PeerJ Preprints: Palliative Carehttps://peerj.com/preprints/index.atom?journal=peerj&subject=6090Palliative Care articles published in PeerJ PreprintsThe investigation of polymorph transition of erlotinib saltshttps://peerj.com/preprints/18352016-03-072016-03-07Wioleta MaruszakMarta ŁaszczKinga TrzcińskaWojciech ŁuniewskiKrzysztof BańkowskiKamil Jatczak
Erlotinib is a reversible tyrosine kinase inhibitor, which acts on the epidermal growth factor receptor (EGFR) and is used to treat non-small cell lung cancer (NSCLC), pancreatic cancer and several other types of cancer [1]. It is known that erlotinib forms different salts which can exist in multiple crystalline solid forms. This important property known as a polymorphism may have an impact on physical and chemical stability of the drug substance (API), processability during manufacturing in the final drug product and bioavailability of the drug to the patient. Changes in the crystal structure of API can lead to the undesired changes in properties. Hence, the control of the polymorphic form is essential during the drug substance manufacture and requires a thorough understanding of solid-state changes that may occur in pharmaceutical materials. To achieve a comprehensive understanding of solid-state transformations different analytical techniques are applied. In our studies the variable–temperature powder X-ray diffraction (VT–PXRD), differential scanning calorimetry (DSC), thermogravimetry (TGA), Fourier transformed infrared (FTIR), attenuated total reflectance (ATR) and Raman spectroscopy were used to investigate the correlation between the thermal behavior and structural transformations of polymorphic forms of erlotinib salts. VT-PXRD method has detected the temperature range of the existence of polymorphic transitions, spectroscopy methods have characterized intramolecular vibrations and thermal methods have provided information on the transition and melting temperature and relationships between polymorphic forms.
Erlotinib is a reversible tyrosine kinase inhibitor, which acts on the epidermal growth factor receptor (EGFR) and is used to treat non-small cell lung cancer (NSCLC), pancreatic cancer and several other types of cancer [1]. It is known that erlotinib forms different salts which can exist in multiple crystalline solid forms. This important property known as a polymorphism may have an impact on physical and chemical stability of the drug substance (API), processability during manufacturing in the final drug product and bioavailability of the drug to the patient. Changes in the crystal structure of API can lead to the undesired changes in properties. Hence, the control of the polymorphic form is essential during the drug substance manufacture and requires a thorough understanding of solid-state changes that may occur in pharmaceutical materials. To achieve a comprehensive understanding of solid-state transformations different analytical techniques are applied. In our studies the variable–temperature powder X-ray diffraction (VT–PXRD), differential scanning calorimetry (DSC), thermogravimetry (TGA), Fourier transformed infrared (FTIR), attenuated total reflectance (ATR) and Raman spectroscopy were used to investigate the correlation between the thermal behavior and structural transformations of polymorphic forms of erlotinib salts. VT-PXRD method has detected the temperature range of the existence of polymorphic transitions, spectroscopy methods have characterized intramolecular vibrations and thermal methods have provided information on the transition and melting temperature and relationships between polymorphic forms.Certified Family Service Coordinator: A model for professional practice and recognitionhttps://peerj.com/preprints/16172015-12-302015-12-30Donald B. Stouder
The use of the Family Service Coordinator is still a relative newcomer to the organ procurement/transplantation field. Since no comprehensive training and recognition program exists, Lifesharing, A Donate Life Organization, decided to develop a Certified Family Service Coordinator program. We defined the goals of the program as 1) to improve the care we provide to our families and increase consent for organ donation; 2) to streamline and standardize our best practices; 3) to learn new skills and improve individual understanding and practice; 4) to share our own wealth of experience; and 5) to provide professional certification and recognition. In addition, given the limitations of time and resources that affect most organ procurement organizations, we wanted to see if a comprehensive training program could be developed using resources that were easily and inexpensively acquired on the Internet.
