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Book: Handbuch Palliativmedizin

Bally, Klaus / Büche, Daniel / Fusi-Schmidhauser, Tanja / Pautex, Sophie / Vayne-Bossert, Petra

2021

Author's details	Klaus Bally, Daniel Büche, Tanja Fusi-Schmidhauser, Sophie Pautex, Petra Vayne-Bossert (Hrsg.) ; unter Mitarbeit von Johanna Anneser [und vielen weiteren]
Keywords	Palliative Care ; Symptome ; Palliativmedizin ; Schmerzen ; Palliativpflege ; Patientengeschichte ; Fortschritte ; Grundversorgung ; Hämatologie ; Lebensqualität ; Onkologie ; Gesundheitsberufe ; Spezialisten ; Krebskranke ; Ärzte ; Weiterbildung ; Ausbildung ; Sterbebegleitung
Subject	Palliative care ; Palliative Pflege ; Palliative Krankenpflege ; Sterbehilfe ; Sterben ; Sterbebeistand ; Sterbender ; Thanatotherapie ; Orthothanasie ; Palliative Medizin
Language	German
Size	574 Seiten, Illustrationen, Diagramme
Edition	4., aktualisierte und ergänzte Auflage
Publisher	Hogrefe AG
Publishing place	Bern
Publishing country	Switzerland
Document type	Book
Old title	Vorangegangen ist
HBZ-ID	HT020688191
ISBN	978-3-456-85969-9 ; 3-456-85969-4 ; 9783456759692 ; 9783456959696 ; 345675969X ; 3456959699
Database	Catalogue ZB MED Medicine, Health

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2021 A 1133	available for loan (reading room)	Lesesaal EG

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Article: Palliative Care For Patients with Advanced COPD in Primary Care.

Fusi-Schmidhauser, Tanja

Praxis

2021 Volume 110, Issue 15, Page(s) 902–906

Abstract: Patients with advanced COPD have a high symptom burden that is often multidimensional. Identification of patients who might benefit from palliative care through validated identification tools, multidimensional symptom management, and timely discussion of ...

Abstract	Patients with advanced COPD have a high symptom burden that is often multidimensional. Identification of patients who might benefit from palliative care through validated identification tools, multidimensional symptom management, and timely discussion of advance planning are elements of a palliative care approach for these patients and their families. Coordination among stakeholders providing care and support to these patients is central to ensuring high-quality care and meeting all of their needs.
MeSH term(s)	Humans ; Palliative Care ; Primary Health Care ; Pulmonary Disease, Chronic Obstructive/therapy
Language	English
Publishing date	2021-11-22
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	209026-0
ISSN	1661-8165 ; 1661-8157 ; 0369-8394
ISSN (online)	1661-8165
ISSN	1661-8157 ; 0369-8394
DOI	10.1024/1661-8157/a003790
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Article ; Online: Dexmedetomidine: a magic bullet on its way into palliative care-a narrative review and practice recommendations.

Gaertner, Jan / Fusi-Schmidhauser, Tanja

Annals of palliative medicine

2022 Volume 11, Issue 4, Page(s) 1491–1504

Abstract: Background and objective: Dexmedetomidine is a potent adrenergic alpha-2 receptor agonist. It was first approved for sedation for mechanically ventilated patients. Being a sedative medication that is not associated with respiratory depression and ... ...

