Comprehensive wound malodor management: Win the RACE.

Complex wounds that give off a foul odor are common in various patient care settings. Wound malodor has grave effects, both physical and psychological, and its management presents a serious challenge for caregivers. Multiple factors and processes involved in malodor production need to be considered in designing a comprehensive treatment plan described by the acronym RACE: removal of necrotic tissue, antibacterials, odor concealers, and education and support.

Sigma-1 receptors and animal studies centered on pain and analgesia.

Introduction: Neuropathic pain is difficult to relieve with standard analgesics and tends to be resistant to opioid therapy. Sigma-1 receptors activated during neuropathic injury may sustain pain. Neuropathic injury activates sigma-1 receptors, which results in activation of various kinases, modulates the activity of multiple ion channels, ligand activated ion channels and voltage-gated ion channels; alters monoamine neurotransmission and dampens opioid receptors G-protein activation.

How well is palliative care integrated into cancer care? A MASCC, ESMO, and EAPC Project.

Introduction: The benefits of integration of palliative care into oncology have become evidence-based. How palliative care is perceived and structured in various settings and countries would be of interest.

Method: We used a previously published questionnaire to survey multiple institutions with members in MASCC and ESMO.

MASCC/ESMO/EAPC survey of palliative programs.

Background: Palliative care program structure is important to integrating palliative services into cancer care. A first step in understanding the structure of palliative care programs is to survey existing programs.

Method: This data was generated from members of MASCC, the European Society of Medical Oncology (ESMO), and the European Association of Palliative Care (EAPC) who completed the surveys on the website.

Long-term and short-term effects of insomnia in cancer and effective interventions.

Sleep disorders and insomnia are more prevalent in patients with cancer than in the normal population. Sleep disorders consist of delayed sleep latency, waking episodes after sleep onset, unrefreshing sleep, reduced quality of sleep, and reduced sleep efficiency. Sleep disorders cluster with pain, fatigue, depression, anxiety, and vasomotor symptoms, depending on stage of disease, treatment, and comorbidities.

Cobalt, linac, or other: what is the best solution for radiation therapy in developing countries?

The international growth of cancer and lack of available treatment is en route to become a global crisis. With >60% of cancer patients needing radiation therapy at some point during their treatment course, the lack of available facilities and treatment programs worldwide is extremely problematic. The number of deaths from treatable cancers is projected to increase to 11.

Fighting insomnia and battling lethargy: the yin and yang of palliative care.

There is an interdependent relationship between insomnia and fatigue in the medical literature, but both remain distinct entities. Insomnia entails problematic sleep initiation, maintenance, or restoration with an accompanying decrease in perceived daytime function. Lethargy is a symptom that has a wide differential diagnosis that heavily overlaps with cancer-related fatigue; however, insomnia may contribute to worsened fatigue and lethargy in cancer patients.

Does serum albumin and creatinine predict survival of inpatient palliative care patients?

Introduction: Low creatinine and albumin are found among the chronically ill patients. This study retrospectively reviewed albumin and creatinine levels for survival in patients upon admission.

Methods: Records of patients admitted over 2 months were reviewed.

New developments in the treatment of intracerebral hemorrhage.

Understanding of intracerebral hemorrhage (ICH) pathophysiology and technological advances are now providing the opportunity to significantly reduce the morbidity and mortality associated with this debilitating type of stroke. As reviewed in this article, several ongoing clinical trials may transform the way this patient population is treated within the next 5 years. Although more research is needed, a new era for ICH management is beginning.

Early integration of palliative and supportive care in the cancer continuum: challenges and opportunities.

Palliative care has become synonymously associated with hospice care in the minds of patients and physicians. Supportive care is a more acceptable term and leads to earlier referral. Miscommunication and a "collusion of hope" centered on cancer treatment is detrimental to care at the end of life and results in complicated bereavement.

Topics in research: structuring studies in palliative care.

Purpose Of Review: This review describes the advances in trial methodology and presents new methodologies to meet some of the challenges of conducting trials in a palliative care setting. To describe why this review is timely and relevant.

Recent Findings: This review discusses the process required to conduct trials of complex interventions described by the Britain's Medical Research Council.

Reconstructing analgesic trials: reasons for following the lead of oncologists.

Purpose Of Review: Changes in drug trial designs in oncology, which involve targeted therapies and well genotyped cancers have important implications to the present trial designs used for analgesic development.

Recent Findings: Pain phenotypes influence analgesic responses. Analgesics can now be targeted to pain phenotypes.

Twelve reasons for considering buprenorphine as a frontline analgesic in the management of pain.

