Aims and objectives
To evaluate the availability of, adherence to, and perceived usefulness of guidelines and protocols for managing hydration and subcutaneous hydration in palliative care settings.
...Background
Hydration at the end of life and the use of a subcutaneous route to hydrate generate some controversy among health professionals for different reasons. Having guidelines and protocols to assist in decision‐making and to follow a standard procedure may be relevant in clinical practice.
Design
Cross‐sectional telephone survey, with closed‐ended and open‐ended questions designed specifically for this study.
Methods
Data were obtained from 327 professionals, each from a different palliative care service. Mean, standard deviation, minimum and maximum were calculated for continuous variables; frequency distributions were obtained for categorical variables. A qualitative content analysis was performed on the open‐ended questions. The article adheres to the STROBE guidelines for reporting observational studies.
Results
Only 24.8% of the participants had guidelines available to assist in making decisions regarding hydration, and 55.6% claimed to follow them ‘always or almost always’. Of the participants, 38.8% had subcutaneous hydration protocols available, while 78.7% stated that they ‘always or almost always’ followed these protocols. The remaining participants considered the protocols as useful tools despite not having them available.
Conclusions
Only 25% of the participants' services had guidelines for hydration, and less than 40% had protocols for subcutaneous hydration. However, adherence was high, especially in cases where protocols existed. Among the participants who did not have guidelines and protocols, attitudes were mostly favourable, but mainly as a reference and support for an individualised clinical practice.
Relevance to clinical practice
Guidelines and protocols on hydration in palliative care may be more useful as a solid reference and support for individualised practice than as instruments for standardising care. From this perspective, their development and availability in palliative care services are recommended.
Background:
The increase in the elderly population associated with a higher incidence of cancer strongly endorses palliative care (PC). Hypodermoclysis (HDC) is a feasible technique for drugs and ...fluids delivery at the home care setting.
Objectives:
To assess the use and benefits of HDC in patients with end-of-life cancer assisted by a single home-based palliative care program (HPCP) in Belo Horizonte, Brazil.
Methods:
This was a retrospective study that analyzed medical charts from patients with end-of-life cancer who were assisted by an HPCP in a 1-year period of time.
Results:
A total of 333 patients, 81.7% with advanced cancer, were included. The most frequent symptoms were fatigue (44.4%) and pain (43.2%). Hypodermoclysis was used in 77.5% of the patients for the administration of fluids or medicines. Continuous palliative sedation was applied to 70.5% of patients. The place of death was home for 90.2% of the patients.
Conclusion:
Receiving home care assistance with palliative intention may decrease the need for dying patients with cancer to visit emergency units, as their symptoms were well controlled. Hypodermoclysis was a safe and effective alternative for hydration and drug delivery when provided and supervised by an experienced team. The place of death is a reliable indicator of the quality of death, and, in this study, the HPCP allowed patients to die at home with their families. It is essential for PC professionals to understand the impact of HDC use at home care setting for patients with end-of-life cancer allowing the increase of quality of death indicators.
Abstract Context Decreased oral intake is very common at the end of life. Dehydration can aggravate symptoms such as fatigue, myoclonus and confusion. Intravenous hydration at home can be ...logistically difficult and expensive. Hypodermoclysis (HDC) is easy to provide and inexpensive; however, it is rarely used to provide hydration at the end of life in the home setting. Objectives The purpose of this study was to determine if caregivers were capable of administering hypodermoclysis in the home hospice setting. Methods All caregivers underwent a 45-minute training session on HDC administration and assessment of infusion site delivered by a specially trained nurse. Caregivers received daily calls and on-site evaluation on day 8. Results A total of 21 patient/caregivers dyads were admitted to this preliminary study: 10 (48%) female patients and 16 (76%) female caregivers. All patients had advanced cancer, receiving hospice care at home. All caregivers who received training were able to start the infusion. The infusion was facilitated by gravity or weight. Side effects were minimal with one (5%) due to the care of the needle and leakage. Conclusion This preliminary study suggests that subcutaneous hydration could be administered by caregivers at home with minimal burden, equipment, and technical support.
