Treatment Of Serious Illness Research Articles

Does specialty palliative care improve serious illness care experience for people with cancer? Results of a consideRATE questions survey at a National Cancer Center Designated Cancer Center in rural Northern New England.

261 Background: Patients' perceived care experience is an important aspect of care quality, particularly during treatment for serious illnesses like cancer. Yet, the effect of specialty palliative care involvement on the care experience of individuals with cancer is underexplored. There is a need for such patient reported quality measures, particularly for patients who may benefit from palliative care. We sought to examine how the presence of palliative care support influenced patient experience. Methods: We surveyed patients and care partners at a National Comprehensive Cancer Network cancer center, The Dartmouth Cancer Center, using the consideRATE questions. consideRATE is a validated patient-reported measure of serious illness experience (PREM) that assesses care of top-ranked elements of serious illness care experience with a Likert-like response scale from very bad (1) to very good (4). We scored mean scores 3.5 or above as “very good.” We collected demographics, type of cancer, identity as a care partner or patient, and patient-reported exposure to the palliative care team, excluding those who were unsure. We performed descriptive statistics, simple and adjusted logistic regressions (controlled for age, gender, race, cancer type, education, income, health insurance, insurance type, and health literacy) to determine to what extent palliative care support affected serious illness care experience scores (consideRATE). Results: We surveyed 244 adults: 114 patients, 128 care partners, and 2 unspecified. One hundred forty-five participants did not receive palliative care; of those, 103 (71%) were women, and 98 (67.6%) were > 55 years. Fifty-six participants received palliative care support; of those, 45 (80.4%) were women, and 38 (67.8%) were > 55 years. Greater than 95% of both groups were white. The most common types of cancer in each group were breast, gastrointestinal, and hematologic. Scores of "very good" on consideRATE were given by 47 (83.9%) of those with palliative services. In adjusted analysis, the OR (odds ratio) of a “very good” consideRATE score was 1.15 for participants who reported palliative care support, compared to those who did not (95% confidence interval 0.8-16.6). Conclusions: In this cohort of rural-residing patients with cancer, whether and to what extent specialty palliative care involvement predicts serious illness care experience scores is unclear. Further investigation of this relationship is required.

Screening of potent inhibitor from Aquilaria malaccensis Lam. against arachidonic inflammatory enzymes: an insight from molecular docking, ADMET, molecular dynamics simulation and MM-PBSA approaches

The three primary enzymes COX (cyclooxygenase), LOX (lipoxygenase) and CYT-P450 (cytochrome P450), which are part of the arachidonic inflammatory pathway, play crucial role in the development of asthma, rheumatoid arthritis and cardiovascular diseases. Ethnomedicinally, plant-derived chemicals have a major role in the treatment of fatal illnesses. Aquilaria malaccensis Lam. widely known as agarwood is prized for its fragrance and therapeutic properties. The phytochemicals and extracts of this plant have significant healing properties in the treatment of serious illnesses. In the current work, an in-silico approach including molecular docking, ADMET (absorption, distribution, metabolism, excretion and toxicity), molecular dynamics (MD) simulation and molecular mechanics/Poisson–Boltzmann surface area (MM-PBSA) was performed to screen 33 bioactive compounds from this plant against COX-2 and 5-LOX in order to find the most effective inhibitor. 2-(2-Phenylethyl)chromone was found to inhibit both 5-LOX and COX-2, showing the highest binding affinities (−9.1 kcal/mol and −9.0 kcal/mol, respectively) than standard Ibuprofen and nordihydroguaiaretic acid (NDGA). 2-(2-Phenylethyl)chromone showed the highest drug-likeness score and low risk of toxicity compared to other phytochemicals. MD modeling and MM-PBSA calculations showed that 2-(2-Phenylethyl)chromone had a strong persistent binding interaction with 5-LOX than COX-2, and this interaction is comparable to the bounded standards Ibuprofen and NDGA. From this study, we may infer that the 2-(2-Phenylethyl)chromone can serve as a potent inhibitor and has scope to be employed in the treatment of inflammatory ailments. Communicated by Ramaswamy H. Sarma

Influência da religiosidade/espiritualidade em cuidadores informais de crianças com leucemia

