Biomedical subjects

Jon Håvard Loge

Publications and source records attributed to Jon Håvard Loge.

16 recordsLinked to original sources

PubMed2006

Symptom profiles and palliative care in advanced pancreatic cancer: a prospective study.

OBJECTIVES: To describe prospectively the prevalence and severity of disease-related symptoms, quality of life (QOL) and need for palliative care in patients with advanced pancreatic cancer. PATIENTS AND METHODS: Fifty-one patients treated for advanced pancreatic cancer filled in the Edmonton Symptom Assessment Scale (ESAS) for symptom registration and the EORTC QLQ-C30 and QLQ-PAN26 quality of life questionnaires at first contact (baseline) and the ESAS in the following consultations. Need for palliative interventions were registered. RESULTS: Of the 22 women and 29 men (mean age, 62 years), 20 had locally unresectable cancer, 19 had metastatic disease, and 12 had recurrent disease after curative resection. Forty-six patients died during follow-up (median survival, 99 days). At baseline, patients reported significantly impaired QOL on nine of 15 scales/items (p<0.01) relative to the general population. Fatigue, loss of appetite, and impaired sense of well-being were the most troublesome symptoms on the ESAS, measured to 4.4(+/-2.8)/5.3(+/-2.3), 4.4(+/-3.2)/5.9(+/-2.7), and 4.0(+/-2.9)/4.6(+/-2.7) (mean+/-SD) at baseline and 8 weeks before death, respectively. Forty-four of the 51 (86%) initial consultations and 107 (58%) of the 185 follow-ups (124 clinical and 61 phone-calls) resulted in palliative care interventions, most frequently changes in opioid or laxative medication and dietary advice. CONCLUSIONS: Patients with advanced pancreatic cancer develop several distressing symptoms. ESAS was useful for assessment of symptom prevalence and intensity and is a clinically adequate method for symptom control. A multidisciplinary approach is necessary for the best palliation of symptoms at the time of diagnosis and during follow-up.

Adult↗

PubMed2006

[Delirium in palliative care].

Delirium has an abrupt onset and represents an emergency. The symptoms of delirium include reduced consciousness, cognitive failure and altered psychomotor activity. In this paper, we present delirium in palliative care based on a literature review and clinical experience. Delirium is the second most common psychiatric condition in cancer patients in general. The exact prevalence in palliative care is unknown. Several factors can precipitate a delirium. The most common factors are probably opioids, dehydration and metabolic disturbances. The assessment must be balanced towards the patient's life expectancy and aims at establishing the diagnosis and identifying precipitating factors. The diagnosis of delirium is easy for those familiar with the diagnostic criteria. The abrupt change in the patients' mental status is the key to correct diagnosis. The assessment can include instruments used in semi-structured interviews. Delirium can probably be prevented. The type and amount of treatment depends upon the patient's life expectancy. Causal treatment is a goal unless the delirium is part of the dying process. Symptom control is generally achieved by haloperidol and regulation of stimuli.

Analgesics, Opioid↗

PubMed2006

[Approaching patients who require palliative care].

The aim of palliative medicine is the best possible quality of life. Based upon literature and clinical experience we address factors of importance for the meeting between the palliative patient and the physician. Family and network, personality and behaviour vary between palliative patients and have effect upon their coping; these factors should be reflected in the meeting between the physician and the patient. Communication with a palliative patient also aims at a systematic assessment of his or her various symptoms and the physician should have a broad armamentarium of communications skills. The optimal way to assess symptoms is by use of clinical interviews supplemented with standardized measurements. Instruments such as the Edmonton Symptom Assessment System are very useful in the assessment of the commonest symptoms. The assessments should include patients' perspectives and what priority they give to relevant interventions. Treatment should be evaluated systematically in order to avoid ineffective treatments and to reduce side effects and interactions. The aim is to give patients as good and as long a time as possible in the place in which they want to spend the last part of their lives. Palliative medicine often combines the art of medicine with new technology. The focus on quality of life and the patient perspective is paramount, and the approach to the patient should reflect this.

Adaptation, Psychological↗

PubMed2006

Pain assessment tools: is the content appropriate for use in palliative care?

