreover, we were able to verify that miR-200c and miR-141 in whole blood are promising biomarkers of PFS and OS, both independently and in combination. These results will have to be further verified in large study cohorts that include the different stages and molecular subtypes of BC with adequate follow-up. A special attention to technical challenges and standardization must be pur- sued in the next validation studies. Furthermore, these findings might have relevant implications for other epi- thelial cancers where the miR-200 s family of microRNA is also deregulated, widening this exciting and growing field.
Mostrar más

15 Lee mas

Communication skills training for healthcare professionals working with people who have cancer

Communication skills training for healthcare professionals working with people who have cancer

We performed meta-analyses of seven healthcare professional (HCP) communication skill outcomes (using open questions, clarifying/summarising, eliciting concerns, showing empathy, giving appropriate information, giving facts only, and negotiating), three 'other' HCP outcomes relating to 'burnout '(emotional exhaustion, depersonalisation, personal accomplishment), and four patient outcomes (psychiatric morbidity, anxiety, perception of HCP communication, satisfaction with HCP communication). Overall, 10 studies contributed data to the meta-analyses. HCPs in the intervention groups were more likely to show empathy towards their patients (6 studies, 844 participant interviews; P = 0.008, I2 = 0%) and less likely to 'give facts only' without individualising their responses to the patient's emotions or offering support (5 studies, 780 participant interviews; P = 0.05, I2 = 68%). We considered these findings to be of a moderate- and low-certainty, respectively (Summary of findings for the main comparison). They were also more likely to use open questions in the post- intervention interviews than the control group (five studies, 796 participant interviews; P = 0.03, I2 = 62%); however the certainty of evidence was very low. In subgroup analyses according to staff type, these benefits of communication skills training (CST) remained statistically significant when 'doctors only' were included in the meta-analyses, but not for 'nurses only'; however, doctors and nurses did not perform differently for any HCP outcomes.
Mostrar más

102 Lee mas

Management of Delirium in Cancer Patient

Management of Delirium in Cancer Patient

Opioid-induced central nervous system (CNS) adverse effects are related to the anticholinergic actions of opioids, with inhibition of central cholinergic activity in multiple cortical and subcortical regions of the brain, in addition to an imbalance in CNS cholinergic and dopaminergic sys- tems [29]. The accumulation of toxic opioid metabolites has also been implicated (Fig. 2). Using the example of morphine as the “gold standard” opioid, the major metabo- lite (44%–55%), morphine-3-glucuronide (M-3-G), has no ␮ -opioid binding and consequently no analgesic properties [37, 41]. M-3-G is thought to be responsible for the cluster of OIN symptoms described above. However, the evidence for this is conflicting. Gong et al. [42], in 1992, reported that M-3-G did not produce excitatory and antianalgesic effects in rats, and Penson et al. [43] more recently, in 2001, did not induce neurotoxicity when small i.v. doses of M-3-G were injected into healthy volunteers. Normorphine, another nonopioid-binding neurotoxic metabolite, accounts for only approximately 5% of morphine metabolism [44]. However, this mediator may play a more prominent role in
Mostrar más

12 Lee mas

Aplicación de la radioterapia intraoperatoria en pacientes con cáncer de mama

Aplicación de la radioterapia intraoperatoria en pacientes con cáncer de mama

The intraoperative radiotherapy is a modality of treatment used in Oncology that allows the use of high therapeutically radiation doses in the surgical unit through the use of a mini portable electron accelerator specifically designed for radiotherapy intraoperative. These treatments of radiotherapy intraoperative have shown their utility in different neoplasic pathologies, it basically consists o n the provision of high doses of therapeutic radiation with portable equipment on the tumor itself or on the operated area through the incision made for surgery. The treatment has demonstrated improvement of patients that need less visits to hospitals in addition to other benefits. Our review is based on research results trough the intraoperative radiotherapy in patients with breast cancer with results comparable with external radiotherapy.
Mostrar más

9 Lee mas

Predictores evolucin quirrgica adversa de pacientes con obstruccin intestinal maligna

Predictores evolucin quirrgica adversa de pacientes con obstruccin intestinal maligna