Abstract Faced with diagnosis and treatment of serious illness in children, including oncology, parents, especially mothers, tend to fully assume the demands of care and, consequently, must develop situational coping strategies. In this regard, this descriptive and cross-sectional study sought to identify the use of religious/spiritual coping by informal caregivers of children with acute lymphoid leukemia via the Brief Religious/Spiritual Coping (SRCOPE) scale. A total of 30 informal caregivers participated in the study, presenting high religious/spiritual coping (mean=3.90; SD=0.34) regarding positive methods (mean=3.67; SD=0.48). Finally, results show that mothers use religious/spiritual coping deal with the imposed demands for care, linked to the child’s health condition. This reinforces the possibility of using spirituality and or religiosity as indicators of physical and mental well-being, since the quality of care is closely related to the caregivers’ health.

Effects of Plant Metabolites on the Growth of COVID-19 (Coronavirus Disease-19) Including Omicron Strain.

According to recent reports out of India, a new strain of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) B1.1.529 Omicron virus has emerged. In comparison to the Wuhan (WHU) strain and the delta variant, this variant showed a far stronger effect on the angiotensin converting enzyme2 (ACE2) receptor. There are several medicinal compounds in plant metabolites, and their diverse chemical structures make them ideal for the treatment of serious illnesses. It's possible that some of these could be useful alternative pharmaceuticals, as well as a starting point for the repurposing of existing medications and new chemical discoveries. SARS-CoV-2 infection triggered a worldwide epidemic of the severe acute respiratory syndrome (SARS). There have been trials for different therapies for SARS-CoV-2 and so also there are recent announcements of extensive research into the development of viable medicines for this global health calamity. After a thorough examination of plant-derived treatments for COVID-19, investigators in the current study decided to focus on plant-derived secondary metabolites (PSMs). According to some researchers, new MDR (Multi-Drug Resistant) antibiotics may one day be developed due to the adaptability of secondary metabolites. Identifying plant metabolites that can treat a wide range of viral infections was one of the study's aims. Many natural medications that could be recommended for the treatment of COVID-19 were discovered as a result of this research, including remedies from plant families, viral candidates that are susceptible, antiviral assays, and mechanisms of therapeutic action. The findings of this study will inspire further research and speed up the development of new antiviral plant-based medications.

Malignant Alveolar Neoplasm in a 10-Month-Old French Bulldog

Background: Malignant tumors are the main cause of death or euthanasia in animals. The oral cavity ranking fourth in number of occurrences. Epidemiological studies with dogs suggest that canine cancer kills 40-50% of individuals aged over 10 years. In view of the interest of academics and professionals in the healthcare of dogs and cats, this paper reports the case of a 10-month-old bitch, which, despite being a young animal, was affected alveolar rhabdomyosarcoma of abrupt evolution. Case: A 10-month-old French Bulldog bitch, weighing 10 kg, was referred to a veterinary hospital in the city of Rio de Janeiro for care. It had a history of mouth bleeding, after chewing a solid mineral material, edema in the region of the right maxilla, and protusion of the gland of the third eyelid. As the clinical examination also revealed a fracture of the maxillary canine, anti-inflammatory and antibiotics were prescribed, to be administered by the owner once a day for 7 days. During the next clinical examination, carried out one week later, an edema was found in the right region of the mouth, which proved difficult to examine. As the patient had already eaten, an appointment was made for the following day for an intervention int he operating room, where the animal could be anesthetized for better observation of the effected region. Blood was collected for hemogram, urea, creatinine, alkaline phosphatase, ALT, and GGT, and an 8 h food fasting and a 4 h water fasting were recommended. On that date, once the dog had been taken to the operating room, was administered the pre anesthesia, in addition to anesthetic induction and manutention. Upon examining the oral cavity, several loose molars were found on the right side, in addition to a tumoral aspect of the gum; thus, it was decided to collect a small sample of the tumoral mass for histopathology. The surgical specimen was placed in a formalin solution and sent to the laboratory for histopathological processing and diagnosis. One week later, the tumor mass was larger and the edema in the right region of the mouth was much larger than on the day of the procedure. Thus, a computerized tomography was requested to further investigate the alterations that had occurred in such a short time. Due to the results of the histopathology and the CT, an immunohistochemical test was suggested which determined the cell profile and morphology and confirmed the diagnosis of alveolar rhabdomyosarcoma according to clinical suspicion. The animal remained in the veterinary hospital for a further 48 h, during which the clinical condition worsened, with the animal suffering heavy bleeding. As the patient was no longer capable of oral intake of food or water, the decision was made with the consent of the owners to induce a painless death to alleviate the suffering of the animal. However, the owners did not authorize a necropsy. Discussion: Veterinary physicians should be conscious of the treatment of serious illnesses that will not result in a benefit for the patient. They should know when to stop the treatment to not cause further pain and suffering to the animals and their owners. Many of the interventions which aim to treat severe malignant neoplasia will not promote an improvement in quality of life or significantly extend the patient’s survival, and do not justify the suffering they entail. A painless death remains the best alternative in such cases. Keywords: cancer, malignant neoplasm, alveolar rhabdomyosarcoma, oral cavity.

