Palliative Care Department Research Articles

Occult Central Lymph Node Metastasis in cN0 Papillary Thyroid Carcinoma Patients Undergoing TOETVA Procedure

Background. In this study, we evaluate the rate of CLNM and related factors in patients with cN0 PTC undergoing transoral endoscopic thyroidectomy vestibular approach (TOETVA), a feasible and safe procedure that is widely approved for early stage PTC patients. Method. A cross-sectional study was performed on 346 patients who underwent TOETVA due to thyroid cancer in the Department of Oncology and Palliative Care, Hanoi Medical University Hospital, from January 2020 to December 2021. The clinical, surgical, and pathological characteristics were recorded. Results. The mean age was 36.1 ± 9.1 (13–67) years. Females accounted for 96%. Total thyroidectomy was applied in 55 cases (15.9%), and conservative thyroidectomy accounted for 291 (84.4%). The median number of harvested lymph nodes in ipsilateral and bilateral CND groups is 5 (IQR: 3–7) and 7 (IQR: 3–10). The median number of metastasized lymph nodes in these two groups is 2 (IQR: 1–3) and 3 (IQR: 2–6), respectively. The rate of CLNM was 39.9%. Thyroiditis increased the number of harvested lymph nodes: 8.3 ± 0.7 (1–24) nodes, p = 0.002 . Tumor size on ultrasound, young age (<29 years old), and stage of tumor increased the possibility of CLNM, p < 0.05 . Univariate and multivariate logistic regression revealed that young age (<29 years old) and gross tumor invasion were independent risk factors of high number of CLNM with p < 0.05 . Conclusion. In summary, CLNM rate in patients with cN0 PTC accounted for 39.9%. With the facilities of pCND by TOETVA, a procedure that is widely approved for early PTC and has excellent cosmetics and oncological results, pCND should be considered in patients with risk factors like young age or large tumor. High volume of CLNM is associated with young age and gross tumor extension, and total thyroidectomy should be indicated in these patient groups.

Need to rethink before prescribing acetaminophen in malnourished patients? Acetaminophen-induced liver injury in a malnourished cancer patient in palliative care department

Need to rethink before prescribing acetaminophen in malnourished patients? Acetaminophen-induced liver injury in a malnourished cancer patient in palliative care department

Nephrology-Palliative Care Collaboration to Promote Outpatient Hemodialysis Goals of Care Conversations.

Goals of care conversations and corresponding life-sustaining treatment (LST) progress notes were completed for only one-fourth of patients on outpatient dialysis despite hospital-wide training with nephrologists at the Edward Hines, Jr. Veterans Affairs Hospital. The purpose of this quality improvement project was to increase completion of LST progress notes and corresponding orders among patients on dialysis through an interdisciplinary nephrology-palliative care collaboration. The nephrology and palliative care departments began an interdisciplinary collaboration for nephrology to consult palliative care to initiate goals of care conversations and complete LST progress notes with patients on dialysis. A coordinated workflow process was created that included multidisciplinary efforts for patient selection, patient education, and introduction and completion of goals of care conversations for patients on dialysis. Completion rates for LST notes increased from 27% to 81% following the 13-month intervention, with 69 of 85 patients having a documented LST progress note. A collaboration between nephrology and palliative care increased high-quality LST progress note completion. The next steps include expanding these collaborations at other dialysis units and evaluating the impact on patient outcomes.

National survey on the availability of oncology palliative care services at tertiary general and cancer hospitals in China

BackgroundThis nationwide survey studied the level of palliative care (PC) access for Chinese patients with cancer among cancer care providers either in tertiary general hospitals or cancer hospitals in China.MethodsUsing a probability-proportionate-to-size method, we identified local tertiary general hospitals with oncology departments to match cancer hospitals at the same geographic area. A PC program leader or a designee at each hospital reported available PC services, including staffing, inpatient and outpatient services, education, and research, with most questions adapted from a previous national survey on PC. The primary outcome was availability of a PC service.ResultsMost responders reported that some type of PC service (possibly called “comprehensive cancer care,” “pain and symptom management,” or “supportive care”) was available at their institution (84.3% of tertiary general hospitals, 82.8% of cancer hospitals). However, cancer hospitals were significantly more likely than tertiary general hospitals to have a PC department or specialist (34.1% vs. 15.5%, p < 0.001). The most popular services were pain consultation (> 92%), symptom management (> 77%), comprehensive care plans (~ 60%), obtaining advanced directives and do-not-resuscitate orders (~ 45%), referrals to hospice (> 32%), and psychiatric assessment (> 25%). Cancer hospitals were also more likely than tertiary general hospitals to report having inpatient beds for PC (46.3% vs. 30.5%; p = 0.010), outpatient PC clinics (28.0% vs. 16.8%; p = 0.029), educational programs (18.2% vs. 9.0%, p = 0.014), and research programs (17.2% vs. 9.3%, p < 0.001).ConclusionsCancer hospitals are more likely to offer PC than are tertiary general hospitals in China. Our findings highlight opportunities to further increase the PC capacity in Chinese hospitals.

