For people with COVID-19 and terminal disease, what are the effects of pharmacological interventions for palliative symptom control?

2021 ◽  
Author(s):  
Jane Burch ◽  
Sera Tort
Keyword(s):  
Symptom Control ◽  
Pharmacological Interventions ◽  
Terminal Disease

Delirium

2015 ◽  
Author(s):  
Meera Agar ◽  
Yesne Alici ◽  
William S. Breitbart
Keyword(s):  
Palliative Care ◽  
Symptom Control ◽  
Terminally Ill ◽  
Symptomatic Treatment ◽  
Significant Morbidity ◽  
Pharmacological Interventions ◽  
Advanced Illness ◽  
Delirious Patient ◽  
Risks And Benefits ◽  
Impending Death

Delirium is the most common and serious neuropsychiatric complication in palliative care settings. It is a source of significant morbidity in patients, and often distresses family members and staff. Delirium is often a harbinger of impending death and can significantly interfere with pain and symptom control. Unfortunately delirium is often under-recognized or misdiagnosed in the terminally ill, and even when recognized, it frequently goes untreated or is inappropriately treated. Clinicians who care for patients with advanced illness must be able to diagnose delirium accurately, undertake appropriate assessment of aetiologies, and understand the risks and benefits of the pharmacological and non-pharmacological interventions currently available for managing delirium. Symptomatic treatment with antipsychotics or sedative medications is often necessary for the delirious patient with advanced illness to minimize distress to patients, families, and staff.

Delirium

2021 ◽  
pp. 764-772
Author(s):  
Meera Agar ◽  
Yesne Alici ◽  
Augusto Caraceni ◽  
William Breitbart
Keyword(s):  
Palliative Care ◽  
Poor Prognosis ◽  
Symptom Control ◽  
Care Patient ◽  
Treatment Goals ◽  
Palliative Care Patient ◽  
Significant Morbidity ◽  
Pharmacological Interventions ◽  
Advanced Illness ◽  
Illness Trajectory

Delirium is the most common and serious neuropsychiatric disorder experienced by people with advanced illness. It leads to significant morbidity, and significant distress for the person themselves, family members and staff. Delirium often bodes of a poor prognosis and can significantly interfere with pain and symptom control. Unfortunately, delirium is often under-recognized or misdiagnosed in the palliative care patient, and even when recognized, it frequently goes untreated or is inappropriately treated. Clinicians who care for patients with advanced illness must be able to diagnose delirium accurately; undertake appropriate assessment of aetiologies and consider their treatment with due consideration of treatment goals and illness trajectory; and individualize the pharmacological and non-pharmacological interventions to support delirium recovery, maximize patient safety, and reduce distress from symptoms.

scholarly journals Pharmacological and non-pharmacological interventions to improve symptom control, functional exercise capacity and quality of life in interstitial lung disease: an evidence synthesis

2020 ◽  
pp. 00107-2020
Author(s):  
S Bajwah ◽  
J Colquitt ◽  
E Loveman ◽  
C Bausewein ◽  
H Almond ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Exercise Capacity ◽  
Evidence Synthesis ◽  
Symptom Control ◽  
Pharmacological Interventions ◽  
Pharmacological Studies ◽  
Functional Exercise ◽  
Functional Exercise Capacity ◽  
Control Functional

We assessed efficacy and effectiveness of pharmacological and non-pharmacological interventions in improving symptom control, functional exercise capacity and quality of life (Qol) in people living with fibrotic interstitial lung disease (ILD).We summarised evidence from three previous reviews (to June 2014) and conducted an updated search of nine databases and grey literature (2011–19) (registration: CRD42017065933) for prospective studies of interventions aimed to alleviate symptoms, improve Qol or functional exercise capacity in fibrotic ILD. Data were synthesised through narrative synthesis or meta-analysed as appropriate.Forty-seven studies with 2527 participants were included. From 22 pharmacological studies of eleven different interventions (n=1683) the most tested interventions were bosentan and sildenafil. From 25 non-pharmacological studies, the most tested intervention was for pulmonary rehabilitation / exercise training (PR) (22 studies, n=748). An improvement in 6-min walk distance (6MWD) immediately following PR (6 studies; n=200, MD [95%CI] 39.9 m [18.2 to 61.5]) but not longer-term (3 or 6 months, 4 studies; n=147, MD 5.3 m [−12.9 to 23.4]. Multiple, varied outcome measures were used, e.g. 37 studies assessing dyspnoea used 10 different scales with lack of reporting of rate of deterioration in outcomes. Evidence gap mapping highlighted the most and least researched symptoms were dyspnoea and cough respectively.This evidence synthesis highlights overwhelmingly that the most researched symptom is dyspnoea and the strongest evidence base is for short-term PR. The least researched symptom was cough. Research going forward must focus on prioritising and standardising meaningful outcomes and focusing interventions on neglected symptoms.