Abstract	Background and objective: Dexmedetomidine is a potent adrenergic alpha-2 receptor agonist. It was first approved for sedation for mechanically ventilated patients. Being a sedative medication that is not associated with respiratory depression and holding analgesic properties fosters the interest for this drug in the palliative care field. The primary objectives of this review were to identify the key indications for the real-world use of dexmedetomidine in palliative care and other disciplines. Methods: A narrative review after extensive PubMed search was performed from 1950 to present on October 21st 2021. The language of the publications was restricted to English, German, French and Italian. Key content and findings: (I) Current dexmedetomidine use. There is a growing body of evidence that dexmedetomidine may reduce the incidence and severity of delirium, reduce opioid-consumption and postoperative nausea in intensive care settings. It is also used to facilitate withdrawal from different substances (alcohol, opioids, heroin). Concerning safety aspects of the drug, some studies reported an increased rate of serious cardiovascular events in patients with pre-existing heart conditions due to bradycardia and arterial hypo- and hypertension. Since the drug has a main hepatic metabolism, dose reduction is mandatory in patients with hepatic impairment. (II) Dexmedetomidine and palliative care. There have been sporadic case reports about the successful use of dexmedetomidine in palliative care. Indications for symptom control included sedation for hyperactive delirium, cancer pain, opioid-induced-hyperalgesia, dystonia, cough, vomiting, shivering and dyspnea. It is mainly applied via the intravenous (i.v.), subcutaneous, but also nasal and, buccal routes. Admixture ("syringe-driver") studies showed that dexmedetomidine is compatible with morphine, hydromorphone, hyoscine and haloperidol. In 2021, a first prospective cohort study became available. Here, the authors reported promising result for dexmedetomidine use in hyperactive terminal delirium for reducing delirium intensity and agitation. Especially the unique "conscious sedation" or "awake sedation" that allows patients to arouse easily under sedation and report comfort or distress was discussed by the authors. Conclusions: In this review, we present the main findings for dexmedetomidine from palliative care settings and other disciplines. The potential benefits and criticalities of the drug are discussed and practical recommendations for its use are provided.
MeSH term(s)	Analgesics, Opioid/therapeutic use ; Delirium/chemically induced ; Delirium/drug therapy ; Dexmedetomidine/therapeutic use ; Humans ; Palliative Care ; Prospective Studies ; Psychomotor Agitation/drug therapy
Chemical Substances	Analgesics, Opioid ; Dexmedetomidine (67VB76HONO)
Language	English
Publishing date	2022-04-06
Publishing country	China
Document type	Journal Article ; Review
ZDB-ID	2828544-X
ISSN	2224-5839 ; 2224-5839
ISSN (online)	2224-5839
ISSN	2224-5839
DOI	10.21037/apm-21-1989
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Article ; Online: Correction to: The role of palliative care in relapsed and metastatic head and neck cancer patients in a single ESMO integrated oncology and palliative care centre.

Espeli, Vittoria Guro / Fusi-Schmidhauser, Tanja / Mangan, Dylan / Gamondi, Claudia

European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery

2022 Volume 279, Issue 12, Page(s) 5903

Language	English
Publishing date	2022-08-05
Publishing country	Germany
Document type	Published Erratum
ZDB-ID	1017359-6
ISSN	1434-4726 ; 0937-4477
ISSN (online)	1434-4726
ISSN	0937-4477
DOI	10.1007/s00405-022-07583-5
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Article: Hypercalcemia: An Underestimated Value Always Good for a Surprise.

Di Giulio, Vincenzo / Fusi-Schmidhauser, Tanja / Pons, Marco

Praxis

2021 Volume 110, Issue 2, Page(s) 97–100

Abstract: We present the unusual case of a 62-year-old male with profound asthenia and dyspnea for the last two months. Blood exams showed a severe hypercalcemia. Suspecting an underlying malignancy, we performed a 18F-FDG PET-CT, revealing widespread metabolic ... ...

Abstract	We present the unusual case of a 62-year-old male with profound asthenia and dyspnea for the last two months. Blood exams showed a severe hypercalcemia. Suspecting an underlying malignancy, we performed a 18F-FDG PET-CT, revealing widespread metabolic uptakes in muscles, consistent with an inflammatory process. The muscular biopsy showed a non-necrotising granuloma with multinucleated giant cells, pathognomonic for the diagnosis of acute isolated muscular sarcoidosis. A high-dose steroid therapy was started with clinical improvement and serum calcium normalization.
MeSH term(s)	Fluorodeoxyglucose F18 ; Humans ; Hypercalcemia/diagnosis ; Hypercalcemia/drug therapy ; Hypercalcemia/etiology ; Male ; Middle Aged ; Positron Emission Tomography Computed Tomography ; Positron-Emission Tomography ; Radiopharmaceuticals
Chemical Substances	Radiopharmaceuticals ; Fluorodeoxyglucose F18 (0Z5B2CJX4D)
Language	English
Publishing date	2021-12-31
Publishing country	Switzerland
Document type	Case Reports ; Journal Article
ZDB-ID	209026-0
ISSN	1661-8165 ; 1661-8157 ; 0369-8394
ISSN (online)	1661-8165
ISSN	1661-8157 ; 0369-8394
DOI	10.1024/1661-8157/a003801
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Article ; Online: Effect of opioids for breathlessness in heart failure: a systematic review and meta-analysis.