Caregiver burden among family caregivers of patients with advanced cancer in a palliative context: A mixed-method study.

To examine the multidimensional properties of caregiver burden among family caregivers of patients with advanced cancer in a palliative context. A sequential, explanatory, mixed-method study was performed. Family caregivers of patients diagnosed with advanced cancer were recruited from a palliative care department of a third-level hospital in Sichuan Province, China. The Caregiver Burden Inventory, Social Support Rating Scale and Connor-Davidson Resilience Scale were used to collect quantitative data, and a total of 150 caregivers were recruited from January 2022 to September 2022. Qualitative data were collected through semi-structured interviews, and a total of 22 caregivers were interviewed from October 2022 to November 2022. Survey data were analysed using descriptive statistics, and the factors of caregiver burden were identified using the Mann-Whitney U test, Kruskal-Wallis H test and Spearman correlations. Interpretative phenomenological analysis was performed to analyse the interview data to initially explore the multidimensions of caregiver burden. The following-a-thread method and convergence coding matrix were used for triangulation to examine the multidimensional properties of caregiver burden. The participants experienced a moderate level of caregiver burden (32.97 ± 13.09). Through triangulation, six meta-themes and nine meta-subthemes were identified as multidimensional properties of caregiver burden, including physical (too many caring tasks and poor health condition), emotional (strong negative emotions resulting from patients' suffering and insufficient and ineffective family communication), social (less social interaction and social role conflict) and economic burdens, factors that aggravate burden (prevention and control of COVID-19 and spousal relationship with patients) and factors that mitigate burden (social support). Multiple dimensions of caregiver burden were experienced by family caregivers of patients with advanced cancer in the palliative context. Family-centred palliative care must be further developed. It is important to develop family-centred palliative care. Therefore, the focus must be on developing a rational understanding of palliative care in public and a culture-oriented death education in palliative units. This study adopted a mixed-method approach to comprehensively understand the phenomenon of and factors in caregiver burden in the Chinese palliative oncology context. Our findings suggest that family caregivers in palliative oncology experience a moderate level of caregiver burden, with dimensions including physical, emotional, social and economic burdens, among which emotional burden is the most prominent. The findings of this study provide policy makers and nurse practitioners with targets to be addressed in family-centred care in Chinese palliative units. The results of this study are reported based on the guidelines of the Mixed-Methods Article Reporting Standards. Eligible caregivers were invited to participate in the study and semi-structured interviews. Nurse managers of the palliative unit helped us access the patient-management system.

A Qualitative Study of Stakeholders' Perspectives of Implementing Interprofessional Shared Decision-Making Education in Palliative Care.

Introduction Shared decision-making (SDM) in palliative care is a highly complex process that requires an interdisciplinary team. Interprofessional team members need education on how to facilitate discussion of patient/family wishes at the end of life in hospital settings. So far, interprofessional shared decision-making (IP-SDM) education frameworks have been used to a limited extent in the area of education on palliative care. The aim of this study was to explore policymakers', health professionals', faculty members', and students' perspectives on implementing an IP-SDM educational framework in palliative care to identify aspects that should be prioritized to further develop interprofessional education for SDM in palliative care. Methods We used the qualitative method to capture the micro, meso, and macro factors using Oandasan and Reeves' model for the implementation of IP-SDM education regarding palliative care. Data collection tools included in-depth, face-to-face interviews with individual policymakers and focus group interviews with health professionals, faculty members, and undergraduate health professionals. The interview guide explores the teaching of SDM in palliative care, factors that could facilitate or hinder the implementation of IP-SDM education for health professionsstudents in palliative care, and interventions to facilitate the implementation of this approach. This study was conducted at the Oncology and Palliative Care Department at King Abdulaziz Medical City in the Ministry of National Guard Health Affairs and at King Saud bin Abdulaziz University for Health Sciences in Jeddah, Saudi Arabia. Results The results indicated a high demand for IP-SDM in palliative care. The findings revealed factors that can facilitate or hinder the implementation of IP-SDM education in palliative care for undergraduate health professionsstudents that is going to the local community. Factors include culture, religion, gender, power issues, team hierarchy, and respect among team members. Also, our findings have revealed potential solutions to the hindering factors. Conclusions IP-SDM education in palliative care is a highly relevant topic for improving patient outcomes. However, it might be a complex process to implement, especially given the challenges of palliative care settings. We recommend starting such a course in the early clinical phases of undergraduate health professional education.