Introduction. Malignant bowel obstruction (MBO) is a common problem in patients with advanced colorectal or ovarian cancer. The management of this group of patients is complex and controversial. Objective. To analyze the factors associated with morbidity and mortality in patients who underwent surgery for MBO in a tertiary referral center in Mexico City. Material and methods. Hospital records of pa- tients who underwent surgery for malignant bowel obstruction from January 1987 through December 2005 were retrospectively analyzed. Demographic data, clinical and surgical variables were recorded. Morbidity and mortality within 30-day of surgical procedure were registered. Factors associated with outcome were analyzed with the chi-square test. Survival cur- ves were constructed with the Kaplan-Meier method. Results. One-hundred and thirty patients were included. Primary neoplasm was the cause of bowel obstruction in 51 (39.2%) patients. Resection and anastomosis was performed in 45 pa- tients (34.6%); in 30 cases (23.1%) a palliative estoma was constructed. Hospital mortality rate was 10.8%, and major postoperative morbidity was 16.2%. Factors associated with a significant increase in surgical mortality were: advanced patient age 17.2% (p = 0.009), hipoalbuminemia 14.45% (p = 0.027) and surgery performed for neoplasms different from those of gastrointestinal origin 17.6% (p = 0.005). Surgical morbidity was significantly higher in patients with poor performance status 16.2% (p = 0.017), advanced age 18% (p = 0.04), and low albumin levels 13.5% (p = 0.03). Median survi- val for the entire cohort was nine months (95% CI 5-13). Actuarial one, three and five year survival were 38.4, 27.5 and 25.4%, respectively. The most significant predictor of survival was performance status. Conclusions. When surgical manage- ment of MBO is considered, a careful assessment of the factors shown here to predict an adverse surgical outcome and poor prognosis is required.
Mostrar más

5 Lee mas

Immune Microenvironment in Colorectal Cancer: A New Hallmark to Change Old Paradigms

Immune Microenvironment in Colorectal Cancer: A New Hallmark to Change Old Paradigms

Multiple analyses clearly point out that the impact on survival of CD8+ lymphocytes in colon cancer is more obvious with longer follow-up periods [42]. Moreover, in follow-up studies conducted on patients with high or low levels of CD8, survival curves during the first two years are very similar, further separating [24]. Chiba et al. [38] proposed the hypothesis that the presence of CD8+ T-cells in tumor tissue could trigger an immunosurveillance status in the organism, avoiding the development of distant metastasis. Pag`es et al. [40] proved that early metastasis development was associated with a poor immune response in tumor tissue. This group demonstrated in 490 patients of colorectal cancer that those patients with a high density of CD45RO+ cells had better prognosis in terms of disease free and overall survival compared with patients with a low density of these memory cells. Tumors without signs of early metastatic invasion had increased infiltrates of immune cells, particularly CD8+ T-cells [40]. Furthermore, Pag`es et al. [43] reported in 2009 another study in which they classified 602 early-stage colorectal cancers (stage I and II) into different prognostic groups depending on the density of CD45RO+ and CD8+ cells in two tumor regions (center and invasive margin). Immune classification was found to be an independent prognostic factor in multivariate analysis (P < 0.0001), revealing recurrence rates of 4,8% versus 75% in high versus low CD8+ and CD45RO+ infiltration, respectively [43]. Similarly, Mlecnik et al. [44] studied the intratumoral immune infiltrates in a broader population of stage I to IV colorectal cancers, measuring again the lymphocyte infiltrates in the center and the invasive margin of 599 specimens. They used the same immune score of their previous study, defining five patient groups (Im0, Im1, Im2, Im3, Im4). Patients with low densities of CD45RO and CD8 in both tumor regions were classified Im0, and the rest of groups were classified depending upon the density in every tumor region up to the group of four high densities (Im4). In this population, disease free survival and overall survival was far better in the Im3 and Im4 groups, and multivariate analysis confirmed the advantage of the immune score (HR 0,64; P < 0, 001) compared with the classical TNM staging [44].
Mostrar más

9 Lee mas

Determinación de interleucina-10 (IL-10) en pacientes con cáncer en estadios III y IV tratados con dexametasonaDetermination Of Interleukine-10 In Cancer Patients In Stages Iii And Iv Treated With Dexamethasone.

Determinación de interleucina-10 (IL-10) en pacientes con cáncer en estadios III y IV tratados con dexametasonaDetermination Of Interleukine-10 In Cancer Patients In Stages Iii And Iv Treated With Dexamethasone.

description Dexamethasone treatment in patients with cancer in stages III and IV is associated with immune response.. suppression, possibly because of the inhibiting effect produced by a[r]

3 Lee mas

SEOM Clinical Guideline of localized rectal cancer (2016).