Gaertner, Jan / Fusi-Schmidhauser, Tanja / Stock, Stephanie / Siemens, Waldemar / Vennedey, Vera

Heart (British Cardiac Society)

2023 Volume 109, Issue 14, Page(s) 1064–1071

Abstract: Background: For the treatment of breathlessness in heart failure (HF), most textbooks advocate the use of opioids. Yet, meta-analyses are lacking.: Methods: A systematic review was performed for randomised controlled trials (RCTs) assessing effects ... ...

Abstract	Background: For the treatment of breathlessness in heart failure (HF), most textbooks advocate the use of opioids. Yet, meta-analyses are lacking. Methods: A systematic review was performed for randomised controlled trials (RCTs) assessing effects of opioids on breathlessness (primary outcome) in patients with HF. Key secondary outcomes were quality of life (QoL), mortality and adverse effects. Cochrane Central Register of Controlled Trials, MEDLINE and Embase were searched in July 2021. Risk of bias (RoB) and certainty of evidence were assessed by the Cochrane RoB 2 Tool and Grading of Recommendations Assessment, Development and Evaluation criteria, respectively. The random-effects model was used as primary analysis in all meta-analyses. Results: After removal of duplicates, 1180 records were screened. We identified eight RCTs with 271 randomised patients. Seven RCTs could be included in the meta-analysis for the primary endpoint breathlessness with a standardised mean difference of 0.03 (95% CI -0.21 to 0.28). No study found statistically significant differences between the intervention and placebo. Several key secondary outcomes favoured placebo: risk ratio of 3.13 (95% CI 0.70 to 14.07) for nausea, 4.29 (95% CI 1.15 to 16.01) for vomiting, 4.77 (95% CI 1.98 to 11.53) for constipation and 4.42 (95% CI 0.79 to 24.87) for study withdrawal. All meta-analyses revealed low heterogeneity (I Conclusion: Opioids for treating breathlessness in HF are questionable and may only be the very last option if other options have failed or in case of an emergency. Prospero registration number: CRD42021252201.
MeSH term(s)	Humans ; Analgesics, Opioid/adverse effects ; Dyspnea/drug therapy ; Dyspnea/etiology ; Heart Failure/complications ; Heart Failure/drug therapy
Chemical Substances	Analgesics, Opioid
Language	English
Publishing date	2023-06-26
Publishing country	England
Document type	Meta-Analysis ; Systematic Review ; Journal Article
ZDB-ID	1303417-0
ISSN	1468-201X ; 1355-6037
ISSN (online)	1468-201X
ISSN	1355-6037
DOI	10.1136/heartjnl-2022-322074
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Article ; Online: Palliative care integration for patients with advanced chronic obstructive pulmonary disease (COPD): Identifying essential components using participatory action research.

Fusi-Schmidhauser, Tanja / Froggatt, Katherine / Preston, Nancy

Palliative medicine

2021 Volume 35, Issue 10, Page(s) 1933–1940

Abstract: Background: Chronic obstructive pulmonary disease (COPD) is a life-limiting condition with palliative care needs. Despite increasing awareness about the role palliative care can play in care provision for patients with advanced COPD, integration in ... ...