Fatigue Prevalence Among Palliative Care Cancer Patients in Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia: A Cross-Sectional Study.

Objective: The aims of the current study are to assess the prevalence of cancer-related fatigue, to examine the difference in cancer-related fatigue severity in relation to patients' characteristics (age, gender, type of cancer, and palliative performance status), and to explore the correlation between cancer-related fatigue and pain, dyspnea, insomnia, and depression among palliative care patients. Methods: A cross-sectional descriptive observational study conducted at Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia. The study included cancer patients who received palliative care services from January 2016 to December 2021. Clinical data of study participants were retrospectively collected from Palliative Care department patient registry. Symptoms were assessed and scored using Edmonton Symptom Assessment Scale. Data analysis was performed using SPSS statistical software. Results: A total of 2616 patients were included in the study, 52.3% were females and 47.7% were males. The median age of study participants was 56 years (range: 2-101 years). Among all study population, the highest reported cancer type was gastrointestinal malignancy (33.5%), while the least was unknown primary malignancy (1.4%). With regards to Edmonton Symptom Assessment Scale, pain (86.4%) and fatigue (83%) were the highest reported symptom in comparison to constipation (17.3%) and insomnia (7.1%). Conclusion: Cancer-related fatigue is a prevalent and concerning issue among palliative care patients. It is essential that healthcare providers recognize the prevalence of fatigue among patients with life-limiting illnesses, assess patients for fatigue routinely, incorporate strategies for managing fatigue, work closely with affected individuals and their families in order to guide the establishment of a personalized care plan that addresses the patient's unique needs and preferences.

Clinical and diagnostic observation of primary lymphoma of the central nervous system

Background. Lymphoma of the central nervous system (CNS), both primary and secondary, is a rare but very aggressive type of non-Hodgkin’s lymphoma. Primary CNS lymphoma (PCNSL) refers to cases confined to the CNS parenchyma, dura mater, leptomeninges, cranial nerves, and spinal cord or intraocular region. The prognosis of PCNSL has been very dismal with an overall survival of 1.5 months without treatment and a 5-year survival rate of 30%. Due to the introduction of high-dose methotrexatebased chemotherapy regimens, there has been substantial progress in treating patients with lymphomas of the CNS, leading to improved survival. Diagnosis and differential diagnosis of PCNSL can often cause complications because it may have similar clinical and radiological signs with some other tumors, primarily with high-grade gliomas and metastatic lesion of the CNS. Stereotactic biopsy remains the main diagnostic method.&#x0D; Purpose – to investigate the complexity of the diagnostic and therapeutic process in PCNSL on the example of a clinical case.&#x0D; Materials and methods. Clinical observation of patient K., 59 years old, who underwent examination and inpatient treatment at the Department of Radiation Pathology and Palliative Care of the State Organization «Grigoriev Institute for Medical Radiology and Oncology of the National Academy of Medical Sciences of Ukraine» regarding multifocal lesions of the brain (volumetric formations of the white matter of the left hemisphere of the brain).&#x0D; Results and discussion. In this clinical case, the presence of multiple volumetric white matter formations of the left hemisphere of the brain in the frontal and temporal lobes of the brain with pronounced perifocal edema, mass effect and signal amplification from the described formations after the administration of a contrast agent in the patient in magnetic resonance imaging allowed us to assume metastatic lesion of the central nervous system. However, a comprehensive examination made it possible to exclude the presence of primary cancer, as well as an infectious lesion of the brain. The diagnosis of primary non-Hodgkin’s diffuse large B-cell lymphoma with damage to the central nervous system was established only after the neurosurgical removal of one of the neoplasms with the conduction of pathohistological and immunohistochemical studies.&#x0D; Conclusion. Multifocal brain injury often causes difficulties in diagnosis. Magnetic resonance imaging using T1, T2 and Flair imaging, although very important for the diagnosis of PCNSL, is not always specific. Timely cerebral biopsy with immunohistochemical examination remains the method of choice for verification of the pathological process, which is necessary for the correct treatment.

