Glioblastoma multiforme(GBM)is the most common malignant primary brain tumor with a poor prognosis and limited survival.Patients with GBM have a high demand for palliative care.In our present case,a 21-year-old female...Glioblastoma multiforme(GBM)is the most common malignant primary brain tumor with a poor prognosis and limited survival.Patients with GBM have a high demand for palliative care.In our present case,a 21-year-old female GBM patient received inpatient palliative care services including symptom management,mental and psychological support for the patient,psychosocial and clinical decision support for her family members,and pre-and post-death bereavement management for the family.Furthermore,we provided the family members with comprehensive psychological preparation for the patient's demise and assisted the patient's family throughout the mourning period.The aim of this study is to provide a reference and insights for the clinical implementation of palliative care for patients with malignant brain tumors.展开更多
The concept of End-of-Life Care(EOLC)came into China in the late1980s.However,hospice and palliative care in medical practice develope slowly.In recent years,profesionals,patients and their families,as well as governm...The concept of End-of-Life Care(EOLC)came into China in the late1980s.However,hospice and palliative care in medical practice develope slowly.In recent years,profesionals,patients and their families,as well as government begin to attach importance to it.There is a hospice and palliative care movement now in China.This article gives an overview of the progress and the current status in multiple aspects of hospice and palliative care in China's Mainland,and points out the barriers and challenges for its further development in the future.展开更多
Objective To investigate doctors'feelings when providing medical care to end-stage patients,and their understanding as well as reflection about theoretical concepts of palliative medicine.Methods Questionnaires we...Objective To investigate doctors'feelings when providing medical care to end-stage patients,and their understanding as well as reflection about theoretical concepts of palliative medicine.Methods Questionnaires were delivered through a social networking platform to1500clinicians of different specialties in10proviences of China.It covered issues of background information,self-assessment of familiarity to palliative care,prior training history,emotional attitude toward end-stage patients,and the reflections on clinical practice.Logistic regression analysis and chi-square test were used to analyse the categorical variables.Results There were379clinicians who completed the questionnaires and submitted successfully.Among them,66.8%(253/379)had attended palliative care training courses more than twice;66.8%(253/379)clinicians percieved powerless feeling when facing end-stage patients.We found that the education on palliative medicine was significantly associated to doctors'better comprehension on the concept of palliative care(OR=6.923,P=0.002).Doctors who were more familiar with palliative medicine were less likely to perceive powerless feelings(χ^2=13.015,P<0.001),and would be more likely to concern about patients and their family members in their clinical work(χ^2=28.754,P<0.001,χ^2=24.406,P<0.001).Conclusion The powerless feeling is prevalent in Chinese doctors when facing end-stage patients.Palliative care help them overcome the negative feelings and act more caring in clinic.More careful designed educational strategies that adapt to Chinese actual situation are needed to improve doctors'cognition on palliative care.展开更多
Objectives The in-hosptial palliative care consultation(PCC) is emerging as a routine service in some medical center in China. The current study evaluated how physicians in primary care team and consultation team perc...Objectives The in-hosptial palliative care consultation(PCC) is emerging as a routine service in some medical center in China. The current study evaluated how physicians in primary care team and consultation team perceive the PCC service for the purpose of investigating the effectiveness of this consultation model in a general hospital.Methods In-hosptial palliative care consultations have been carried out at Peking Union Medical College Hosptial by a dedicated consultation team, and 37 consultations were completed in 2016. A questionnaire was designed for physicians in terms of its benefits to patients,their family as well as the primary care team. Physicians who applied for consultation in 2016 formally(requested from the department other than the Geriatrics) and informally(by rotating residents and unemployed visiting doctors in geriatric department) were invited to participate in the survey by scanning a two dimentional code on social networking platform.Results There were 103 physicians participated in the survey, including primary care physicians from the department of Internal Medicine(n=8), Gynaecology(n=16) and Surgery(n=13), rotating residents(n=30), visiting doctors(n=16) in Geriatric department, and PCC team members(n=20). 94.0% of the non-PCC physicians agreed that PCC relieved the suffering of patients; 89.2% thought PCC improved the quality of patients' life; there were 91.6%, 95.2%, 90.4% physicians who felt it relieved the anxiety of patients, of family members and of care providers, respectively. There were 96.4% physicians who felt it could ease the tension in physician-patient relationship; 97.6% felt it lower the risk for medical negligence, and 96.4% of doctors who applied for PPC felt satisfied with PCC service in terms of process and achieving objectives of consultation. More primary-team physician agree "PCC service helps the physicians better understand palliative care" than PCC members(97.6% vs. 80%, P<0.05), while both were interested in learning more on palliative medicine(100% vs. 96.4%, P>0.05).Conclusion Palliative care consultation service in a general hospital is efficacious and acclaimed.The primary care physicians and the PCC members hold positive attitudes to the benefits that the PCC services bring to patients, family members, and physicians themselves. PCC for terminal patients in a general hospital may serve as a good modle for promotion of palliative care in China.展开更多