Abstract	Background: Chronic obstructive pulmonary disease (COPD) is a life-limiting condition with palliative care needs. Despite increasing awareness about the role palliative care can play in care provision for patients with advanced COPD, integration in standard care remains underdeveloped. The unpredictability of the disease progression and misconceptions about palliative care being equivalent to end-of-life care often prevent a timely integrated approach in advanced COPD. Aim: To identify practices designed to increase integration of palliative care in the management of patients with advanced COPD in a respiratory service in Southern Switzerland. Design: A participatory action research approach was chosen and key stakeholders were involved to develop new knowledge and practices, supported by a Theory of Change framework. Data from each cycle and retrospective analysis at the end of the whole research were analysed using thematic analysis. Setting/participants: Five action research cycles with seven healthcare professionals working in palliative or respiratory care settings were conducted. Results: Three elements of integrated palliative care in advanced COPD were identified: multidimensional assessment, healthcare professionals' education and interdisciplinary team meetings, which are the pillars of a new integrated palliative care model for patients with advanced COPD. Conclusions: The new integrated palliative care model in advanced COPD includes essential elements with a focus on patients, healthcare professionals and care delivery. Further research on testing this model in clinical practice, service development, implementation processes and possible outcomes, including evaluation of the financial impact of integrated palliative care is necessary to foster this care approach across all possible settings.
MeSH term(s)	Health Services Research ; Hospice and Palliative Care Nursing ; Humans ; Palliative Care ; Pulmonary Disease, Chronic Obstructive/therapy ; Retrospective Studies
Language	English
Publishing date	2021-10-26
Publishing country	England
Document type	Journal Article
ZDB-ID	639247-7
ISSN	1477-030X ; 0269-2163
ISSN (online)	1477-030X
ISSN	0269-2163
DOI	10.1177/02692163211028972
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Article ; Online: Pancreatic Pseudocysts in the Mediastinal Space: An Urban Legend?

Blanc, Jérôme / Fusi-Schmidhauser, Tanja

European journal of case reports in internal medicine

2019 Volume 6, Issue 9, Page(s) 1228

Abstract: Pancreatic pseudocysts are a frequent complication of chronic pancreatitis. Nonetheless, they seldom extend beyond the peripancreatic region. However, migration towards the mediastinum may cause heterogeneous and non-specific symptoms, such as dysphagia, ...

Abstract	Pancreatic pseudocysts are a frequent complication of chronic pancreatitis. Nonetheless, they seldom extend beyond the peripancreatic region. However, migration towards the mediastinum may cause heterogeneous and non-specific symptoms, such as dysphagia, chest pain and dyspnoea, which depend on the localization and extension of the cysts. We present the case of a patient with chronic pancreatitis who was admitted to our ward for low-grade fever and mild dyspnoea and who rapidly developed bilateral laterocervical swelling associated with acute dyspnoea and trismus. A total body CT scan showed multiple abdominal pancreatic pseudocysts, one of which had migrated to the mediastinum and towards the retropharyngeal space. Clinicians should always consider the possibility of extra-pancreatic pseudocysts in patients with known pancreatitis so that uncommon clinical presentations with a potentially fatal outcome will be recognized. Learning points: Mediastinal pancreatic pseudocysts are a rare manifestation of acute and chronic pancreatitis.The clinical presentation of mediastinal pancreatic pseudocysts is variable, and they may rarely have a fatal outcome.
Language	English
Publishing date	2019-09-04
Publishing country	Italy
Document type	Journal Article
ISSN	2284-2594
ISSN (online)	2284-2594
DOI	10.12890/2019_001228
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Article ; Online: The role of palliative care in relapsed and metastatic head and neck cancer patients in a single ESMO integrated oncology and palliative care centre.

Espeli, Vittoria Guro / Fusi-Schmidhauser, Tanja / Mangan, Dylan / Gamondi, Claudia

2022 Volume 279, Issue 12, Page(s) 5897–5902

Abstract: Background: Palliative care (PC) for patients with advanced cancer improves symptom management and quality of life and may promote home deaths. Limited data are available regarding PC in advanced head and neck cancer (HNC) patients. The aim of this ... ...