Need for pediatric specifications for chronic pain diagnoses in the International Classification of Diseases (ICD-11).

aGerman Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany bDepartment of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany cDepartment of Neuroscience, Physiology and Pharmacology, University College London, London, United Kingdom dDepartment of Anesthesiology & Pain Medicine, University of Washington School of Medicine, Seattle, WA, United States eSeattle Children's Research Institute, Seattle, WA, United States *Corresponding author. Address: Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Dr.-Friedrich Steiner Str.5, 45711 Datteln, Germany. Tel.: +49-2363-975-180; fax: +49-2363-975-181. E-mail address: [email protected] (J. Wager).

Factors associated with knowledge of diagnosis, prognosis & distress in cancer patients receiving palliative care - A retrospective cohort analysis.

Demographic attributes of cancer patients are associated with the awareness of diagnosis, the prognosis of cancer and their associated psychological distress. This study was aimed to assess the knowledge of diagnosis, prognosis and psychological distress among patients reporting to the pain and palliative care department in a tertiary cancer hospital, south India. Data of all patients visiting the palliative care outpatient department of a tertiary cancer centre in south India between January and June 2018 were included in the study (n=754). A structured pro forma was used to collect information on the sociodemographic details and clinical aspects and a distress thermometer was used to assess the level of distress. Information, thus collected, were analysed using descriptive statistics and logistic regression. Around 16.2 per cent of the patients were unaware of their diagnosis while two third (68%) were unaware of the prognosis. More than half of the patients reported significant distress (54.1%). Gender, education, not working and being diagnosed with head-and-neck cancers were associated with knowledge of diagnosis, while educational level predicted the knowledge of prognosis. Younger age group, head-and-neck cancer, haematology cancer, state of being unaware of diagnosis and prognosis were found to be associated with distress. Higher educational levels and better socio-economic status increase the likelihood of patients being aware of their diagnosis and prognosis. Being unaware of the prognosis remains associated with the higher level of distress.

Incision caring for thyroid nodules surgery without drainage at Hanoi Medical University Hospital

Thyroid nodules are the most common among endocrine gland tumors, including benign thyroid nodules and thyroid cancer. Surgery is the mainstay of treatment in thyroid nodules. Drainage making patients more painful after surgery, and at the same time prolonging hospital stay. WE conducted a randomized controlled trial. Study subjects were randomly divided into 2 groups: placement of drainage and no drainage by random selection before surgery. Total of 84 study subjects include patients with thyroid nodules who underwent surgery at the Department of Oncology and Palliative Care, Hanoi Medical University Hospital from May 2018 to November 2018. Average age was 47.12 ± 11.2 (17 - 76) years old; tumor palpable sign was 58.3%; 58.3% of nodules are in two lobes and nodules ≤ 10mm was 39.3%, TIRADS 4: 76.2%; and 58.3% thyroid cancer and 41.7% benign thyroid nodule. Univariate analysis of clinical characteristics between the two study groups: Similarities in age group, tumor size, number of tumors, histological diagnosis between the two intervention groups. Group without drainage had VAS0: 3.8 ± 0.2, VAS1: 2.3 ± 0.8, complications of fluid collection accumulation 9.5%, subcutaneous hematoma accumulation 4.8%, hypoparathyroidism 4.8%, hoarseness 7.1%, no cases of bleeding requiring reoperation and postoperative infection, hospital stay 4.7 ± 0.5 days, satisfaction level 4.6 ± 0.5, higher than drainage group. No drainage in several thyroid surgery cases is safe, with shortened surgery period, hospitalized period, and brings comfort and convenience to patients in the postoperative period.