Objective To examine the quality of life and palliative care needs of elderly patients with advanced heart failure （HF）. Methods This was a correlation descriptive study conducted at a 650-bed sub-acute hospital. Pa...Objective To examine the quality of life and palliative care needs of elderly patients with advanced heart failure （HF）. Methods This was a correlation descriptive study conducted at a 650-bed sub-acute hospital. Patients who were aged 65 or over, diagnosed with HF of New York Heart Association Class III or IV symptoms, and mentally sound were eligible to the study. The Edmonton Symptom Assessment Scale, the overall quality of life single item scale, and the McQill Quality of Life Questionnaire （MQoL）, were used for measurement. Multi- ple regression analysis was performed to determine factors for predicting quality of life. Results A convenience sample of 112 patients was recruited. Their age was 81.5 ± 8.5 years. The three most distressing symptoms reported by the patients were tiredness （5.96 ± 2.78）, drowsiness （5.47± 2.93）, and shortness of breath （5.34 ± 2.96）. Their mean overall quality of life single item scale score was 4.72 ± 2.06 out of 10. The mean MQoL physical subscale score was the lowest （4.20 ± 1.767）, whereas their mean psychological subscale was the highest （7.14 ±2.39）. However, in a multivariate analysis model, quality of life was significantly associated with existential wellbeing, physical wellbeing, psychological wellbeing and educational level. Conclusions The findings highlight that spiritual concerns are significant palliative care needs among elderly patients with advanced HF, in addition to symptom management. This is in line with the argument that palliative care that places great emphasis on holistic care should be integrated to the care of this group of patients.展开更多
Value-based care model has been evolving to organize medical services around the patient and provide the full cycle of care for a medical condition.The full cycle of care model encompasses inpatient,outpatient,rehabil...Value-based care model has been evolving to organize medical services around the patient and provide the full cycle of care for a medical condition.The full cycle of care model encompasses inpatient,outpatient,rehabilitation as well as supportive care such as palliative care and nutrition support.Cancer rehabilitation and palliative care have emerged as two important parts of value-based practice for oncology patients.More clinical evidence suggests that early intervention of oncology rehabilitation program and palliative care are likely to improve the patient outcome and reduce the overall medical cost for the patient and his or her family as well as for medical service providers.Although interest has been raised in Chinese oncologists,but effectiveness of incorporating these two services in clinical practices has not been adequately demonstrated.An understanding of scope of cancer rehabilitation and palliative care may help facilitate the integration of both into the oncology care continuum in efforts to improve patients'physical,psychological,cognitive,functional health and quality of life.展开更多
The locations and modalities of palliative care services to patients with severe/end-stage illness can be diverse,ranging from general hospitals to home-based care.The concept of palliative care hasn't been fully ...The locations and modalities of palliative care services to patients with severe/end-stage illness can be diverse,ranging from general hospitals to home-based care.The concept of palliative care hasn't been fully applied to medical practice by care providers in China's Mainland,where the seriously ill or terminal patients mainly receive medical care in hospitals.The implementation of palliative care in medical practice has developed greatly in Peking Union Medical College hospital in terms of clinical patient care,education,and research.This article gives an overview of it,and the experiences in team building,promotion,support seaking and fund raising were also discussed in this article.We hope to explore an effective dilivering model of palliative care for end-stage patients that is adaptive to Chinese culture and social environment.展开更多