SEOM Clinical Guideline of localized rectal cancer (2016).

For T2N0 rectal cancer, total mesorectal excision is the standard of care. TEM exclusive treatment leads to inac- ceptable local recurrence rates. However, some alternative has been proposed in two recent trials. In phase II trial ACOSOG Z6041, selected T2N0 rectal tumors received radiotherapy combined with capecitabine plus oxaliplatin followed by local excision. After a mean follow-up of 56 months, local recur- rence rate was 4%. 3- and 5-year disease-free survival for the per-protocol group was 86.9 and 80.3% [13]. These findings suggest that neoadjuvant chemoradiotherapy plus local TEM might be an alternative to radical surgery in selected patients with distal rectal cancer seeking organ-preserving surgery to avoid a permanent stoma.
Mostrar más

9 Lee mas

Capecitabine and irinotecan with bevacizumab 2-weekly for metastatic colorectal cancer: the phase II AVAXIRI study.

Capecitabine and irinotecan with bevacizumab 2-weekly for metastatic colorectal cancer: the phase II AVAXIRI study.

Quality of life, as measured using the EQ-5D-3 L ques- tionnaire, was maintained throughout the study, suggest- ing that treatment did not have a substantial negative impact on patients’ everyday activities. The evidence supports the validity of the EQ-5D-3 L tool in measuring quality of life in cancer patients [30], although the 5- level classification system, EQ-5D-5 L, has less ceiling effect and greater discriminative power [31] and we would consider using this tool in future studies. It is tricky to compare the VAS scores in Figure 3 with the EQ- 5D-3 L scores. The subjective nature of the VAS scores gives some insight into the psychological tolerance of the effect of treatment on patients than the more objective EQ-5D-3 L. This self-perception of wellbeing improves over the course of the study. It would be interesting to Table 3 Grade 3 and 4 adverse events related to
Mostrar más

9 Lee mas

Circulating Levels of Inflammatory Proteins and Survival in Patients with Gallbladder Cancer

Circulating Levels of Inflammatory Proteins and Survival in Patients with Gallbladder Cancer

proteins included chemokines (chemokine [C-C motif] ligand 19 [CCL19] and 20 [CCL20]), an acute-phase protein (CRP), proinflammatory cytokines (soluble tumor necrosis factor receptor 1 [sTNFRI] and 2 [sTNFRII], and IL-6), growth factors (soluble vascular endothelial growth factor receptor 3 [sVEGFR3], and tumor necro- sis factor-related apoptosis-inducing ligand (TRAIL). Kaplan-Meier survival estimates for 2 frequently evalu- ated proteins (IL-6 and CRP), and one protein (TRAIL) were shown in Fig. 1B–D, and others in Supplementary Figs 1–5. Elevated levels of seven proteins were associated with a poorer survival in patients with GBC, with adjusted HRs (comparing Quartile 4 [Q4] vs 1 [Q1]) ranging from 2.49 (95% CI = 1.41, 4.41) for chemokine (C-C motif) ligand 20 (CCL20) to 3.77 (95% CI = 1.98, 7.19) for tumor necrosis factor-alpha receptor II (sTNFRII). The difference in stage-adjusted median survival time between Q4 and Q1 ranged from 4.7 to 10.1 months (Table 2). In contrast, elevated levels of TRAIL were associated with an increased survival (HR for Q4 vs Q1 = 0.26; 95% CI = 0.14, 0.47, P trend across marker categories = 8.3 × 10 −5 ). The median stage-adjusted survival time was 7.9
Mostrar más

9 Lee mas

TítuloEffect of diagnostic delay on survival in patients with colorectal cancer: a retrospective cohort study

TítuloEffect of diagnostic delay on survival in patients with colorectal cancer: a retrospective cohort study

Although symptoms vary with tumour location, typical symptoms associated with CRC include rectorrhagia, hema- tochezia or melena, changes in bowel habits, abdominal pain, loss of weight, iron deficiency anaemia, and intestinal obstruction [8]. Once the symptoms are presented, it is un- clear the role of diagnostic and therapeutic delay in the prognosis of these patients. Intuitively, longer diagnostic delays (defined as the time between the first symptoms and the diagnosis of CRC) or therapeutic delays (defined as the time between first symptoms and initiation of treatment) might be associated with a poor prognosis. However, in regard to CRC, contradictory results have been obtained: whereas most studies have not found a significant associ- ation between delay and survival [9–14], other authors have reported, as expected, a poorer prognosis for patients with greater delays [15, 16]. Counterintuitive results have even been published, showing that patients with shorter diagnos- tic intervals had higher mortality rates [15, 17], leading to what is called the “waiting-time paradox”.
Mostrar más