The use of the Family Service Coordinator is still a relative newcomer to the organ procurement/transplantation field. Since no comprehensive training and recognition program exists, Lifesharing, A Donate Life Organization, decided to develop a Certified Family Service Coordinator program. We defined the goals of the program as 1) to improve the care we provide to our families and increase consent for organ donation; 2) to streamline and standardize our best practices; 3) to learn new skills and improve individual understanding and practice; 4) to share our own wealth of experience; and 5) to provide professional certification and recognition. In addition, given the limitations of time and resources that affect most organ procurement organizations, we wanted to see if a comprehensive training program could be developed using resources that were easily and inexpensively acquired on the Internet.Gastric Cancer Transcription Factors in Patient Reported Outcomes (GCTF-PRO) – Draft proposalhttps://peerj.com/preprints/13442015-09-052015-09-05Sonia Lee
The GCTF-PRO seeks to examine the extent gastric cancer patients are tapping into new information particularly outside of conventional healthcare disclosures. Its significance is in assessing dimensions of QOL paradigms that frame statistical power using predictive methods. It seeks to embed evidence-based theories (perceptual and cognitive) to awareness levels in an attempt to bridge the biotechnological advances with prognostic/ diagnostic-related patient satisfactions. At present, it may complement existing GC QOL instruments and offer a novel approach on how cellular level prognoses could possibly correlate with QOL measures.
The GCTF-PRO seeks to examine the extent gastric cancer patients are tapping into new information particularly outside of conventional healthcare disclosures. Its significance is in assessing dimensions of QOL paradigms that frame statistical power using predictive methods. It seeks to embed evidence-based theories (perceptual and cognitive) to awareness levels in an attempt to bridge the biotechnological advances with prognostic/ diagnostic-related patient satisfactions. At present, it may complement existing GC QOL instruments and offer a novel approach on how cellular level prognoses could possibly correlate with QOL measures.Suffering and mental health among older people living in nursing homes - a mixed-methods studyhttps://peerj.com/preprints/9432015-04-012015-04-01Jorunn DragesetElin DysvikBirgitte EspehaugGerd Karin NatvigBodil Furnes
Background. Knowledge about mixed-methods perspectives that examine anxiety, depression, social support, mental health and the phenomenon of suffering among cognitively intact NH residents is scarce. We aimed to explore suffering and mental health among cognitively intact NH residents. Methods. This study used a mixed-methods design to explore different aspects of the same phenomena of interest to gain a more comprehensive understanding. The qualitative core component comprised a qualitative interview from 18 nursing home residents (≥65 years) about experiences related to pain, grief and loss. The supplementary component comprised interview from the same respondents using the SF-36 Health Survey subscales , the Hospital Anxiety and Depression Scale and the Social Provisions Scale. Results. The individual descriptions reveal suffering caused by painful experiences during life. The quantitative results indicated that symptoms of anxiety and depression were related to mental health and symptoms of anxiety were related to bodily pain and emotional role limitations. Attachment and social integration were associated with vitality and social functioning. Discussion. To improve the situation, more attention should be paid to the residents’ suffering related to anxiety, depression and psychosocial relations.
