Development of specialist palliative care in Dutch hospitals between 2014 and 2020: a repeated survey.

Background: Specialist palliative care teams (SPCTs) have significant benefits for patients with advanced disease or frailty, including improved quality of life, greater satisfaction with care, and less potentially inappropriate care at the end of life. Experienced SPCTs are recognised to have higher referral rates compared to novice teams. The aim of this study was to assess the development of hospital-wide integration of specialist palliative care (PC) and of SPCTs in Dutch hospitals between 2014 and 2020.

Lung Mean Dose Prediction in Transarterial Radioembolization (TARE): Superiority of [Ho]-Scout Over [Tc]MAA in a Prospective Cohort Study.

Purpose: Radiation pneumonitis is a serious complication of radioembolization. In holmium-166 ([Ho]) radioembolization, the lung mean dose (LMD) can be estimated (eLMD) using a scout dose with either technetium-99 m-macroaggregated albumin ([Tc]MAA) or [Ho]-microspheres. The accuracy of eLMD based on [Tc]MAA (eLMD) was compared to eLMD based on [Ho]-scout dose (eLMD) in two prospective clinical studies.

Comparison of 3 Different Therapeutic Particles in Radioembolization of Locally Advanced Intrahepatic Cholangiocarcinoma.

Our objective was to compare 3 different therapeutic particles used for radioembolization in locally advanced intrahepatic cholangiocarcinoma. Y-glass, Y-resin, and Ho-labeled poly(l-lactic acid) microsphere prescribed activity was calculated as per manufacturer recommendations. Posttreatment quantitative Y PET/CT and quantitative Ho SPECT/CT were used to determine tumor-absorbed dose, whole-normal-liver-absorbed dose, treated-normal-liver-absorbed dose, tumor-to-nontumor ratio, lung-absorbed dose, and lung shunt fraction.

Epidural anesthesia is no longer the standard of care in abdominal surgery with ERAS. What are the alternatives?

Epidural anesthesia has been considered the gold standard for perioperative analgesia, but the implementation of enhanced recovery after surgery (ERAS) protocols and a shift from open to laparoscopic surgery have diminished the advantage of epidural anesthesia. The authors summarize data from two newer meta-analyses and discuss the consequences for the role of epidural anesthesia (EA) in the perioperative setting. These meta-analyses enabled to distinguish between pre- and post-ERAS outcomes.

Home Telemonitoring Improved Pain Registration in Patients With Cancer.

Introduction: For adequate pain treatment in patients with cancer, it is important to monitor and evaluate pain regularly. Although the numeric rating scale (NRS) is implemented in hospitals in the Netherlands, pain is still not systematically registered during outpatient consultations. The aim of this study was to assess whether home telemonitoring increases pain registration in medical records of outpatients with cancer.

Cowper's syringocele in the pediatric population: a retrospective study of 122 patients.

Introduction And Objective: Syringocele is a rare cystic dilatation of the duct of Cowper's gland, afflicting mostly the pediatric population. Syringoceles have a wide range of symptoms and may cause urethral obstruction. The authors analyzed to clarify the clinical manifestation, diagnostic approach, management, and incidence in the pediatric population.

Sublingual sufentanil for postoperative pain relief: first clinical experiences.

Background: The sublingual sufentanil tablet system (SSTS) is a novel hand-held patient-controlled analgesia device developed for treatment of moderate-to-severe postoperative pain. Here we present the first results of its clinical use.

Methods: Adult patients undergoing major surgery in five hospitals in the Netherlands received the SSTS for postoperative pain relief as part of multimodal pain management that further included paracetamol and a nonsteroidal anti-inflammatory drug (NSAID).

The efficacy of standard laxative use for the prevention and treatment of opioid induced constipation during oxycodone use: a small Dutch observational pilot study.

Background: Dutch clinical guidelines recommend that a standard laxative treatment (SLT) should be prescribed concomitantly when starting opioid treatment to prevent opioid-induced constipation (OIC).

Methods: Clinical evidence for SLT in the treatment of OIC is lacking, therefore an observational pilot study was performed to explore the efficacy and tolerability of SLT on OIC in patients treated with the opioid oxycodone.

Results: Twenty-four patients (58% female, median (range) age 65 (39-92)) were included in this pilot study.

Fixed ratio (2:1) prolonged-release oxycodone/naloxone combination improves bowel function in patients with moderate-to-severe pain and opioid-induced constipation refractory to at least two classes of laxatives.

Objective: The effects of combined oxycodone/naloxone prolonged release tablets (OXN PR) were investigated in patients with moderate-to-severe chronic cancer-related or non-cancer pain. All patients had opioid-induced constipation (OIC) which persisted despite substantial laxative therapy.

Research Design And Methods: This pooled analysis included 75 patients with OIC at study entry that was refractory to at least two laxatives with different modes of action.