Inadequate pain assessment prevents optimal treatment in palliative care. The content of pain assessment tools might limit their usefulness for proper pain assessment, but data on the content validity of the tools are scarce. The objective of this study was to examine the content of the existing pain assessment tools, and to evaluate the appropriateness of different dimensions and items for pain assessment in palliative care. A systematic search was performed to find pain assessment tools for patients with advanced cancer who were receiving palliative care. An ad hoc search with broader search criteria supplemented the systematic search. The items of the identified tools were allocated to appropriate dimensions. This was reviewed by an international panel of experts, who also evaluated the relevance of the different dimensions for pain assessment in palliative care. The systematic literature search generated 16 assessment tools while the ad hoc search generated 64. Ten pain dimensions containing 1,011 pain items were identified by the experts. The experts ranked intensity, temporal pattern, treatment and exacerbating/relieving factors, location, and interference with health-related quality of life as the most important dimensions. None of the assessment tools covered these dimensions satisfactorily. Most items were related to interference (231) and intensity (138). Temporal pattern (which includes breakthrough pain), ranked as the second most important dimension, was covered by 29 items only. Many tools include dimensions and items of limited relevance for patients with advanced cancer. This might reduce compliance and threaten the validity of the assessment. New tools should reflect the clinical relevance of different dimensions and be user-friendly.

Humans↗

PubMed2006

Physicians' interpretation of the prognostic term "terminal": a survey among Norwegian physicians.

OBJECTIVE: Optimal clinical practice depends upon a precise language with common understanding of core terms. The aim of the present study was to examine how Norwegian physicians understand the commonly used but poorly defined term "terminal". METHODS: A questionnaire was mailed to 1605 Norwegian physicians, representative of the Norwegian medical community. Nine hundred and sixty-eight responded and defined "terminal" in expected weeks left to live. The effects of gender, age, specialty, and experience with prognostication toward end of life on the estimation of "terminal" were investigated. RESULTS: Norwegian physicians on average expect a "terminal" patient to have 3.6 (+/- 3.5 SD) weeks to live with expectation ranging from 0 to 26 weeks. The majority (83.5%) defined "terminal" as less than 5 weeks' survival; 15.0% as 5 to 12 weeks' survival and 1.5% as more than 12 weeks' survival. No difference between genders was observed, whereas the youngest physicians (27-39 years) held shorter definitions than the other age groups. Physicians in internal medicine, surgery, and anaesthesiology held significantly shorter estimations of "terminal" than did physicians in general practice, public health, and psychiatry. SIGNIFICANCE OF RESULTS: Our study shows that the majority of Norwegian physicians restrict "terminal" to the last 2-4 weeks of patients' lives. A life expectancy of a few days compared to several weeks should lead to different clinical actions. Efforts should therefore be made to come to a common definition of the term. In our opinion the use of "terminal" should be limited to when death is expected within a few days.

Adult↗

PubMed2006

Methodological and structural challenges in palliative care research: how have we fared in the last decades?

The heterogeneity of the palliative care population represents challenges to research methodology, including study design, informed consent (and ethical issues in general), assessment and classification of symptoms and signs, as well as practical issues in the clinic. The aim of this report is to describe and examine the status of palliative care research in Europe by means of a survey and a literature review. Only one European country, the UK, has taken a national initiative to stimulate and promote palliative care research through the supportive and palliative care collaboratives (SUPAC) in 2005. There are few European research groups in palliative care reaching a critical size, several countries do not have academic chairs in palliative care, and there is no clear trend that chairs are emerging in general. There is little public funding for palliative care research. Palliative care researchers need to compete on the 'open market' or rely on private foundations. There has been a steady increase in the number of abstracts for presentation at the EAPC Research Forums, from 200 in 2000, to 480 in 2006. The literature review indicated that the majority of publications are surveys and descriptive/observational studies, and few randomised, controlled, studies were published. In conclusion, the quantity of research seems to be steadily increasing. There may be a need for larger multi-centre studies, and in order to perform such studies, national and international structures, encompassing research above the critical size, with a multi-disciplinary background including both basic scientists and clinicians is required.

