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4 results

  • Prophylaxis and treatment of cancer-related dyspnea with pharmacologic agents: A systematic review and network meta-analysis

  • Ronald Chow, David Hui, Saverio Caini, Charles B. Simone II, Elizabeth Prsic, Gabriel Boldt, Michael Lock
  • Journal:
    Palliative & Supportive Care / Volume 20 / Issue 5 / October 2022
    Published online by Cambridge University Press:
    14 October 2021, pp. 744-751
  • Introduction

    Cancer-related dyspnea is a common symptom in patients with cancer. It has also been reported to be a predictor of poorer prognosis, which can then change clinical treatment and advance care planning. Currently, no definitive recommendation for pharmacologic agents for cancer-related dyspnea exists. The aim of this systematic review and network meta-analysis is to compare pharmacologic agents for the prophylaxis and treatment of cancer-related dyspnea.

    Methods

    A search was conducted in the databases of PubMed, Embase, and Cochrane CENTRAL through May 2021. Standardized mean differences (SMDs), as reported by studies or calculated from baseline and follow-up dyspnea scores, were amalgamated into a summary SMD and 95% confidence interval (CI) using a restricted maximum likelihood multivariate network meta-analysis.

    Results

    Twelve studies were included in this review; six reported on prophylaxis of exertional dyspnea, five on treatment of everyday dyspnea, and one on treatment of episodic dyspnea. Morphine sulfate was better at controlling everyday dyspnea than placebo (SMD 1.210; 95% CI: 0.415–2.005). Heterogeneity in study design and comparisons, however, led to some concerns with the underlying consistency assumption in network meta-analysis design.

    Conclusion

    Optimal pharmacologic interventions for cancer-related dyspnea could not be determined based on this analysis. Further trials are needed to report on the efficacy of pharmacologic interventions for the prophylaxis and treatment of cancer-related dyspnea.

  • Chapter 8 - Management of somatoform disorders

  • Edited by James J. Amos, University of Iowa, Robert G. Robinson, University of Iowa
  • Book:
    Psychosomatic Medicine
    Published online:
    04 August 2010
    Print publication:
    27 May 2010, pp 73-81

  • Summary

    Consultation psychiatrists are skilled clinicians and expert liaisons in the general hospital setting. Clear communication improves the process of the consultation as well as the result, by ensuring accurate, timely, and helpful interventions. The first steps in the consultation process include the institutional and personal organization, consulting individual, patient, consult question and acuteness of the consult. Medications can be the cause and cure formyriad psychiatric issues. Identifying unnecessary and/or psychiatrically offensive medications is a significant part of consultation psychiatry. Anticholinergic medications, benzodiazepines, and narcotics are particularly deliriogenic in the medically ill or debilitated. Interventions other than medications can be helpful as well, including reorienting and reassuring the patient as needed, providing necessary assistive devices (including hearing aids and eyeglasses), using interpretive services when needed, explaining procedures and communicating clearly with the patient, and having family meetings.

  • 15 - From bench to bedside: influence of theories of plasticity on human neurorehabilitation

  • from Section A3 - Plasticity after injury to the CNS
    • By Agnes Floel, Human Coritical Physiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA, Leonardo G. Cohen, Human Coritical Physiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
  • Edited by Michael Selzer, University of Pennsylvania, Stephanie Clarke, Université de Lausanne, Switzerland, Leonardo Cohen, National Institute of Mental Health, Bethesda, Maryland, Pamela Duncan, University of Florida, Fred Gage, Salk Institute for Biological Studies, San Diego
  • Book:
    Textbook of Neural Repair and Rehabilitation
    Published online:
    05 March 2012
    Print publication:
    16 February 2006, pp 248-266

  • Summary

    The primary vehicle for acquiring knowledge on plasticity in the human central nervous system (CNS) has been animal research. Understanding of mechanisms, development of strategies to purposefully modulate these mechanisms, and translation into rational strategies to promote recovery of function are the goals of modern neurorehabilitation. Training leads to specific changes in brain organization in the motor, somatosensory, auditory, and visual domain. Acute and chronic alterations in neurotransmitter regulation after injury affect plasticity, and may thus provide a basis for new pharmacologic targets for stroke recovery. One of the strategies proposed to enhance functional recovery and sensory substitution is to use mechanical devices interfaced with human sensory afferents or interacting with the CNS. Intravenous human umbilical cored blood cells (HUCB) infusion may have a beneficial effect on recovery processes. Growth factors seem to exert their effects by local processes including autocrine, paracrine, and juxtacrine stimulation.