ObjectiveTo systematically review the efficacy of palliative care in heart failure patients. MethodsPubMed, EMbase, CINAHL, The Cochrane Library, VIP, CNKI, CBM and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) on the efficacy of palliative care in heart failure patients from inception to September 2021. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies; then, meta-analysis was performed using RevMan 5.3 software. ResultsA total of 11 RCTs involving 912 patients were included. The results of meta-analysis showed that palliative care could improve the quality of life of patients with heart failure (KCCQ & McGill QoL: SMD=0.85, 95%CI 0.13 to 1.58, P=0.02; MLHFQ: SMD=−1.32, 95%CI −2.10 to −0.54, P=0.000 9), reduce the level of depression (SMD=−0.58, 95%CI −0.87 to −0.28, P=0.000 1) and anxiety (SMD=−0.51, 95%CI −0.89 to −0.13, P=0.008), improve the adverse symptoms (SMD=−1.46, 95%CI −2.67 to −0.24, P=0.02), reduce the readmission rate (RR=0.64, 95%CI 0.42 to 0.98, P=0.04) and the per hospitalization time (MD=−0.94, 95%CI −1.28 to −0.60, P<0.000 01). However, it had no obvious effect on the mortality of patients (RR=1.00, 95%CI 0.63 to 1.57, P=0.99). ConclusionCurrent evidence shows that palliative care can improve the quality of life, emotional state and adverse symptoms of patients with heart failure, and reduce the length of hospital stay and readmission rate. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusion.
Surgical removal or destruction of the focal brain area is the main treatment for drug-resistant epilepsy, but it is not suitable for all patients. Epileptiologists in the United States have opted for a new type of palliative therapy called responsive neurostimulation (RNS). The RNS system continuously monitors the electrical activity of the brain in the area of possible seizures and places electrodes in the epileptic area to provide electrical stimulation when abnormal discharges are detected, stopping seizures. Controlled clinical trials have demonstrated the long-term effectiveness and safety of the RNS system, with continued improvement in seizure reduction rates over time. RNS system not only has a good effect on temporal lobe epilepsy and cortical functional area epilepsy, but also can dynamically monitor cortical EEG, so as to better understand the epilepsy status of each patient and provide personalized diagnosis and treatment. In this paper, the development history, structure, advantages and disadvantages of RNS system are reviewed, and its indications as palliative treatment for drug-resistant epilepsy are discussed.