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Sample records for pain palliation philippines

  1. Palliative care - managing pain

    MedlinePlus

    Palliative care helps people with serious illnesses feel better. One of the problems a serious illness can cause ... Bookbinder M, McHugh ME. Symptom management in palliative care and ... Challenging pain problems. In: Walsh D, Caraceni AT, Fainsinger ...

  2. Palliative care - managing pain

    MedlinePlus

    End of life - pain management; Hospice - pain management ... Bookbinder M, McHugh ME. Symptom management in palliative care and end of life care. Nurs Clin North Am . 2010;45:271-327. Mercadente S. Challenging pain problems. In: ...

  3. [Palliative pain therapy, cannabinoids].

    PubMed

    Radbruch, L; Elsner, F

    2005-10-01

    Cancer pain treatment should follow the recommendations of the World Health Organisation. Treatment should be with oral application, regular application times and following the analgesic step-ladder. Non-opioids such as dipyrone or non-steroids are used for slight to moderate pain, step-2 opioids such as tramadol or tilidine/naloxone for moderate pain and step-3 opioids such as morphine, oxycodone or hydromorphone for severe pain. Transdermal application of fentanyl or buprenorphine offer a non-invasive parenteral alternative for patients with stable pain syndromes. Cannabinoids such as tetrahydrocannabinol offer a valuable add-on option for cancer patients with refractory pain, spasticity, nausea or appetite loss. PMID:15965665

  4. Integrated pain and palliative medicine model.

    PubMed

    Bhatnagar, Sushma; Gupta, Mayank

    2016-07-01

    Pain is one of the most common, distressing and feared symptom among cancer and other patients in need of palliative care. An estimated 25% of cancer patients and 25 million people die in pain each year. Effective pain and symptom management are the core elements of palliative care which aims at reducing suffering and improving quality of life (QOL) throughout the course of illness starting from diagnosis, in sync with curative treatments and at end of life. There is a prevailing shortage of manpower apt to deal with pain and providing cost-effective palliative care and with the rise of cancer, other chronic diseases and explosion of new life-prolonging therapeutic modalities, this 'Patient-pain and palliative physician' discrepancy is only going to increase, more so in developing countries. The need of the hour is to train all healthcare physicians and nurses especially those working in the field of chronic pain in principles of effective pain and symptom palliation, to integrate cancer pain and symptom management into existing pain management fellowships and to introduce a holistic pain and palliative care model at all levels of healthcare system. Simultaneously, of equal importance is to conduct research, evidence building and formulate policies and guidelines for meticulous symptom management among the diverse category of patients and diseases so as to have a personalized and individualistic approach to patient management. In this comprehensive review, we have pondered upon the need, advantages, barriers and recommendations to achieve ideal 'Integrated pain and palliative medicine' services, their equitable implementation and delivery to 'whomsoever in need of them'. PMID:27334349

  5. Pain Assessment in Noncommunicative Adult Palliative Care Patients.

    PubMed

    McGuire, Deborah B; Kaiser, Karen Snow; Haisfield-Wolfe, Mary Ellen; Iyamu, Florence

    2016-09-01

    Palliative care patients who have pain are often unable to self-report their pain, placing them at increased risk for underrecognized and undertreated pain. Use of appropriate pain assessment tools significantly enhances the likelihood of effective pain management and improved pain-related outcomes. This paper reviews selected tools and provides palliative care clinicians with a practical approach to selecting a pain assessment tool for noncommunicative adult patients. PMID:27497016

  6. Chronic pain in the outpatient palliative care clinic.

    PubMed

    Merlin, Jessica S; Childers, Julie; Arnold, Robert M

    2013-03-01

    Chronic pain is common. Many patients with cancer and other life-limiting illnesses have chronic pain that is related to their disease, and some have comorbid chronic nonmalignant chronic pain. As palliative care continues to move upstream and outpatient palliative care programs develop, palliative care clinicians will be called upon to treat chronic pain. Chronic pain differs from acute pain in the setting of advanced disease and a short prognosis in terms of its etiology, comorbidities-especially psychiatric illness and substance abuse-and management. To successfully care for these patients, palliative care providers will need to learn new clinical competencies. This article will review chronic pain management core competencies for palliative care providers. PMID:22556285

  7. Using cannabinoids in pain and palliative care.

    PubMed

    Peat, Sue

    2010-10-01

    Interest in the use of cannabinoids in a clinical setting is gradually increasing, particularly in patients where more conventional treatments have failed. They have been reported as offering perceived benefits in a wide range of conditions, but the major interest at present is centred on their place in pain management and in the palliation of symptoms secondary to terminal cancer and neurological disease. The potential benefits include symptomatic relief for patients suffering from intractable neuropathic pain, anorexia, anxiety and muscle spasm. There is clear consensus that cannibinoids should not be used as a first-line monotherapy, but should be considered as valuable adjuvants to more commonly indicated therapeutic options in the management of palliative care patients. Scientific evidence documenting the benefits of the canibinoids nabilone and sativex is accumulating, but needs to be evaluated carefully in the light of the paucity of available data. Both drugs are usually used under the guidance of specialist units. Nabilone and Sativex are now controlled drugs, and are frequently used outside of their licensed indication (control of chemotherapy-induced nausea and vomiting) and hence particular care needs to be taken in evaluating the rational for their use. Sativex has been recently licenced for use in the management of patients with multiple sclerosis. PMID:20972379

  8. Growing Pains: Palliative Care Making Gains

    Cancer.gov

    An article about the growth of palliative care, a medical subspecialty that has been shown to improve patient outcomes such as symptom management, quality of life, and patient and family satisfaction with care.

  9. Chronic pain management as a barrier to pediatric palliative care.

    PubMed

    Thompson, Lindsay A; Meinert, Elizabeth; Baker, Kimberly; Knapp, Caprice

    2013-12-01

    Pain is common as a presenting complaint to outpatient and emergency departments for children, yet pain management represents one of the children's largest unmet needs. A child may present with acute pain for an intermittent issue or may have acute or chronic pain in the setting of chronic illness. The mainstay of treatment for pain uses a stepwise approach for pain management, such as set up by the World Health Organization. For children with life-limiting illnesses, the Institute of Medicine guidelines recommends referral upon diagnosis for palliative care, meaning that the child receives comprehensive services that include pain control in coordination with curative therapies; yet barriers remain. From the provider perspective, pain can be better addressed through a careful assessment of one's own knowledge, skills, and attitudes. The key components of pain management in children are multimodal, regardless of the cause of the pain. PMID:23329083

  10. [Hypnosis as an alternative treatment for pain in palliative medicine].

    PubMed

    Peintinger, Christa; Hartmann, Wolfgang

    2008-01-01

    Pain--which can have a variety of causes--constitutes a severe problem for patients in need of palliative care, because this pain usually dramatically impairs their quality of life. Thus, the more advanced a terminal illness has become, the more hospital staff should focus on holistic treatment, encompassing body, mind and soul of the patient. Apart from conventional medication-based pain therapy, there is also a variety of non-medicinal treatments for pain. One of these methods is hypnosis, an imaginative treatment that activates available resources; it is not only an effective way of alleviating pain, but it also can ease psychological problems at the same time. PMID:19165446

  11. When patients are stressed, in pain, suggest palliative care.

    PubMed

    2016-06-01

    Case managers are in a good position to recognize patients who have serious medical problems that are causing them and their family members stress, and refer them for a palliative care consultation, experts say. The palliative care team coordinates with the team providing medical care and helps control pain and other physical symptoms, relieves depression and anxiety, and provides support and spiritual help for the patient and family. The core palliative care team typically includes a medical specialist, a nurse who also acts as a case manager, a social worker, and a spiritual counselor. Palliative care improves outcomes and patient satisfaction when patients have a consultation early in the stay or even in the emergency department. PMID:27323510

  12. Satisfaction with and Perception of Pain Management among Palliative Patients with Breakthrough Pain: A Qualitative Study.

    PubMed

    Pathmawathi, Subramanian; Beng, Tan Seng; Li, Lee Mei; Rosli, Roshaslina; Sharwend, Supermanian; Kavitha, Rasaiah R; Christopher, Boey Chiong Meng

    2015-08-01

    Breakthrough pain is a significant contributor to much suffering by patients. The experience of intense pain may interfere with, and affect, daily life functioning and has major consequences on patients' well-being if it is not well managed. The area of breakthrough pain has not been fully understood. This study thus aimed to explore the experiences of breakthrough pain among palliative patients. A qualitative study based on a series of open-ended interviews among 21 palliative patients suffering from pain at an urban tertiary hospital in Malaysia was conducted. Five themes were generated: (i) pain viewed as an unbearable experience causing misery in the lives of patients, (ii) deterioration of body function and no hope of recovery, (iii) receiving of inadequate pain management for pain, (iv) insensitivity of healthcare providers toward patients' pain experience, and (v) pain coping experiences of patients. The findings revealed that nonpharmacologic approaches such as psychosocial support should be introduced to the patients. Proper guidance and information should be given to healthcare providers to improve the quality of patient care. Healthcare providers should adopt a sensitive approach in caring for patients' needs. The aim is to meet the needs of the patients who want to be pain free or to attain adequate relief of their pain for breakthrough pain. PMID:26256219

  13. [High-dose buprenorphine for outpatient palliative pain therapy].

    PubMed

    Gastmeier, K; Freye, E

    2009-04-01

    The case of a 78-year-old patient with cancer-related pain and additionally mixed-pain syndrome is presented. Pain therapy with buprenorphine TTS 210 microg/h every 3 days was sufficient in the beginning, later the therapy was changed because of increasing problems of tape fixing during fever periods under chemotherapy to a continuous infusion of buprenorphine intravenously via an external medication pump. During the course of therapy it became necessary to increase the dose to 99.9 mg/day buprenorphine. Under this medication a sufficient pain reduction (median NRS 2-3) over a period of 135 days could be achieved. At the same time the patient was vigilant and cooperative without signs of intoxication until the end of life at home in the presence of his family.If no signs of intoxication occur under extreme opioid therapy and a sufficient pain therapy can be achieved, a rotation to another opioid is not necessary. However, outpatient palliative care requires a frequent adaptation to the individually varying opioid demand of the patient and time-consuming nursing care. PMID:19066981

  14. Palliation of bone pain with Sn-117m(4+)DTPA

    SciTech Connect

    Atkins, L.F.; Mausner, L.F.; Meinken, G.E.

    1994-05-01

    Sn-117m(4+)DTPA prepared at Brookhaven National Laboratory has favorable physical and biological characteristics for use as a palliative agent to relieve pain from osseous metastases. The short range of the emitted conversion electrons permits large bone radiation doses without excessive radiation to the bone marrow. An accompanying 158.6 keV gamma is useful for monitoring the distribution. The T1/2 of 13.6 days provides an adequate shelf life. A previous study in humans has demonstrated favorable dosimetry with a bone surface dose of approximately 57.9 mGy/MBq and a bone surface to marrow ratio of 10:1. This study was instituted to find a dose level which was effective and to monitor effects on bone marrow. Sn-117m was administered to 14 patients. Administered activity ranged between 66 and 573 MBq or 1.2-5.8 MBq/kg body weight. At the lower dose levels (<3.1 MBq/kg, n=7), 1 obtained good relief of pain, 1 partial relief, and 1 no relief. The remaining 4 were not evaluated because of the need for further treatment of soft tissue disease or because of intervening death. The 7 patients treated at the higher dose level (4.8-5.8 MBq/kg) included patients with prostate (3), breast (3) and unknown (1) primary cancers. All patients experienced relief of pain, 5 excellent and 2 partial. No marrow suppression was observed as a result of Sn-117m therapy. Initial observations indicate that Sn-117m DTPA is effective in palliation of pain from osseous metastases without producing bone marrow suppression. Further studies at a higher dose level are planned.

  15. Elderly Patients With Painful Bone Metastases Should be Offered Palliative Radiotherapy

    SciTech Connect

    Campos, Sarah; Presutti, Roseanna; Zhang Liying; Salvo, Nadia; Hird, Amanda; Tsao, May; Barnes, Elizabeth A.; Danjoux, Cyril; Sahgal, Arjun; Mitera, Gunita; Sinclair, Emily; DeAngelis, Carlo; Nguyen, Janet; Napolskikh, Julie; Chow, Edward

    2010-04-15

    Purpose: To investigate the efficacy of palliative radiotherapy (RT) in relieving metastatic bone pain in elderly patients. Methods and Materials: The response to RT for palliation of metastatic bone pain was evaluated from a prospective database of 558 patients between 1999 and 2008. The pain scores and analgesic intake were used to calculate the response according to the International Bone Metastases Consensus Working Party palliative RT endpoints. Subgroup analyses for age and other demographic information were performed. Results: No significant difference was found in the response rate in patients aged >=65, >=70, and >=75 years compared with younger patients at 1, 2, or 3 months after RT. The response was found to be significantly related to the performance status. Conclusion: Age alone did not affect the response to palliative RT for bone metastases. Elderly patients should be referred for palliative RT for their painful bone metastases, regardless of age, because they receive equal benefit from the treatment.