A 90-year-old man was diagnosed with primary gastric diffuse large B-cell lymphoma(PGDLBL)by PET/CT examination,gastroscopy,biopsy and histopathological analysis at a regular physical check in April,2016.The patient r...A 90-year-old man was diagnosed with primary gastric diffuse large B-cell lymphoma(PGDLBL)by PET/CT examination,gastroscopy,biopsy and histopathological analysis at a regular physical check in April,2016.The patient received R-CO chemotherapy(rituximab,cyclophosphamide,and vincristine)and radiotherapy subsequently,with enteral nutritional treatment through 3-cavity nasogastric tube due to development of pyloric obstruction.To satisfy patient's strong desire of eating by himself,we performed surgery of exploratory laparotomy and Roux-en-Y gastric bypass(RGB)to relieve pylorus obstruction.Postoperatively,the patient resumed oral feeding,supplemented by nasogastric tube feeding at 1350-1550 Kcal daily.He is now 94 years old with fairly well nutrition and normal communication.The outcome of 4 year follow-up suggests that nutritional treatment and palliative medicine are important for improving prognosis and life-quality of very elderly patients with end-stage tumors apart from the effective chemotherapy,radiotherapy,and surgery.展开更多
The establishment and development of volunteer team are very important in the whole process of palliative care.The concept and practice of palliative care have been developed in Peking Union Medical College Hospital(P...The establishment and development of volunteer team are very important in the whole process of palliative care.The concept and practice of palliative care have been developed in Peking Union Medical College Hospital(PUMCH)since the end of2012.Great progress has been made in different aspects.Volunteers play an extremely important role in the development of palliative care in PUMCH.The whole work began with the establishment of volunteer teams.This article introduces the process of the establishment and development of palliative care volunteer team in PUMCH,aiming to provide practical references for hospitals in China's Mainland to develop their own palliative care volunteer team.展开更多
Heart failure （HF） had emerged as an epidemic since two decades ago and is now a major threatening public health problem affecting 23 million population worldwide,
Objectives To identify symptom clusters among patients with advanced heart failure （HF） and the independent relationships with their quality of life （QoL）. Methods This is the secondary data analysis of a cross-se...Objectives To identify symptom clusters among patients with advanced heart failure （HF） and the independent relationships with their quality of life （QoL）. Methods This is the secondary data analysis of a cross-sectional study which interviewed 119 patients with advanced HF in the geriatric unit of a regional hospital in Hong Kong. The symptom profile and QoL were assessed by using the Edmonton Symptom Assessment Scale （ESAS） and the McGill QoL Questionnaire. Exploratory factor analysis was used to identify the symptom clusters. Hier- archical regression analysis was used to examine the independent relationships with their QoL, after adjusting the effects of age, gender, and comorbidities. Results The patients were at an advanced age （82.9± 6.5 years）. Three distinct symptom clusters were identified： they were the distress cluster （including shortness of breath, anxiety, and depression）, the decondition cluster （fatigue, drowsiness, nausea, and reduced appetite）, and the discomfort cluster （pain, and sense of generalized discomfort）. These three symptom clusters accounted for 63.25% of variance of the patients＇ symptom experience. The small to moderate correlations between these symptom clusters indicated that they were rather independent of one another. After adjusting the age, gender and comorbidities, the distress （β = -0.635, P 〈 0.001）, the decondition （β = -0.148, P = 0.01）, and the discomfort （β = -0.258, P 〈 0.001） symptom clusters independently predicted their QoL. Conclusions This study identified the distinctive symptom clusters among patients with advanced HF. The results shed light on the need to develop palliative care interventions for optimizing the symptom control for this life-limiting disease.展开更多
Heart failure （HF）, a complex clinical syndrome due to structural or functional disorder of the heart, is a major global health issue, with a prevalence of over 5.8 million in the USA alone, and over 23 million worl...Heart failure （HF）, a complex clinical syndrome due to structural or functional disorder of the heart, is a major global health issue, with a prevalence of over 5.8 million in the USA alone, and over 23 million worldwide. As a leading cause of hospitalizations among patients aged 65 years or older, HF is a major consumer of healthcare resources, creating a substantial strain on the healthcare system. This paper discusses the epidemiology of HF, financial impact, and multifaceted predicaments in end-stage HF care. A search was conducted on the U.S National Library of Medicine website （www.pubmed.gov） using keywords such as end-stage heart failure, palliative care, ethical dilemmas. Despite the poor prognosis of HF （worse than that for many cancers）, many HF patients, caregivers, and clinicians are unaware of the poor prognosis. In addition, the unpredictable clinical trajectory of HF complicates the planning of end-of-life care, such as palliative care and hospice, leading to underutilization of such resources. In conclusion, ethical dilemmas in end-stage HF are numerous, embroiling not only the patient, but also the caregiver, healthcare team, and society.展开更多
As one of the methods of palliative care,aromatherapy has been applied gradually in clinical nursing work in China in recent years.Through aromatherapy,terminal cancer patients can get not only relieves of physical sy...As one of the methods of palliative care,aromatherapy has been applied gradually in clinical nursing work in China in recent years.Through aromatherapy,terminal cancer patients can get not only relieves of physical symptoms,but also spiritual relaxation and peace,thus have improved quality of life at the end stage.In this paper,we report in detail about how aromatherapy was applied for symptom control in a cancer patient with unknown primary malignancy and multiple metastasis and its effects on the terminal life of this patient.展开更多
