Patients In Terminal Stage Research Articles

THE RELATIONSHIP BETWEEN FEAR OF DEATH AND MEANING OF LIFE IN NURSING STUDENTS AND NURSES CARING FOR TERMINAL PATIENTS

IThis study aims to determine the relationship between fear of death and the meaning of life in nursing students and nurses caring for terminally ill patients. The study was conducted in a cross-sectional and relationship-seeking research design. The research was conducted between March 15 and June 30, 2023. 123 nurses and 139 nursing students working with terminal-stage patients at a university hospital participated in the study. The study was conducted with a total of 262 participants.
 The Personal Information Form was collected using the Fear of Death Scale (DAS) and the Meaning of Life Scale (MLQ). The relationship between fear of death and the meaning of life in nursing students and nurses caring for terminally ill patients was determined to be 31.74 (7.13) years old on average for the nurses participating in the study and 22.71 (1.66) years for the nursing students. 61% of nurses and 66.2% of nursing students were women. It was determined that 56.1% of the nurses had undergraduate degrees and 77.7% of the students were third-year students. According to the Student t-test analysis, a significant difference was detected between the groups in terms of the total score of the DAS, and the DAS scores of the nursing students were statistically significantly higher. According to the Pearson correlation analysis, a weak negative relationship was detected between the total scores of the nurses' DAS and MLQ, while no significant difference was found between the scale scores of the nursing students. In this study, the Cronbach's alpha coefficient of the Death Anxiety Scale (DAS) was found to be 0.96 and the Meaning of Life Scale (MLQ) was 0.68. It can be said that there is no relationship between the fear of death and the meaning of life in nursing students who care for terminal patients, but there is a relationship between the fear of death and the meaning of life in nurses.

Morphological assessment of actin and desmin expression at different cold myocardial ischemia times: observational study

Background. Heart transplantation is currently the treatment of choice for patients in terminal stages of chronic heart failure. The critical shortage of donor organs and the growing need for heart transplantation necessitate the expansion of donor selection criteria, including the estimated ischemia time of the donor heart. Despite numerous studies, the issue remains regarding the safe cold ischemia time; no definite limit to the acceptable preservation time is known and no relevant pathomorphological data are available on the state of the donor heart myocardium at different time parameters. Objective. To comparatively assess the features of cardiomyocyte pathomorphology and expression of protein markers (actin and desmin) in the myocardium of a donor heart prior to the main stage of orthotopic heart transplantation. Methods. The work adopted the design of an observational clinical study, which was prospective in nature. The study used intraoperative myocardial biopsy specimens of the left atrial appendage from donors aged up to 60 years, following cold ischemia of the transplant in Bretschneider solution (Dr. Franz Köhler Chemie GmbH, Germany) lasting up to 240 minutes (Group 1, n = 10) and over 240 minutes (Group 2, n = 7). The nature of pathomorphological myocardial transformation in the left atrial appendage of the donor heart was determined at different cold ischemia times. Histological myocardial sections were stained with hematoxylin and eosin according to standard procedures. After that, they were further studied using light and polarization microscopy; the immunohistochemical method was used to analyze the expression of actin and desmin. Morphometry was performed using the ImageJ 1.48v software (USA). In the analysis of actin and desmin amount, the area of DAB(3,3′-diaminobenzidine)-positive products of the immunohistochemical reaction was estimated as a percentage of the image area. The volume density of immunohistochemically detectable actin and desmin was determined using 20 images at a magnification of 40×10. In order to study the intensity of the immune reaction, a semiquantitative method was used, which involved counting the number of cells in 25 randomly selected fields of view. The types of myocardial contracture damage were assessed via polarization microscopy. Results. Patients included in the first and second groups were comparable in terms of mean age and anthropometric indices. The mean age of patients amounted to 50 [44;59] years in Group 1 and 50 [49;50] years in Group 2, р = 0.193. The body mass index was 25 [22;27] in Group1 and 25 [21;31] in Group 2, р = 0.288. Both groups showed male predominance: 8 (80%) in Group 1 and 6 (85.7%) in Group 2, р = 0.256. The comprehensive morphological assessment of ischemic myocardial damage at different cold ischemia times revealed the uniformity and reversibility of changes in cellular structures (in both groups) that take the form of I–II class contractures, lysis changes in individual cardiomyocytes (only in Group 2), preserved immunohistochemical reactions to actin and desmin in both groups at their average intensity and the complete absence of areas showing no reaction to desmin, which gives an idea about the degree of preservation of their macromolecular structure. Conclusion. The obtained study results showed that due to having a balanced elemental composition that determines the metabolic protection of cells and their ionic balance, the Bretschneider solution effectively protects the donor heart during its transportation, with the myocardial cold ischemia lasting up to 240 min and more.