Quality of life in incurable patients as a criterion of effectiveness of palliative care

Introduction. The problem of palliative care developing is actual due to the increasing the proportion of older people and the number of patients with incurable diseases. The task of palliative care is to improve the quality of life in the incurable patient. To choose the best ways for solving this problem it is important to analyze all components of QL and it’s important for the evaluating the effectiveness of the measures taken.&#x0D; The aim of this study was to assess the quality of life in patients in the palliative care unit and its trend.&#x0D; Material and methods. The base of study — palliative care department. The EORTIC — QLQ30 and MSAS — SF questionnaires were used. The sample of patients included 82 people. The share of people with non-oncological diseases was 54.9%, with cancer — 45.1%. The study was conducted with an interval of one month.&#x0D; Results. The analysis of the trend in the quality of life showed unreliable (p &gt; 0.05) decrease in the QL: 31.5 — 25.4 points (the maximum is 100 points). The trend in the partial components were multidirectional. The indicators of the functional scale and the symptom scale decreased from 34.7 to 29.8 points and from 30.3 to 29.9 points. The indicator of financial well-being increased: 35.0 and 38.6 points, social &#x0D; well–being — from 14.0 to 17.1. According to the scales characterizing the psycho-emotional status of patients, there is a positive trend: the average score of emotional well-being increased from 68.1 to 74.4; cognitive — from 44.7 to 53.2. The overall GDI distress index on the MSAS-SF scale increased from 2.3 to 2.4 points (with a maximum of 4 points).&#x0D; Limitations. patients receiving palliative care; satisfactory condition; follow-up interval — at least a month.&#x0D; Conclusion. Trend assessment in the quality of life in patients receiving palliative care should be carried out to obtain a comprehensive understanding of the urgent problems of the patient treatment, correction of therapeutic and care measures and may indicate their effectiveness.

Investigate the Possibility of Using Phosphorescence in Clinical Oncology as an Early Prognostic Test in Detecting Brain Carcinogenesis

Phosphorescence is considered one of the non-invasive glioblastoma testing methods based on studying molecular energy and the metabolism of L-tryptophan (Trp) through KP, which provides essential information on regulating immunity and neuronal function. This study aimed to conduct a feasibility study using phosphorescence in clinical oncology as an early prognostic test in detecting Glioblastoma. This study was conducted on 1039 patients who were operated on with follow-up between January 1, 2014, and December 1, 2022, and retrospectively evaluated in participating institutions in Ukraine (the Department of Oncology, Radiation Therapy, Oncosurgery, and Palliative Care at the Kharkiv National Medical University). Method of protein phosphorescence detection included two steps. During the first step, of luminol-dependent phosphorescence intensity in serum was carried out after its activation by the light source, according to the spectrofluorimeter method, as follows. At a temperature of 30 °C, serum drops were dried for 20 min to form a solid film. After that, we put the quartz plate with dried serum in a phosphoroscope of luminescent complex and measured the intensity. With the help of Max-Flux Diffraction Optic Parallel Beam Graded Multilayer Monochromator (Rigaku Americas Corporation) following spectral lines as 297, 313, 334, 365, 404, and 434 nm were distinguished and absorbed by serum film in the form of light quantum. The monochromator exit split width was 0.5 mm. Considering the limitations of each of the non-invasive tools currently available, phosphorescence-based diagnostic methods are ideally integrated into the NIGT platform: a non-invasive approach for visualizing a tumor and its main tumor characteristics in the spatial and temporal order. Because trp is present in virtually every cell in the body, these fluorescent and phosphorescent fingerprints can be used to detect cancer in many different organs. Using phosphorescence, it is possible to create predictive models for GBM in both primary and secondary diagnostics. This will assist clinicians in selecting the appropriate treatment option, monitoring treatment, and adapting to the era of patient-centered precision medicine.

In Memoriam: J. Randall Curtis, MD

Journal of Palliative MedicineAhead of Print In MemoriamJ. Randall Curtis, MDSusan D. BlockSusan D. BlockAddress correspondence to: Susan D. Block, MD, Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, 44 Binney Street, Boston, MA 02138, USA. E-mail Address: susan_block@dfci.harvard.eduDepartment of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.Search for more papers by this authorPublished Online:18 Apr 2023https://doi.org/10.1089/jpm.2023.0202AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"J. Randall Curtis, MD." Journal of Palliative Medicine, , pp. –FiguresReferencesRelatedDetails Volume 0Issue 0 InformationCopyright 2023, Mary Ann Liebert, Inc., publishersTo cite this article:Susan D. Block.J. Randall Curtis, MD.Journal of Palliative Medicine.ahead of printhttp://doi.org/10.1089/jpm.2023.0202Online Ahead of Print:April 18, 2023PDF download