Background End-of-life care is not usually a priority in cardiology departments. We sought to evaluate the changes in end-of-life care after the introduction of a do-not-resuscitate （DNR） order protocol. Methods ＆ ...Background End-of-life care is not usually a priority in cardiology departments. We sought to evaluate the changes in end-of-life care after the introduction of a do-not-resuscitate （DNR） order protocol. Methods ＆ Results Retrospective analysis of all deaths in a cardiology department in two periods, before and after the introduction of the protocol. Comparison of demographic characteristics, use of DNR orders, and end-of-life care issues between both periods, according to the presence in the second period of the new DNR sheet （Group A）, a conven- tional DNR order （Group B） or the absence of any DNR order （Group C）. The number of deaths was similar in both periods （n = 198 vs. n = 197）. The rate of patients dying with a DNR order increased significantly （57.1% vs. 68.5%; P = 0.02）. Only 4% of patients in both periods were aware of the decision taken about cardiopulmonary resuscitation. Patients in Group A received the DNR order one day earlier, and 24.5% received it within the first 24 h of admission （vs. 2.6% in the first period; P 〈 0.001）. All patients in Group A with an implantable cardioverter defibrillator （ICD） had shock therapies deactivated （vs. 25.0% in the first period; P = 0.02）. Conclusions The introduction of a DNR order protocol may improve end-of-life care in cardiac patients by increasing the use and shortening the time of registration of DNR orders. It may also contribute to increase ICD deactivation in patients with these orders in place. However, the introduction of the sheet in late stages of the disease failed to improve patient participation.展开更多
1 Introduction Virtually all cardiovascular diseases including arrhythmias,valve disease,coronary artery disease and heart failure(HF)are increasingly common with advancing age.^([1])Age and disease-related changes in...1 Introduction Virtually all cardiovascular diseases including arrhythmias,valve disease,coronary artery disease and heart failure(HF)are increasingly common with advancing age.^([1])Age and disease-related changes in the heart including fibrosis in the atrial and ventricular myocardium and conduction system,scar tissue from myocardial infarction or other cardiomyopathic processes,increased inflammatory cytokines and changes to ion channels are just some of the factors that predispose older adults to arrhythmias.^([2]).展开更多
Dyspnea is a common and disabling symptom of respiratory and heart diseases, which is growing in incidence. During hospital admis- sion, breathlessness is under-diagnosed and under-treated, although there are treatmen...Dyspnea is a common and disabling symptom of respiratory and heart diseases, which is growing in incidence. During hospital admis- sion, breathlessness is under-diagnosed and under-treated, although there are treatments available for controlling the symptom. We have developed a tailored implementation strategy directed to medical staff to promote the application of these pharmacological and non-pharmacological tools in dealing with dyspnea. The primary aim is to decrease the rate of patients that do not receive an adequate relief of dyspnea. This is a four-stage quasi-experimental study. The intervention consists in two teaching talks that will be taught in Cardiology and Respiratory Medicine Departments. The contents will be prepared by Palliative Care specialists, based on available tools for management of dyspnea and patients＇ needs. A cross-sectional study of dyspnea in hospitalized patients will be performed before and after the intervention to ascertain an improvement in dyspnea intensity due to changes in medical practices. The last phase consists in the creation of consensus protocols for dyspnea management based in our experience. The results of this study are expected to be of great value and may change clinical practice in the near future and promote a changing for the better of dyspnea care.展开更多
If a patient is dying and still suffering great pain, what is the least harmful alternative? Here we prefer continuous sedation until death (CSD). CSD differs from physician-assisted death (PAD) in many aspects. First...If a patient is dying and still suffering great pain, what is the least harmful alternative? Here we prefer continuous sedation until death (CSD). CSD differs from physician-assisted death (PAD) in many aspects. Firstly, CSD is not used to shorten life or cause death, but instead its intention is to relieve suffering. Secondly, once CSD is associated with a reduction in or suspension of food intake, the duration of sedation is too short to have an impact on survival rate. Thirdly, CSD is titrated while PAD is often overdosed. Fourthly, the sanctity of life could be maintained since sedation is used merely as a means of quelling suffering. Last but no least, for unconscious patients, the same medicines are frequently used for both palliative sedation and standard surgical procedures.展开更多
基金National High Level Hospital Clinical Research Funding(2022-PUMCH-B-113).