Aged↗

PubMed2005

[Pain assessment in cognitively impaired elderly patients].

BACKGROUND: Pain assessment in nursing home patients is often challenging because of cognitive failure. Demented patients receive less optimal pain treatment than those who are cognitively intact. Inappropriate pain assessment is likely to be an important reason for problems with proper diagnosis and treatment of pain in the cognitively impaired. Self-report of pain by standardized questionnaires is recommended for those with mild cognitive failure. For those who are unable to self-report, observational assessment is an alternative. MATERIALS AND METHODS: Structured pain assessment tools are reviewed, with emphasis on their feasibility in cognitively impaired patients. RESULTS: Several assessment tools for observational pain assessment are available, but none of them is satisfactory validated. Observational tools are used by a trained observer who rates behaviour indicative of pain according to pre-defined clues. The Checklist of Non-verbal Pain Indicators (CNPI) and the Doloplus-2 are both observational tools that are translated into Norwegian. The Norwegian CNPI is in an early phase of validation, while the Doloplus-2 is tested in a Norwegian pilot validation study with promising results. INTERPRETATION: It is important to establish a common standard for systematic pain assessment in the cognitively impaired, both clinically and in research. Further validation of the CNPI and the Doloplus-2 is recommended.

Aged↗

PubMed2005

The Norwegian Doloplus-2, a tool for behavioural pain assessment: translation and pilot-validation in nursing home patients with cognitive impairment.

BACKGROUND: Pain assessment is challenging in cognitively impaired (CI) patients due to inadequate self-report skills and observational ratings are an alternative. The Doloplus-2 is developed for pain assessment in the CI and rates somatic, psychomotor and psychosocial behaviours as indicators of pain. AIMS: To translate the Doloplus-2 into Norwegian, to test the Doloplus-2 with regard to criterion validity and to obtain the administrators' evaluation of the clinical performance of the Doloplus-2. METHODS: Nurses at three nursing homes, in collaboration with two research assistants, administered the Doloplus-2 to 59 patients with dementia. The results were compared against experienced clinicians' pain ratings. Regression analyses were performed to explore each different item's contribution to the total pain score. The administrators also completed a debriefing questionnaire. RESULTS: The instrument was translated according to international guidelines. Regression analyses demonstrate that the Doloplus-2 score accounts for 62% (R2) of the expert score and that the four most informative items could explain 68% of the expert score. Analyses of the different Doloplus-2 items indicate that facial expressions explain most and social life least of the expert's pain ratings. The administrators reported that Doloplus-2 was helpful and easy to administer, but questioned the validity of the psychosocial domain. CONCLUSIONS: The Norwegian Doloplus-2 demonstrates satisfactory criterion validity and clinical value in this pilot study. However, the content of the instrument needs a general re-evaluation, especially with regard to the psychosocial items.

Adult↗

PubMed2003

Quality of life in palliative care: principles and practice.

In healthcare, most researchers and clinicians agree that quality of life (QOL) is related to symptoms, functioning, psychological and social wellbeing, and probably to a lesser extent to meaning and fulfillment. This multidimensional health-oriented concept has been named health-related quality of life (HRQOL). However, during end-of-life care spirituality and existential issues become more prominent, as well as family members' perception of quality of care. Outcome measures in palliative care require constructs that reflect the specific goals of palliative care, such as improving QOL before death, symptom control, family support and satisfaction, as well as patients' perceptions of 'purpose' and 'meaning of life'. It is generally recommended that internationally developed and validated patient-rated multidimensional questionnaires should be used when assessing HRQOL in research. However, 'multidimensionality', with often more than 10 possible outcomes, is a threat both to statistical analysis and clinical interpretation of data. Preferentially, a more limited number of outcomes based upon the research question(s) should be defined prior to data collection in the study protocol. The researcher needs to carefully evaluate the content of the questionnaire, in addition to other properties, such as the validity and reliability, before the final decision is made with regards to which instrument to use in a given study.

Anxiety↗

PubMed2003

Which cancer patients die in nursing homes? Quality of life, medical and sociodemographic characteristics.