Management of Cancer Patients with Opioid-Induced Constipation (OIC): The Experience of Three Italian Centres

Objectives: To present the Training on the field about OIC undertaken by three Italian oncological centres involving professionals of different sub-specialties. Methods: Four on-site interactive meetings of multidisciplinary hospital teams; interactive presentation and discussion, questionnaires administration at the baseline and at the end of the field programme over two years (2019-2021). Outcomes evaluated by estimated increase of OIC diagnosis and OIC treatments. Results: Shared principles about OIC prevention and management in all the steps (from laxatives to PAMORAs), and use of PROMs. Participants were asked about their initial awareness at the inception of the Training on the field programme and their final experiences at the end. Discussion: The experience of this Training on the field underlined the cardinal role of a constant teamwork in the Onco-ematology and Palliative Care Departments and the territory with a shared and tested algorithm. The proposed platform of activities is a call to action to mitigate the burden of pain and OIC if specialists act in concert during all the steps of the trajectory of cancer patients requiring opioid treatment. Multidisciplinary teamwork may help redefine and optimize doses and time schedules tailored to each patient and can contribute to designing controlled studies of OIC

Cancer referrals at African Inland Church Kijabe Hospital, Kiambu County (2014-2020) and the impact of COVID-19.

In Kenya, cancer is the third leading cause of death. The African Inland Church Kijabe Hospital (AICKH) is a level 4 missionary hospital. The hospital serves the Kenyan population in many areas, including cancer care, and some of these services were affected during the coronavirus disease 2019 (COVID-19) pandemic. We aimed to leverage a recently established hospital-based cancer registry of patients treated at AICKH between 2014 and 2020 to describe the cancer cases and patient referral patterns seen at AICKH during the COVID-19 pandemic in 2020. A cross-sectional retrospective survey was conducted through medical records abstraction in the surgery, breast clinic, palliative care and pathology departments. A total of 3279 cases were included in the study, with females accounting for 58.1% of the cases. The top-three cancers overall were breast (23.0%), oesophagus (20.5%) and prostate (8.6%). There was a minimal increase in the number of cancer cases in 2020 (1.7%) compared with 2019, with an increase of 19.3% in 2019 compared with 2018. In conclusion, AICKH is one of the few hospitals in Kenya where a large number of cancer patients seek healthcare, and referral of cancer cases changed in 2020, which may be due to the COVID-19 pandemic. Future efforts can leverage this registry to determine the impacts of cancer diagnosis and treatment on survival outcomes.

Appropriateness of Empirical Prescriptions of Ceftriaxone and Identification of Opportunities for Stewardship Interventions: A Single-Centre Cross-Sectional Study.

Third-generation cephalosporins are widely used due to the convenient spectrum of activity, safety, and posology. However, they are associated with the emergence of multidrug-resistant organisms, which makes them important targets for antimicrobial stewardship interventions. We aimed to assess the appropriateness of empirical prescriptions of ceftriaxone in a tertiary hospital. This cross-sectional study analysed empirical ceftriaxone prescriptions in January and June 2021. Patients under other antimicrobials 48 h before admission were excluded. The quality of ceftriaxone prescription was assessed regarding the initial appropriateness, duration of inappropriate ceftriaxone therapy, and missed opportunities for de-escalation. Of 465 prescriptions, 46.5% were inappropriate. The ceftriaxone prescription was inappropriate in 95.7% of lower respiratory tract infections (LRTI) globally and in nearly 40% of urinary tract infections (UTI) in medical and intensive care departments. Intensive care, internal medicine, and palliative care departments showed the highest number of inappropriate ceftriaxone prescriptions and longer length of inappropriate ceftriaxone prescriptions compared to the hospital's average. Improvement of empirical ceftriaxone prescription in LRTI and urinary infections, adherence to local guidelines and de-escalation practices, and targeted interventions focusing on critical departments may significantly reduce the inappropriate empirical use of ceftriaxone.