文摘Glioblastoma multiforme(GBM)is the most common malignant primary brain tumor with a poor prognosis and limited survival.Patients with GBM have a high demand for palliative care.In our present case,a 21-year-old female GBM patient received inpatient palliative care services including symptom management,mental and psychological support for the patient,psychosocial and clinical decision support for her family members,and pre-and post-death bereavement management for the family.Furthermore,we provided the family members with comprehensive psychological preparation for the patient's demise and assisted the patient's family throughout the mourning period.The aim of this study is to provide a reference and insights for the clinical implementation of palliative care for patients with malignant brain tumors.
基金supported by the Educational Reform Project of Peking Union Medical College(2015zlgc0120)
文摘The concept of End-of-Life Care(EOLC)came into China in the late1980s.However,hospice and palliative care in medical practice develope slowly.In recent years,profesionals,patients and their families,as well as government begin to attach importance to it.There is a hospice and palliative care movement now in China.This article gives an overview of the progress and the current status in multiple aspects of hospice and palliative care in China's Mainland,and points out the barriers and challenges for its further development in the future.
基金supported by the Educational Reform Project of Peking Union Medical College(2015zlgc0120)~~
文摘Objective To investigate doctors'feelings when providing medical care to end-stage patients,and their understanding as well as reflection about theoretical concepts of palliative medicine.Methods Questionnaires were delivered through a social networking platform to1500clinicians of different specialties in10proviences of China.It covered issues of background information,self-assessment of familiarity to palliative care,prior training history,emotional attitude toward end-stage patients,and the reflections on clinical practice.Logistic regression analysis and chi-square test were used to analyse the categorical variables.Results There were379clinicians who completed the questionnaires and submitted successfully.Among them,66.8%(253/379)had attended palliative care training courses more than twice;66.8%(253/379)clinicians percieved powerless feeling when facing end-stage patients.We found that the education on palliative medicine was significantly associated to doctors'better comprehension on the concept of palliative care(OR=6.923,P=0.002).Doctors who were more familiar with palliative medicine were less likely to perceive powerless feelings(χ^2=13.015,P<0.001),and would be more likely to concern about patients and their family members in their clinical work(χ^2=28.754,P<0.001,χ^2=24.406,P<0.001).Conclusion The powerless feeling is prevalent in Chinese doctors when facing end-stage patients.Palliative care help them overcome the negative feelings and act more caring in clinic.More careful designed educational strategies that adapt to Chinese actual situation are needed to improve doctors'cognition on palliative care.