Background. Knowledge about mixed-methods perspectives that examine anxiety, depression, social support, mental health and the phenomenon of suffering among cognitively intact NH residents is scarce. We aimed to explore suffering and mental health among cognitively intact NH residents. Methods. This study used a mixed-methods design to explore different aspects of the same phenomena of interest to gain a more comprehensive understanding. The qualitative core component comprised a qualitative interview from 18 nursing home residents (≥65 years) about experiences related to pain, grief and loss. The supplementary component comprised interview from the same respondents using the SF-36 Health Survey subscales , the Hospital Anxiety and Depression Scale and the Social Provisions Scale. Results. The individual descriptions reveal suffering caused by painful experiences during life. The quantitative results indicated that symptoms of anxiety and depression were related to mental health and symptoms of anxiety were related to bodily pain and emotional role limitations. Attachment and social integration were associated with vitality and social functioning. Discussion. To improve the situation, more attention should be paid to the residents’ suffering related to anxiety, depression and psychosocial relations.Perioperative morbidity and mortality of cardiothoracic surgery in patients with a do-not-resuscitate orderhttps://peerj.com/preprints/128v12013-11-272013-11-27Bryan G MaxwellRobert L. LobatoMolly B. CasonJim K. Wong
Background: Do-not-resuscitate (DNR) orders are often active in patients with multiple comorbidities and a short natural life expectancy, but limited information exists as to how often these patients undergo high-risk operations and of the perioperative outcomes in this population. Methods: Using comprehensive inpatient administrative data from the Public Discharge Data file (years 2005 through 2010) of the California Office of Statewide Health Planning and Development, which includes a dedicated variable recording DNR status, we identified cohorts of DNR patients who underwent major cardiac or thoracic operations and compared them to age- and procedure-matched comparison cohorts. The primary study outcome was in-hospital mortality. Results: DNR status was not uncommon in cardiac (n=2,678, 1.1% of all admissions for cardiac surgery, age 71.6 ± 15.9 years) and thoracic (n=3,129, 3.7% of all admissions for thoracic surgery, age 73.8 ± 13.6 years) surgical patient populations. Relative to controls, patients who were DNR experienced significantly greater in-hospital mortality after cardiac (37.5% vs. 11.2%, p<0.0001) and thoracic (25.4% vs. 6.4%) operations. DNR status remained an independent predictor of in-hospital mortality on multivariate analysis after adjustment for baseline and comorbid conditions in both the cardiac (OR 4.78, 95% confidence interval 4.21-5.41, p<0.0001) and thoracic (OR 6.11, 95% confidence interval 5.37-6.94, p<0.0001) cohorts. Conclusions: DNR status is associated with worse outcomes of cardiothoracic surgery even when controlling for age, race, insurance status, and serious comorbid disease. DNR status appears to be a marker of substantial perioperative risk, and may warrant substantial consideration when framing discussions of surgical risk and benefit, resource utilization, and biomedical ethics surrounding end-of-life care.
Background: Do-not-resuscitate (DNR) orders are often active in patients with multiple comorbidities and a short natural life expectancy, but limited information exists as to how often these patients undergo high-risk operations and of the perioperative outcomes in this population. Methods: Using comprehensive inpatient administrative data from the Public Discharge Data file (years 2005 through 2010) of the California Office of Statewide Health Planning and Development, which includes a dedicated variable recording DNR status, we identified cohorts of DNR patients who underwent major cardiac or thoracic operations and compared them to age- and procedure-matched comparison cohorts. The primary study outcome was in-hospital mortality. Results: DNR status was not uncommon in cardiac (n=2,678, 1.1% of all admissions for cardiac surgery, age 71.6 ± 15.9 years) and thoracic (n=3,129, 3.7% of all admissions for thoracic surgery, age 73.8 ± 13.6 years) surgical patient populations. Relative to controls, patients who were DNR experienced significantly greater in-hospital mortality after cardiac (37.5% vs. 11.2%, p<0.0001) and thoracic (25.4% vs. 6.4%) operations. DNR status remained an independent predictor of in-hospital mortality on multivariate analysis after adjustment for baseline and comorbid conditions in both the cardiac (OR 4.78, 95% confidence interval 4.21-5.41, p<0.0001) and thoracic (OR 6.11, 95% confidence interval 5.37-6.94, p<0.0001) cohorts. Conclusions: DNR status is associated with worse outcomes of cardiothoracic surgery even when controlling for age, race, insurance status, and serious comorbid disease. DNR status appears to be a marker of substantial perioperative risk, and may warrant substantial consideration when framing discussions of surgical risk and benefit, resource utilization, and biomedical ethics surrounding end-of-life care.