Research on the design of serious illness insurance scheme in Shanghai based on micro-simulation

BackgroundUrban and rural residents’ basic medical insurance (URRBMI) is an institutional arrangement for rural residents and unemployed urban residents in China. The serious illness medical insurance system (SIMIS) was established to provide additional medical cover. At present, the SIMIS payment method in China is based on large expenses, and only a few areas, such as Shanghai, pay according to the treatment of serious diseases. This study aims to simulate and analyse the effect of the two payment methods on SIMIS in Shanghai.MethodsWe developed a micro-simulation model to predict the number and characteristics of SIMIS participants among urban and rural residents in Shanghai and to simulate the process of medical treatment, medical consumption, and medical insurance payments for each insured person from 2020 to 2025. We then summarised and analysed the payment compensation effect, and compared it with Shanghai’s current policies.ResultsThe payment of SIMIS according to high expenses, the total medical expenses of seriously ill patients show an increasing trend, with an average annual growth rate of 3.56%. The URRBMI fund payment covers 56%–58% of total medical expenses, and the SIMIS fund covers 5%–7% of the total medical expenses. Both cover 62%–63% of total medical expenses. Self-payment under SIMIS covers 22%–23% of the total medical expenses, total self-payment covers 14%–15% of the total medical expenses, and the medical expenses borne by individuals cover 36%–38% of the total medical expenses.The fund expenditure is 213 million yuan and average annual cost borne by individual patients ranges from 40 000 to 60 000 yuan.ConclusionsThe policy of designing SIMIS according to national guidelines does not meet the development needs of Shanghai. Shanghai should take the current policy of paying compensation according to the treatment of serious illness as the policy basis, consider the security needs of patients with large medical expenses outside the scope of protection, and adjust policies appropriately to prevent poverty caused by illness.

Relevance and prospects for the development of fitness boxing in the modern conditions of the functioning of the health-improving fitness system

The significance and prospects for the development of fitness boxing in the modern conditions of the functioning of the fitness industry are shown. Adverse trends in the deterioration of the health status of the population of Ukraine require finding ways to prevent them. One of the main directions of improving society is the widespread introduction of various means and forms of physical activity recommended by the modern fitness industry. To increase the popularity of fitness classes and meet wide consumer demand, non-traditional sports for this form, such as boxing, are being developed and actively used. It was revealed that fitness boxing has confidently taken its place in the health fitness system as a form of martial arts and its popularity is growing all over the world. It is shown that boxing takes a leading place among various types of martial arts that are cultivated in fitness clubs in Kiev.
 It has been determined that a fitness boxing is a popular and interesting type of physical activity that helps to maintain and improve physical fitness to the required level, allows you to master self-defense skills and increase self-confidence, helps to restore health in the treatment of serious illnesses and the formation of an active life position.

Ototoxicity (cochleotoxicity) classifications: A review

Objective: Drug-mediated ototoxicity, specifically cochleotoxicity, is a concern for patients receiving medications for the treatment of serious illness. A number of classification schemes exist, most of which are based on pure-tone audiometry, in order to assist non-audiological/non-otological specialists in the identification and monitoring of iatrogenic hearing loss. This review identifies the primary classification systems used in cochleototoxicity monitoring. By bringing together classifications published in discipline-specific literature, the paper aims to increase awareness of their relative strengths and limitations in the assessment and monitoring of ototoxic hearing loss and to indicate how future classification systems may improve upon the status-quo. Design: Literature review. Study sample: PubMed identified 4878 articles containing the search term ototox*. Results: A systematic search identified 13 key classification systems. Cochleotoxicity classification systems can be divided into those which focus on hearing change from a baseline audiogram and those that focus on the functional impact of the hearing loss. Conclusions: Common weaknesses of these grading scales included a lack of sensitivity to small adverse changes in hearing thresholds, a lack of high-frequency audiometry (>8 kHz), and lack of indication of which changes are likely to be clinically significant for communication and quality of life.