基金supported by the Educational Reform Project of Peking Union Medical College(2015zlgc012)~~
文摘Objectives The in-hosptial palliative care consultation(PCC) is emerging as a routine service in some medical center in China. The current study evaluated how physicians in primary care team and consultation team perceive the PCC service for the purpose of investigating the effectiveness of this consultation model in a general hospital.Methods In-hosptial palliative care consultations have been carried out at Peking Union Medical College Hosptial by a dedicated consultation team, and 37 consultations were completed in 2016. A questionnaire was designed for physicians in terms of its benefits to patients,their family as well as the primary care team. Physicians who applied for consultation in 2016 formally(requested from the department other than the Geriatrics) and informally(by rotating residents and unemployed visiting doctors in geriatric department) were invited to participate in the survey by scanning a two dimentional code on social networking platform.Results There were 103 physicians participated in the survey, including primary care physicians from the department of Internal Medicine(n=8), Gynaecology(n=16) and Surgery(n=13), rotating residents(n=30), visiting doctors(n=16) in Geriatric department, and PCC team members(n=20). 94.0% of the non-PCC physicians agreed that PCC relieved the suffering of patients; 89.2% thought PCC improved the quality of patients' life; there were 91.6%, 95.2%, 90.4% physicians who felt it relieved the anxiety of patients, of family members and of care providers, respectively. There were 96.4% physicians who felt it could ease the tension in physician-patient relationship; 97.6% felt it lower the risk for medical negligence, and 96.4% of doctors who applied for PPC felt satisfied with PCC service in terms of process and achieving objectives of consultation. More primary-team physician agree "PCC service helps the physicians better understand palliative care" than PCC members(97.6% vs. 80%, P<0.05), while both were interested in learning more on palliative medicine(100% vs. 96.4%, P>0.05).Conclusion Palliative care consultation service in a general hospital is efficacious and acclaimed.The primary care physicians and the PCC members hold positive attitudes to the benefits that the PCC services bring to patients, family members, and physicians themselves. PCC for terminal patients in a general hospital may serve as a good modle for promotion of palliative care in China.
文摘Objective To examine the quality of life and palliative care needs of elderly patients with advanced heart failure （HF）. Methods This was a correlation descriptive study conducted at a 650-bed sub-acute hospital. Patients who were aged 65 or over, diagnosed with HF of New York Heart Association Class III or IV symptoms, and mentally sound were eligible to the study. The Edmonton Symptom Assessment Scale, the overall quality of life single item scale, and the McQill Quality of Life Questionnaire （MQoL）, were used for measurement. Multi- ple regression analysis was performed to determine factors for predicting quality of life. Results A convenience sample of 112 patients was recruited. Their age was 81.5 ± 8.5 years. The three most distressing symptoms reported by the patients were tiredness （5.96 ± 2.78）, drowsiness （5.47± 2.93）, and shortness of breath （5.34 ± 2.96）. Their mean overall quality of life single item scale score was 4.72 ± 2.06 out of 10. The mean MQoL physical subscale score was the lowest （4.20 ± 1.767）, whereas their mean psychological subscale was the highest （7.14 ±2.39）. However, in a multivariate analysis model, quality of life was significantly associated with existential wellbeing, physical wellbeing, psychological wellbeing and educational level. Conclusions The findings highlight that spiritual concerns are significant palliative care needs among elderly patients with advanced HF, in addition to symptom management. This is in line with the argument that palliative care that places great emphasis on holistic care should be integrated to the care of this group of patients.
文摘Value-based care model has been evolving to organize medical services around the patient and provide the full cycle of care for a medical condition.The full cycle of care model encompasses inpatient,outpatient,rehabilitation as well as supportive care such as palliative care and nutrition support.Cancer rehabilitation and palliative care have emerged as two important parts of value-based practice for oncology patients.More clinical evidence suggests that early intervention of oncology rehabilitation program and palliative care are likely to improve the patient outcome and reduce the overall medical cost for the patient and his or her family as well as for medical service providers.Although interest has been raised in Chinese oncologists,but effectiveness of incorporating these two services in clinical practices has not been adequately demonstrated.An understanding of scope of cancer rehabilitation and palliative care may help facilitate the integration of both into the oncology care continuum in efforts to improve patients'physical,psychological,cognitive,functional health and quality of life.
基金supported by the Educational Reform Project of Peking Union Medical College(2015zlgc0120)~~
文摘The locations and modalities of palliative care services to patients with severe/end-stage illness can be diverse,ranging from general hospitals to home-based care.The concept of palliative care hasn't been fully applied to medical practice by care providers in China's Mainland,where the seriously ill or terminal patients mainly receive medical care in hospitals.The implementation of palliative care in medical practice has developed greatly in Peking Union Medical College hospital in terms of clinical patient care,education,and research.This article gives an overview of it,and the experiences in team building,promotion,support seaking and fund raising were also discussed in this article.We hope to explore an effective dilivering model of palliative care for end-stage patients that is adaptive to Chinese culture and social environment.