The Past, Present, and Future Implications for Buddhist Nursing in Japan: A Narrative Review

This study aimed to clarify the past, present, and future implications for Buddhist nursing in Japan through a review of literature. Using Ichushi-Web, the medical literature database in Japan, a search was undertaken for papers containing the keyword “Buddhist nursing,” resulting in 10 hits. These were carefully perused, contents extracted and then organized using the matrix method (Garrard, 2020). These were qualitatively described through discussions among five researchers. Buddhism was officially introduced to Japan in 538 CE, after which the practice of Chinese medicine began, also based on Buddhist thought. Japan’s oldest nursing book was written by the monk Ryochu around 1240 CE. From 1868, however, Buddhist nursing fell into disuse following Shinto’s establishment as the state religion. In 1885, nursing education began as a profession, and nurses began caring for the affluent. Terminal-stage patients have concerns about the meaning and purpose of life, as well as the afterlife, and Buddhist nursing is currently practiced in Vihara terminal care facilities. One problem, however, is that no system of certification of qualifications for Buddhist nurses presently exists. Nonetheless eight Buddhist nursing colleges or universities offer instruction in Buddhist nursing. Previous studies on Buddhist nursing have been insufficient to produce evidence. From a historical perspective in Japan, it is believed that the essence of Buddhism, which is “teachings to bring happiness to the living,” can be applied to nursing. We believe that Buddhist nursing can serve as one of the keys to solving nursing problems in a modern society that is fraught with difficulties.

EVALUATION OF A PATIENT WITH LUNG CANCER IN A PALLIATIVE CARE CENTER IN ACCORDANCE WITH THE ROPER, LOGAN, TIERNEY NURSING MODEL: A CASE REPORT

Lung cancer creates a significant burden on the health care system in the world, with its high incidence, the need for advanced technology in diagnosis and treatment, and the need for additional health services. Supporting the patient's care and independence and finding solutions to existing problems in the rapidly increasing number of terminal stage patients with lung cancer in the world and in our country require a very comprehensive approach. Care, one of the most important functions of nursing, is a concept that should not be ignored in nursing practices in the rapidly changing and developing field of health. The care plan should be designed with an individualized nursing care philosophy, taking into account individual differences, the course of the disease, and differences between patient types. In this direction, the Nursing Model Based on Daily Living Activities systematizes and groups care for individuals with a holistic approach and allows the individual to diagnose how much he can do these activities on his own and independently. In this way, the individual can be allowed to go through the pre-death process in a manner worthy of human dignity. Aim: In this case report, it is aimed to diagnose, evaluate and manage the nursing process of a lung cancer patient hospitalized in a palliative care center in accordance with the "Roper, Logan, Tierney Nursing Model". Method: A 67-year-old male patient, hospitalized in a city hospital palliative care center in Turkey, is receiving treatment and rehabilitation with the diagnosis of "Pulmonary Disease". During the rehabilitation process, the patient was handled with a holistic approach and diagnosed with the contribution of the nursing model based on daily life activities, the nursing process was managed, the nursing diagnoses identified in the patient and interventions appropriate to these diagnoses were planned and implemented. The case report study was explained and verbal and written informed consent was obtained from the patient's relative. Results: After the analysis of the systematized data, the problems were revealed more clearly and solution-oriented approaches were developed. Conclusion: It has been observed that the application of the nursing model based on daily life activities in the nursing process increases the quality of care.

Palliative oral care in terminal cancer patients: Integrated review.