Application of physical therapy methods for patients after stroke with spasticity in the early period

acute cerebrovascular accident is the leading cause of disability. Stroke ranks 4th among diseases that lead to death or disability. The consequences of stroke include neurological disorders, motor disorders (plegia, hemiparesis, paresis, muscle spasticity), loss of sensation, pelvic dysfunction, loss of coordination and balance, high risk of falls, and impaired ability to move independently and perform daily activities. To achieve optimal independence, stroke patients need qualified rehabilitation care as part of a multidisciplinary team. Evidence-based medicine, treatment, and rehabilitation interventions have improved significantly in the acute and early periods for stroke patients. However, in the late period, today, more than half of patients remain limited in their daily activities and have movement disorders that significantly affect their quality of life and independence. Description of the objective. To substantiate the use of evidence-based medicine methods in physical therapy to restore motor function in patients after stroke in the early period. Materials and methods. From October to December 2021, 20 patients with spasticity, aged 47-85 years, who had suffered an ischemic and hemorrhagic stroke, took part in the examination and rehabilitation activities at Kyiv City Clinical Hospital № 6, Palliative Care Department, for a period of 3 weeks to 1 month. Voluntary consent for examination, treatment, and rehabilitation was obtained from all patients and their caregivers. The diagnostic methods used were computed tomography, magnetic resonance imaging, and, if necessary, laboratory tests. Tests and scales for physical therapy were used to determine functional impairment in stroke patients with muscle spasticity: Rankin Scale, Riverbed Mobility Index, Pain Score, Modified Ashworth Scale, Degree of Arm and Hand Recovery; Degree of Leg and Foot Recovery. Results. After analyzing the methods of evidence-based medicine on the topic of the problem, we have confirmation that in the early period, recovery rates are high. However, in the late period after a stroke, the onset of muscle spasticity significantly limits the motor capabilities of patients and complicates the recovery process. In the late period, the effectiveness of methods to overcome spasticity has not been fully developed, and attention is not focused on the complications that arise and accompany them throughout the recovery period. The appearance of muscle spasticity significantly limits the motor capabilities of patients, affects the psycho-emotional state of a person, and causes pain, which prevents the full use of the affected limb. Muscle spasticity inhibits and complicates the restoration of motor function in the long term. Conclusions. The study confirms the high effectiveness of the proposed methods of evidence-based medicine in reducing pain and increasing the range of motion in the shoulder, elbow, and wrist joints in the early period in patients after stroke. As for the late period, this issue remains incomplete and requires further study. In the palliative care unit of Kyiv City Clinical Hospital № 6, an individual multidisciplinary approach to patients after stroke was used, which contributed to the achievement of the goals. It can be stated that evidence-based medicine methods for the acute and early period have a positive effect on patient independence, and improve cognitive function and motor activity of the affected limbs.

Assessment of Spiritual Care Practices Among Nurses Caring for Cancer Patients in a Tertiary Hospital in Nigeria.

The importance of spirituality in health and wellness has been documented in the literature. While the developed countries have reported robust evidence of spirituality in nursing practices, there is scant evidence in low- and middle-income countries like Nigeria. This study assessed the spiritual care practices of the nurses attending to cancer patients in a tertiary health institution in Ilorin. It further determined factors associated with spiritual caring practices among nurses. A descriptive cross-sectional study was conducted between November 2021 and December 2021 to assess spiritual care practices among nurses caring for cancer patients. During the study period, 66 nurses were recruited randomly from the hospital's medical and surgical clinics, palliative care department, and Obstetrics and Gynecology department. Twelve items validated Nurses' spiritual care practices questionnaire was adapted for this study. Data were analyzed using IBM SPSS version 23. The mean age of the respondents was 36.5 years ( + 10.1) while female respondents made up 83.3%. About 48% of the nurses had good spiritual caring practices while 52% had poor spiritual caring practices. Nurses with training in oncology (96%) with p = .001 and those with spirituality training (86.2%) with p = .017 showed significant association with spiritual care practices. This study concluded that spiritual care practices among nurses are sub-optimal with training as a significantly associated factor with spiritual care practices. It is, therefore, suggested that spiritual care practices should be incorporated into all nursing training and curriculum. This will allow them to better support the spiritual needs of the patients, especially those with chronic diseases like cancer.

Experience of using teleconsultation in the department of outpatient palliative care in Kaliningrad

The article discusses the basic concepts of teleconsultation and features of this type of medical activity in the provision of palliative care. The reasons of relevance of introducing video-consultation in daily practice of palliative care doctor are analyzed. The article presents the data about the results of application of teleconsultation in providing palliative care in outpatient settings on the basis of department of outpatient palliative care for adults.