Integrating traditional medical practice with primary healthcare system in Eritrea.

The purpose of this paper was to assess the perceptions and attitudes of modern medical practitioners (MMPs) and traditional medical practitioners (TMPs) about traditional medical practice and to analyze the utilization of traditional medicine in Eritrea. The data for this study were collected in a 10-month period from January to October 2004. A cross-sectional study was conducted in three sub-zones of Eritrea: Dekemhare, Ghinda, and Maekel. A total of 500 (250 each) MMPs and TMPs, and 1657 households were included in the study. Data were collected both by questionnaire and an interview (with key informants). Our study reveals that there is a significant difference in perception and attitude between MMPs and TMPs about traditional medical practice in Eritrea. Their differences lie not only in their way of thinking but also in their perceptions of man and health. Our study further shows that in most rural communities in Eritrea, the use of traditional medicine and self-care is extensive. This is the case even in the presence of the supposedly free/subsidized health care available in government health centers. Higher confidence in traditional medicine for the treatment of serious illnesses, irrespective of availability of western medical service in many parts of Eritrea, indicates the need for selective integration of traditional medical practice with the primary healthcare system of the country.

What the Good Doctor Said: A Critical Examination of Design Issues of the RSBY Through Provider Perspectives in Chhattisgarh, India

The Rashtriya Swasthya Bima Yojana (RSBY) is a state funded health insurance scheme targeted for families below poverty line (BPL) in India providing a coverage of ₹30,000 for a family of five. This qualitative study covered three districts in Chhattisgarh, India, and included empanelled private for-profit, public and not-for-profit institutions. RSBY beneficiaries constituted a miniscule proportion of the total patient load in large multispecialty hospitals, institutions capable of providing treatment for serious illnesses. Small private nursing homes were the biggest gainers. There was evidence of complicated conditions being booked instead of simpler ones. Some government hospitals reported declines in patient loads after the introduction of the RSBY, clearly signalling a shift from the public to the private sector. Community and Primary Health Centres are unable to compete with private providers as the latter have relatively better patient facilities and specialists. Significantly, for the not-for-profit sector, used to functioning on tight price lines, the RSBY is beginning to provide the elusive sustainability.

Access to Dietitians: In Primary Health Care

Primary health care aims to provide timely treatment of serious illness, teach health promotion, and maintain health for patients with chronic diseases. In partnership with the primary care network at Vancouver Coastal Health (VCH), family physicians (FPs), and dietitians, this practice needs assessment was undertaken to explore how VCH could support access to primary care nutrition services. Both qualitative and quantitative approaches were used. Data from two focus groups, one for dietitians and the other for physicians, were compiled and formed the questions for the survey. The data were analyzed using the inductive approach, to consider the messages or themes that appeared from the focus groups and the survey. A review of information from the focus groups, surveys, and literature revealed four common themes of findings: accessibility, collaboration in chronic disease management, health promotion, and information sharing. Sixty-six percent of FPs perceived that primary health nutrition services were fair to poor. Both dietitian and physician groups recognized that collaboration in the areas of chronic diseases and health promotion was essential, and that sharing of information among providers could improve this service.

Impact of Training on Assessment of Diarrhoea and Acute Respiratory Infection at Government Health Facilities in Egypt

Egypt began training of physicians in case management of diarrhoea and acute respiratory infection (ARI) in the 1980s and 1990s respectively. Data from an independent assessment demonstrate the impact of training in the use of clinical practice guidelines on the quality of clinical examinations of 579 children presenting with diarrhoea or ARI. These examinations were conducted by 115 government physicians in 80 government health facilities and in two Egyptian governorates. The quality of care, although better than that in the past, remains poor, and training had little effect. Poor examinations were related to misclassification and inappropriate treatment of serious illnesses. Such errors have potentially serious consequences. Egypt is now implementing the Integrated Management of Childhood Illness strategy. This effort should be independently assessed to measure the improvement in the quality of care provided by government health facilities in Egypt.