  16. Radionuclide therapy for palliation of pain due to osteoblastic metastases.

    PubMed

    Hellman, R S; Krasnow, A Z

    1998-01-01

    Beta-emitting, bone-seeking radiopharmaceuticals, administered systemically, represent a good alternative or adjuvant to external beam radiotherapy for palliation of painful osteoblastic bone metastases. The most frequently used radiopharmaceutical for this purpose is strontium 89, followed by samarium 153 ethylenediaminetetramethylene phosphonate, and infrequently phosphorus 32 orthophosphate. Prior to consideration for radionuclide therapy, recent bone scans should be evaluated in order to determine if the patient has painful osteoblastic lesions likely to respond to therapy. Approximately 70% of patients with prostate and breast cancer will have a reduction in pain in response to radionuclide therapy, beginning within 2 to 4 weeks and lasting between 2 and 6 months. Patients who are expected to live 3 or more months are more likely to benefit than patients with shorter duration life expectancy. Hematosuppression is the chief side effect of radionuclide therapy, with leukopenia and thrombocytopenia more likely to be clinically significant than anemia. Relative contraindications for treatment include osteolytic lesions, pending spinal cord compression or pathologic fracture, preexisting severe myelosuppression, urinary incontinence, inability to follow radiation safety precautions, and severe renal insufficiency. PMID:15859838

  17. Psychiatric Morbidity, Pain Perception, and Functional Status of Chronic Pain Patients in Palliative Care

    PubMed Central

    Rajmohan, V; Kumar, Suresh K

    2013-01-01

    Context: Psychological factors, such as that exist when we experience pain, can profoundly alter the strength of pain perception. Aim: The study aims to estimate the prevalence of psychiatric disorders, and its association with perception of pain and functional status in chronic patients in palliative care. Materials and Methods: The sample was selected via simple randomisation and post consent were assessed using (1) a semi- structured questionnaire to elicit socio-demographic information and medical data (2) Brief Pain Inventory (3) ICD-10 Symptom Checklist (4) ICD-10-Diagnostic Criteria for Research (DCR) (5) Montgomery Asberg Depression Rating Scale (MADRS) (6) Covi Anxiety Rating Scale (7) Karnofsky Performance Status Scale. Data was analysed using independent sample t test and chi square test. Results: The psychiatric morbidity was 67% with depression and adjustment disorders being the major diagnosis. There was a significant association between psychiatric morbidity pain variables (P = 0.000). Psychiatric morbidity significantly impaired activity, mood, working, walk, sleep, relationship, and enjoyment. There was no association between aetiology of pain, type of cancer, treatment for primary condition and treatment for pain and psychiatric morbidity. The functional status of cancer patients was also poorer in patients with psychiatric morbidity (P = 0.008). Conclusion: There is a high prevalence of psychiatric illness in chronic pain patients of any aetiology. Psychiatric morbidity is associated with increased pain perception, impairment in activity and poor functional status. PMID:24347904

  18. Method for palliation of pain in human bone cancer using therapeutic tin-117m compositions

    DOEpatents

    Srivastava, Suresh C.; Meinken, George E.; Mausner, Leonard F.; Atkins, Harold L.

    1998-12-29

    The invention provides a method for the palliation of bone pain due to cancer by the administration of a unique dosage of a tin-117m (Sn-117m) stannic chelate complex in a pharmaceutically acceptable composition. In addition, the invention provides a method for simultaneous palliation of bone pain and radiotherapy in cancer patients using compositions containing Sn-117m chelates. The invention also provides a method for palliating bone pain in cancer patients using Sn-117m-containing compositions and monitoring patient status by imaging the distribution of the Sn-117m in the patients. Also provided are pharmaceutically acceptable compositions containing Sn-117m chelate complexes for the palliation of bone pain in cancer patients.

  19. Method for palliation of pain in human bone cancer using therapeutic tin-117m compositions

    DOEpatents

    Srivastava, S.C.; Meinken, G.E.; Mausner, L.F.; Atkins, H.L.

    1998-12-29

    The invention provides a method for the palliation of bone pain due to cancer by the administration of a unique dosage of a tin-117m (Sn-117m) stannic chelate complex in a pharmaceutically acceptable composition. In addition, the invention provides a method for simultaneous palliation of bone pain and radiotherapy in cancer patients using compositions containing Sn-117m chelates. The invention also provides a method for palliating bone pain in cancer patients using Sn-117m-containing compositions and monitoring patient status by imaging the distribution of the Sn-117m in the patients. Also provided are pharmaceutically acceptable compositions containing Sn-117m chelate complexes for the palliation of bone pain in cancer patients. 5 figs.

  20. Mechanism-based Classification of Pain for Physical Therapy Management in Palliative care: A Clinical Commentary

    PubMed Central

    Kumar, Senthil P; Saha, Sourov

    2011-01-01

    Pain relief is a major goal for palliative care in India so much that most palliative care interventions necessarily begin first with pain relief. Physical therapists play an important role in palliative care and they are regarded as highly proficient members of a multidisciplinary healthcare team towards management of chronic pain. Pain necessarily involves three different levels of classification–based upon pain symptoms, pain mechanisms and pain syndromes. Mechanism-based treatments are most likely to succeed compared to symptomatic treatments or diagnosis-based treatments. The objective of this clinical commentary is to update the physical therapists working in palliative care, on the mechanism-based classification of pain and its interpretation, with available therapeutic evidence for providing optimal patient care using physical therapy. The paper describes the evolution of mechanism-based classification of pain, the five mechanisms (central sensitization, peripheral neuropathic, nociceptive, sympathetically maintained pain and cognitive-affective) are explained with recent evidence for physical therapy treatments for each of the mechanisms. PMID:21633629

  1. Sclerotic Vertebral Metastases: Pain Palliation Using Percutaneous Image-Guided Cryoablation

    SciTech Connect

    Costa de Freitas, Ricardo Miguel Menezes, Marcos Roberto de; Cerri, Giovanni Guido; Gangi, Afshin

    2011-02-15

    Cryoablative therapies have been proposed to palliate pain from soft-tissue or osteolytic bone tumors. A case of a patient with painful thoracic and sacral spine sclerotic metastases successfully treated by image-guided percutaneous cryoablation with the aid of insulation techniques and thermosensors is reported in this case report.

  2. Opioid availability and palliative care in Nepal: influence of an international pain policy fellowship.

    PubMed

    Paudel, Bishnu Dutta; Ryan, Karen M; Brown, Mary Skemp; Krakauer, Eric L; Rajagopal, M R; Maurer, Martha A; Cleary, James F

    2015-01-01

    Globally, cancer incidence and mortality are increasing, and most of the burden is shifting to low- and middle-income countries (LMICs), where patients often present with late-stage disease and severe pain. Unfortunately, LMICs also face a disproportionate lack of access to pain-relieving medicines such as morphine, despite the medical and scientific literature that shows morphine to be effective to treat moderate and severe cancer pain. In 2008, an oncologist from Nepal, one of the poorest countries in the world, was selected to participate in the International Pain Policy Fellowship, a program to assist LMICs, to improve patient access to pain medicines. Following the World Health Organization public health model for development of pain relief and palliative care, the Fellow, working with colleagues and mentors, has achieved initial successes: three forms of oral morphine (syrup, immediate-release tablets, and sustained-release tablets) are now manufactured in the country; health-care practitioners are receiving training in the use of opioids for pain relief; and a new national palliative care association has developed a palliative care training curriculum. However, long-term implementation efforts, funding, and technical assistance by governments, philanthropic organizations, and international partners are necessary to ensure that pain relief and palliative care become accessible by all in need in Nepal and other LMICs. PMID:24768596

  3. Pain Management and Symptom-Oriented Drug Therapy in Palliative Care

    PubMed Central

    Klein, Carsten; Lang, Ute; Bükki, Johannes; Sittl, Reinhard; Ostgathe, Christoph

    2011-01-01

    Summary Patients with advanced life-limiting disease often suffer from symptoms that considerably impair their quality of life and that of their families. Palliative care aims to alleviate these symptoms by a multidimensional approach. Pharmacotherapy is an essential component. The objective of this review is to give an overview of symptom-oriented drug therapy for the most important symptoms in palliative care. Leading symptoms that affect quality of life include pain, dyspnea, nausea and emesis, weakness and disorientation. Careful examination and history taking help to understand the individual mechanisms underlying these symptoms. Specific pharmacotherapy provides an efficient way to achieve symptom control in the context of palliative care. PMID:21547023

  4. External beam radiotherapy for palliation of pain from metastatic carcinoma of the prostate

    SciTech Connect

    Benson, R.C. Jr.; Hasan, S.M.; Jones, A.G.; Schlise, S.

    1982-01-01

    Radiotherapy often is used for palliation of bone pain from metastatic cancer of the prostate but an objective evaluation of its efficacy in a large series of patients is unavailable. We report the results of external beam irradiation in 62 patients who had bone pain secondary to stage D carcinoma of the prostate. The variables used to judge pain before and after radiotherapy included subjective evaluation of pain, status of activity and quantitation of analgesic use. Complete relief of pain was achieved in 26 patients (42 per cent), partial relief in 22 (35 per cent) and no relief in 14 (23 per cent). On the basis of our experience external beam irradiation is useful palliative therapy for pain from metastatic cancer of the prostate.

  5. Cancer-related pain in older adults receiving palliative care: Patient and family caregiver perspectives on the experience of pain

    PubMed Central

    McPherson, Christine J; Hadjistavropoulos, Thomas; Lobchuk, Michelle M; Kilgour, Kelly N

    2013-01-01

    BACKGROUND: Despite an emphasis on pain management in palliative care, pain continues to be a common problem for individuals with advanced cancer. Many of those affected are older due to the disproportionate incidence of cancer in this age group. There remains little understanding of how older patients and their family caregivers perceive patients’ cancer-related pain, despite its significance for pain management in the home setting. OBJECTIVES: To explore and describe the cancer pain perceptions and experiences of older adults with advanced cancer and their family caregivers. METHODS: A qualitative descriptive approach was used to describe and interpret data collected from semistructured interviews with 18 patients (≥65 years of age) with advanced cancer receiving palliative care at home and their family caregivers. RESULTS: The main category ‘Experiencing cancer pain’ incorporated three themes. The theme ‘Feeling cancer pain’ included the sensory aspects of the pain, its origin and meanings attributed to the pain. A second theme, ‘Reacting to cancer pain’, included patients’ and family caregivers’ behavioural, cognitive (ie, attitudes, beliefs and control) and emotional responses to the pain. A third theme, ‘Living with cancer pain’ incorporated individual and social-relational changes that resulted from living with cancer pain. CONCLUSIONS: The findings provide an awareness of cancer pain experienced by older patients and their family caregivers within the wider context of ongoing relationships, increased patient morbidity and other losses common in the aged. PMID:23957019

  6. [The nurse-healthcare assistant partnership in a mobile pain and palliative care team].

