Articles of interest in other scholarly journals
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Hayes RD, Lee W, Rayner L, et al. Palliat Med 2011. [Epub ahead of print]
In the community, depression is more common in women than in men; however, in patients receiving palliative care this is not seen. In this cross-sectional study, 300 patients were interviewed and depression evaluated. It was found that depending on others for help with basic tasks (eating, dressing, washing or using the toilet) was a risk factor for depression only in men, with 37.8% of dependent men being depressed compared to 2.4% of similarly affected women. Furthermore, in men, the level of dependency was related to the severity of the depression.
Staples MP, Kallmes DF, Comstock BA, et al. BMJ 2011; 343:d3952
This study aimed to determine if selected subgroups (pain of recent onset or severe pain) with osteoporotic vertebral compression fractures would benefit from vertebroplasty. A meta-analysis of combined individual patient data from two placebo-controlled blinded trials was used. These studies, powered for subgroup analyses, failed to show an advantage of vertebroplasty over placebo for participants with recent onset fracture or severe pain and do not support the hypothesis that selected subgroups would benefit from vertebroplasty. At one month, those in the vertebroplasty group were also more likely to be taking opioids.
Farrokhi MR, Alibai E, Maghami Z. Journal of Neurosurgery-Spine 2011; 14 (5)
This randomised controlled trial of 82 patients compared the efficacy of percutaneous vertebroplasty versus optimal medical therapy in controlling pain and improving the quality of life (QOL) in patients with osteoporotic vertebral compression fractures. Significant improvement in pain and QOL from vertebroplasty was detected at one week and maintained over two years, with improvement in vertebral body height and deformity. The incidence of new fractures was also less with vertebroplasty.
Banerjee S, Hellier J, Dewey M, et. al.The Lancet 2011; 378 (9789): 403 – 411
In this randomised, parallel-group, double-blind, placebo-controlled, Health Technology Assessment Study of the Use of Antidepressants for Depression in Dementia (HTA-SADD) trial, the effect of mirtazapine and sertraline was evaluated. The primary outcome, which was reduction in depression at 13 weeks, did not differ between control and either antidepressant groups. This was unchanged at 39 weeks. There were more adverse reactions with mirtazapine and sertraline compared with control. The authors suggest that due to the absence of benefit compared with placebo and increased risk of adverse events, the present practice of use of these antidepressants, with usual care, for first-line treatment of depression in Alzheimer’s disease should be reconsidered.
Assessing constipation in palliative care within a gastroenterology framework
Clark K, Currow DC. Palliat Med 2011.[Epub ahead of print]
A non-systematic review of the literature was undertaken to assess the approaches to assessment and treatment. This found that in palliative care, constipation is assessed by patients’ reports, physical examination and sometimes an abdominal x-ray. However, data in non-palliative care patients refutes the usefulness of self-reported symptoms to localise whether problems are due to colon dysfunction or structures of defaecation. Plain radiographs are most useful to exclude a bowel obstruction only. In patients with resistant constipation, gastroenterology guidelines recommend an assessment approach that includes measuring colon transit time and an assessment of the structures that facilitate defaecation. The authors suggest that a modified gastroenterology guideline approach may be tolerable to palliative care patients and offer the chance of developing targeted palliation.
A prevalence study of errors in opioid prescribing in a large teaching hospital
Davies ED, Schneider F, Childs S, et al. International Journal of Clinical Practice 2011. [Epub ahead of print]
Opioid prescribing errors were assessed in a teaching hospital prior to implementation of the National Patient Safety Agency ‘Reducing Dosing Errors with Opioid Medicines’ recommendations, using a one day snapshot of opioid prescriptions on inpatient drug charts. A total of 722 charts were reviewed, 330 had opioid prescriptions and 90 opioid prescribing errors were found. These were mostly either unclear prescription or missing information. There were four potentially lethal, 26 serious, 38 significant and 22 minor errors. By implementing new pain guidelines and e-learning package focused on these errors, patient safety is hoped to be improved.
Short Cuts by Jason Boland, Consultant in Palliative Medicine, Barnsley Hospice, United Kingdom