Atopic diathesis encompassing atopic dermatitis (AD), allergic rhinoconjunctivitis, food allergy, eosinophilic esophagitis, and asthma is a widely prevalent condition with a broad heterogeneity in ...clinical course, age of onset, and lifespan persistence. A primary event in AD is the commonly inherited epidermal barrier dysfunction. Together with the host-microbiome interactions, barrier defect and allergen exposure modulate both innate and adaptive immunity, thus triggering and maintaining the inflammatory response. Microbiome diversity, together with the host's contact with nonpathogenic microbes in childhood, is a prerequisite for functional maturation of the immune system, which is in part mediated by microbiome-induced epigenetic changes. Yet, whether microbiome alterations are the result or the reason for barrier impairment and inflammatory response of the host is unclear. Exposure to locally prevalent microbial species could contribute to further modification of the disease course. The objective of this review is to reveal the link between changes in the skin microbiota, barrier dysfunction, and inflammation in AD. Addressing unmet needs includes determining the genetic background of AD susceptibility; the epigenetic modifications induced by the microbiota and other environmental factors; the role of globally diverse provoking factors; and the implementation of personalized, phenotype-specific therapies such as a epidermal barrier restoration in infancy and microbiota modulation via systemic or topical interventions, all of which open gaps for future research.
Patients requiring home-based palliative care have advanced complex illnesses with functional limitations and decline. This retrospective study reviewed caregiver administration of subcutaneous (SQ) ...medications and fluids when symptom control could not be achieved using the oral route.
Medical records from September 1, 2017 to February 28, 2018 were reviewed for 272 consecutive patients who received SQ administration of medications or fluids at a home-based palliative care program. We analyzed the clinical characteristics of patients and caregivers, medications administered, and catheter outcomes.
Patients' median age was 74 years, and 163 (60%) were women. The most common cancer diagnoses were stomach 26 (12%), lung 22 (10%), and colorectal 20 (9%). Dementia 24 (44%), cerebrovascular disease 9 (16%), and congestive heart failure 7 (13%) were the most frequent nonmalignant diseases. Poor symptom control 162 (60%) and impaired oral intake 107 (39%) were the most common indications for an SQ route of administration. Nonprofessional caregivers trained by a nurse administered medications to 218 patients (80%). During interventions, the patients received a mean of 4 medications (±2 standard deviation). A total of 903 catheters were inserted, 15/732 (2%) catheters handled by nonprofessional caregivers caused a local infection, compared with 3/171 (1.8%) of catheters handled by nurses. Hydromorphone was the most common opioid used (57%), followed by morphine (35%). The median length of stay in the program was 24 days (interquartile range: 11-60).
SQ administration of medications and fluids by nonprofessional caregivers trained by health care professionals is feasible and promising, but additional testing is needed.
Objective: to mapping the evidence on hypodermoclysis in child health care. Methods: this is a scope review, with a search in Medical Literature Analysis and Retrieval System Online, Latin American ...and Caribbean Health Sciences Literature, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Scopus Elsevier, Web of Science and Embase. Studies published in Portuguese, English and Spanish were included, with no time cut. Results: a total of 11 studies were analyzed, with a predominance of literature reviews. The main themes were: use of recombinant human hyaluronidase as a facilitator of subcutaneous absorption; comparison between subcutaneous and intravenous rehydration; advantages of hypodermoclysis; patient pain and puncture attempts. Conclusion: this study allowed mapping the scientific evidence on hypodermoclysis, revealing it to be a viable and valid alternative for administering medications in children. Contributions to practice: the use of the technique can bring benefits and provides evidence to indicate and apply it in child care.
Objetivo: mapear as evidências sobre hipodermóclise na assistência à saúde da criança. Métodos: trata-se de uma revisão de escopo, com busca nas bases Medical Literature Analysis and Retrieval System Online, Literatura Latino-Americana e do Caribe em Ciências da Saúde, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Scopus Elsevier, Web of Science e Embase. Incluíram-se estudos publicados em português, inglês e espanhol, sem recorte temporal. Resultados: foram analisados 11 estudos com predomínio de revisões de literatura. Os principais temas foram: uso da hialuronidase humana recombinante como facilitadora da absorção subcutânea; comparação entre a reidratação subcutânea e intravenosa; vantagens da hipodermóclise; dor do paciente e as tentativas de punção. Conclusão: este estudo permitiu mapear as evidências científicas sobre hipodermóclise, revelando ser uma alternativa viável e válida para administrar medicamentos em crianças. Contribuições para a prática: o uso da técnica pode trazer benefícios e fornece evidências para indicá-la e aplicá-la na assistência à criança.
Objective
To determine the efficacy and safety of fremanezumab administration in Japanese and Korean patients with chronic migraine (CM).
Background
Available preventive treatments for CM are limited ...by various efficacy and safety issues. Fremanezumab, a monoclonal antibody that targets the calcitonin gene‐related peptide pathway involved in migraine pathogenesis, has been shown to be effective and well tolerated in large‐scale, international Phase 3 trials.