    PubMed

    Chevaucherie, Isabelle; Fernandes, Martine; Lariche, Stéphanie; Mussault, Pascale

    2015-02-01

    The mission of the mobile pain and palliative care team is to improve the quality of care and comfort of patients. At Longjumeau general hospital the nurse-healthcare assistant partnership within this team enables the patient to benefit from the caregivers' two-way perspective, while allowing the professionals to share knowledge and to be stronger in the face of suffering. PMID:26144825

  7. Philippines.

    PubMed

    1983-09-01

    This discussion of the Philippines focuses on the following: the people; geography; history; government; political conditions; economy (agriculture, mining, industry, and foreign trade); defense; foreign relations; and relations between the US and the Philippines. In 1982 the population was estimated at 51.6 million with an annual growth rate of 2.4%. The infant mortality rate was 59/1000 (1982), and life expectancy was 64 years (1981). The Philippine people are mostly of Malay stock, descended from the Indonesians and Malays who migrated to the islands long before the Christian era. The most significant ethnic minority group is the Chinese, who have played an important role in commerce since the 9th century, when they first came to the islands to trade. About 90% of the people are Christian. The Philippine Archipelago extends about 1770 kilometers north to south along the southeastern rim of Asia, forming a land chain between the Pacific Ocean on the east and the South China Sea on the west. The archipelago consists of some 7100 islands and islets. The history of the Philippines may be broken down into 4 distinct phases: the pre Spanish period, the Spanish period (1521-1898); the American period (1898-1946); and the years since independence (1946-present). A new constitution, to replace that of 1935, was completed by a constitutional convention in November 1972 and was proclaimed in effect in January 1973. The 1973 constitution provided for a parliamentary system, initially with extensive powers vested in a prime minister. Major amendments adopted in 1981 revised the system to make the president head of government. From independence of 1972, the Philippines practiced relatively traditional constiutional democracy. In addition to more moderate, legitimate opposition, the government has been opposed by 2 insurgencies, whose roots predated martial law, and by some urban terrorism. The Philippine economy grew rapidly during the period of rehabilitation and expansion

  8. Cancer Pain: A Critical Review of Mechanism-based Classification and Physical Therapy Management in Palliative Care

    PubMed Central

    Kumar, Senthil P

    2011-01-01

    Mechanism-based classification and physical therapy management of pain is essential to effectively manage painful symptoms in patients attending palliative care. The objective of this review is to provide a detailed review of mechanism-based classification and physical therapy management of patients with cancer pain. Cancer pain can be classified based upon pain symptoms, pain mechanisms and pain syndromes. Classification based upon mechanisms not only addresses the underlying pathophysiology but also provides us with an understanding behind patient's symptoms and treatment responses. Existing evidence suggests that the five mechanisms – central sensitization, peripheral sensitization, sympathetically maintained pain, nociceptive and cognitive-affective – operate in patients with cancer pain. Summary of studies showing evidence for physical therapy treatment methods for cancer pain follows with suggested therapeutic implications. Effective palliative physical therapy care using a mechanism-based classification model should be tailored to suit each patient's findings, using a biopsychosocial model of pain. PMID:21976851

  9. Philippines.

    PubMed

    1986-08-01

    The Philippines is an archipelago of 7100 islands and islets, 11 of which compose about 95% of the total area and population. The majority of the Filipinos are descendants of Indonesians and Malays. Approximately 90% of the population are Christian with the majority of the remaining 10% being Moslems. In the 1960s, the annual population growth rate was roughly 3%, but it fell to 2.4% in the late 1970s and was still 2.4% in 1985. In 1970, President Marcos implemented an official family planning policy to reduce the high growth rate and thereby stimulate economic development. A population commission coordinates family planning efforts. Both the Spanish (1521-1898) and the United States (1898-1946) have ruled the Philippines with a brief occupation by the Japanese (1942-1945). The US assisted in the reconstruction of the economy following World War II and continues to maintain and operate military bases. Further, from 1946-1986, the Philippines has received $3.7 billion in economic and military assistance from the US. The government operated under a constitutional democracy from 1946-1972, but in 1972 President Marcos declared martial law. In 1981, martial law ended and Marcos called for a presidential election. After winning the election, he called for an amendment of the 1972 constitution making him, rather than the prime minister, the head of government. Even though martial law ended in 1981, the Marcos government retained its wide powers to arrest and detain anyone. In February 1986, popular support backed by a peaceful civilian-military uprising brought Corazon Aquino to the Presidency. In the mid 1980s a severe economic recession hit the Philippines with the real GNP growth rate ranging from -5.3%-0%. The Philippines have diplomatic relations with the south east Asian nations, many East Bloc nations, the US, China, Cuba, and the Soviet Union. PMID:12178014

  10. Pharmacovigilance in hospice/palliative care: net effect of gabapentin for neuropathic pain

    PubMed Central

    Sanderson, Christine; Quinn, Stephen J; Agar, Meera; Chye, Richard; Clark, Katherine; Doogue, Matthew; Fazekas, Belinda; Lee, Jessica; Lovell, Melanie R; Rowett, Debra; Spruyt, Odette; Currow, David C

    2015-01-01

    Objective Hospice/palliative care patients may differ from better studied populations, and data from other populations cannot necessarily be extrapolated into hospice/palliative care clinical practice. Pharmacovigilance studies provide opportunities to understand the harms and benefits of medications in routine practice. Gabapentin, a γ-amino butyric acid analogue antiepileptic drug, is commonly prescribed for neuropathic pain in hospice/palliative care. Most of the evidence however relates to non-malignant, chronic pain syndromes (diabetic neuropathy, postherpetic neuralgia, central pain syndromes, fibromyalgia). The aim of this study was to quantify the immediate and short-term clinical benefits and harms of gabapentin in routine hospice/palliative care practice. Design Multisite, prospective, consecutive cohort. Population 127 patients, 114 of whom had cancer, who started gabapentin for neuropathic pain as part of routine clinical care. Settings 42 centres from seven countries. Data were collected at three time points—at baseline, at day 7 (and at any time; immediate and short-term harms) and at day 21 (clinical benefits). Results At day 21, the average dose of gabapentin for those still using it (n=68) was 653 mg/24 h (range 0–1800 mg) and 54 (42%) reported benefits, of whom 7 (6%) experienced complete pain resolution. Harms were reported in 39/127 (30%) patients at day 7, the most frequent of which were cognitive disturbance, somnolence, nausea and dizziness. Ten patients had their medication ceased due to harms. The presence of significant comorbidities, higher dose and increasing age increased the likelihood of harm. Conclusions Overall, 42% of people experienced benefit at a level that resulted in continued use at 21 days. PMID:25324335

  11. Pain Palliation by Percutaneous Acetabular Osteoplasty for Metastatic Hepatocellular Carcinoma

    SciTech Connect

    Hokotate, Hirofumi; Baba, Yasutaka; Churei, Hisahiko; Nakajo, Masayuki; Ohkubo, Kouichi; Hamada, Kenji

    2001-09-15

    A 68-year-old man with hepatocellular carcinoma and known skeletal metastasis developed right hip pain and gait disturbance due to an osteolytic metastasis in the right acetabulum. This was treated initially with chemoembolization and radiation therapy. When these procedures proved unsuccessful percutaneous injection of acrylic bone cement into the acetabulum was undertaken. Immediately after this procedure, he obtained sufficient pain relief and improved walking ability, which continued for 3 months until he died of hepatic insufficiency.

  12. Evaluating palliative care: bereaved family members' evaluations of patients' pain, anxiety and depression.

    PubMed

    McPherson, Christine J; Addington-Hall, Julia M

    2004-08-01

    Palliative care surveys often rely on bereaved family members to act as proxies to provide information on patient care at the end of life, after the patient's death. However, when comparing bereaved family members' assessments with those of the patients, agreement is found to be better for symptoms that are more concrete and observable than subjective aspects such as psychological symptoms and pain. To date, little is known about how proxies actually evaluate these types of symptoms. The present study used retrospective verbal protocol analysis to elucidate the thought processes of 30 bereaved relatives during their evaluations of patients' pain, anxiety and depression. The qualitative analysis raised awareness of the difficulties experienced by proxies when discerning the presence of symptoms. It also provided insights into the cues and strategies used when making decisions, contributing to a fuller understanding of how proxies distinguish symptoms. Recommendations are made to improve the design of retrospective palliative care surveys. PMID:15276191

  13. The Pain Relief Promotion Act of 1999: a serious threat to palliative care.

    PubMed

    Orentlicher, D; Caplan, A

    2000-01-12

    Recent educational efforts in the US medical community have begun to address the critical issue of palliative care for terminally ill patients. However, a newly introduced bill in Congress, the Pain Relief Promotion Act of 1999 (PRPA), could dramatically hinder these efforts if enacted. The act criminally punishes the use of controlled substances to cause-or assist in causing-a patient's death. The primary purposes of PRPA are to override the physician-assisted suicide law currently in effect in Oregon and prohibit other states from enacting similar laws. The act also includes valuable provisions for better research and education in palliative care, but the benefits of those provisions are outweighed by the punitive sections of the act. Under PRPA, the quality of palliative care in the United States could be compromised when physicians, fearing criminal prosecution, err on the side of caution rather than risk their patients' deaths by using highly aggressive pain treatments. Furthermore, PRPA would put Drug Enforcement Administration officials, who have no medical expertise, in the position of regulating medical decisions. The act also would interfere with individual states' long-standing authority over medical practice. Finally, PRPA would discourage physicians from engaging in experimentation and innovation in palliative care, again out of concern for crossing the line between relief of suffering and physician-assisted suicide. Other bills have been introduced that go much further than PRPA to encourage palliative care, without its problematic provisions. Regardless of the controversy surrounding physician-assisted suicide in the United States, the need for quality end-of-life care will be far better served if Congress enacts one of these bills rather than PRPA. PMID:10634344

  14. Evidence-based review of interventions to improve palliation of pain, dyspnea, depression.

    PubMed

    Naqvi, Fatima; Cervo, Frank; Fields, Suzanne

    2009-08-01

    This review of the guideline developed by the Clinical Efficacy Subcommittee of the American College of Physicians and the accompanying systematic review offers clinicians evidence-based recommendations for palliative care. Seriously ill patients should be assessed for pain, dyspnea, and depression. Clinicians should use therapies of proven effectiveness to manage pain, depression, and dyspnea, including opioids in patients with unrelieved dyspnea and oxygen for short-term relief of hypoxemia. Clinicians should ensure that advance care planning, including completion of advance directives, occurs. PMID:20722311

  15. Palliative Sedation and What Constitutes Active Dying: A Case of Severe Progressive Dystonia and Intractable Pain.

    PubMed

    Strand, Jacob J; Feely, Molly A; Kramer, Neha M; Moeschler, Susan M; Swetz, Keith M

    2016-05-01

    We present the case of a 34-year-old woman with Klippel-Feil syndrome who developed progressive generalized dystonia of unclear etiology, resulting in intractable pain despite aggressive medical and surgical interventions. Ultimately, palliative sedation was required to relieve suffering. Herein, we describe ethical considerations including defining sedation, determining prognosis in the setting of an undefined neurodegenerative condition, and use of treatments that concurrently might prolong or alter end-of-life trajectory. We highlight pertinent literature and how it may be applied in challenging and unique clinical situations. Finally, we discuss the need for expert multidisciplinary involvement when implementing palliative sedation and illustrate that procedures and rules need to be interpreted to deliver optimal patient-centered plan of care. PMID:25487783

  16. Tin-117m(4+)-DTPA for palliation of pain from osseous metastases: A pilot study

    SciTech Connect

    Atkins, H.L.; Mausner, L.F.; Srivastava, S.C. ||

    1995-05-01

    The physical and biological attributes of {sup 117m}Sn(4+)-DTPA indicate that it should be an effective agent for palliative therapy of painful bony metastatic disease. The aim of this study was to evaluate whether or not this agent could effectively reduce pain while sparing the hemopoietic marrow from adverse effects. Fifteen patients (10 males and 5 females) with painful bony metastases from various primary cancers were included in the study. Seven patients received 1.22 to 3.11 MBq/kg of {sub 117m}Sn intravenously (Group 1) and eight patients received 4.85 to 5.77 MBq/kg (Group 2). All but one were treated as outpatients and followed for a minimum of 2 mo. In the first group, pain relief was nonassessable in four patients because of death or additional treatment of soft-tissue disease by another modality. One patient had no relief of pain, one had complete relief of pain and one had transient relief of pain. No myelotoxicity was observed. For Group 2, three patients achieved complete relief of pain, two good relief, two partial relief and one began to experience pain relief when he suffered a pathological fracture 2 mo most-treatment. None of these patients had myelotoxicity. Tin-117m(4+)-DTPA can reduce pain from metastatic disease to bone without inducing adverse reactions related to bone marrow. Further studies are needed to assess tolerance levels for the bone marrow and to evaluate response rates and duration of effect. 6 refs., 4 figs., 4 tabs.

  17. Efficacy of Magnetic Resonance-guided Focused Ultrasound Surgery for Bone Metastases Pain Palliation

    NASA Astrophysics Data System (ADS)

    Kawasaki, Motohiro; Nanba, Hirofumi; Kato, Tomonari; Tani, Toshikazu; Ushida, Takahiro

    2011-09-01

    Magnetic resonance-guided focused ultrasound surgery (MRgFUS) is a novel treatment method that achieves non-invasive thermal ablation by focusing many ultrasound waves on a target tissue with real-time monitoring of the location and temperature of the target during the procedure. We investigated the palliative effect on pain and safety of MRgFUS in painful bone metastases. Six patients (mean age, 65.8 years) who met eligibility criteria for the clinical study approved by our Institutional Ethics Committee based on the cooperative protocol were treated with MRgFUS. Targeted sites included the sacrum (n = 1), ilium (n = 2), scapula (n = 2), and femur (n = 1). The mean follow-up period was 9.2 months. All procedures were performed as a single-session treatment using the treatment system that is integrated into the patient table of a magnetic resonance image (MRI) scanner. Endpoints were change in the intensity of pain due to bone metastases from before to after the treatment, as measured on a numerical rating scale, pain interference with daily activities as determined by the Brief pain inventory (BPI), change in images, and safety. Pain relief was obtained in all patients early after treatment, with a reduction in the mean pain score from 6.0±1.3 at baseline to 1.2±1.0 at the end of follow-up as well as in pain interference with daily activities. The mean time required for a single-session treatment was 83.7±37.0 min, with a mean number of sonications required of 13.3±3.7 and mean energy applied of 846.4±273.5 J. No significant growth of tumors was observed, nor were there treatment-related adverse events. These results suggest that MRgFUS has a non-invasive palliative effect on the localized pain in patients with bone metastasis. MRgFUS could become an option in treatment strategies for painful bone metastases in the future.