In this study, cancer patients' characteristics associated with death in nursing homes were explored. The study sample included 395 cancer patients who had participated in a trial of palliative care, 260 (66%) patients died in hospital, 80 (20%) at home and 55 (14%) in nursing homes. Health-related quality of life was prospectively recorded using the EORTC QLQ-C30 questionnaire. Death in nursing home was associated with greater age, not living with spouse and poor performance status. Patients dying in nursing homes reported severe functioning impairments and more fatigue and appetite loss compared with those dying elsewhere. The association between death in nursing homes and poor physical, role, cognitive and social functioning remained significant when sociodemographic and medical differences were taken into account. Further research on frail elderly cancer patients is warranted to improve their care, to evaluate the appropriateness of nursing home placement and for future planning of palliative care services.

Adult↗

PubMed2003

The validity of EORTC QLQ-C30 fatigue scale in advanced cancer patients and cancer survivors.

Fatigue is a major complaint among advanced cancer patients. Several instruments are available for measuring fatigue. The EORTC QLQ-C30 is one of the most frequently used health-related quality of life (HRQOL) instruments, and it includes a three-item fatigue subscale. Limited knowledge exists about the validity, performance and sensitivity of EORTC QLQ-C30 fatigue scale as compared with a fatigue-specific instrument. The aim of the present study was to validate the EORTC QLQ-C30 fatigue scale (FA) against the Fatigue Questionnaire (FQ). The FQ is frequently used and was developed to measure fatigue in both cancer and noncancer populations. The FQ measures physical (PF, seven items) and mental fatigue (MF, four items). The study population included two different cohorts: A) patients with advanced metastatic cancer included in a prospective randomized study of palliative radiotherapy (n = 238); B) patients with leukaemia and malignant lymphoma curatively treated with stem-cell transplantation and high-dose chemotherapy (n = 128). The analysis demonstrated that the FA correlated higher with the PF scale (r = 0.67-0.75) as compared with the MF scale (r = 0.49-0.61). The item scale correlations between FA items and the PF scale were consistently higher than between FA items and the MF scale. A factor analysis including all the items within the FA and the FQ identified two factors. All FA items loaded on a PF factor (0.70-0.85). A floor/ ceiling effect, indicating a high number of respondents with lowest, respectively, highest scores was observed more frequently in the FA as compared with the FQ. The PF discriminated better between diagnostic groups with different levels of fatigue than the FA did. In conclusion, the EORTC QLQ-C30 fatigue scale is measuring physical fatigue. A floor/ ceiling effect seems to appear for the EORTC QLQ-C30 fatigue scale. The validity of the EORTC QLQ-C30 fatigue scale is to be questioned for use in palliative care patients. In studies with fatigue as a defined end point, a domain-specific instrument should, therefore, be added.

Adult↗

PubMed2002

[Chronic fatigue].

Explore the source record for details and available documents.

Chronic Disease↗

PubMed2002

[Melatonin treatment of a blind child with serious sleep disorders].

BACKGROUND: Children with developmental and neurological disabilities are prone to develop serious sleep-wake cycle disorders that may be difficult to treat. MATERIAL AND METHODS: Case history. RESULTS: A 5-year old blind boy with multiple disabilities developed a chronic sleep-wake cycle disorder as his main clinical problem. Treatment included introduction of strict sleep habits and strengthening of environmental "zeitgebers". After five months melatonin 3 mg was administered at night for 4 weeks. The observation period also included 3 weeks without melatonin. Sleep was registered prospectively by a sleep diary. Strict sleep habits combined with strengthening of "zeitgebers" partially improved the sleep problems, but did not establish a normal sleep pattern. When melatonin was added, he normalized his sleep pattern in a few days. His sleep problems returned during the weeks in which he did not receive melatonin. No side effects were observed. INTERPRETATION: Melatonin is a promising treatment alternative for serious sleep problems in blind children.

Blindness↗

PubMed2002

[Melatonin treatment of sleep disorders in disabled children].

