Identifying Palliative Care Needs in Patients With Heart Failure Using Patient Reported Outcomes.

CONTEXT: Heart failure (HF) is considered a multifaceted and life-threatening syndrome characterized by high symptom-burden and significant mortality. OBJECTIVES: To describe the symptom-burden in patients with HF and identify their palliative care needs. In this respect, symptom burden related to sex, age and classification of HF using New York Heart Association Functional Classification (NYHA) were analyzed. METHODS: A cross-sectional questionnaire survey included adult HF patients according to NYHA II, III, and IV. Palliative care needs were assessed using validated patient reported outcomes measures; SF-36v1, HeartQoL, EORTC- QLQ-C15-PAL, MFI-20 and HADS. Patients were recruited from the Department of Cardiology, North Zealand Hospital, Denmark. RESULTS: In total, 314 patients (79%) completed the questionnaire (233 men). Mean age = 74 years (range 35-94 years). In all, 42% had NYHA III or IV and 53% self-rated their health to be fair or poor. In all, 19% NYHA II and 67% NYHA III/IV patients had ≥4 severe palliative symptoms according to EORTC-QLQ-C15-PAL. In addition, NYHA III/IV had a mean of 8.9 symptoms and a mean of 5.4 severe symptoms. Women, older patients, and those with NYHA III/IV had worse outcomes regarding health-related quality of life, functional capacity, and symptom burden. CONCLUSIONS: Patients with HF have a high prevalence of symptoms and, thus, potential palliative care needs. Predominantly, women, older patients, and those with higher severity of disease have the highest symptom burden. PROMs can help cardiologists address the palliative care needs and systematic assessment may be a prerequisite to integrate symptom-modifying and palliative care interventions.

Co-Occurrence of Prevalent Symptoms in Patients Receiving Hemodialysis - A Cross-Sectional Survey.

Patients with chronic kidney disease undergoing hemodialysis generally have a significant symptom burden, which may interfere with their quality of life. The aim of this study was to identify the prevalence of fatigue, pain, anxiety, and depression in patients on hemodialysis and analyze their co-occurrence. A cross-sectional study used self-reported measures. A total of 242 patients aged 18 years or older were initially screened; 141 were included in the study; 129 answered the questionnaires (response rate 91%). Preva lences were 24.8% had moderate to severe fatigue, 38.0% had pain, 32.6% had anxiety, and 29.5% had depression. The prevalence of coexistent moderate to severe symptoms ranged from 15.5% to 25.6%. Further research is needed to better understand the symptom burden and their co-occurrence in patients receiving hemodialysis.

The impact of caring on caregivers of patients with life-threatening organ failure.

OBJECTIVES: This study aimed at characterizing 3 populations of family/friend caregivers of patients with different life-threatening organ failure regarding health-related quality of life, caregiver burden, and dyadic coping. METHODS: Three cross-sectional (population) studies were conducted at a tertiary hospital in Denmark (2019-2020). Patients with renal failure (RF), cystic fibrosis (CF), and intestinal failure (IF) were asked to designate the closest person with ≥18 years old involved in the care (caregiver) to participate in this study. Number of caregivers included were RF = 78, CF = 104, and IF = 73. Electronic questionnaires were filled in by caregivers to assess health-related quality of life and caregiver burden and by caregivers and respective patients to assess dyadic coping. RESULTS: The 3 caregiver groups had self-perception of poor health and energy; however, caregivers of CF patients perceived their physical role functioning better than those caregiving for RF and IF patients (p = 0.002). The level of caregiver burden was reported as not high, but caregivers used in average 13 hours/day for caring. Moreover, cleaning tasks (p = 0.005) and personal care (p = 0.009) were more demanding in RF and IF patients. Caregivers also did not differ regarding dyadic coping. When comparing patients and caregivers, stress communication by oneself and the partner differed (p < 0.001). SIGNIFICANCE OF RESULTS: Caregivers spent many hours in the care role, they reported poor health, and dyadic coping may be improved. Interventions in caregivers of patients with life-threatening organ failure could help to improve care management at home, caregiver's health, and dyadic coping between caregiver and patient and consequently reduce caregiver burden.