  18. Refractory pain, existential suffering, and palliative care: releasing an unbearable lightness of being.

    PubMed

    Smith, George P

    2011-01-01

    Since the beginning of the hospice movement in 1967, "total pain management" has been the declared goal of hospice care. Palliating the whole person's physical, psychosocial, and spiritual states or conditions is central to managing the pain that induces suffering. At the end-stage of life, an inextricable component of the ethics of adjusted care requires recognition of a fundamental right to avoid cruel and unusual suffering from terminal illness. This Article urges wider consideration and use of terminal sedation, or sedation until death, as an efficacious palliative treatment and as a reasonable medical procedure in order to safeguard the "right" to a dignified death. Once the state establishes a human right to avoid refractory pain of whatever nature in end-stage illness, a coordinate responsibility must be assumed by health care providers to make medical judgments consistent with preserving the best interests of a patient's quality of life by alleviating suffering. The principle of medical futility is the preferred construct for implementing this professional responsibility. Rather than continue to be mired in the vexatious quagmire of the doctrine of double effect--all in an effort to "test" whether end-stage decisions by health care providers are licit or illicit--a relatively simple test of proportionality, or cost-benefit analysis, is proffered. Imbedded, necessarily, in this equation is the humane virtue of compassion, charity, mercy or agape. Assertions of state interest in safeguarding public morality by restricting intimate associational freedoms to accelerate death in a terminal illness are suspicious, if, indeed, not invalid. No terminally ill individual suffering from either intractable somatic or non-somatic pain, or both, should be forced to continue living. PMID:25330560

  19. International Patterns of Practice in Palliative Radiotherapy for Painful Bone Metastases: Evidence-Based Practice?

    SciTech Connect

    Fairchild, Alysa; Barnes, Elizabeth; Ghosh, Sunita; Ben-Josef, Edgar; Roos, Daniel; Hartsell, William; Holt, Tanya; Wu, Jackson; Janjan, Nora; Chow, Edward

    2009-12-01

    Purpose: Multiple randomized controlled trials have demonstrated the equivalence of multifraction and single-fraction (SF) radiotherapy for the palliation of painful bone metastases (BM). However, according to previous surveys, SF schedules remain underused. The objectives of this study were to determine the current patterns of practice internationally and to investigate the factors influencing this practice. Methods and Materials: The members of three global radiation oncology professional organizations (American Society for Radiology Oncology [ASTRO], Canadian Association of Radiation Oncology [CARO], Royal Australian and New Zealand College of Radiologists) completed an Internet-based survey. The respondents described what radiotherapy dose fractionation they would recommend for 5 hypothetical cases describing patients with single or multiple painful BMs from breast, lung, or prostate cancer. Radiation oncologists rated the importance of patient, tumor, institution, and treatment factors, and descriptive statistics were compiled. The chi-square test was used for categorical variables and the Student t test for continuous variables. Logistic regression analysis identified predictors of the use of SF radiotherapy. Results: A total of 962 respondents, three-quarters ASTRO members, described 101 different dose schedules in common use (range, 3 Gy/1 fraction to 60 Gy/20 fractions). The median dose overall was 30 Gy/10 fractions. SF schedules were used the least often by ASTRO members practicing in the United States and most often by CARO members. Case, membership affiliation, country of training, location of practice, and practice type were independently predictive of the use of SF. The principal factors considered when prescribing were prognosis, risk of spinal cord compression, and performance status. Conclusion: Despite abundant evidence, most radiation oncologists continue to prescribe multifraction schedules for patients who fit the eligibility criteria of

  20. Hemi body irradiation: An economical way of palliation of pain in bone metastasis in advanced cancer

    PubMed Central

    Pal, Santanu; Dutta, Samrat; Adhikary, Shyam Sundar; Bhattacharya, Biswamit; Ghosh, Balaram; Patra, Niladri B.

    2014-01-01

    Test (P < 0.05) was significant in VAS score changes, VRS score changes, PPR score changes, and GPS score changes. Along with the decrease in morphine tablets, the Linear Correlation of various scales for pain reduction like VAS, VRS, PPR, and GPS were significant. As such, the quality of life was better due to decreased pain and also, a decrease in the dose of analgesics. Grade 1 and 2 hematological toxicity and grade 1 diarrhea were observed as common side-effects. The average total cost of treatment including hospital stay, medicines, and radiation charges was around INR 400.00. Conclusion: This study shows that hemibody irradiation is not only an effective modality for palliation of severe bone pain in advanced cancer cases but also economical, involves short hospital stay, with acceptable side-effects, utilizes the simple Telecobalt machine, and is less cumbersome in comparison to other currently available pain palliation methods like oral morphine and radiopharmaceuticals. PMID:24665443

  1. Stereotactic mesencephalotomy for palliative care pain control: A case report, literature review and plea to rediscover this operation.

    PubMed

    Ivanishvili, Zurab; Pujara, Shyam; Honey, C Michael; Chang, Stephano; Honey, Christopher R

    2016-08-01

    Introduction Stereotactic mesencephalotomy is an ablative procedure which lesions the pain pathways (spinothalamic and trigeminothalamic tracts) at the midbrain level to treat medically refractory, nociceptive, contralateral pain. Sparsely reported in contemporary English language literature, this operation is at risk of being lost from the modern-day neurosurgical practice. Methods We present a case report and brief review of the literature on stereotactic mesencephalotomy. A 17-year-old girl with cervical cord glioblastoma and medically refractory unilateral head and neck pain was treated with contralateral stereotactic mesencephalotomy. The lesion was placed at the level of the inferior colliculus, half way between the lateral edge of the aqueduct and lateral border of the midbrain. Results The patient had no head and neck pain immediately after the procedure and remained pain-free for the remainder of her life (five months). She was weaned off her pre-operative narcotics and was able to leave hospital, meeting her palliative care goals. Conclusions Cancer-related unilateral head and neck nociceptive pain in the palliative care setting can be successfully treated with stereotactic mesencephalotomy. We believe that stereotactic mesencephalotomy is the treatment of choice for a small number of patients typified by our case. The authors make a plea to the palliative care and neurosurgical communities to rediscover this operation. PMID:26760110

  2. Relationship between pain and chronic illness among seriously ill older adults: expanding role for palliative social work.

    PubMed

    Morrissey, Mary Beth; Viola, Deborah; Shi, Qiuhu

    2014-01-01

    Confronting the issue of pain among chronically ill older adults merits serious attention in light of mounting evidence that pain in this population is often undertreated or not treated at all (Institute of Medicine, 2011 ). The relationship between pain and chronic illness among adults age 50 and over was examined in this study through the use of longitudinal data from the University of Michigan Health and Retirement Study, sponsored by the National Institute on Aging and the Social Security Administration. Findings suggested positive associations between pain and chronic disease, pain and multimorbidity, as well as an inverse association between pain and education. Policy implications for workforce development and public health are many, and amplification of palliative social work roles to relieve pain and suffering among seriously ill older adults at all stages of the chronic illness trajectory is needed. PMID:24628140

  3. Palliative Surgery in Treating Painful Metastases of the Upper Cervical Spine

    PubMed Central

    Wu, Xinghuo; Ye, Zhewei; Pu, Feifei; Chen, Songfeng; Wang, Baichuan; Zhang, Zhicai; Yang, Cao; Yang, Shuhua; Shao, Zengwu

    2016-01-01

    Abstract Increased incidence of upper cervical metastases and higher life expectancy resulted in higher operative rates in patients. The purpose of this study was to explore the methods and the clinical outcomes of palliative surgery for cervical spinal metastases. A systematic review of a 15-case series of upper cervical metastases treated with palliative surgery was performed. All cases underwent palliative surgery, including anterior tumor resection and internal fixation in 3 cases, posterior tumor resection and internal fixation in 10 cases, and combined anterior and posterior tumor resection and internal fixation in 2 cases. Patients were followed-up clinically and radiologically after the operation, and visual analog scale (VAS) and activities of daily living scores were calculated. In addition, a literature review was performed and patients with upper cervical spine metastases were analyzed. The mean follow-up period was 12.5 months (range, 3–26 months) in this consecutive case series. The pain was substantially relieved in 93.3% (14/15) of the patients after the operation. The VAS and Japanese Orthopedic Association scores showed improved clinical outcomes, from 7.86 ± 1.72 and 11.13 ± 2.19 preoperatively to 2.13 ± 1.40 and 14.26 ± 3.03 postoperatively, respectively. The mean survival time was 9.5 months (range, 5–26 months). Dural tear occurred in 1 patient. Wound infections, instrumentation failure, and postoperative death were not observed. Among our cases and other cases reported in the literature, 72% of the patients were treated with simple anterior or posterior operation, and only 12% of the patients (3/25) underwent complex combined anterior and posterior operation. Metastatic upper cervical spine disease is not a rare occurrence. Balancing the perspective of patients on palliative surgery concerning the clinical benefits of operation versus its operative risks can assist the decision for surgery. PMID:27149472

  4. Integrating palliative care in public health: the Colombian experience following an international pain policy fellowship.

    PubMed

    Leon, Marta; Florez, Sandra; De Lima, Liliana; Ryan, Karen

    2011-06-01

    Access to palliative care is insufficient in many countries around the world. In an effort to improve access to palliative care services and treatments, a public health approach as suggested by the World Health Organization was implemented in Colombia to improve opioid availability, increase awareness and competences about palliative care for healthcare workers, and to include palliative care as a component of care in legislation. As a result, opioid availability has improved, a mandatory palliative care course for medical undergraduate students has been implemented and a palliative care law is being discussed in the Senate. This article describes the strategy, main achievements and suggestions for implementing similar initiatives in developing countries. PMID:21228093

  5. Metastatic Bone Pain Palliation using 177Lu-Ethylenediaminetetramethylene Phosphonic Acid

    PubMed Central

    Alavi, Mehrosadat; Omidvari, Shapour; Mehdizadeh, Alireza; Jalilian, Amir R.; Bahrami-Samani, Ali

    2015-01-01

    177Lu-ethylenediaminetetramethylene phosphonic acid (EDTMP) is presently suggested as an excellent bone seeking radionuclide for developing metastatic bone pain (MBP) palliation agent owing to its suitable nuclear decay characteristics. To find the exact dosage and its efficiency, this clinical study was performed on the human being, using 177Lu-EDTMP for MBP palliation. 177Lu-EDTMP was prepared by Iran, atomic energy organization. Thirty consecutive patients with determined tumors, incontrollable MBP, and positive bone scan at 4 weeks before the beginning of the study participated in this study in the nuclear medicine ward. 177Lu-EDTMP in the form of sterile slow IV injection was administered with a dose of 29.6 MBq/kg. Short form of brief pain inventory questionnaire was used to evaluate the efficiency of the intervention. Questionnaires were filled out by an expert nuclear physician every 2 weeks while the cell blood count was also checked every 2 weeks up to 12 weeks for evaluation of bone marrow suppression and hematological toxicity. Furthermore, whole body scan was done at days 1, 3, and 7. Twenty-five patients showed a significant pain relief since 2 weeks after the injection, and continued until the end of the follow up period (12 weeks). There were no significant early complications such as bone marrow suppression, hematological toxicity, and no systemic adverse effects. No complication was observed in renal function. Twenty one patients showed flare phenomenon that was started after the 12.2 ± 1.78 h lasting for 38.4 ± 23.08. Sixteen patients (53%) were completely treated; nine patients (30%) showed a partial response, and five patients (17%) had no response to treatment. Total response to treatment was achieved in 25 patients (83%). At the end of the evaluation, no bone marrow suppression or hematologic toxicity was observed. 177Lu-EDTMP has shown suitable physical and biological properties with good results in long term bone pain relief for patients

  6. Solitary Painful Osseous Metastases: Correlation of Imaging Features with Pain Palliation after Radiofrequency Ablation—A Multicenter American College of Radiology Imaging Network Study