11 Lee mas

Use of Functional Foods and Oral Supplements as Adjuvants in Cancer Treatment

Use of Functional Foods and Oral Supplements as Adjuvants in Cancer Treatment

Based on the evidence analyzed, the use of supple- ments as adjuvants in cancer treatment must be con- sidered carefully. Overall, foods containing functional nutrients are considered a safer option than supple- ments because of the higher concentration, hence dosage, in the supplement. In addition, foods are com- posed of a complex variety of nutrients that work synergistically, thus providing an added benefit to the patient. In conclusion, for the cancer patient who re- ceives radiation to the abdominopelvic area, when possible, the authors recommend a diet with suffi- cient protein, composed of foods rich in omega-3 fatty acids to promote anti-inflammation and prevent cachexia, and importantly, a diet rich in foods contain- ing antioxidants and polyphenols to protect healthy cells from the oxidation derived from cancer treat- ment. Furthermore, since the use of probiotics has been proven safe for cancer patients, a diet that con- tains foods with probiotics may confer beneficial ef- fects not only to protect the gastrointestinal tract but also provide an anti-inflammatory environment for the patient.
Mostrar más

11 Lee mas

Clinical and prognostic implications of delirium in elderly patients with non-ST-segment elevation acute coronary syndromes

Clinical and prognostic implications of delirium in elderly patients with non-ST-segment elevation acute coronary syndromes

and it could potentially be used to screen and identify those elderly patients admitted with NSTE-ACS, these patients need more a proactive implementation of preventive strate- gies for delirium. Regarding the latter, our study shows some potentially preventable precipitants, such as infections or the use of diuretics. For instance, early removal of uri- nary or venous catheters, and minimizing the duration of mechanical ventilation could be useful to prevent delir- ium. [30] Additionally, excessive depletion of these patients

8 Lee mas

Perioperative anemia management in colorectal cancer patients: A pragmatic approach.

Perioperative anemia management in colorectal cancer patients: A pragmatic approach.

In contrast, post-operative management in gastroin- testinal surgery is becoming well established with ERAS protocols starting 24 h prior to surgery with carbohydrate loading, minimization of preoperative fasting and early oral or enteral feeding given to patients the first day fol- lowing surgery (with oral nutritional supplements if nec- essary). ERAS is aimed to reduce surgical stress, insulin resistance, unnecessary protein losses and postoperative complications. In comparison with traditional care, ERAS programs were associated with significantly decreased length of hospital stay and total and general complica- tions, without affecting readmission rates, surgical com- plications, and mortality [90] .
Mostrar más

15 Lee mas

Delirium in terminal cancer inpatients: short term survival and missed diagnosis

Delirium in terminal cancer inpatients: short term survival and missed diagnosis

Delirium increases morbidity (Gustafson et al., 1988), causes distress to patients, family members, and health care professionals (Breitbart, Gibson, & Tremblay, 2002; Bruera et al., 2009). It increases also health expenditure (de la Cruz, Ransing, et al., 2015). Moreover, the presence of delirium diminishes survival in palliative care patients, even as early as 21 days after its onset (Caraceni et al., 2000; Lawlor et al., 2000), and next to performance scales (e.g., Karnofsky Performance Status, Eastern Cooperative Oncology Group Scale), it is an important factor in clinical indexes designed to predict mortality among the same population (Baba et al., 2015; Scarpi et al., 2011). Regardless of the high prevalence reported, delirium is still underdiagnosed and/or mistreat- ed in patients suffering from cancer (Wada, Wada, Wada, & Onishi, 2010), perhaps because of its fluctuating course and the lack of an intentional search for the syndrome by the health care staff (Inouye, 2006). Besides the impact in patients’ outcomes (de la Cruz, Fan, et al., 2015), a non-rec- ognized or mistreated delirium leads to unnecessary treat- ments and delays in end-of-life issues (Reddy, Nguyen, El Osta, & Bruera, 2008).
Mostrar más

