Monday, February 23, 2009
The Journal of Vascular and Interventional Radiology recently published an observational study on the use of permanent drainage catheters for malignant ascites. (It specifically looked at the PleurX catheter which is also frequently used for pleural effusions). The study gives a general sense of the tolerability of the procedure, as well as some gross prognostic data. It involves 34 patients all of whom had had at least 2 therapeutic paracenteses within a month and who reported relief of symptoms after paracentesis. 50% of the patients had died by 30 days, which is unlikely to be a result of the catheter, and more likely an indication of what a terrible prognostic indicator refractory/recurrent malignant ascites is. 85% of patients had no (even minor) catheter interventions before death or the end of the 12 week observation period.
BMJ has a metaanalysis looking at randomized controlled trials of acupuncture vs sham acupuncture vs no acupuncture, concluding that kinda maybe sorta there is a small demonstrable benefit of active treatment over sham/placebo-acupuncture.
JCO has a look at who gets referred for specialist psychooncology services in a cancer center.
JAGS has a paper looking at functional trajectories in older patients admitted to a nursing home after a hospital stay. It provides some supplemental data to some other research I blogged about recently about the prognostic implications of older patients acquiring new disabilities after an acute hospital stay. This paper looks at the natural history of being admitted to a nursing home with new disabilities after an acute hospital stay and finds that, overall, most patients either don't return home or do so with persistent disabilities (that is - they don't return fully to baseline) unfortunately. This new paper does present some mortality data but it's buried in the text in a not-very-helpful way (just because I'm interested in the mortality data doesn't mean the writers and reviewers were I guess). For example, they have a category in their analysis of 'stays in nursing home with continuous disability;' in the text they report that, for instance, 70% of the patients who stayed in a NH for at least a month with who they classified as having 'continuous disability' actually died in the NH without making it home.