    PubMed Central

    Guenette, Jeffrey P.; Lopez, Michael J.; Kim, Eunhee

    2013-01-01

    Purpose: To identify the correlation of pre- and postablation imaging features with pain relief, pain intensity, and patient mood after radiofrequency (RF) ablation of solitary painful osseous metastases. Materials and Methods: This prospective, multicenter group trial was approved by each institutional review board. Participants were enrolled between November 1, 2001, and April 6, 2006. Written informed consent was obtained from all subjects, and patient confidentiality protocols were followed in compliance with HIPAA. Computed tomography (CT)-guided RF ablation and contrast material–enhanced 1-month follow-up CT and/or magnetic resonance imaging were performed in 49 subjects (24 men, 25 women; age range, 34–83 years) with a confirmed malignant solitary bone lesion of maximum dimension of 8 cm or smaller that was causing intractable pain. Pain intensity and patient mood were measured before and after RF ablation. Tumor imaging features were recorded. Unadjusted and adjusted linear mixed-effects models, with a random intercept for each subject, were used to model patient mood, pain relief, and pain intensity scores at three times after ablation as a function of each tumor characteristic. Results: Decreased postablation tumor pain correlated with preablation tumor volume (P = .02) and pathologic fracture (P = .01), while pain relief correlated with pathologic fracture (P = .03) and percentage of bone-tumor interface (BTI) ablated (P = .02). Conversely, presence of an irregular rim after ablation (P = .02) and rim thickness (P = .01) correlated with increased pain. There was no evidence in this study that RF ablation of larger tumor percentage or larger volume leads to better pain relief or decreased pain (P > .05). Conclusion: Existing pathologic fracture and smaller tumor size appear to be predictive parameters of success when selecting patients for palliative RF ablation of painful solitary osseous metastases. Successful palliation also appears to be related

  7. Palliative therapy with I-131 labeled bezylidenediphosphonic acid: In vivo kinetics and response to pain induced by bone metastases

    SciTech Connect

    Eisenhut, M.; Berberich, R.; Kimmig, B.; Oberhausen, E.; Georgi, P.; Zum Winkel, K.

    1985-05-01

    I-131 labeled ..cap alpha..-amino-(4-hydroxybenzylidene)diphosphonic acid (BDP3) was recently suggested as a palliative acting radiopharmaceutical against pain syndromes associated with disseminated bone metastases. Such an application was supported by the in vivo kinetics of I-131-BDP3 in rats. The authors investigated the palliative effectiveness of I-131-BDP3 in 18 patients with typical pain symptoms induced by bone metastases of various primary carcinoma. The blood clearance was rapid. More than 90% disappeared from the blood pool at 4 hr after injection. The excretion of the activity occured solely through the kidneys and the median total body retention at 48 hr was 51% (range 30-64%). The thyroid activity decreased during therapy indicating no cleavage reactions as long as I-131-BDP3 is bound to the bone tissue. The binding of I-131-BDP3 to bone is very long since the effective half life was in the order of magnitude of the physical half life. Additionally the effective half lifes in the metastatic ares (median 182 hr; range 177-205 hr) proved to be longer than in unaffected areas (145 hr; 140-165 hr). The palliative therapies were performed with doses of 6 - 48 mCi. The response amounted to 44% complete pain relief, 6% substantial pain relief, 22% minimal improvement and 28% no change. The duration of response ranged between 1 and 8 weeks.

  8. Pain medicine and palliative care as an alternative to euthanasia in end-of-life cancer care

    PubMed Central

    Erdek, Michael

    2015-01-01

    There exists support for euthanasia or physician-assisted suicide (PAS) in cases of terminal cancer. One of the premises for this approach is the goal of the alleviation of suffering. Do current means of pain control in the greater overall setting of palliative care serve as a desirable alternative? A contrast comparison may be drawn between the above approaches using both theological and medical sources to show that the enlightened use of both interventional and non-interventional pain medicine approaches in an integrated palliative care setting are a theologically grounded and medically feasible alternative to euthanasia or PAS in this population. Lay summary: Patients suffering from terminal cancer often have pain. Some have advocated euthanasia or physician-assisted suicide as a potential way of alleviating this suffering. Further examination of this topic, however, shows this approach may be essentially utilitarian and fail to consider the inherent value of human life. There has been significant development in recent years in the fields of pain medicine and palliative care, which afford alternate means of addressing suffering in this patient population. PMID:25999611

  9. Pain medicine and palliative care as an alternative to euthanasia in end-of-life cancer care.

    PubMed

    Erdek, Michael

    2015-05-01

    There exists support for euthanasia or physician-assisted suicide (PAS) in cases of terminal cancer. One of the premises for this approach is the goal of the alleviation of suffering. Do current means of pain control in the greater overall setting of palliative care serve as a desirable alternative? A contrast comparison may be drawn between the above approaches using both theological and medical sources to show that the enlightened use of both interventional and non-interventional pain medicine approaches in an integrated palliative care setting are a theologically grounded and medically feasible alternative to euthanasia or PAS in this population. Lay summary: Patients suffering from terminal cancer often have pain. Some have advocated euthanasia or physician-assisted suicide as a potential way of alleviating this suffering. Further examination of this topic, however, shows this approach may be essentially utilitarian and fail to consider the inherent value of human life. There has been significant development in recent years in the fields of pain medicine and palliative care, which afford alternate means of addressing suffering in this patient population. PMID:25999611

  10. Transmucosal Immediate-Release Fentanyl for Breakthrough Cancer Pain: Opportunities and Challenges for Use in Palliative Care.

    PubMed

    Chang, Andrew; Roeland, Eric J; Atayee, Rabia S; Revta, Carolyn; Ma, Joseph D

    2015-09-01

    Opioids are used to treat breakthrough cancer pain (BTCP) and can be classified by relative duration and onset of action. Regulatory approvals of numerous transmucosal immediate-release fentanyl (TIRF) formulations provide alternative options to palliative care-trained providers in the management of BTCP. TIRFs have been formulated as a sublingual tablet, sublingual spray, intranasal spray, pectin-based nasal spray, buccal tablet, and buccal soluble film. Differences exist between TIRFs regarding formulation design and dosing to treat BTCP. Opportunities for use include palliation of BTCP in head and neck cancer and/or radiation-induced mucositis. The purpose of this review is to discuss TIRF formulation and dosing, pharmacokinetics, clinical efficacy, patient acceptability, and safety/tolerability. In addition, barriers to TIRF utilization will be discussed. PMID:26368648

  11. Rhemium-186-monoaminemonoamidedithiol-conjugated bisphosphonate derivatives for bone pain palliation.

    PubMed

    Ogawa, Kazuma; Mukai, Takahiro; Arano, Yasushi; Otaka, Akira; Ueda, Masashi; Uehara, Tomoya; Magata, Yasuhiro; Hashimoto, Kazuyuki; Saji, Hideo

    2006-05-01

    To develop a radiopharmaceutical for the palliation of painful bone metastases based on the concept of bifunctional radiopharmaceuticals, we synthesized a bisphosphonate derivative labeled with rhenium-186 (186Re) that contains a hydroxyl group at the central carbon of its bisphosphonate structure, we attached a stable 186Re-MAMA chelate to the amino group of a 4-amino butylidene-bisphosphonate derivative [N-[2-[[4-[(4-hydroxy-4,4-diphosphonobutyl)amino]-4-oxobutyl]-2-thioethylamino]acetyl]-2-aminoethanethiolate] oxorhenium (V) (186Re-MAMA-HBP) and we investigated the effect of a hydroxyl group at the central carbon of its bisphosphonate structure on affinity for hydroxyapatite and on biodistribution by conducting a comparative study with [N-[2-[[3-(3,3-diphosphonopropylcarbamoyl)propyl]-2-thioethylamino]acetyl]-2-aminoethanethiolate] oxorhenium (V) (186Re-MAMA-BP). The precursor of 186Re-MAMA-HBP, trityl (Tr)-MAMA-HBP, was obtained by coupling a Tr-MAMA derivative to 4-amino-1-hydroxybutylidene-1,1-bisphosphonate. 186Re-MAMA-HBP was prepared by a reaction with 186ReO(4-) and SnCl2 in citrate buffer after the deprotection of the Tr groups of Tr-MAMA-HBP. After reversed-phase high-performance liquid chromatography, 186Re-MAMA-HBP had a radiochemical purity of over 95%. Compared with 186Re-MAMA-BP, 186Re-MAMA-HBP showed a greater affinity for hydroxyapatite beads in vitro and accumulated a significantly higher level in the femur in vivo. Thus, the introduction of a hydroxyl group into 186Re complex-conjugated bisphosphonates would be effective in enhancing accumulation in bones. These findings provide useful information on the design of bone-seeking therapeutic radiopharmaceuticals. PMID:16720243

  12. Evaluating a Human Rights-Based Advocacy Approach to Expanding Access to Pain Medicines and Palliative Care: Global Advocacy and Case Studies from India, Kenya, and Ukraine.

    PubMed

    Lohman, Diederik; Amon, Joseph J

    2015-01-01

    Palliative care has been defined as care that is person-centered and attentive to physical symptoms and psychological, social, and existential distress in patients with severe or life-threatening illness. The identification of access to palliative care and pain treatment as a human rights issue first emerged among palliative care advocates, physicians, and lawyers in the 1990s, with a basis in the right to health and the right to be free from cruel, inhuman, and degrading treatment. Using a case study approach, we evaluate the results of a human rights-based advocacy approach on access to pain medicine and palliative care in India, Kenya, and Ukraine. In each country, human rights advocacy helped raise awareness of the issue, identify structural barriers to care, define government obligations, and contribute to the reform of laws, policies, and practices impeding the availability of palliative care services. In addition, advocacy efforts stimulated civil society engagement and high-level political leadership that fostered the implementation of human rights-based palliative care programs. Globally, access to palliative care was increasingly recognized by human rights bodies and within global health and drug policy organizations as a government obligation central to the right to health. PMID:26766856

  13. 125I brachytherapy in the palliation of painful bone metastases from lung cancer after failure or rejection of conventional treatments

    PubMed Central

    Gilani, Saba; Zhong, Zhihui; Zhang, Tao; Zhang, Fujun; Gao, Fei

    2016-01-01

    Purpose This study sought to assess the safety and effect of 125I seed implantation for palliation of painful bone metastases from lung cancer after failure or rejection of conventional treatments. Materials and Methods 89 patients with painful bone metastases secondary to lung cancer were consented and enrolled in this study from June 2013 to May 2015. All patients had failed or refused conventional treatments underwent percutaneous CT-guided 125I seed implantation. The Brief Pain Inventory (BPI) was used to measure pain intensity prior to treatment (T0), 2, 4, 6, 8 and 12 weeks (T2, T4, T6, T8 and T12) after treatment in a 24-hour period. Analgesic, quality of life (QOL) scores and complications were also recorded. Four patients were excluded as they were lost to follow-up or had incomplete data. Results 85 patients with 126 bone metastases from lung cancer were treated. There were significantly lower scores after treatment in the visual analog scale (VAS) and analgesic. The VAS scores for worst pain was 6.3±1.8 at T0. At T2, T4, T6, T8 and T12, the score in a 24-hour period decreased to 4.9±1.2 (P<0.01), 3.7±1.3 (P<0.01), 3.4±1.2 (P<0.01), 2.6±0.9 (P<0.01), and 1.4±0.8 (P<0.01) respectively. Comparison of QOL scores showed improvements including sleep, appetite, spiritual state, and fatigue at T2, T4, T6, T8 and T12 when compared to T0. No serious complications or massive bleeding were observed. Conclusions 125I brachytherapy is a safe and effective method for palliation of painful bone metastases from lung cancer after failure or rejection of conventional treatments. PMID:26919235

  14. 68Ga-PSMA PET/CT Imaging and 153Sm-EDTMP Bone Pain Palliation Therapy.