Mechanistic studies on the effect of easy degradable carbon on pharmaceuticals removal in intermittently fed moving bed biofilm reactors.

This study was conducted to provide for the first time systematic data on how intermittent feeding with carbon (ethanol) affects the kinetics of pharmaceuticals degradation in a moving bed biofilm reactor (MBBR). The relationship between the degradation rate constants (K) of 36 pharmaceuticals and the length of famine was tested with 12 different feast-famine ratios: For 17 pharmaceuticals, intermittent feeding increased K with a factor of 3-17, while for six other pharmaceuticals, it decreased K. Concerning intermittent loading, three dependencies were detected: 1) for some compounds (e.g., valsartan, ibuprofen, iohexol), the K decreased linearly with carbon loading, 2) for three compounds (2 sulfonamides and benzotriazole) K increased linearly with carbon loading 3) for most compounds (e.g., beta blockers, macrocyclic antibiotics, candesartan, citalopram, clindamycin, gabapentin) K had a maximum around 6 d famine (with 2 d feast). Optimizing processes on MBBRs need therefore be conducted based on a prioritization of compounds.

Identification of palliative care needs in hemodialysis patients: An update.

OBJECTIVE: End-stage kidney disease and hemodialysis (HD) treatment are associated with a high symptom burden in many patients. This study aimed at updating patient-reported outcomes concerning quality of life, fatigue, anxiety, and depression in HD patients treated in a single center in order to assess the need for palliative care provision. METHOD: A cross-sectional design, in which a sample of patients treated at a single HD department (Rigshospitalet, Denmark) between January and June 2019, was analyzed using the Kidney Disease Quality of Life Short Form, the Multidimensional Fatigue Inventory, and the Hospital Anxiety and Depression Scale. In addition, we compared the results with previously published data from the same department (2000) and with an age- and sex-matched sample from the Danish general population (1997/2014). Chi-square and t-tests were used for comparisons. RESULTS: Screened patients = 242, included = 141, analyzed = 131 (70.2% male, mean age = 61.3 years). HD patients reported low scores for quality of life, high scores for fatigue, and approximately 30% had anxiety/depression. Regarding quality of life, they had significantly lower scores on general health (P ≤ 0.000), vitality (P = 0.009), social functioning (P = 0.001), mental health (P = 0.007), and mental component (P = 0.005) compared with former data of HD patients. Moreover, they reported significantly poorer quality of life and worse fatigue compared with the general Danish population. SIGNIFICANCE OF RESULTS: In the patients undergoing HD, quality of life was poor and worsened when compared with former HD patients' data. Additionally, fatigue, depression, and anxiety in HD patients were prevalent. A clear need for palliative care provision was observed.

Ex-situ bioremediation of polycyclic aromatic hydrocarbons in sewage sludge.

Polycyclic aromatic hydrocarbons (PAH) are regarded as environmental pollutants. A promising approach to reduce PAH pollution is based on the implementation of the natural potential of some microorganisms to utilize hydrocarbons. In this study Proteiniphilum acetatigenes was used for bioaugmentation of sewage sludge to improve the PAH removal. Bioaugmentation experiments were performed in parallel semi-continuously fed reactors started up with digested primary and secondary sludge. Three bioaugmentation approaches were investigated: A1, addition of bacteria once during starting up; A2, addition of bacteria at the beginning and then every 2nd day and A3, addition of encapsulated bacteria once during starting up. Removal of PAH was found to be both biotic and abiotic. All three approaches had a positive effect of the biological removal of PAH. Highest biological removal of individual PAH (up to 80%) was observed using continuous addition (approach A2) of the bacteria to the reactors. In general, the effect of bioaugmentation was higher in the reactors fed with primary sludge compared to the reactors fed with mixed sludge. Bioaugmentation resulted in biological removal of low molecular weight PAH in the reactors fed with primary sludge using all three approaches while clear biological removal of the medium- and high molecular weight PAH only was observed if the bacteria were added continuously (approach A2).