Palliative care (PC) aims to improve quality of life in patients and its families against life threatening diseases, through suffering's prevention and relief. It is the duty of the dental surgeon to possess the knowledge needed to treat a patient with little life span, in order to establish an adequate treatment plan for each situation. To synthesize the published evidence on oral conditions, impact, management and challenges in managing oral conditions among palliative patients. Articles were selected from PubMed and Scopus electronic platforms, using a research strategy with diverse descriptors related to "palliative care", "cancer" and "oral health". The article's selection was done in two phases. The first one was performed by the main researcher through the reading of the abstracts. In the second phase two researchers selected eligible articles after reading in full those previous selected. Data was tabulated and analyzed, obtaining information about what is found in literature related to this subject and what is necessary to be approached in future researches about PC. As results, the total of 15 articles were eligible, being one a qualitative analysis, 13 (92.8%) clinical trials and one observational study. Of the 15 articles, 8 (53.4%) involved questionnaires, while the rest involved: one systematic review about oral care in a hospital environment, 2 oral exams and oral sample collection, one investigation of terminal patient's (TP) oral assessment records, 2 collection of oral samples and their respective analysis and one treatment of the observed oral complications. It can be concluded that the oral manifestations in oncologic patients in terminal stage are, oral candidiasis, dry mouth, dysphagia, dysgeusia, oral mucositis and orofacial pain. Determining a protocol for the care of these and other complications of cancer - or cancer therapy - based on scientific evidence with the latest cutting-edge research results is of fundamental importance for the multidisciplinary team that works in the care of patients in PC. To prevent complications and its needed to initial the dentist as early as possible as a multidisciplinary member. It has been suggested palliative care protocol based on the up to date literature available for some frequent oral complications in TP with cancer. Other complications in terminal patients and their treatments still need to have further studying.

Implementation Status of Palliative Care for Patients Died in Peking Union Medical College Hospital,2019

Objective To reveal the current situation of palliative care for patients who died in Peking Union Medical College Hospital,so as to guide the practice of palliative care for patients in terminal stage. Methods A retrospective study was conducted on patients who died in Peking Union Medical College Hospital from January 1,2019 to December 31,2019.The general clinical data of the patients,whether they received palliative care,and the treatment details including invasive rescue measures,symptom controlling,and psychological,social,and spiritual care status before dying were collected for descriptive analysis. Results A total of 244 inpatients died in 2019,including 135 males and 109 females,with an average age of (65.9±16.4) years (1 day to 105 years).Among the 244 patients,112 (45.9%) died of neoplastic diseases and 132 (54.1%) died of non-neoplastic diseases.Sixty-one (25.0%) patients received palliative care before death,and they were mainly distributed in internal medicine departments such as nephrology (100.0%),gastroenterology (80.0%),and geriatrics (72.7%).Twenty-nine patients received sound palliative care,with all symptoms under control and no invasive treatment before death,and twenty-six patients received psychological,social,and spiritual care.Compared with the patients who were not exposed to the concept of palliative care,the patients who received palliative care showed decreased probabilities of cardiopulmonary resuscitation (0 vs 20.2%;χ2=13.009,P<0.001),tracheal intubation (3.3% vs 48.6%;χ2=38.327,P<0.001),and invasive mechanical ventilation (4.9% vs 47.5%;χ2=33.895,P<0.001) and an increased probability of psychological,social,and spiritual care (54.1% vs 2.4%;χ2=91.486,P<0.001). Conclusion The concept of palliative care has a positive impact on the death of end-stage patients.Palliative care services can increase the probability of end-stage patients receiving psychological,social,and spiritual care and reduce the use of invasive treatment.

Regulations For Implementing Passive Euthanasia In The Terminal Stage Patients (End of Life) Which Is In Accordance With Justice and Legal Certainty In Indonesia

Euthanasia is an act of intentionally not doing something aimed at prolonging someone's life or intentionally doing something to shorten or also end the life of a patient which is carried out to hasten his death, while enabling a good death without unnecessary suffering. Thus, in practice, in a terminal condition, a doctor may or may not perform an act that may result in the death of a patient in accordance with the written request of the patient/family. This dilemmatic condition requires legal certainty in order to uphold justice and humanity as well as legal protection. The problems are 1) How is passive euthanasia applied for terminal patients? 2) How is legal certainty in the application of euthanasia in Indonesia? 3) How is the implementation of euthanasia that meets the community's sense of justice? To answer these problems, a research using normative juridical methods is needed through primary data collection in the form of empirical data from interviews and filling out questionnaires about knowledge and level of agreement on euthanasia. Secondary data in the form of research on primary, secondary and tertiary legal materials. 8The results of the study show that the implementation of regulations in the Act and Ministerial Regulations that lead to the implementation of euthanasia has so far been applied, especially to terminal patients. However, the legal certainty of the act has not been clearly described because there are rules that are not in line. Euthanasia cannot be equated with ordinary homicide. To fulfill justice and humanity as well as legal protection, euthanasia regulations are needed in a harmonious positive law