    PubMed

    Sasikumar, Arun; Joy, Ajith; Nanabala, Raviteja; Pillai, M R A; Thomas, Boben

    2016-07-01

    Ga-labeled prostate-specific membrane antigen (PSMA) is a potential tool in the imaging of recurrent prostate cancer. Ga-PSMA imaging is also useful for radiotherapy planning and in targeted therapy with Lu-PSMA. A few case reports regarding the use of Ga-PSMA in nonprostate cancer malignancies are also reported. We describe the use of Ga-PSMA imaging before Sm-EDTMP bone pain palliation therapy in a 58-year-old hormone refractory prostate cancer patient with extensive bone metastases. PMID:27055142

  15. Production, biodistribution assessment and dosimetric evaluation of 177Lu-TTHMP as an agent for bone pain palliation

    PubMed Central

    Zolghadri, Samaneh; Yousefnia, Hassan; Jalilian, Amir Reza; Ghannadi-Maragheh, Mohammad

    2015-01-01

    Objective(s): Recently, bone-avid radiopharmaceuticals have been shown to have potential benefits for the treatment of widespread bone metastases. Although 177Lu-triethylene tetramine hexa methylene phosphonic acid (abbreviated as 177Lu-TTHMP), as an agent for bone pain palliation, has been evaluated in previous studies, there are large discrepancies between the obtained results. In this study, production, quality control, biodistribution, and dose evaluation of 177Lu-TTHMP have been investigated and compared with the previously reported data. Methods: TTHMP was synthesized and characterized, using spectroscopic methods. Radiochemical purity of the 177Lu-TTHMP complex was determined using instant thin-layer chromatography (ITLC) and high performance liquid chromatography (HPLC) methods. The complex was injected to wild-type rats and biodistribution was studied for 7 days. Preliminary dose evaluation was investigated based on biodistribution data in rats. Results: 177Lu was prepared with 2.6-3 GBq/mg specific activity and radionuclide purity of 99.98%. 177Lu-TTHMP was successfully prepared with high radiochemical purity (>99%). The complex showed rapid bone uptake, while accumulation in other organs was insignificant. Dosimetric results showed that all tissues received almost insignificant absorbed doses in comparison with bone tissues. Conclusion: Based on the obtained results, this radiopharmaceutical can be a good candidate for bone pain palliation therapy in skeletal metastases.

  16. Quality of Life After Palliative Radiation Therapy for Patients With Painful Bone Metastases: Results of an International Study Validating the EORTC QLQ-BM22

    SciTech Connect

    Zeng Liang; Chow, Edward; Bedard, Gillian; Zhang, Liying; Fairchild, Alysa; Vassiliou, Vassilios; Alm El-Din, Mohamed A.; Jesus-Garcia, Reynaldo; Kumar, Aswin; Forges, Fabien; Tseng, Ling-Ming; Hou, Ming-Feng; Chie, Wei-Chu; Bottomley, Andrew

    2012-11-01

    Purpose: Radiation therapy (RT) is an effective method of palliating painful bone metastases and can improve function and reduce analgesic requirements. In advanced cancer patients, quality of life (QOL) is the primary outcome of interest over traditional endpoints such as survival. The purpose of our study was to compare bone metastasis-specific QOL scores among patients who responded differently to palliative RT. Methods and Materials: Patients receiving RT for bone metastases across 6 countries were prospectively enrolled from March 2010-January 2011 in a trial validating the QLQ-BM22 and completed the QLQ-BM22 and the core measure (QLQ-C30) at baseline and after 1 month. Pain scores and analgesic intake were recorded, and response to RT was determined according to the latest published guidelines. The Kruskal-Wallis nonparametric and Wilcoxon rank sum tests compared changes in QOL among response groups. A Bonferroni-adjusted P<.003 indicated statistical significance. Results: Of 79 patients who received palliative RT, 59 were assessable. Partial response, pain progression, and indeterminate response were observed in 22, 8, and 29 patients, respectively; there were no patients with a complete response. Patients across all groups had similar baseline QOL scores apart from physical functioning (patients who progressed had better initial functioning). One month after RT, patients who responded had significant improvements in 3 of 4 QLQ-BM22 domains (painful site, P<.0001; painful characteristic, P<.0001; and functional interference, P<.0001) and 3 QLQ-C30 domains (physical functioning, P=.0006; role functioning, P=.0026; and pain, P<.0001). Patients with progression in pain had significantly worse functional interference (P=.0007) and pain (P=.0019). Conclusions: Patients who report pain relief after palliative RT also have better QOL with respect to bone metastasis-specific issues. The QLQ-BM22 and QLQ-C30 are able to discriminate among patients with varying

  17. Reliability and Concurrent Validity of the Palliative Outcome Scale, the Rotterdam Symptom Checklist, and the Brief Pain Inventory

    PubMed Central

    Perez-Hoyos, Santiago; Agra-Varela, Yolanda

    2013-01-01

    Abstract Background Some domains of the questionnaires used to measure symptoms and quality of life (QOL) in patients with advanced cancer seem to measure similar dimensions or constructs, so it would be useful for clinicians to demonstrate the interchangeability of equivalent domains of the questionnaires in measuring the same constructs. Objective This study investigated the reliability and concurrent validity of the Palliative Outcome Scale (POS), the Rotterdam Symptom Checklist (RSCL), and the Brief Pain Inventory (BPI), used to measure symptom control in patients with advanced cancer. Design This was an evaluative study. Setting/Subjects Subjects were patients with advanced cancer attended by Spanish primary care physicians. Measurements Secondary analysis was performed of 117 outpatients who completed the POS, BPI, and RSCL at two different times, with an interval of 7 to 10 days. Bland and Altman analyses and plot, repeatability coefficient, as well as Spearman correlations were carried out. Results There were 117 included patients. Mean age was 69.4 (11.5) years, gender was 60% male, 37.6% completed only elementary school, diagnoses were mainly digestive and lung cancer, with a low functional rate and presence of oncologic pain. First and second questionnaire rounds showed significant correlations and agreement. Agreement was shown between pain intensity of BPI and pain and physical scales of RSCL, and between physical symptoms of RSCL and of POS, with significant correlations in equivalent dimensions. Conclusion BPI, POS, and RSCL have shown adequate reliability and moderate concurrent validity among them. PMID:23808642

  18. 175Yb-TTHMP as a good candidate for bone pain palliation and substitute of other radiopharmaceuticals

    PubMed Central

    Safarzadeh, Laleh

    2014-01-01

    Bone metastasis is one of the most frequent causes of pain in cancer patients. Different radioisotopes such as P-32, Sm-153, Ho-166, Lu-177, and Re-186 with several chemical ligands as ethylenediaminetetramethylene phosphonic acid (EDTMP), 1,4,7,10-tetraazacyclododecane-1,4,7,10-tetramethylene phosphonic acid (DOTMP), and propylenediaminetetramethylene phosphonate (PDTMP) are recommended for bone pain palliation. In this work, 175Yb-triethylenetetraminehexamethylene phosphonic acid (TTHMP) was produced as a proper alternative to other radiopharmaceuticals. Relatively long half-life (T1/2 = 4.18 days), maximum energy beta particle Eβ =470 keV (86.5%), low abundance gamma emission 396 keV (6.4%), 286 keV (3.01%), 113.8 keV (1.88%) and low cost are considered advantageous of Yb-175 are to wider usage of this isotope; in addition, TTHMP is an ideal carrier moiety for bone metastases. Production, quality control, and biodistribution studies of 175Yb-TTHMP were targeted. Yb-175 chloride was obtained by thermal neutron bombardment of a natural Yb2O3 sample at Tehran Research Reactor (TRR), radiolabeling was completed in 1 h by the addition of TTHMP at the room temperature and pH was 7.5-8, radiochemical purity was higher than 95%. Biodistribution studies in normal rats were carried out. The results showed favorable biodistribution features of 175Yb-TTHMP, indicating significant accumulation in bone tissues compared with clinically used bone-seeking radiopharmaceuticals. This research presents 175Yb-TTHMP can be a good candidate for bone pain palliation and substitute of other radiopharmaceuticals, however, further biological studies in other mammals are still needed. PMID:25210277

  19. Dimethyl sulfoxide-sodium bicarbonate infusion for palliative care and pain relief in patients with metastatic prostate cancer.

    PubMed

    Hoang, Ba X; Le, Bao T; Tran, Hau D; Hoang, Cuong; Tran, Hung Q; Tran, Dao M; Pham, Cu Q; Pham, Tuan D; Ha, Trung V; Bui, Nga T; Shaw, D Graeme

    2011-01-01

    Prostate cancer (adenocarcinoma of the prostate) is the most widespread cancer in men. It causes significant suffering and mortality due to metastatic disease. The main therapy for metastatic prostate cancer (MPC) includes androgen manipulation, chemotherapy, and radiotherapy and/or radioisotopes. However, these therapeutic approaches are considered palliative at this stage, and their significant side effects can cause further decline in patients' quality of life and increase non-cancer-related morbidity/mortality. In this study, the authors have used the infusion of dimethyl sulfoxide-sodium bicarbonate (DMSO-SB) to treat 18 patients with MPC. The 90-day follow-up of the patients having undergone the proposed therapeutic regimen showed significant improvement in clinical symptoms, blood and biochemistry tests, and quality of life. There were no major side effects from the treatment. In searching for new and better methods for palliative treatment and pain relief, this study strongly suggested therapy with DMSO-SB infusions could provide a rational alternative to conventional treatment for patients with MPC. PMID:21936635

  20. Palliative Surgery in Treating Painful Metastases of the Upper Cervical Spine: Case Report and Review of the Literature.

    PubMed

    Wu, Xinghuo; Ye, Zhewei; Pu, Feifei; Chen, Songfeng; Wang, Baichuan; Zhang, Zhicai; Yang, Cao; Yang, Shuhua; Shao, Zengwu

    2016-05-01

    Increased incidence of upper cervical metastases and higher life expectancy resulted in higher operative rates in patients. The purpose of this study was to explore the methods and the clinical outcomes of palliative surgery for cervical spinal metastases.A systematic review of a 15-case series of upper cervical metastases treated with palliative surgery was performed. All cases underwent palliative surgery, including anterior tumor resection and internal fixation in 3 cases, posterior tumor resection and internal fixation in 10 cases, and combined anterior and posterior tumor resection and internal fixation in 2 cases. Patients were followed-up clinically and radiologically after the operation, and visual analog scale (VAS) and activities of daily living scores were calculated. In addition, a literature review was performed and patients with upper cervical spine metastases were analyzed.The mean follow-up period was 12.5 months (range, 3-26 months) in this consecutive case series. The pain was substantially relieved in 93.3% (14/15) of the patients after the operation. The VAS and Japanese Orthopedic Association scores showed improved clinical outcomes, from 7.86 ± 1.72 and 11.13 ± 2.19 preoperatively to 2.13 ± 1.40 and 14.26 ± 3.03 postoperatively, respectively. The mean survival time was 9.5 months (range, 5-26 months). Dural tear occurred in 1 patient. Wound infections, instrumentation failure, and postoperative death were not observed. Among our cases and other cases reported in the literature, 72% of the patients were treated with simple anterior or posterior operation, and only 12% of the patients (3/25) underwent complex combined anterior and posterior operation.Metastatic upper cervical spine disease is not a rare occurrence. Balancing the perspective of patients on palliative surgery concerning the clinical benefits of operation versus its operative risks can assist the decision for surgery. PMID:27149472

  1. Intravenous paracetamol infusion: Superior pain management and earlier discharge from hospital in patients undergoing palliative head-neck cancer surgery

    PubMed Central

    Majumdar, Saikat; Das, Anjan; Kundu, Ratul; Mukherjee, Dipankar; Hazra, Bimal; Mitra, Tapobrata

    2014-01-01

    Background: Paracetamol; a cyclooxygenase inhibitor; acts through the central nervous system as well as serotoninergic system as a nonopioid analgesic. A prospective, double-blinded, and randomized-controlled study was carried out to compare the efficacy of preoperative 1g intravenous (iv) paracetamol with placebo in providing postoperative analgesia in head-neck cancer surgery. Materials and Methods: From 2008 February to 2009 December, 80 patients for palliative head-neck cancer surgery were randomly divided into (F) and (P) Group receiving ivplacebo and iv paracetamol, respectively, 5 min before induction. Everybody received fentanyl before induction and IM diclofenac for pain relief at8 hourly for 24 h after surgery. Visual analogue scale (VAS) and amount of fentanyl were measured for postoperative pain assessment (24 h). Results and Statistical analysis: The mean VAS score in 1st, 2nd postoperative hour, and fentanyl requirement was less and the need for rescue analgesic was delayed in ivparacetamol group which were all statistically significant. Paracetamol group had a shorter surgical intensive care unit (SICU) and hospital stay which was also statistically significant. Conclusion: The study demonstrates the effectiveness of ivparacetamol as preemptive analgesic in the postoperative pain control after head-neck cancer surgery and earlier discharge from hospital. PMID:25276627

  2. Education in palliative care.

    PubMed

    Weissman, David E; Blust, Linda

    2005-02-01

    Palliative care education includes the domains of pain and nonpain symptom management, communications skills, ethics and law, psychosocial care, and health systems. Defining key attitudes, knowledge, and skill objectives, and matching these to appropriate learning formats, is essential in educational planning. Abundant educational resource material is available to support classroom and experiential palliative care training. PMID:15639043