Methods
Randomized, placebo‐controlled trial of patients with CM who received subcutaneous fremanezumab monthly (675 mg at baseline and 225 mg at weeks 4 and 8), fremanezumab quarterly (675 mg at baseline and placebo at weeks 4 and 8), or matching placebo. Primary endpoint was the mean change from baseline in the monthly (28‐day) average number of headache days of at least moderate severity during the 12 weeks after the first dose.
Results
Among 571 patients randomized (safety set, n = 569; full analysis set, n = 566), the least‐squares mean (±standard error SE) reduction in the average number of headache days of at least moderate severity per month during 12 weeks was significantly greater with fremanezumab monthly (–4.1 ± 0.4) and fremanezumab quarterly (–4.1 ± 0.4) than with placebo (–2.4 ± 0.4). The difference from the placebo group in the mean change (95% confidence interval CI) was −1.7 days (−2.54, −0.80) for the fremanezumab monthly group and −1.7 days (−2.55, −0.82) for the fremanezumab quarterly group (p < 0.001 vs. placebo for both fremanezumab groups). The percentage of patients with a ≥50% reduction in the average number of headache days of at least moderate severity per month (response rate) was higher with fremanezumab monthly (29.0%) and fremanezumab quarterly (29.1%) than with placebo (13.2%) in addition to other improvements in secondary endpoints, including reduction of acute medication use (mean change from baseline during 12‐week period ± SE: fremanezumab monthly, –3.7 ± 0.4; fremanezumab quarterly, –3.9 ± 0.4; placebo, –2.4 ± 0.4) and improvements in disability scores (mean change from baseline in six‐item Headache Impact Test score at 4 weeks after third injection ± SE: fremanezumab monthly, –8.1 ± 0.7; fremanezumab quarterly, –8.0 ± 0.7; placebo, –6.5 ± 0.7). Fremanezumab was well tolerated with a similar incidence of adverse events including injection‐site reactions as placebo (patients with at least one treatment‐emergent adverse event: fremanezumab total, n = 232 61.4%; placebo, n = 118 61.8%).
Conclusion
Fremanezumab effectively prevents CM in Japanese and Korean patients and was well tolerated. No safety signal was detected.
Hydration therapy is essential in the care of the older patient. Subcutaneous (SC) hydration is a relevant method for parenteral hydration, but clinical trials on the subject have methodological ...shortcomings compared to updated standards.
Assessor-blinded, non-inferiority RCT to explore if SC is a safe alternative to intravenous (IV) hydration.
Eligible patients were: Admitted patients 65 years or older with a need for parenteral hydration. The targeted sample size was 67 patients in each group.
Patients were randomised to parenteral hydration via an IV or SC catheter during a 24 hours observation period. The non-randomised catheter (inactive) was placed as a sham on the patient, thereby blinding the caregivers and outcome assessors.
Our primary outcome was the proportion of patients reporting at least one adverse effect with a non-inferiority calculation using a 20% margin.
We included 51 patients, with 24 randomised to SC and 27 to IV. We were unable to reach our target sample size due to challenges in recruitment, time limitation, and COVID-19. For the outcome of adverse effects, SC was non-inferior to IV (p = 0.012). Time spent on inserting the catheters was shorter with SC (p = 0.001). The groups did not differ by pain of insertion, discomfort during infusion, or the risk of developing delirium.
SC is a safe alternative to IV hydration, is faster to place and should be an available method for parenteral hydration wherever older adults are cared for.
ClinicalTrials.gov Identifier: NCT03710408.
Objective: to describe the use of hypodermoclysis in unconventional pediatric treatments. Method: an integrative review, with sampling period from 2010 to 2018, in five databases. Two independent ...reviewers selected the articles. Next, an evaluation of the level of evidence was performed, according to the Joanna Briggs Institute. Results: Six international articles were selected, with levels of evidence 1 and 3. The unconventional diseases and situations for treatment via hypodermoclysis were: polyarticular juvenile idiopathic arthritis; prevention of hyponatremia during fluid restriction; sedation in dental treatment; rheumatic disorders; antibiotic therapy and refractory pulmonary arterial hypertension. Conclusion: the procedure is an effective and safe option for the administration of medications in children, justified due to the minimization of pain intensity and the protection of the child, family and nursing staff from stress. However, more research is needed to substantiate it scientifically, and for its implementation in the professional practice.
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