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Key issues in the treatment of advanced breast cancer. Expectations and outcomes.

Advanced breast cancer is common and can cause extensive morbidity, often over long periods of time. A variety of treatments, including symptomatic measures, surgery, radiotherapy, endocrine treatment and cytotoxic drugs, may be applicable for individual patients. Cytotoxic chemotherapy is the most contentious therapy because of its potentially severe adverse effects. While clinical trials give information concerning objective response rates, they are of relatively little value in ascertaining the true value of treatment in routine practice. In recent years, increasing importance has been attached to the evaluation of symptom relief and quality of life. A scoring method for outcome analysis has been developed, in which the resultant of beneficial and adverse effects of treatments is estimated. Sensitivity analysis demonstrated the robustness of this method, which indicated that only about 20% of all patients with advanced breast cancer given first-line chemotherapy gain net benefit. This result was corroborated in a prospective study in which patient reports of benefit were systematically recorded. Most of the expenditure incurred when treating patients with advanced breast cancer is derived from treatment of serious illness rather than from specific antitumour treatment; cytotoxic drug therapy accounts for less than 10% of total expenditure.

PULMONARY PHARMACOLOGY IN PREGNANCY

The pharmacologic treatment of any pregnant patient with a respiratory illness should occur only after careful consideration of the effects of altered maternal physiology and the potential effects on the developing fetus. Pregnancy changes gastrointestinal absorption of drugs, creates an increased volume of distribution, decreases protein binding, and increases renal excretion and hepatic metabolism of most drugs. These changes may necessitate variation in dose or dosing interval of drugs administered during pregnancy. Before administration of a therapeutic agent, the available animal and human data summarizing fetal effects should be reviewed. Most of the bronchodilators and more common antibiotics used for respiratory infections have been used without adverse fetal effects. Important exceptions do exist and certain agents should be avoided. When the patient expresses concern over a pharmacologic or radiologic exposure during pregnancy, a detailed history of the type, timing, and duration of exposure and genetic consultation should be obtained. Finally, drug treatment of serious illness in the pregnant patient should not be withheld unless the risk of the agent in question clearly outweighs the fetal and maternal risk of untreated disease.

Access, Science, and Regulation

There is a potential tension between the desirable goals of assuring early availability of promising agents for treatment of serious illnesses without adequate therapy and developing such agents in a rigorous way that will yield scientifically valid answers about their safety and effectiveness. Because the two goals are linked to fundamental principles and values, it is possible for people who feel strongly about one of them to ignore the importance of the other. But it is neither necessary nor desirable to choose one goal exclusively; Early access is reasonable on both ethical and medical grounds and can be provided, with care and planning, without degrading the quality of evidence we develop to support new agents. A clear picture of the effectiveness and safety of a drug, and information on how best to use it is most critical, not to academics and regulators, but to the patients whose lives and health may depend on the drug, and obtaining this information does not require that access be denied until it is all in hand.

A Prognosis for Pediatrics

In a recent issue of theAmerican Journal of Diseases of Children(127:537-558, 1974) a symposium concerning the changing roles and relationships in the provision of child health care appeared, featuring papers by five national leaders in health care planning, education, provision, and evaluation. Their presentations have significant implications for all physicians who provide health care for children, but more for the currently practicing pediatrician than others, since his options to change the direction of his practice are limited. Traditionally, the primary care pediatrician has conducted a high-volume practice in a solo or small partnership arrangement. He has provided preventive services and health maintenance supervision, and has managed acute minor illnesses on an ambulatory basis. Only a small part of his efforts, however, have been spent in the diagnosis and treatment of serious illnesses in the hospital for which most of his postgraduate training prepared him. These problems have increasingly

Tenejapa Medicine I: The Curer

T HE TREATMENT of serious illness in Tenejapa-a Tzeltlal-speaking community in the Chiapas highlands-is primarily the province of the /hpolil/, curer.2 We propose to examine the role of the curer, placing particular emphasis on the characteristics and performances which not only define the role but which also, in their internal variation, are the basis for evaluation of curers and selection of one curer rather than another.