基金the Millitary Logistical Special Project for Health Care(18BJZ07)。
文摘A 90-year-old man was diagnosed with primary gastric diffuse large B-cell lymphoma(PGDLBL)by PET/CT examination,gastroscopy,biopsy and histopathological analysis at a regular physical check in April,2016.The patient received R-CO chemotherapy(rituximab,cyclophosphamide,and vincristine)and radiotherapy subsequently,with enteral nutritional treatment through 3-cavity nasogastric tube due to development of pyloric obstruction.To satisfy patient's strong desire of eating by himself,we performed surgery of exploratory laparotomy and Roux-en-Y gastric bypass(RGB)to relieve pylorus obstruction.Postoperatively,the patient resumed oral feeding,supplemented by nasogastric tube feeding at 1350-1550 Kcal daily.He is now 94 years old with fairly well nutrition and normal communication.The outcome of 4 year follow-up suggests that nutritional treatment and palliative medicine are important for improving prognosis and life-quality of very elderly patients with end-stage tumors apart from the effective chemotherapy,radiotherapy,and surgery.
基金supported by the Educational Reform Project of Peking Union Medical College(2015zlgc0120)~~
文摘The establishment and development of volunteer team are very important in the whole process of palliative care.The concept and practice of palliative care have been developed in Peking Union Medical College Hospital(PUMCH)since the end of2012.Great progress has been made in different aspects.Volunteers play an extremely important role in the development of palliative care in PUMCH.The whole work began with the establishment of volunteer teams.This article introduces the process of the establishment and development of palliative care volunteer team in PUMCH,aiming to provide practical references for hospitals in China's Mainland to develop their own palliative care volunteer team.
文摘Heart failure （HF） had emerged as an epidemic since two decades ago and is now a major threatening public health problem affecting 23 million population worldwide,
文摘Objectives To identify symptom clusters among patients with advanced heart failure （HF） and the independent relationships with their quality of life （QoL）. Methods This is the secondary data analysis of a cross-sectional study which interviewed 119 patients with advanced HF in the geriatric unit of a regional hospital in Hong Kong. The symptom profile and QoL were assessed by using the Edmonton Symptom Assessment Scale （ESAS） and the McGill QoL Questionnaire. Exploratory factor analysis was used to identify the symptom clusters. Hier- archical regression analysis was used to examine the independent relationships with their QoL, after adjusting the effects of age, gender, and comorbidities. Results The patients were at an advanced age （82.9± 6.5 years）. Three distinct symptom clusters were identified： they were the distress cluster （including shortness of breath, anxiety, and depression）, the decondition cluster （fatigue, drowsiness, nausea, and reduced appetite）, and the discomfort cluster （pain, and sense of generalized discomfort）. These three symptom clusters accounted for 63.25% of variance of the patients＇ symptom experience. The small to moderate correlations between these symptom clusters indicated that they were rather independent of one another. After adjusting the age, gender and comorbidities, the distress （β = -0.635, P 〈 0.001）, the decondition （β = -0.148, P = 0.01）, and the discomfort （β = -0.258, P 〈 0.001） symptom clusters independently predicted their QoL. Conclusions This study identified the distinctive symptom clusters among patients with advanced HF. The results shed light on the need to develop palliative care interventions for optimizing the symptom control for this life-limiting disease.
文摘Heart failure （HF）, a complex clinical syndrome due to structural or functional disorder of the heart, is a major global health issue, with a prevalence of over 5.8 million in the USA alone, and over 23 million worldwide. As a leading cause of hospitalizations among patients aged 65 years or older, HF is a major consumer of healthcare resources, creating a substantial strain on the healthcare system. This paper discusses the epidemiology of HF, financial impact, and multifaceted predicaments in end-stage HF care. A search was conducted on the U.S National Library of Medicine website （www.pubmed.gov） using keywords such as end-stage heart failure, palliative care, ethical dilemmas. Despite the poor prognosis of HF （worse than that for many cancers）, many HF patients, caregivers, and clinicians are unaware of the poor prognosis. In addition, the unpredictable clinical trajectory of HF complicates the planning of end-of-life care, such as palliative care and hospice, leading to underutilization of such resources. In conclusion, ethical dilemmas in end-stage HF are numerous, embroiling not only the patient, but also the caregiver, healthcare team, and society.