Buprenorphine is an opioid that has a complex and unique pharmacology which provides some advantages over other potent mu agonists. We review 12 reasons for considering buprenorphine as a frontline analgesic for moderate to severe pain: (1) Buprenorphine is effective in cancer pain; (2) buprenorphine is effective in treating neuropathic pain; (3) buprenorphine treats a broader array of pain phenotypes than do certain potent mu agonists, is associated with less analgesic tolerance, and can be combined with other mu agonists; (4) buprenorphine produces less constipation than do certain other potent mu agonists, and does not adversely affect the sphincter of Oddi; (5) buprenorphine has a ceiling effect on respiratory depression but not analgesia; (6) buprenorphine causes less cognitive impairment than do certain other opioids; (7) buprenorphine is not immunosuppressive like morphine and fentanyl; (8) buprenorphine does not adversely affect the hypothalamic-pituitary-adrenal axis or cause hypogonadism; (9) buprenorphine does not significantly prolong the QTc interval, and is associated with less sudden death than is methadone; (10) buprenorphine is a safe and effective analgesic for the elderly; (11) buprenorphine is one of the safest opioids to use in patients in renal failure and those on dialysis; and (12) withdrawal symptoms are milder and drug dependence is less with buprenorphine. In light of evidence for efficacy, safety, versatility, and cost, buprenorphine should be considered as a first-line analgesic.

Drug management of visceral pain: concepts from basic research.

Visceral pain is experienced by 40% of the population, and 28% of cancer patients suffer from pain arising from intra- abdominal metastasis or from treatment. Neuroanatomy of visceral nociception and neurotransmitters, receptors, and ion channels that modulate visceral pain are qualitatively or quantitatively different from those that modulate somatic and neuropathic pain. Visceral pain should be recognized as distinct pain phenotype.

Long-term follow-up of type II endoleak embolization reveals the need for close surveillance.

Objective: Aneurysm growth after endovascular aneurysm repair (EVAR) in patients with type II endoleak is associated with adverse outcomes. This study evaluated the long-term success of embolization of type II endoleaks in preventing aneurysm sac growth.

Methods: We retrospectively reviewed outcomes of patients who underwent infrarenal EVAR who were treated for a type II endoleak between 2000 and 2008.

A review of α1-antitrypsin deficiency.

α(1)-Antitrypsin (AAT) deficiency is an underrecognized genetic condition that affects approximately 1 in 2,000 to 1 in 5,000 individuals and predisposes to liver disease and early-onset emphysema. AAT is mainly produced in the liver and functions to protect the lung against proteolytic damage (e.g.

Comparative predictors of mortality for endovascular and open repair of ruptured infrarenal abdominal aortic aneurysms.

Background: The continued success of elective endovascular aneurysm repair (EVAR) has led to an extension of this technology to ruptured aortas. The purpose of this study was to evaluate our results of ruptured infrarenal aortic aneurysm (rAAA).

Methods: The treatment results of all patients who underwent repair of rAAAs between January 1990 and May 2008 were reviewed retrospectively.

Acute mesenteric ischemia.

Acute mesenteric ischemia is a life-threatening surgical emergency associated with high morbidity and mortality rates. Presentation, physical exam, laboratory values and non-invasive imaging may all be non-specific. Angiography remains the gold standard for diagnosis.

Recent development in therapeutics for breakthrough pain.

Breakthrough pain is defined as transitory flares of pain. Breakthrough pain is caused by cancer, cancer complications, treatment or comorbidities. The usual onset to maximum breakthrough pain intensity time is 3 min and duration is 30 min; therefore, the assessment for response needs to be at short intervals.

Aortic stenosis and aortic insufficiency in children: impact of valvuloplasty and modified Ross-Konno procedure.

Aortic stenosis and aortic insufficiency in young children present multiple challenges to the patient, family, and surgeon. Mechanical valves require anticoagulation therapy, which is a poor option in active youngsters and noncompliant adolescents. Aortic valvuloplasty and the various forms of the Ross/Ross-Konno operations appear to be good solutions in this patient population due to valve preservation for the former and autograft growth for the latter.

Effect of rimonabant on progression of atherosclerosis in patients with abdominal obesity and coronary artery disease: the STRADIVARIUS randomized controlled trial.

Context: Abdominal obesity is associated with metabolic abnormalities and increased risk of atherosclerotic cardiovascular disease. However, no obesity management strategy has demonstrated the ability to slow progression of coronary disease.

Objective: To determine whether weight loss and metabolic effects of the selective cannabinoid type 1 receptor antagonist rimonabant reduces progression of coronary disease in patients with abdominal obesity and the metabolic syndrome.