Regulations For Implementing Passive Euthanasia In The Terminal Stage Patients (End of Life) Which Is In Accordance With Justice and Legal Certainty In Indonesia

Euthanasia is an act of intentionally not doing something aimed at prolonging someone's life or intentionally doing something to shorten or also end the life of a patient which is carried out to hasten his death, while enabling a good death without unnecessary suffering. Thus, in practice, in a terminal condition, a doctor may or may not perform an act that may result in the death of a patient in accordance with the written request of the patient/family. This dilemmatic condition requires legal certainty in order to uphold justice and humanity as well as legal protection. The problems are 1) How is passive euthanasia applied for terminal patients? 2) How is legal certainty in the application of euthanasia in Indonesia? 3) How is the implementation of euthanasia that meets the community's sense of justice? To answer these problems, a research using normative juridical methods is needed through primary data collection in the form of empirical data from interviews and filling out questionnaires about knowledge and level of agreement on euthanasia. Secondary data in the form of research on primary, secondary and tertiary legal materials. 8The results of the study show that the implementation of regulations in the Act and Ministerial Regulations that lead to the implementation of euthanasia has so far been applied, especially to terminal patients. However, the legal certainty of the act has not been clearly described because there are rules that are not in line. Euthanasia cannot be equated with ordinary homicide. To fulfill justice and humanity as well as legal protection, euthanasia regulations are needed in a harmonious positive law

Palliative arthroscopic debridement with continuous irrigation forinfected total knee arthroplastyin high mortality riskpatients.

This study aimed to evaluate the infection control rate of palliative arthroscopic debridement, antibiotics, and implant retention (DAIR) for the high mortality risk or terminal cancer stage patients. From March 2018 to August 2021, 21 patients met the following inclusion criteria: old age of more than 80, diagnosed as a terminal stage of cancer, high risk of mortality and morbidity representing as Charlson comorbidity index (CCI) ≥ 5, low daily activity with disabled extremity, and re-infection after two-stage revision. Each patient underwent arthroscopic DAIR and additional continuous irrigation for 48hours. The need for subsequent re-arthroscopic DAIR or two-stage revision was determined by the post-operative trends of C-reactive protein (CRP) levels. Infection control was defined as continuing controlled status of infection based on clinical and laboratory results by one or two times of arthroscopic DAIR within initial two months. Treatment failure was defined as more than three times arthroscopic debridement, two-stage revision surgery, or expired due to uncontrolled infection. Arthroscopic DAIR controlled the infection in 19 (90.5%) of the 21 cases. The other knee underwent a total of three times of re-arthroscopic DAIR and the other one underwent two-stage revision. Although five patients expired during the follow-up period due to worsening medical problems or terminal cancer, there were no deaths from uncontrolled infection, sepsis, or surgery-related complications. Arthroscopic debridement with continuous irrigation for the infection TKA with high mortality risk or terminal cancer patients showed a 90.5% infection control rate. For high-risk patients, arthroscopic debridement with continuous irrigation can be an alternative treatment to improve the quality of life during survival.

Terminal Dönem Hasta Yakınlarının Ölüme ve Saygın Ölüm İlkelerine İlişkin Tutumları Arasındaki İlişki

