Lawrence Lam

Impact of Medical Qigong on quality of life, fatigue, mood and inflammation in cancer patients: a randomized controlled trial

Background: Substantial numbers of cancer patients use complementary medicine therapies, even without a supportive evidence base. This study aimed to evaluate in a randomized controlled trial, the use of Medical Qigong (MQ) compared with usual care to improve the quality of life (QOL) of cancer patients. Patients and methods: One hundred and sixty-two patients with a range of cancers were recruited. QOL and fatigue were measured by Functional Assessment of Cancer Therapy—General and Functional Assessment of Cancer Therapy—Fatigue, respectively, and mood status by Profile of Mood State. The inflammatory marker serum C-reactive protein (CRP) was monitored serially. Results: Regression analysis indicated that the MQ group significantly improved overall QOL (t144u2009=u2009−5.761, Pu2009<u20090.001), fatigue (t153u2009=u2009−5.621, Pu2009<u20090.001), mood disturbance (t122 =2.346, Pu2009=u20090.021) and inflammation (CRP) (t99u2009=u20092.042, Pu2009<u20090.044) compared with usual care after controlling for baseline variables. Conclusions: This study indicates that MQ can improve cancer patients’ overall QOL and mood status and reduce specific side-effects of treatment. It may also produce physical benefits in the long term through reduced inflammation.

Do community specialist palliative care services that provide home nursing increase rates of home death for people with life-limiting illnesses? A systematic review and meta-analysis of comparative studies.

CONTEXTnSystematic reviews and meta-analyses suggest that community specialist palliative care services (SPCSs) can avoid hospitalizations and enable home deaths. But more information is needed regarding the relative efficacies of different models. Family caregivers highlight home nursing as the most important service, but it is also likely the most costly.nnnOBJECTIVESnTo establish whether community SPCSs offering home nursing increase rates of home death compared with other models.nnnMETHODSnWe searched MEDLINE, AMED, Embase, CINAHL, the Cochrane Database of Systematic Reviews, and CENTRAL on March 2 and 3, 2011. To be eligible, articles had to be published in English-language peer-reviewed journals and report original research comparing the effect on home deaths of SPCSs providing home nursing vs. any alternative. Study quality was independently rated using Cochrane grades. Maximum likelihood estimation of heterogeneity was used to establish the method for meta-analysis (fixed or random effects). Potential biases were assessed.nnnRESULTSnOf 1492 articles screened, 10 articles were found eligible, reporting nine studies that yielded data for 10 comparisons. Study quality was high in two cases, moderate in three and low in four. Meta-analysis indicated a significant effect for SPCSs with home nursing (odds ratio 4.45, 95% CI 3.24-6.11; P<0.001). However, the high-quality studies found no effect (odds ratio 1.40, 95% CI 0.97-2.02; P=0.071). Bias was minimal.nnnCONCLUSIONnA meta-analysis found evidence to be inconclusive that community SPCSs that offer home nursing increase home deaths without compromising symptoms or increasing costs. But a compelling trend warrants further confirmatory studies. Future trials should compare the relative efficacy of different models and intensities of SPCSs.

Impact of a novel online learning module on specialist palliative care nurses’ pain assessment competencies and patients’ reports of pain: Results from a quasi-experimental pilot study