Abstract	Background: Palliative care (PC) for patients with advanced cancer improves symptom management and quality of life and may promote home deaths. Limited data are available regarding PC in advanced head and neck cancer (HNC) patients. The aim of this study was to describe the type of care and modalities of integration of specialized PC in a population of relapsed and/or metastatic head and neck cancer patients, followed in a single institution over 4 years. Methods: Between January 2016 and December 2019, data on patients with relapsed and/or metastatic head and neck cancer not suitable for curative treatment diagnosed at the Oncology Institute of Southern Switzerland were reviewed retrospectively. Site, type and lines of treatment, treatment response, referral to specialist palliative care (yes or no), type of symptoms, tracheostomy and/or feeding-tube presence, and site of death were documented. Comparisons were made between patients benefitting from PC integration vs standard care. Results: Eighty-six patients with relapsed/metastatic HNC were identified, 63 (73.3%) of whom were referred to specialized PC. Patients were mainly men (66, 76.7%), with a median age of 69 years (range 44-95). The most common site of tumour was the oropharynx (31, 36%), followed by the larynx (21, 24.4%), oral cavity (19, 22.1%), hypopharynx (14, 16.3%), and unknown primary (1, 1.2%). Forty-four patients (51.2%) were treated with systemic treatment. The median time interval between the diagnosis and palliative care referral was 1.7 months. At the time of our analysis, 69 patients had died (58 in the PC group and 11 in the non-PC group). Fifteen patients (25.9%) in the PC group and 4 (36.4%) in the non-PC group had received aggressive treatment (chemotherapy, tracheostomy and/or feeding tube) in the last month of life, with no significant difference between groups (p = 0.44). There was no difference in the incidence of home death (19.1% PC group vs 9.1% non-PC group, p = 0.67) or presence of caregiver (69.8% PC group vs 78.2% non-PC group, p = 0.58) between groups, while palliative care was associated with more opioid use (90.5% vs 17.4%, p < 0.0001). Patients in the PC group had a shorter survival compared to the non-PC group (5.7 vs 19.9 months, p = 0.0063). Conclusions: This study shows that patients appear to be at risk of receiving inappropriate invasive treatments close to death and of dying in hospital settings. Further research is needed to investigate how early PC may affect decision-making around treatments and improve HNC patients' holistic wellbeing.
MeSH term(s)	Male ; Humans ; Adult ; Middle Aged ; Aged ; Aged, 80 and over ; Female ; Palliative Care ; Retrospective Studies ; Quality of Life ; Medical Oncology ; Head and Neck Neoplasms/therapy ; Neoplasms
Language	English
Publishing date	2022-07-12
Publishing country	Germany
Document type	Journal Article
ZDB-ID	1017359-6
ISSN	1434-4726 ; 0937-4477
ISSN (online)	1434-4726
ISSN	0937-4477
DOI	10.1007/s00405-022-07535-z
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Article ; Online: Should end-of-life patients be enrolled as participants in clinical research? A best-fit framework synthesis.

Oriani, Anna / Fusi-Schmidhauser, Tanja / Guo, Ping

Journal of advanced nursing

2020 Volume 77, Issue 4, Page(s) 1656–1666

Abstract: Aim: To identify and appraise evidence about ethical concerns regarding conducting medical research with end-of-life patients.: Design: A best-fit framework synthesis of the literature regarding ethical issues in research involving adult patients at ... ...

Abstract	Aim: To identify and appraise evidence about ethical concerns regarding conducting medical research with end-of-life patients. Design: A best-fit framework synthesis of the literature regarding ethical issues in research involving adult patients at the end of life was conducted. Data sources: Five databases were searched (Cumulative Index to Nursing and Allied Health Literature, Web of Science, Embase, MEDLINE, and PsychINFO) between January 2000-August 2019. Review methods: Data were synthesized and categorized according to the moral positions described by Foster. Results: In all, 18 papers that met the inclusion criteria were included in this review. These papers provided rich knowledge not only about various ethical objections to researching the end of life but also about the social, moral, and clinical requirements to perform rigorous studies on clinical interventions in this field. Conclusions: Research on people at end of life is not an unsolvable ethical dilemma between providing the best possible care and enhancing new therapies. It is important to find a balance between the moral duties of providing care and achieving research outcomes that are rigorous and meaningful for service users. Impact: Research ethics committees can be challenged by the evaluation of human research. This review provides up-to-date evidence on key challenges and ethical considerations about researching with end-of-life patients. Summary statement: This study is a review of relevant evidence and key ethical challenges and issues around palliative and end-of-life research. Our findings provided important recommendations for clinicians, research, and ethics committee members when evaluating clinical research with people at their end of life.
MeSH term(s)	Adult ; Death ; Humans ; Morals ; Palliative Care
Language	English
Publishing date	2020-12-08
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	197634-5
ISSN	1365-2648 ; 0309-2402
ISSN (online)	1365-2648
ISSN	0309-2402
DOI	10.1111/jan.14712
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