  3. Efficacy and Safety of a Fixed Combination of Tramadol and Paracetamol (Acetaminophen) as Pain Therapy Within Palliative Medicine

    PubMed Central

    Husic, Samir; Izic, Senad; Matic, Srecko; Sukalo, Aziz

    2015-01-01

    Goal: The goal of the research was to determine the efficacy of a fixed combination of tramadol and paracetamol (acetaminophen) in the treatment of pain of patients with the advanced stage of cancer. Material and methods: A prospective study was conducted at the Center for Palliative Care, University Clinical Center Tuzla, Bosnia and Herzegovina, from January 1st to December 31st 2013. A total of 353 patients who were treated with a fixed combination of tramadol and acetaminophen (37.5 mg and 325 mg) at the initial dosage 3x1 tablet (112.5 mg tramadol and 975 mg acetaminophen) for pain intensity 4, up to 4x2 tablets (300 mg of tramadol and 2600 mg paracetamol) for pain intensity 7 and 8. If the patient during previous day has two or more pain episodes that required a “rescue dose” of tramadol, increased was the dose of fixed combination tramadol and acetaminophen to a maximum of 8 tablets daily (300 mg of tramadol and 2600 mg paracetamol). Statistical analysis was performed by biomedical software MedCalc for Windows version 9.4.2.0. The difference was considered significant for P<0.05. Results: The average duration of treatment with a fixed combination tramadol and acetaminophen was 57 days (13-330 days). Already after 24 hours of treatment the average pain score was significantly lower (p<0.0001) compared to the admission day [5.00 (4:00 to 8:00) during the first days versus 2.00 (1:00 to 7:00) during the second day of treatment]. The average dose of the fixed combination tramadol and acetaminophen tablets was 4.8 ± 1.8 (180 mg of tramadol and 1560 mg paracetamol). Side effects, in the treatment of pain with a fixed combination tramadol and acetaminophen, were found in 29.18% of patients, with a predominance of nausea and vomiting. Conclusion: Fixed combination of tramadol and acetaminophen can be used as an effective combination in the treatment of chronic cancer pain, with frequent dose evaluation and mild side effects. PMID:25870531

  4. Patterns of Practice in Palliative Radiotherapy for Painful Bone Metastases: A Survey in Japan

    SciTech Connect

    Nakamura, Naoki; Shikama, Naoto; Wada, Hitoshi; Harada, Hideyuki; Nozaki, Miwako; Nagakura, Hisayasu; Tago, Masao; Oguchi, Masahiko; Uchida, Nobue

    2012-05-01

    Purpose: To determine the current patterns of practice in Japan and to investigate factors that may make clinicians reluctant to use single-fraction radiotherapy (SF-RT). Methods and Materials: Members of the Japanese Radiation Oncology Study Group (JROSG) completed an Internet-based survey and described the radiotherapy dose fractionation they would recommend for four hypothetical cases describing patients with painful bone metastasis (BM). Case 1 described a patient with an uncomplicated painful BM in a non-weight-bearing site from non-small-cell lung cancer. Case 2 investigated whether management for a case of uncomplicated spinal BM would be different from that in Case 1. Case 3 was identical with Case 2 except for the presence of neuropathic pain. Case 4 investigated the prescription for an uncomplicated painful BM secondary to oligometastatic breast cancer. Radiation oncologists who recommended multifraction radiotherapy (MF-RT) for Case 2 were asked to explain why they considered MF-RT superior to SF-RT. Results: A total of 52 radiation oncologists from 50 institutions (36% of JROSG institutions) responded. In all four cases, the most commonly prescribed regimen was 30 Gy in 10 fractions. SF-RT was recommended by 13% of respondents for Case 1, 6% for Case 2, 0% for Case 3, and 2% for Case 4. For Case 4, 29% of respondents prescribed a high-dose MF-RT regimen (e.g., 50 Gy in 25 fractions). The following factors were most often cited as reasons for preferring MF-RT: 'time until first increase in pain' (85%), 'incidence of spinal cord compression' (50%), and 'incidence of pathologic fractures' (29%). Conclusions: Japanese radiation oncologists prefer a schedule of 30 Gy in 10 fractions and are less likely to recommend SF-RT. Most Japanese radiation oncologists regard MF-RT as superior to SF-RT, based primarily on the time until first increase in pain.

  5. Bupivacaine administered intrathecally versus rectally in the management of intractable rectal cancer pain in palliative care

    PubMed Central

    Zaporowska-Stachowiak, Iwona; Kowalski, Grzegorz; Łuczak, Jacek; Kosicka, Katarzyna; Kotlinska-Lemieszek, Aleksandra; Sopata, Maciej; Główka, Franciszek

    2014-01-01

    Background Unacceptable adverse effects, contraindications to and/or ineffectiveness of World Health Organization step III “pain ladder” drugs causes needless suffering among a population of cancer patients. Successful management of severe cancer pain may require invasive treatment. However, a patient’s refusal of an invasive procedure necessitates that clinicians consider alternative options. Objective Intrathecal bupivacaine delivery as a viable treatment of intractable pain is well documented. There are no data on rectal bupivacaine use in cancer patients or in the treatment of cancer tenesmoid pain. This study aims to demonstrate that bupivacaine administered rectally could be a step in between the current treatment options for intractable cancer pain (conventional/conservative analgesia or invasive procedures), and to evaluate the effect of the mode of administration (intrathecal versus rectal) on the bupivacaine plasma concentration. Cases We present two Caucasian, elderly inpatients admitted to hospice due to intractable rectal/tenesmoid pain. The first case is a female with vulvar cancer, and malignant infiltration of the rectum/vagina. Bupivacaine was used intrathecally (0.25–0.5%, 1–2 mL every 6 hours). The second case is a female with ovarian cancer and malignant rectal infiltration. Bupivacaine was adminstered rectally (0.05–0.1%, 100 mL every 4.5–11 hours). Methods Total bupivacaine plasma concentrations were determined using the high-performance liquid chromatography-ultraviolet method. Results Effective pain control was achieved with intrathecal bupivacaine (0.077–0.154 mg·kg−1) and bupivacaine in enema (1.820 mg·kg−1). Intrathecal bupivacaine (0.5%, 2 mL) caused a drop in blood pressure; other side effects were absent in both cases. Total plasma bupivacaine concentrations following intrathecal and rectal bupivacaine application did not exceed 317.2 ng·mL−1 and 235.7 ng·mL−1, respectively. Bupivacaine elimination was

  6. Preparation, Biological Evaluation and Dosimetry Studies of 175Yb-Bis-Phosphonates for Palliative Treatment of Bone Pain

    PubMed Central

    Fakhari, Ashraf; Jalilian, Amir R.; Yousefnia, Hassan; Shanehsazzadeh, Saeed; Samani, Ali Bahrami; Daha, Fariba Johari; Ardestani, Mehdi Shafiee; Khalaj, Ali

    2015-01-01

    Objective: Optimized production and quality control of ytterbium-175 (Yb-175) labeled pamidronate and alendronate complexes as efficient agents for bone pain palliation has been presented. Methods: Yb-175 labeled pamidronate and alendronate (175Yb-PMD and 175Yb-ALN) complexes were prepared successfully at optimized conditions with acceptable radiochemical purity, stability and significant hydroxyapatite absorption. The biodistribution of complexes were evaluated up to 48 h, which demonstrated significant bone uptake ratios for 175Yb-PAM at all-time intervals. It was also detected that 175Yb-PAM mostly washed out and excreted through the kidneys. Results: The performance of 175Yb-PAM in an animal model was better or comparable to other 175Yb-bone seeking complexes previously reported. Conclusion: Based on calculations, the total body dose for 175Yb-ALN is 40% higher as compared to 175Yb-PAM (especially kidneys) indicating that 175Yb-PAM is probably a safer agent than 175Yb-ALN. PMID:27529886

  7. Lumbar paravertebral blockade as intractable pain management method in palliative care

    PubMed Central

    Zaporowska-Stachowiak, Iwona; Kotlinska-Lemieszek, Aleksandra; Kowalski, Grzegorz; Kosicka, Katarzyna; Hoffmann, Karolina; Główka, Franciszek; Łuczak, Jacek

    2013-01-01

    Optimal symptoms control in advanced cancer disease, with refractory to conventional pain treatment, needs an interventional procedure. This paper presents coadministration of local anesthetic (LA) via paravertebral blockade (PVB) as the alternative to an unsuccessful subcutaneous fentanyl pain control in a 71-year old cancer patient with pathological fracture of femoral neck, bone metastases, and contraindications to morphine. Bupivacaine in continuous infusion (0.25%, 5 mL · hour−1) or in boluses (10 mL of 0.125%–0.5% solution), used for lumbar PVB, resulted in pain relief, decreased demand for opioids, and led to better social interactions. The factors contributing to an increased risk of systemic toxicity from LA in the patient were: renal impairment; heart failure; hypoalbuminemia; hypocalcemia; and a complex therapy with possible drug-drug interactions. These factors were taken into consideration during treatment. Bupivacaine’s side effects were absent. Coadministered drugs could mask LA’s toxicity. Elevated plasma α1-acid glycoprotein levels were a protective factor. To evaluate the benefit-risk ratio of the PVB treatment in boluses and in constant infusion, bupivacaine serum levels were determined and the drug plasma half-lives were calculated. Bupivacaine’s elimination was slower when administered in constant infusion than in boluses (t½ = 7.80 hours versus 2.64 hours). Total drug serum concentrations remained within the safe ranges during the whole treatment course (22.9–927.4 ng mL−1). In the case presented, lumbar PVB with bupivacaine in boluses (≤ 137.5 mg · 24 hours−1) was an easy to perform, safe, effective method for pain control. Bupivacaine in continuous infusion (≤150 mg · 12 hours−1) had an acceptable risk-benefits ratio, but was ineffective. PMID:24043944

  8. Palliative Care

    MedlinePlus

    Palliative care is treatment of the discomfort, symptoms, and stress of serious illness. It provides relief from distressing ... care at the end of life, always includes palliative care. But you may receive palliative care at any ...

  9. Palliative Care

    MedlinePlus

    ... 5 Things to Know About Zika & Pregnancy Palliative Care KidsHealth > For Parents > Palliative Care Print A A ... decisions about their child's care. Who Needs Palliative Care? Any child who has a serious, complex, or ...

  10. Grief and Palliative Care: Mutuality

    PubMed Central

    Moon, Paul J

    2013-01-01

    Grief and palliative care are interrelated and perhaps mutually inclusive. Conceptually and practically, grief intimately relates to palliative care, as both domains regard the phenomena of loss, suffering, and a desire for abatement of pain burden. Moreover, the notions of palliative care and grief may be construed as being mutually inclusive in terms of one cueing the other. As such, the discussions in this article will center on the conceptualizations of the mutuality between grief and palliative care related to end-of-life circumstances. Specifically, the complementarity of grief and palliative care, as well as a controvertible view thereof, will be considered. PMID:25278758

  11. ¹⁷⁷Lu-Labeled Agents for Neuroendocrine Tumor Therapy and Bone Pain Palliation in Uruguay.

    PubMed

    Balter, Henia; Victoria, Trindade; Mariella, Terán; Javier, Gaudiano; Rodolfo, Ferrando; Andrea, Paolino; Graciela, Rodriguez; Juan, Hermida; Eugenia, De Marco; Patricia, Oliver

    2016-01-01

    Lutetium-177 is an emerging radionuclide due its convenient chemical and nuclear properties. In this paper we describe the development and evaluation in Uruguay of the targeted 177Lu labelled radiopharmaceuticals EDTMP (for bone pain palliation) and DOTA-TATE (neuroendocrine tumors). We optimized the preparation of these 177Lu radiopharmaceuticals including radiolabelling, quality control methods, in vitro and in vivo stability and their therapeutic application in patients. Radiation dosimetry aspects of 177Lu are also included. Nine male patients with prostate cancer and four female patients with breast carcinoma with multiple bone metastatic lesions were treated with 177Lu-EDTMP. Four patients with gastroentheropancreatic neuroendocrine tumors (GEP-NET) and one patient with bronchial NET were treated with 1- 3 cycles with a cumulative dose of 4.44-22.2 GBq of 177Lu-DOTA-TATE. Scintigraphic images of the patients treated with 177Lu-EDTMP evidenced high and rapid uptake in bone metastasis, remaining after 7 days post administration. Images allow skeletal visualization with high definition and demonstrate increased uptake in bone metastases. For 177Lu-DOTA-TATE, partial remissions were obtained in 4 patients and the remaining patient did not show significant progression 3 months after the second cycle. No serious adverse effects were registered, even in two patients with confirmed renal disease and high risk for renal disease Dosimetry assessments confirm the predictive value of the personalized therapy with radiolabelled peptides. We found it is possible to accumulate high therapeutic doses in tumours in sequential administrations of 177Lu-DOTA-TATE, increasing the probability of biological response without significant impairment of the renal function in patients with risk factors. These results demonstrate the attractive therapeutic properties of these two 177Lu labelled agents and the feasibility of this metabolic therapy in regions far away from 177Lu producing

  12. The management of cancer-related breakthrough pain: recommendations of a task group of the Science Committee of the Association for Palliative Medicine of Great Britain and Ireland.