Aim: The aim of this study is to determine the relationship between the attitudes of the relatives of terminal stage patients towards death and principles about dying with dignity. &#x0D; Material and Method: This descriptive cross-sectional study was carried out with 308 patient relatives between 20 December 2021 and 21 March 2022. The data were collected using a “Patient Information Form”, ‘Death Attitude Profile-Revised (DAP-R)’ and ‘Assessment Scale of Attitudes towards Principles about Dying with Dignity’ (ASAPDD). Descriptive statistics, Student t test, One-Way ANOVA test, Kruskal Wallis test, Mann Whitney-U test, Pearson correlation and regression analysis were used to analyze the data.&#x0D; Results: The mean age of the relatives of the patients participating in the study was 34.88±2.32, 86.0% were female. 38.6% of the relatives of the patients stated that the patient in the intensive care unit was their mother/father, and 44.1% stated that the patient stayed in the intensive care unit for 3-7 days. The mean DAP-R total score was 107.30±25.1 and the ASAPDD total score was 30.62±10.70. A positive and highly significant relationship was found between DAP-R and ASAPDD. &#x0D; Conclusions: It was determined that as the attitudes of the relatives of the patients towards death became negative, the level of adopting the principles about die with dignity increased. Health professionals should provide death counseling to the relatives of patients in order to increase the quality of life of patients in the terminal period.

Preoperative care for patients in terminal stage of disease from the perspective of nurses

Objective: to understand the meanings attributed by nurses to preoperative care provided to terminal disease patients. Methods: qualitative research that used the Grounded Theory as methodological reference and was conducted in the surgical wards of a university hospital. Results: eleven nurses participated in the research. A theory was elaborated for the central phenomenon: Nurses caring for terminal disease patients in the preoperative period in the context of a surgical ward. Conclusion: nurses attribute meanings to this care that has its own particularities, that requires professional preparation and that demands, even more, an effective communication within the multidisciplinary team and in the relationship with the patient and family. Contributions to practice: the theory presented allows professionals to reflect on their praxis, understand the intervening conditions for ethical dilemmas and conflicts involved and consequences, as well as strategies to improve care in this scenario.

Inhaled opioids for cancer pain relief: A narrative review.

Despite the many new possibilities, cancer pain treatment is not always effective and often poses a challenge for practitioners. At the end-of-life care, both oral and subcutaneous drug delivery very often are not attainable. The increasing number of patients in terminal stage of chronic diseases forced us to look for the alternative ways of administration of pain treatment. In this context, the potentially rapid onset of action and ease of use make aerosolized drug delivery an attractive option in palliative care settings. The objective of this review was to identify literature on pain relief with inhaled opioids. The evidence suggests that nebulized opioids might be effective in the treatment of pain in various aetiologies; however, randomized controlled studies on nebulization therapy for cancer pain are lacking.

A Patient With Failed Liver Transplantation After the Use of PD-1 Blockade Combined With Lenvaxen.

Hepatocellular carcinoma (HCC) is a common malignant tumor with high extent of invasiveness. Its invasion process is closely related to complex tumor microenvironment and microvascular characteristics. Recently, immune combined targeted therapy has been applied to patients, combination therapy program with better effect needs to be explored. Atezolizumab combined Bevacizumab regimen in phase III clinical trial IMbrave150 was approved by U.S. Federal Drug Administration (FDA) for HCC treatment. This program is mostly used for liver malignant tumors have failed other treatments. Patients in terminal stage, overall curative has an unsatisfactory effect, survival time of patients is limited. Therefore, seeking best plan for combined treatment to improve patient's life quality and survival rate are still one of the most important clinical difficulties. This report describes a 37-year-old male who suffered from HCC repeatedly relapsed after hepatectomy. The patient received transcatheter arterial chemoembolization (TACE), microwave ablation (MWA), targeted therapy, and other combined treatments, all showed poor treatment effects. He received liver transplantation (LT) after receiving PD-1 blockade combined targeted therapy, eventually died due to severe immune rejection. It's first case of an allogeneic liver transplantation patient who received PD-1 blockade and Lenvaxen combined therapy. PD-1 blockade treatment and clinical observations of this case were summarized.

The “Community-based Integrated Care System” and Discourse Ethics – From the Viewpoint of Autonomy and Solidarity –

Since the establishment of the Long-term Care Insurance System in 2000, the promotion of the Community-based Integrated Care System has been promoted. The policy of the Long-term Care Insurance System sets in-home care services before reducing the economic burden in this country. However, this idea is not used in the latest report. The policy that individuals requiring care and terminal stage patients be sent into a large-scale accommodation in a depopulated area and live there until they die, is not adopted because of the belief or philosophy of the foundation of respect for dignity. In this study, I discuss the problems of the core concepts of the community-based integrated care system; we reconsider these problems from the standpoint of discourse ethics, which considers autonomy and solidarity as equal fundamental principles.