基金supported by the Educational Reform Project of Peking Union Medical College(2015zlgc0120)~~
文摘As one of the methods of palliative care,aromatherapy has been applied gradually in clinical nursing work in China in recent years.Through aromatherapy,terminal cancer patients can get not only relieves of physical symptoms,but also spiritual relaxation and peace,thus have improved quality of life at the end stage.In this paper,we report in detail about how aromatherapy was applied for symptom control in a cancer patient with unknown primary malignancy and multiple metastasis and its effects on the terminal life of this patient.
文摘Background End-of-life care is not usually a priority in cardiology departments. We sought to evaluate the changes in end-of-life care after the introduction of a do-not-resuscitate （DNR） order protocol. Methods ＆ Results Retrospective analysis of all deaths in a cardiology department in two periods, before and after the introduction of the protocol. Comparison of demographic characteristics, use of DNR orders, and end-of-life care issues between both periods, according to the presence in the second period of the new DNR sheet （Group A）, a conven- tional DNR order （Group B） or the absence of any DNR order （Group C）. The number of deaths was similar in both periods （n = 198 vs. n = 197）. The rate of patients dying with a DNR order increased significantly （57.1% vs. 68.5%; P = 0.02）. Only 4% of patients in both periods were aware of the decision taken about cardiopulmonary resuscitation. Patients in Group A received the DNR order one day earlier, and 24.5% received it within the first 24 h of admission （vs. 2.6% in the first period; P 〈 0.001）. All patients in Group A with an implantable cardioverter defibrillator （ICD） had shock therapies deactivated （vs. 25.0% in the first period; P = 0.02）. Conclusions The introduction of a DNR order protocol may improve end-of-life care in cardiac patients by increasing the use and shortening the time of registration of DNR orders. It may also contribute to increase ICD deactivation in patients with these orders in place. However, the introduction of the sheet in late stages of the disease failed to improve patient participation.
文摘1 Introduction Virtually all cardiovascular diseases including arrhythmias,valve disease,coronary artery disease and heart failure(HF)are increasingly common with advancing age.^([1])Age and disease-related changes in the heart including fibrosis in the atrial and ventricular myocardium and conduction system,scar tissue from myocardial infarction or other cardiomyopathic processes,increased inflammatory cytokines and changes to ion channels are just some of the factors that predispose older adults to arrhythmias.^([2]).
文摘Dyspnea is a common and disabling symptom of respiratory and heart diseases, which is growing in incidence. During hospital admis- sion, breathlessness is under-diagnosed and under-treated, although there are treatments available for controlling the symptom. We have developed a tailored implementation strategy directed to medical staff to promote the application of these pharmacological and non-pharmacological tools in dealing with dyspnea. The primary aim is to decrease the rate of patients that do not receive an adequate relief of dyspnea. This is a four-stage quasi-experimental study. The intervention consists in two teaching talks that will be taught in Cardiology and Respiratory Medicine Departments. The contents will be prepared by Palliative Care specialists, based on available tools for management of dyspnea and patients＇ needs. A cross-sectional study of dyspnea in hospitalized patients will be performed before and after the intervention to ascertain an improvement in dyspnea intensity due to changes in medical practices. The last phase consists in the creation of consensus protocols for dyspnea management based in our experience. The results of this study are expected to be of great value and may change clinical practice in the near future and promote a changing for the better of dyspnea care.
文摘If a patient is dying and still suffering great pain, what is the least harmful alternative? Here we prefer continuous sedation until death (CSD). CSD differs from physician-assisted death (PAD) in many aspects. Firstly, CSD is not used to shorten life or cause death, but instead its intention is to relieve suffering. Secondly, once CSD is associated with a reduction in or suspension of food intake, the duration of sedation is too short to have an impact on survival rate. Thirdly, CSD is titrated while PAD is often overdosed. Fourthly, the sanctity of life could be maintained since sedation is used merely as a means of quelling suffering. Last but no least, for unconscious patients, the same medicines are frequently used for both palliative sedation and standard surgical procedures.