Background: Pain is a complex multidimensional phenomenon moderated by consumer, provider and health system factors. Effective pain management cuts across professional boundaries, with failure to screen and assess contributing to the burden of unrelieved pain. Aim: To test the impact of an online pain assessment learning module on specialist palliative care nurses’ pain assessment competencies, and to determine whether this education impacted positively on palliative care patients’ reported pain ratings. Design: A quasi-experimental pain assessment education pilot study utilising ‘Qstream©’, an online methodology to deliver 11 case-based pain assessment learning scenarios, developed by an interdisciplinary expert panel and delivered to participants’ work emails over a 28-day period in mid-2012. The ‘Self-Perceived Pain Assessment Competencies’ survey and chart audit data, including patient-reported pain intensity ratings, were collected pre-intervention (T1) and post-intervention (T2) and analysed using inferential statistics to determine key outcomes. Setting/participants: Nurses working at two Australian inpatient specialist palliative care services in 2012. Results: The results reported conform to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Guidelines. Participants who completed the education intervention (n = 34) increased their pain assessment knowledge, assessment tool knowledge and confidence to undertake a pain assessment (p < 0.001). Participants were more likely to document pain intensity scores in patients’ medical records than non-participants (95% confidence interval = 7.3%–22.7%, p = 0.021). There was also a significant reduction in the mean patient-reported pain ratings between the admission and audit date at post-test of 1.5 (95% confidence interval = 0.7–2.3) units in pain score. Conclusion: This pilot confers confidence of the education interventions capacity to improve specialist palliative care nurses’ pain assessment practices and to reduce patient-rated pain intensity scores.

The Role of Ondansetron in the Management of Cholestatic or Uremic Pruritus—A Systematic Review

CONTEXTnPruritus associated with hepatic or renal failure can be a troublesome symptom, refractory to treatment and associated with significant physical and emotional distress and a reduction in quality of life for patients already burdened with chronic disease. Serotonin has been implicated as a possible pathological mediator, and, therefore, 5HT(3) antagonists have been suggested as a possible therapeutic intervention.nnnOBJECTIVESnThis review of the literature systematically explores the role of ondansetron in the management of cholestatic or uremic pruritus.nnnMETHODSnElectronic databases were systematically searched for randomized controlled trials examining the role of ondansetron in cholestatic or uremic pruritus between 1966 and 2008.nnnRESULTSnFive randomized controlled trials were included in this systematic review: three for cholestatic pruritus and two for uremic pruritus. All trials examined ondansetron vs. placebo, with differing treatment protocols. Overall, three studies showed no benefit to ondansetron over placebo; however, two studies in cholestatic pruritus showed small reductions in pruritus with questionable clinical significance.nnnCONCLUSIONnOndansetron was demonstrated to have negligible effect on cholestatic or uremic pruritus on the basis of a limited number of studies.

Exploring the relationship between the frequency of documented bowel movements and prescribed laxatives in hospitalized palliative care patients.

Retrospective analysis of 211 admissions to a palliative care unit was undertaken to explore the relationship between prescribed laxatives and the frequency of documentation of bowel movements. Bivariate analysis flailed to identify relationships between laxatives and the frequency of bowel movements. Relationships were identified between less frequent bowel movements and type and duration of illness phase. Regression analysis identified 2 variables strongly predictive of the frequency with which bowel movements were documented. People in longer illness phases were more likely to have regular bowel movements (Z = 3.02, P = .003). The second significant result was that, even accounting for the short duration of the terminal phase, people who were dying were 13 times less likely to have any bowel movements documented than those in the stable phase (OR = 13.2, 95%CI = 2.0-89.2). The lack of relationship between laxatives and documentation of bowel movements suggests alternative approaches to understanding and managing the symptom of constipation in palliative care are necessary.

A Retrospective Analysis of Primary Diagnosis, Comorbidities, Anticholinergic Load, and Other Factors on Treatment for Noisy Respiratory Secretions at the End of Life

BACKGROUNDnNoisy respiratory secretions (NRS) at the end of life have been described in 23%-92% of deaths in palliative care units. Despite limited evidence to support the efficacy of the antisecretory medications, hyoscine hydrobromide and glycopyrrolate, administration of these medications remains standard palliation. Predicting those at risk of NRS could allow early and targeted intervention.nnnMETHODSnA retrospective analysis of 199 deaths in a palliative care unit was undertaken to identify if any patient, disease, or treatment-related factors might be predictive or protective of the symptom.nnnRESULTSnIn the last 72 hours of life, 60% received antisecretory medication (mean, 2; range, 0-16 doses). Significant unadjusted associations were found between administration of antisecretory medications and survival as well as the anticholinergic drug load from other medications. Results obtained from logistic regressions revealed patients with a higher anticholinergic load from prescribed medications were more likely to require treatment for NRS (odds ratio [OR]=2.9, 95% confidence interval [CI]=1.4-5.7). There were no other factors significantly associated with developing the symptom.nnnCONCLUSIONnA high anticholinergic load from medications was not protective and instead predicted the need for treatment for NRS at the end of life.