Advanced Dementia: Brain-State Characteristics and Clinical Indicators of Early Mortality.

There is an urgent need in advanced dementia for evidence-based clinical prognostic predictors that could positively influence ethical decisions allowing health provider and family preparation for early mortality. Accordingly, the authors review and discuss the prognostic utility of clinical assessments and objective measures of pathological brain states in advanced dementia patients associated with accelerated mortality. Overall, due to the paucity of brain-activity and clinical-comorbidity predictors of survival in advanced dementia, authors outline the potential prognostic value of brain-state electroencephalography (EEG) measures and reliable clinical indicators for forecasting early mortality in advanced dementia patients. In conclusion, two consistent risk-factors for predicting accelerated mortality in terminal-stage patients with advanced dementia were identified: pressure ulcers and paroxysmal slow-wave EEG parameters associated with cognitive impairment severity and organic disease progression. In parallel, immobility, malnutrition, and co-morbid systemic diseases are highly associated with the risk for early mortality in advanced dementia patients. Importantly, the authors' conclusions suggest utilizing reliable quantitative-parameters of disease progression for estimating accelerated mortality in dementia patients entering the terminal disease-stages characterized by severe intellectual deficits and functional disability.

Modern approaches to pharmacotherapy of chronic glomerulonephritis

Chronic glomerulonephritis is a dangerous disease that leads to chronic kidney disease. In the terminal stage patients need dialysis, which is difficult to access for a large part of the Russian population. It is the very high-quality conservative treatment that allows to delay the onset of the terminal stage of this disease. The main role in pathogenesis is played by the immune complexes that appear and are deposited in the renal glomeruli, which causes immune damage. According to the clinical course and taking into account the prevailing symptoms chronic glomerulonephritis is divided into latent, nephrotic, hematuric, hypertonic and mixed types, prescribed therapy depends on the morphology and clinical course. Clinically and morphologically chronic glomerulonephritis lasts over 1 year. Drug treatment for chronic glomerulonephritis supposes therapy that involves suppression of immune inflammation and intravascular changes. Rituximab is a chimeric glycosylated human or murine immunoglobulin that has specific affinity for the B-lymphocyte transmembrane protein CD20 causing the lysis of circulating CD20 cells.

PCN32 THE ROLE OF ORAL CARE IN THE PALLIATIVE CARE

The oral problems including dry mouth, stomatitis and candidiasis are one of the important problems which should be resolved in the palliative care. The purpose of this study was to investigate oral problems in this stage and improvement of dry mouth by oral care. Mouth care is an essential aspect of palliative care in all settings and should be considered part of daily routine patient care. Assessment and intervention should be instigated early to optimize patient comfort and prevent more serious problems and treatment complications. The study is a retrospective, quantitative analysis. Through a purposive sampling we analyzed records of tumor- and terminal stage patients who were involved in the service of the Pécs-Baranya County Hospice Foundation and met enroll criteria in 2018. The study subjects were consecutive terminally ill cancer patients admitted over the past half years. The following 3 items were retrospectively investigated. The incidences of these oral problems, the severity of dry mouth and complication with other oral problems and how can improvement of dry mouth use standard oral care by nursing staff. Descriptive (absolute- and relative frequency, variance, mean, modus, and mathematical statistics (correlation, chi-square test, variance-analysis (ANOVA), T-test) were done on the sample (p<0,05) using MS Excel and SPSS 22.0. The incidences of dry mouth, stomatitis, and candidiasis were significantly higher in the last hours. (p< 0.001). Severe cases of candidiasis were noted in 20.0% and dry mouth has benne reporter in 64.8% of people with advanced cancer and taste sensation diminishes in 25–50% of people living with cancer. Accurate diagnosis of oral problems and corresponding appropriate interventions are important for improving quality of end-of-life care.