Symptom control with the syringe driver

2016 ◽  
Author(s):  
Andrew Dickman ◽  
Jennifer Schneider
Keyword(s):  
Respiratory Tract ◽  
End Of Life ◽  
Symptom Management ◽  
Advanced Disease ◽  
Symptom Control ◽  
Oral Route ◽  
Nausea And Vomiting ◽  
Medical Conditions ◽  
Pharmacological Interventions ◽  
Syringe Driver

Symptoms tend to increase during the last days and weeks of life and pharmacological interventions are essential for adequate alleviation. Common symptoms experienced by patients at the end of life include pain, respiratory tract secretions, agitation, delirium, restlessness, nausea, and vomiting. The oral route should be used where possible, but as the patient’s condition deteriorates, it may no longer be feasible to administer medication this way. It is likely that patients will require a combination of drugs to control their coexisting medical conditions as well as for pain and other symptom management. A CSCI provides a simple and effective way to maintain control of commonly encountered symptoms experienced by patients with advanced disease. This chapter discusses how CSCIs of certain drugs can be used to manage such symptoms.

scholarly journals Management of acute agitation in psychosis: an evidence-based approach in the USA

2011 ◽  
Vol 17 (2) ◽  
pp. 91-100 ◽  
Author(s):  
Justin J. Schleifer
Keyword(s):  
Clinical Guideline ◽  
Symptom Control ◽  
Accurate Diagnosis ◽  
Evidence Based ◽  
Historical Evolution ◽  
Pharmacological Interventions ◽  
Psychotic Illness ◽  
Underlying Condition ◽  
The Usa ◽  
Acute Agitation

SummaryAgitation in psychiatric settings, particularly in psychosis, presents a staggering challenge for clinicians, who must both manage the patient's acute symptoms and simultaneously make an accurate diagnosis. Too often, the management of the former confounds the latter. Patients are very often sedated medically, which masks their underlying condition, rendering accurate diagnosis delayed and inherently difficult. Significant data are available regarding both pharmacological and non-pharmacological interventions for agitation that maximise symptom control while minimising confounding side-effects. In this article, a review of the historical evolution of agitation management in psychotic illness is presented, followed by an evidence-based clinical guideline for managing agitation in psychosis in the USA.

Impact of esomeprazole on symptom control in patients with healed erosive esophagitis (EE)

2001 ◽  
Vol 120 (5) ◽  
pp. A441-A441
Author(s):  
D JOHNSON ◽  
N VAKIL ◽  
C HWANG ◽  
J LEVINE
Keyword(s):  
Symptom Control ◽  
Erosive Esophagitis

Self-Injurious Behavior vs. Nonsuicidal Self-Injury

Crisis ◽  
2012 ◽  
Vol 33 (2) ◽  
pp. 106-112 ◽  
Author(s):  
Christopher M. Bloom ◽  
Shareen Holly ◽  
Adam M. P. Miller
Keyword(s):  
Positive Reinforcement ◽  
Empirical Investigation ◽  
High Stress ◽  
Animal Research ◽  
Stress Conditions ◽  
Human Populations ◽  
Pharmacological Interventions ◽  
Self Injury ◽  
Cns Stimulant ◽  
Nonsuicidal Self Injury

Background: Historically, the field of self-injury has distinguished between the behaviors exhibited among individuals with a developmental disability (self-injurious behaviors; SIB) and those present within a normative population (nonsuicidal self-injury; NSSI),which typically result as a response to perceived stress. More recently, however, conclusions about NSSI have been drawn from lines of animal research aimed at examining the neurobiological mechanisms of SIB. Despite some functional similarity between SIB and NSSI, no empirical investigation has provided precedent for the application of SIB-targeted animal research as justification for pharmacological interventions in populations demonstrating NSSI. Aims: The present study examined this question directly, by simulating an animal model of SIB in rodents injected with pemoline and systematically manipulating stress conditions in order to monitor rates of self-injury. Methods: Sham controls and experimental animals injected with pemoline (200 mg/kg) were assigned to either a low stress (discriminated positive reinforcement) or high stress (discriminated avoidance) group and compared on the dependent measures of self-inflicted injury prevalence and severity. Results: The manipulation of stress conditions did not impact the rate of self-injury demonstrated by the rats. The results do not support a model of stress-induced SIB in rodents. Conclusions: Current findings provide evidence for caution in the development of pharmacotherapies of NSSI in human populations based on CNS stimulant models. Theoretical implications are discussed with respect to antecedent factors such as preinjury arousal level and environmental stress.

Pancreatic VIPoma - a diagnostic and symptom control challenge

2017 ◽  
Author(s):  
Ross Jack ◽  
Paul Fineron ◽  
Dilip Patel ◽  
Stuart Ritchie ◽  
Deepak Subedi ◽  
...  
Keyword(s):  
Symptom Control ◽  
Control Challenge
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