Is the Life Space Assessment Applicable to a Palliative Care Population? Its Relationship to Measures of Performance and Quality of Life

CONTEXTnThe spatial environments that palliative care patients frequent for business and leisure constrict as their disease progresses and their physical functioning deteriorates. Measuring a persons movement within his or her own environment is a clinically relevant and patient-centered outcome because it measures function in a way that reflects actual and not theoretical participation.nnnOBJECTIVESnThis exploratory study set out to test whether the Life-Space Assessment (LSA) would correlate with other commonly used palliative care outcome measures of function and quality of life.nnnMETHODSnThe baseline LSA, Australia-modified Karnofsky Performance Status Scale (AKPS), and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 15-Palliative (EORTC QLQ-C15-PAL) scores from two large clinical trials were used to calculate correlation coefficients between the measures. Convergent validity analysis was undertaken by comparing LSA scores between participants with higher (≥70) and lower (≤60) AKPS scores.nnnRESULTSnThe LSA was correlated significantly and positively with the AKPS, with a moderate correlation coefficient of 0.54 (P<0.001). There was a significant weak negative correlation between the LSA and the EORTC QLQ-C15-PAL, with a small coefficient of -0.22 (P=0.027), but a strong correlation between the LSA and the EORTC QLQ-C15-PAL item related to independent activities of daily living (r=-0.654, P<0.01). A significant difference in the LSA score between participants with higher (≥70) and lower (≤60) AKPS scores t(97)=-4.35, P<0.001) was found.nnnCONCLUSIONnThe LSA appears applicable to palliative care populations given the convergent validity and capacity of this instrument to differentiate a persons ability to move through life-space zones by performance status. Further research is required to validate and apply the LSA within community palliative care populations.

Advance care planning in chronic kidney disease: A survey of current practice in Australia

Advance care planning (ACP) in nephrology is widely advocated but not always implemented. The aims of this study were to describe current ACP practice and identify barriers/facilitators and perceived need for health professional education and chronic kidney disease (CKD)‐specific approaches.

Clinical trials of medicinal cannabis for appetite-related symptoms from advanced cancer: a survey of preferences, attitudes and beliefs among patients willing to consider participation

Australian clinical trials are planned to evaluate medicinal cannabis in a range of clinical contexts.

Can A Complex Online Intervention Improve Cancer Nurses’ Pain Screening and Assessment Practices? Results from a Multicenter, Pre-post Test Pilot Study

Abstract Unrelieved cancer pain has an adverse impact on quality of life. While routine screening and assessment forms the basis of effective cancer pain management, it is often poorly done, thus contributing to the burden of unrelieved cancer pain. The aim of this study was to test the impact of an online, complex, evidence‐based educational intervention on cancer nurses pain assessment capabilities and adherence to cancer pain screening and assessment guidelines. Specialist inpatient cancer nurses in five Australian acute care settings participated in an intervention combining an online spaced learning cancer pain assessment module with audit and feedback of pain assessment practices. Participants self‐perceived pain assessment competencies were measured at three time points. Prospective, consecutive chart audits were undertaken to appraise nurses adherence with pain screening and assessment guidelines. The differences in documented pre‐post pain assessment practices were benchmarked and fed back to all sites post intervention. Data were analyzed using inferential statistics. Participants who completed the intervention (n = 44) increased their pain assessment knowledge, assessment tool knowledge, and confidence undertaking a pain assessment (p < .001). The positive changes in nurses pain assessment capabilities translated into a significant increasing linear trend in the proportion of documented pain assessments in patients’ charts at the three time points (χ2 trend = 18.28, df = 1, p < .001). There is evidence that learning content delivered using a spaced learning format, augmented with pain assessment audit and feedback data, improves inpatient cancer nurses self‐perceived pain screening and assessment capabilities and strengthens cancer pain guideline adherence.