BACKGROUND: There is a high prevalence of chronic sleep-wake cycle disorders in developmentally and neurologically disabled children. Such disorders are often resistant to hypnotic and psychotropic drugs. Administration of exogenous melatonin can have an effect upon the circadian rhythm and establish a normal sleep-wake cycle. MATERIAL AND METHODS: Medline, Premedline and EBM Reviews were searched for articles on melatonin treatment of sleep-wake cycle disorders in children. Additionally, sleep was registered systematically in 15 developmentally or neurologically disabled children treated with melatonin. RESULTS AND INTERPRETATION: The search identified 75 articles of which 33 included neurologically or developmentally disabled children. Reported results generally indicate that melatonin improves sleep-wake cycle disorders in these children. However, the majority of studies were open, and knowledge about side effects and long-term effects is limited. Our own experience is in accordance with the literature; melatonin had positive effects in 13 children. Suggestions for practical use of melatonin in disabled children are presented.

Administration, Oral↗

PubMed2002

The Norwegian brief pain inventory questionnaire: translation and validation in cancer pain patients.

The European Association of Palliative Care recommends the Brief Pain Inventory questionnaire (BPI) as a pain assessment tool in clinical studies. After translation into Norwegian, we administered the BPI to 300 hospitalized cancer patients. Cronbach's alphas were computed to assess reliability, and factor analysis was utilized to ascertain construct validity. The BPI interference and pain severity scales were validated against items on pain intensity and pain influence on daily function in the European Organization for Research and Therapy of Cancer (EORTC) QLQ-C30 questionnaire. In total, 235 patients (78%) were able to complete the BPI questionnaire, but 82 (35%) of these questionnaires had one or more missing items. Cronbach's alphas were 0.87 for the pain severity and 0.92 for the interference scales. A factor analysis identified three factors; pain intensity, interference with physical function, and interference with psychological functions/sleep. These three factors explained 82% of the variance. The correlation between BPI pain severity index and the EORTC QLQ-C30 item on pain intensity was 0.70 (P < 0.001). The correlation between BPI interference index and the EORTC QLQ-C30 item on pain influence on daily living was 0.62 (P < 0.001). We conclude that BPI has satisfactory psychometric properties, but is not completed by a significant proportion of patients. Further research is needed to establish pain assessment tools for patients unable to answer a comprehensive pain questionnaire, to establish routines for analysis of missing values, and to investigate if pain interference items also reflect disease-related impairment.

Adult↗

PubMed2002

Subjective health status in Norwegian patients with Addison's disease.

OBJECTIVE: Many patients with Addison's disease have complaints that might be related to the disease or to its treatment. However, only a few studies have addressed the subjective health status of patients with adrenocortical failure. The aim of the present study was to assess the subjective health status with special emphasis on fatigue among patients with Addison's disease. SUBJECTS, DESIGN AND MEASUREMENT: In a postal survey, 79 patients with confirmed primary adrenal failure (Addison's disease) completed the Short Form 36 (SF-36) and the Fatigue questionnaires. The subjective health status in Addison's disease was compared with normative data from the general population. RESULTS: General health and vitality perception were most consistently impaired in the patients with Addison's disease. The scores on physical functioning and role-physical were low in women. Social functioning and role-emotional scores were also lower than normal in the female patients, but this was confined to the patients with autoimmune polyendocrine syndromes. Patients with autoimmune polyendocrine syndromes tended to have lower scores than patients with solitary Addison's disease. The level of fatigue was higher than normal for both men and women. Working disability at ages 18-67 years was 26%, compared with 10% in the corresponding general Norwegian population. The high working disability increased with age and was higher in subgroups with concomitant endocrine diseases. Most subjective health parameters were lower among the disabled compared to the patients in work. CONCLUSIONS: Patients with Addison's disease under replacement therapy with cortisone acetate and fludrocortisone have reduced general health perception and vitality, and increased fatigue. Female patients reported reduced physical function, which might be due to adrenal androgen depletion. Mental health seems more influenced by concomitant endocrine diseases, but mental fatigue might be a specific feature in adrenal failure. The patient population is heterogeneous, with normal findings in a substantial proportion but markedly reduced subjective health status and working ability in many others. Thus, there might be potential for further refinement of replacement therapy.

Addison Disease↗