5 Lee mas

Characterization and risk estimate of cancer in patients with primary Sjögren syndrome

Characterization and risk estimate of cancer in patients with primary Sjögren syndrome

dictating the prognosis and survival [13]. Among the systemic manifestations of SjS, lymphoma is one of the worst complications that physicians should expect. In 1978, Kassan et al. [2] estimated a SIR for NHL of 44.4 in patients with primary SjS. The SIRs estimated by subsequent studies, even though the great majority have been lower, have confirmed that primary SjS patients are at higher risk of lymphoma, with a pooled 14-fold higher risk reported by Liang et al. [19] in a recent meta-analysis. However, this meta- analysis included cohorts of patients in whom the diagnosis of primary SjS was based on the 1993 criteria, whose fulfillment allows the inclusion of patients with negative Ro/La antibodies and negative biopsy. This creates a significant bias, since several studies have reported a lower risk of lymphoprolifera- tion in immunonegative patients [8, 20]. Table 5 summarizes the studies based on the fulfillment of the 2002 criteria [8–11, 21–27]. The SIRs for B-cell lymphoma range between 7 and 9 in population- based studies and between 16 and 48 in hospital- based studies. The majority of these studies were focused only on B-cell lymphoma, and most of them used an old terminology (NHL).
Mostrar más

12 Lee mas

Invasive and Complicated Pneumococcal Infection in Patients with Cancer

Invasive and Complicated Pneumococcal Infection in Patients with Cancer

Data on demographic characteristics, underlying malig- nancies, concurrent diseases, main clinical symptoms, antimicrobial therapy, intensive care unit admission, type of pneumococcal disease, number of days of an- timicrobial therapy, type of antimicrobials used (beta- lactams, third-generation cephalosporins, macrolides, fluoroquinolones, clindamycin, and vancomycin), and infection outcomes were retrieved from patients’ med- ical records and computed institutional databases.

8 Lee mas

Outcome of Bone Metastases in 47 Patients with Differentiated                    Thyroid Cancer

Outcome of Bone Metastases in 47 Patients with Differentiated Thyroid Cancer

Median follow-up was 24 months (range 1-228 months). The survival rate at the end of follow-up was 41 %. One patient (3 %) was considered to have no evidence of disease, 28 patients (59 %) died as a consequence of the DTC. The cause of death was known in 27 cases and it was related to BMs in only 8 patients (30 %). In conclusion, BMs were mainly observed in patients >45 years old, with similar gender distribution. BMs were multiple and had mainly an axial skeletal localization, causing high morbidity in most patients. Although bone turnover markers were elevated in one third of cases, no patient had hypercalcemia. Multiple modali- ties of treatment were used in the majority of cases, which indicates the importance of a multidisciplinary approach. Finally, although BMs were associated with incurable disease, mortality was mainly related to the spread of DTC to other sites, and not specifically to BM. Rev Argent Endocrinol Metab 51:51-58, 2014 No financial conflicts of interest exist.
Mostrar más

8 Lee mas

Clinical response in patients with ovarian cancer treated with  metronomic chemotherapy

Clinical response in patients with ovarian cancer treated with metronomic chemotherapy

The use of platins and taxanes has improved the overall survival for OC. The outcomes depend not only on the chemotherapy schemes, but also on others factors like response to first line chemotherapy, disease free survival upon surgery, and number of previous treatments [22]. Metronomic chemotherapy with low doses of Cy has been proposed as a potential treatment of OC due to its antiangiogenic and immuno- modulating properties [17]. However, the clinical trials that support this approach are scarce, and most of the information comes from case reports [23] and pre-clinical studies. Merritt et al., in a OC pre-clinical model, described that metronomic topotecan has antiproliferative effect and targets some pro-angiogenic mediators like Hif-1 alfa, suggesting it as a novel therapeutic strategy [24]. Likewise, the use of nabpaclitaxel and metronomic topotecan showed significant reductions in tumour weight and proliferation as well as pazopanib did. Those agents seem to be ideal for clinical trials [25, 26]. On the other hand, regarding the resistance to the drugs administered metronomically in different types of tumours, including OC, Chow et al suggested that the sensitivity to MCT using different drugs do not only depends on the antiangiogenic mechanism, but also on other unknown additional mechanisms that could be drug-specific [27].
Mostrar más

10 Lee mas

Show all 10000 documents...