BACKGROUND: Morphine is used for persistent breathlessness despite uncertainty about its efficacy and safety in advanced nonmalignant diseases. We evaluated its symptomatic, functional, physiologic, and adverse effects. METHODS: We conducted a systematic review of randomized trials comparing systemic morphine with placebo or usual care in adults with persistent breathlessness due to advanced nonmalignant disease. We excluded acute or cancer-related breathlessness and non-systemic administration. PubMed, Embase, Scopus, and Web of Science were searched through July 2026. PRISMA 2020, RoB 2, and GRADE were applied. Random-effects meta-analyses used the Paule–Mandel estimator with Hartung–Knapp adjustment. RESULTS: Of 2,721 records, 15 reports representing 11 independent cohorts and 840 participants were included; five cohorts contributed to six meta-analyses. Compared with placebo, morphine probably results in little to no difference in worst daily-life breathlessness [mean difference (MD), −0.15; 95% confidence interval (CI), −0.63 to 0.34; moderate certainty] and may result in little to no difference in average breathlessness (MD, −0.09; 95% CI, −0.61 to 0.42; low certainty). Evidence for six-minute walk distance and respiratory rate was very uncertain. Changes in oxygen saturation and carbon dioxide tension were small and of low certainty. Several trials reported more adverse events or discontinuations with morphine, but heterogeneity in outcome measurement precluded pooling. CONCLUSIONS: Short-term randomized evidence does not support expecting a clinically important benefit of regular oral morphine for daily-life breathlessness. Any therapeutic trial should be individualized, time limited, and closely monitored.
BACKGROUND: Burnout among palliative care physicians is an important workforce concern due to the complex clinical, emotional, and organizational demands of palliative medicine. However, evidence describing burnout domains and associated factors among palliative care physicians in Saudi Arabia remains limited. This study aimed to provide an updated national assessment of burnout and explore occupational, organizational, and emotionally distressing factors associated with burnout domains. METHODS: A national cross-sectional study was conducted among actively practicing palliative care physicians in Saudi Arabia. Burnout was assessed using the Copenhagen Burnout Inventory (CBI), including personal, work-related, and patient-related burnout domains. A 13-item investigatordeveloped Sources of Emotional Distress checklist was used to assess exposure to emotionally challenging clinical situations. RESULTS: Seventy physicians participated (56% of the estimated national workforce). Mean CBI scores were 50.18 for personal, 50.56 for work-related, and 38.39 for patient-related burnout. Over half met the ≥ 50 threshold for personal and work-related burnout, and one-third for patient-related burnout. Physicians endorsed a mean of 7.74 emotional distressors. In adjusted analyses, unmanageable workload and limited institutional support were associated with personal burnout, while emotional-distressor exposure and self-care training were associated with patient-related burnout. CONCLUSIONS: Personal and work-related burnout were more prominent than patient-related burnout among palliative care physicians in Saudi Arabia. Perceived workload and institutional support were associated with personal burnout, whereas cumulative emotional-distressor exposure was associated with patient-related burnout. Strategies addressing workload, institutional support, emotionally complex communication, and physician well-being may be important for sustaining the palliative care workforce.
BACKGROUND: Fear of death (FOD) is a fundamental existential concern associated with psychological well-being, coping processes, and meaning-making. Understanding its relationship with coping resources and meaning in life (MIL) may support the development of interventions addressing death awareness and existential distress. The aim of the study was to examine the associations between FOD, MIL, and psychological immune competences, and to explore the differences according to religiosity and helper occupation. METHODS: A cross-sectional survey was conducted among 249 Hungarian adults in 2019, prior to the COVID-19 pandemic. Participants completed the Meaning in Life Questionnaire, the Psychological Immune System Inventory, and the Multidimensional Fear of Death Scale (MFODS). Correlation analyses, backward linear regression, and independent-samples t-tests were performed. RESULTS: Fear of death was negatively associated with psychological immune competences. Emotional Control was a significant negative predictor of FOD, while Search for Meaning was a significant positive predictor. Presence of Meaning was positively associated with psychological immune functioning. Religious participants reported higher levels of MIL and lower Fear of the Unknown, while helper professionals demonstrated lower FOD, stronger coping resources, and higher levels of MIL. CONCLUSIONS: Meaning-related processes and coping resources appear to play an important role in adapting to mortality awareness. Adaptive coping competences and a stronger sense of meaning may facilitate constructive responses to death-related concerns. As the data were collected before the COVID-19 pandemic, the findings offer a valuable pre-pandemic reference framework for understanding existential adaptation under changing societal conditions.
BACKGROUND: The aim of the study was to assess and compare knowledge regarding pressure injury (PI) prevention and treatment among nurses providing care in patients’ homes and nurses working in hospital surgical departments, taking into account professional and postgraduate education, selfdirected learning, and interest in wound care. METHODS: The study included a cohort of 357 nurses, of whom 140 worked in patients’ home environments (long-term home care, home hospice care, primary healthcare including private practice), while 217 were employed in inpatient surgical units. The study was conducted from March to July 2025 using the Pressure Ulcer Knowledge Test (PZ-PUKT). RESULTS: Differences were observed in nurses’ preferences regarding professional knowledge acquisition. Nurses working in hospital surgical departments more frequently held a Master’s degree in nursing (53%), whereas nurses working in home care more often pursued postgraduate education (39.7% held nursing specializations and 26.9% had completed a specialist course in wound care). Although a higher median level of interest in wound care was observed among nurses working in home care, slightly higher PZ-PUKT knowledge scores were obtained by surgical department nurses (median score 51 among hospital-based nurses vs. 49 among nurses working in primary healthcare/private practice and in long-term home care/home hospice care). CONCLUSIONS: The overall knowledge level among participating nurses, assessed using the Polish version of the PZ-PUKT, was above average. Professional development through Master’s-level education and various forms of postgraduate training, as well as interest in wound care, positively influence knowledge levels in this field.