23. Pain in patients with cancer.

Pain in patients with cancer can be refractory to pharmacological treatment or intolerable side effects of pharmacological treatment may seriously disturb patients' quality of life. Specific interventional pain management techniques can be an effective alternative for those patients. The appropriate application of these interventional techniques provides better pain control, allows the reduction of analgesics and hence improves quality of life.

Lack of relationships between cumulative methylprednisolone dose and bone mineral density in healthy men and postmenopausal women with chronic low back pain.

The medical use of glucocorticoids (GCs) is related to low bone mineral density (BMD). In this study we tested the hypothesis that the cumulative dose of GC is not related to BMD outcome. The study was cross-sectional in design and included healthy individuals with chronic low back pain resistant to conventional treatments.

Neurohistopathological findings after continuous intrathecal administration of morphine or a morphine/bupivacaine mixture in cancer pain patients.

Background: As the number of terminal cancer patients receiving continuous intrathecal infusion of opioids and local anesthetics for relief of pain increases, we decided to investigate the post-mortem findings of the spinal cord, meninges and nerve roots of patients after continuous intrathecal administration of morphine and combined with bupivacaine.

Methods: Neurohistopathological findings were obtained from 10 cancer patients [2 men and 8 women, 29-69 (median 52) yrs old] and 4 controls [4 men, 46-75 (median 64) yrs old]. The cancer patients had been treated for a mean of 98 (range 8-452) d with morphine/NaCl 0.

Patients' refusal to participate in clinical research.

The number of protocol-eligible patients, refusing to participate in a clinical trial is often not mentioned. The aim of this study is to report the number of refusers and to evaluate the reasons for not participating in a clinical study concerning post-operative pain relief and to assess the potential influence on the final study results. Patients refusing to participate in the study were recorded and evaluated for reasons of refusal.

Assessment of respiratory effort by means of strain gauges and esophageal pressure swings: a comparative study.

We characterized apneas by a quantitative method (esophageal pressure measurements) and by a qualitative method (strain gauges) at the same time in 22 patients with sleep-related breathing disorders. Detection of respiratory effort by strain gauges significantly overestimated the total number of central apneas in each patient. Despite this overestimation, none of the patients was wrongly diagnosed as having pure central sleep apnea syndrome.

Long-Term Spinal Opioid Therapy in Terminally Ill Cancer Pain Patients.

In terminally ill cancer patients with refractory pain, long-term spinal opioid therapy may provide a profound analgesia with minimal side effects. The reversibility of the technique and its efficacy throughout the body and for different types of pain are important advantages. For epidural administration, it is preferable to use lipid soluble opioids (sufentanil).

Influence of uvulopalatopharyngoplasty on alpha-EEG arousals in nonapnoeic snorers.

Arousals are more numerous in heavy snorers than in nonsnorers and might be a cause of excessive daytime sleepiness (EDS) in these patients. The present study investigated whether treatment of snoring by uvulopalatopharyngoplasty (UPPP) had an influence on sleep microstructure in nonapnoeic snorers. The polysomnographic records of 10 nonapnoeic snorers were reviewed retrospectively and arousals scored according to the American Sleep Disorders Association (ASDA) 3 s definition.

Intrathecal administration of high-dose morphine solutions decreases the pH of cerebrospinal fluid.

Terminally ill patients suffering from intractable cancer pain are treated in our hospital on an outpatient basis with a percutaneous intrathecal (i.t.) catheter and a portable pump delivering morphine continuously.

Skin temperature response to a pressure load: studies in subjects before and during spinal anesthesia.

The Pressure-Temperature-Time method (PTT-method) is a method to investigate skin temperature changes in response to a pressure load. This method was used to investigate the effect of an acute nerve conduction block on the skin temperature increase of the trochanter major, after the pressure load was removed. The PTT-method was used in a group of 30 subjects, undergoing minor surgical procedures, before and during an anesthetic nerve conduction block at L2-L3.

The validity and reproducibility of the skin vasomotor test--studies in normal subjects, after spinal anaesthesia, and in diabetes mellitus.

Skin sympathetic vasomotor control can be examined in the extremities by the skin vasomotor test. In this test the change in skin blood flow and skin temperature in the hand and foot in response to a cold stimulus is utilized as an index of distal sympathetic nerve fibre integrity. This is of importance in conditions such as diabetes mellitus as peripheral autonomic neuropathy is associated with orthostatic hypotension and diabetic foot complications.

[Continuous intrathecal analgesia in terminal cancer patients within transmural health care].

Objective: To record the daily morphine doses, the influence of the treatment on quality of life and the incidence of side-effects and complications of continuous intrathecal morphine administration.

Setting: Academic Hospital, Free University, Amsterdam.

Design: Prospective.

Computer assistance in keratoconus lens design.

In the past, keratoconus patients have been custom fit with multi-curve spherical contact lenses. Recently it has become possible to commercially manufacture aspherical contact lenses of high-Dk material. A computer assisted fitting technique may be used with these new lenses.