Treatment Strategy for Post-Hepatectomy Recurrent Hepatocellular Carcinoma: A Single Center Experience with 556 Consecutive Cases in China

Background: Treatment strategy for recurrent hepatocellular carcinoma (HCC) remains scantily defined. This study was aimed to establish a treatment strategy to manage post-hepatectomy recurrent HCC and report the clinical outcomes. Methods: From January 2006 to December 2016, 556 consecutive patients who developed post-hepatectomy HCC recurrence were enrolled in the study. The patients were clinically stratified and treated according to a strategy established by a multi-disciplinary team. Clinical data and survival times were collected prospectively and analyzed retrospectively. Results: According to the strategy, there were 298 (53.6%), 214 (38.5%), 32 (5.7%) and 12 (2.2%) patients stratified into Early, Intermediate, Advanced and Terminal stages, respectively. In Early stage patients, 164 (55.0%) received curative treatment in the form of repeat resection or local ablation, 134 (45.0%) received transarterial chemoembolization (TACE), and the 1-, 3-, and 5-year overall survival (OS) rates were 82.0%, 46.8% and 37.3%, respectively. In Intermediate stage patients, 207 (96.7%) received TACE, 7 (3.3%) radiotherapy, and the 1-, 3-, and 5-year OS rates were 73.2%, 31.8% and 15.9%, respectively. In Advanced stage patients, 22 patients received sorafenib, 10 radiotherapy, and the mean survival time (MST) was 25.1 ± 3.1 months. All the 12 patients in Terminal stage received the best supportive treatment, and the MST was 6.5 ± 3.4 months. Clinical stages and duration of disease-free interval were independent factors relating to overall survival. Conclusions: A treatment strategy derived from the Barcelona Clinic Liver Cancer staging system, with some modifications, has been successfully established to manage post-hepatectomy recurrent HCC, and the clinical outcomes were commendable.

Comparison of Analgesic Effects of Nebulized Morphine with Fentanyl Transdermal Patch and Oral Methadone for Cancer Patients in Terminal Stages; a Double-blind Randomized Controlled Study.

Introduction:Recent years have witnessed widespread reports on the effectiveness of nebulized morphine for dyspnea, yet there is no evidence for its effectiveness in analgesic therapy.Objective:This study aims to compare effectiveness and side effects of inhalation morphine with oral methadone and transdermal fentanyl in sequential days in end stage cancer patients.Method:This double-blind, randomized controlled study conducted between April and September 2017. Ninety eligible cancer patients presenting to Sayed al-Shohada Hospital were selected non-randomly according to inclusion criteria and then divided to 3 groups in random order. Pain severity was scored by Visual Analog Scale (VAS). Patients were followed up for 3 days and then data were analyzed by SPSS. The benchmark of success was set as marking 4 or below on VAS and a reduction ratio of 50 percent.Results:Pain severity was equal for 3 groups before the first administration (p>0.05), but it decreased significantly from 8.45 (range 6–10) at baseline to 2.46 (range 1–4) at the end of the 3rd day in the nebulized group. The decrease ratio was equal to 70.8% after three days (p<0.05). Pain severity reduced from 8.45 (range 7–10) to 1.8 (range 1–3) (p<0.05) in the methadone group, and reduced from 8.5 (range 6–10) to 2.13 (range 1–3) in the fentanyl group.Conclusion:Our study showed that nebulized morphine, just like oral methadone and transdermal fentanyl, is effective, safe, and well-tolerated for pain management in patients with cancer.

Palliative care related hotspots and visualized analysis based on Web of Science

Objective To analyze SCI papers related to palliative care and identify research hotspots to offer theoretical guidance and basis for further research and management of palliative care. Methods SCI papers related to palliative care published on Web of Science from 1994 to 2017 were taken as the data source. Classified statistics, bibliometrics and CiteSpace II visualization software were used for relevant description and graphing. Results The number and the cites of published SCI papers on palliative care began to rise substantially since 1994; the US ranked first in terms of the number of published papers, which was followed by China. Totally 24 high frequency keywords and 20 burst terms (research fronts) were found. The results showed that the subject of palliative care research turned from terminal stage patients to specific patients with chronic diseases and medical and nursing workers; psychological problems such as depression and sorrow in family care givers should draw more attention, and problem of races became a tendency as well. Conclusions Palliative care related research has drawn attention from scholars at home and abroad. China's research in palliative care has a late start and remains in its infancy. Our scholars can use the experience of other countries as well as the advance care planning model of Taiwan Region of China for reference so as to find a palliative care model which is suitable for our conditions. Key words: Nursing; Palliative care; Research hotspots; Visualized analysis