    PubMed

    Davies, Andrew N; Dickman, Andrew; Reid, Colette; Stevens, Anna-Marie; Zeppetella, Giovambattista

    2009-04-01

    A task group of the Science Committee of the Association for Palliative Medicine of Great Britain and Ireland (APM) was convened to produce some up-to-date, evidence-based, practical, clinical guidelines on the management of cancer-related breakthrough pain in adults. On the basis of a review of the literature, the task group was unable to make recommendations about any individual interventions, but was able to make a series of 12 recommendations about certain generic strategies. However, most of the aforementioned recommendations are based on limited evidence (i.e., case series, expert opinion). The task group also proposed a definition of breakthrough pain, and some diagnostic criteria for breakthrough pain. PMID:18707904

  13. Human absorbed dose estimation for a new (175)Yb-phosphonate based on rats data: Comparison with similar bone pain palliation agents.

    PubMed

    Vaez-Tehrani, Mahdokht; Zolghadri, Samaneh; Yousefnia, Hassan; Afarideh, Hossein

    2016-09-01

    In this work, the absorbed dose to human organs for (175)Yb-BPAMD was evaluated based on the biodistribution studies in rats. The results showed that the bone surface would receive the highest absorbed dose after injection of (175)Yb-BPAMD with 13.32mGy/MBq, while the other organs receive insignificant absorbed dose. Also, the comparison of (175)Yb-BPAMD with other therapeutic phosphonate complexes demonstrated noticeable characteristics for this new agent. Generally, based on the obtained results, (175)Yb-BPAMD can be considered as a promising agent for bone pain palliative therapy in near future. PMID:27337650

  14. Training Physicians in Palliative Care.

    ERIC Educational Resources Information Center

    Muir, J. Cameron; Krammer, Lisa M.; von Gunten, Charles F.

    1999-01-01

    Describes the elements of a program in hospice and palliative medicine that may serve as a model of an effective system of physician education. Topics for the palliative-care curriculum include hospice medicine, breaking bad news, pain management, the process of dying, and managing personal stress. (JOW)

  15. Treating Palliative Care Patients with Pain with the Body Tambura: A Prospective Case Study at St. Joseph's Hospice for Dying destitute in Dindigul South India

    PubMed Central

    Dietrich, Cordula; Teut, M; Samwel, Kakuko Lopoyetum; Narayanasamy, S; Rathapillil, T; Thathews, G

    2015-01-01

    Background: The Body Tambura is a recently invented stringed instrument that is used for receptive music therapy designed to be placed and attached on the human body. The aim of this study was to record perceived effects of a treatment with the Body Tambura on palliative care patients with special reference to pain. Materials and Methods: A prospective case study was carried out with patients of St. Joseph's Hospice for Dying Destitute in Dindigul/South India. Patients were treated with a treatment after baseline assessment and also on the next day. Outcomes were measured quantitatively by using a numeric rating scale (0–10, 10 maximum intensity of pain felt) at baseline, directly after treatment, and the day after the treatment to determine the intensity of the pain. Results: Ten patients (five women and five men) participated in the study. The majority described the therapy as a pleasant experience. The pain intensity at baseline was reduced from 8.3 ± standard deviation (SD) 1.16 to 4.6 ± 1.52 at day 1 and from 4.6 ± 2.07 to 2.4 ± 1.58 at day 2. Conclusion: A clinically relevant pain reduction was described as short time outcome; the therapy was received and perceived well. Forthcoming research should include a control group, randomization, a larger number of participants, and a longer period of treatment. PMID:26009680

  16. Palliative care: an evolving field in medicine.

    PubMed

    Eti, Serife

    2011-06-01

    Palliative care is an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems: physical, psychosocial, and spiritual. This article discusses illness trajectories and prognostic estimates, prognostic tools, educating physicians and nurses in palliative care, research in palliative medicine, and palliative care in hospitals and the community. PMID:21628032

  17. Determining the Incidence of Pain Flare Following Palliative Radiotherapy for Symptomatic Bone Metastases: Results From Three Canadian Cancer Centers

    SciTech Connect

    Hird, Amanda; Chow, Edward Zhang Liying; Wong, Rebecca; Wu, Jackson; Sinclair, Emily; Danjoux, Cyril; Tsao, May; Barnes, Elizabeth; Loblaw, Andrew

    2009-09-01

    Purpose: To determine the incidence of pain flare following radiotherapy (RT) for painful bone metastases. Materials and Methods: Patients with bone metastases treated with RT were eligible. Worst pain scores and analgesic consumption were collected before, daily during, and for 10 days after treatment. Pain flare was defined as a 2-point increase in the worst pain score (0-10) compared to baseline with no decrease in analgesic intake, or a 25% increase in analgesic intake with no decrease in worst pain score. Pain flare was distinguished from progression of pain by requiring the worst pain score and analgesic intake return to baseline levels after the increase/flare (within the 10-day follow-up period). Results: A total of 111 patients from three cancer centers were evaluable. There were 50 male and 61 female patients with a median age of 62 years (range, 40-89 years). The primary cancers were mainly breast, lung, and prostate. Most patients received a single 8 Gy (64%) or 20 Gy in five fractions (25%). The overall pain flare incidence was 44/111 (40%) during RT and within 10 days following the completion of RT. Patients treated with a single 8 Gy reported a pain flare incidence of 39% (27/70) and, with multiple fractions, 41% (17/41). Conclusion: More than one third of the enrolled patients experienced a pain flare. Identifying at-risk individuals and managing potential pain flares is crucial to achieve an optimal level of care.

  18. Cancer pain

    SciTech Connect

    Swerdlow, M.; Ventafridda, V.

    1987-01-01

    This book contains 13 chapters. Some of the chapter titles are: Importance of the Problem; Neurophysiology and Biochemistry of Pain; Assessment of Pain in Patients with Cancer; Drug Therapy; Chemotherapy and Radiotherapy for Cancer Pain; Sympton Control as it Relates to Pain Control; and Palliative Surgery in Cancer Pain Treatment.

  19. Development of a rhenium-186-labeled MAG3-conjugated bisphosphonate for the palliation of metastatic bone pain based on the concept of bifunctional radiopharmaceuticals.

    PubMed

    Ogawa, Kazuma; Mukai, Takahiro; Arano, Yasushi; Ono, Masahiro; Hanaoka, Hirofumi; Ishino, Seigo; Hashimoto, Kazuyuki; Nishimura, Hiroshi; Saji, Hideo

    2005-01-01

    Rhenium-186-1-hydroxyethylidene-1,1-diphosphonate (186Re-HEDP) has been used for the palliation of metastatic bone pain. Delayed blood clearance and high gastric uptake of radioactivity have been observed upon injection, due to the instability of (186)Re-HEDP in vivo. In this study, on the basis of the concept of bifunctional radiopharmaceuticals, we designed a stable 186Re-mercaptoacetylglycylglycylglycine (MAG3) complex-conjugated bisphosphonate, [[[[(4-hydroxy-4,4-diphosphonobutyl)carbamoylmethyl]carbamoylmethyl]carbamoylmethyl]carbamoylmethanethiolate]oxorhenium(V) (186Re-MAG3-HBP). As a precursor, [1-hydroxy-1-phosphono-4-[2-[2-[2-(2-tritylmercaptoacetylamino)acetylamino]acetylamino]acetylamino]butyl]phosphonic acid (Tr-MAG3-HBP) was synthesized by the conjugation of N-[(tritylmercapto)acetyl]glycylglycylglycine (Tr-MAG3) with the bisphosphonate analogue. After deprotection of the trityl group of Tr-MAG3-HBP, 186Re-labeling was performed by reacting 186ReO4- with SnCl2 in citrate buffer. After purification by HPLC, 186Re-MAG3-HBP showed a radiochemical purity of over 95%. To compare the stability of 186Re-MAG3-HBP and 186Re-HEDP, these (186)Re complexes were incubated in phosphate buffer. No measurable decomposition of 186Re-MAG3-HBP occurred over a 24-h period, while only approximately 30% of 186Re-HEDP remained intact 24 h postincubation. In biodistribution experiments, the radioactivity level of 186Re-MAG3-HBP in bone was significantly higher than that of (186)Re-HEDP. Blood clearance of 186Re-MAG3-HBP was faster than that of 186Re-HEDP. In addition, the gastric accumulation of 186Re-MAG3-HBP radioactivity was lower than that of 186Re-HEDP. In conclusion, 186Re-MAG3-HBP is expected to be a useful radiopharmaceutical for the palliation of metastatic bone pain. PMID:16029015

  20. Would Larger Radiation Fields Lead to a Faster Onset of Pain Relief in the Palliation of Bone Metastases?

    SciTech Connect

    Chow, Edward Makhani, Leila; Culleton, Shaelyn; Makhani, Nadiya; Davis, Lori; Campos, Sarah; Sinclair, Emily

    2009-08-01

    Purpose: Hemibody irradiation has been shown to relieve bony metastatic pain within 24-48 hours of treatment, whereas for local external beam radiation, onset of pain relief is 1-4 weeks after radiation. The primary objective of this study is to examine whether there is a relationship between the areas of radiation treatment and onset of pain relief. Methods and Materials: From Jan 1999 to Jan 2002, a total of 653 patients with symptomatic bone metastases were treated with external beam radiation. Pain scores and analgesic consumption were recorded at baseline and Weeks 1, 2, 4, 8, and 12. The areas of radiation treatment for all patients were calculated, then correlated with the response and analyzed in various ways. We first compared pain score alone with mean radiation field size. Second, we combined pain score and analgesic consumption. Last, we implemented the International Consensus end points for pain score and analgesic intake. Results: Assessment of 653 patients showed no significant correlation comparing pain scores alone with radiation field area, with the exception of Week 4 for partial responders. Again, no significant correlation was found when combining both analgesic intake and pain score against radiation field size. Even when implementing the International Consensus end point definitions for radiation response, the only significant correlation between radiation field size and response was observed in Week 2 for partial response. Conclusion: There was no statistical significance between mean areas of radiation treatment with the onset of pain relief.

  1. The Team Approach to Pain Relief

    MedlinePlus

    ... says that the NIH Clinical Center's Pain and Palliative Care Service helped bring her pain under control. Roberts ... under control. The NIH Clinical Center's Pain and Palliative Care Service worked with Roberts and her physicians to ...

  2. Comparison of Single Versus Multiple Fractions for Palliative Treatment of Painful Bone Metastasis: First Study from North West India

    PubMed Central

    Kapoor, Akhil; Singhal, Mukesh Kumar; Bagri, Puneet Kumar; Nirban, Raj Kumar; Maharia, Sitaram; Narayan, Satya; Kumar, Harvindra Singh

    2015-01-01

    Background: Bone metastasis is a usual cause of pain in advanced cancer. Conventional radiation schedules require larger hospital stay and thus are not suitable for patients with poor general condition. This prospective observational study aims to compare the pain-relieving efficacy of different radiation fractionation schedules, i.e., 8 Gy administered in a single fraction versus 30 Gy administered in 10 fractions. Materials and Methods: Two hundred and fifty consecutive patients of bone metastasis were evaluated for the study, with 63 patients being excluded due to non-fulfillment of the inclusion criteria. The response to radiotherapy leading to pain relief as per the Visual Analog Scale was recorded at the end of treatment, 8 days, 15 days and 1 month during the follow-up visits. Results: Sixty-two percent of the patients received a single fraction while the remaining received 10 fractions. In the 10-fraction group, overall response was present in 60% of the patients. Stable pain was present in 23% of the patients while 9% patients had progressive pain. At 1 month of completion of treatment, 9% patients were lost to follow-up. In the single-fraction arm, overall response was seen in 58%, stable pain in 27% and progressive pain in 7% of the patients. Six percent of the patients were lost to follow-up. Conclusions: Single-fraction treatment for bony metastasis is as effective as multiple fractions to relieve bony pain and provides treatment convenience to both the patient and the caregiver. PMID:25709185

  3. Palliative Care

    MedlinePlus

    ... you with all of these questions and discussions. Making Decisions About End-of-Life Care DNR/DNI/AND ... Experience Positive Growth? Grieving and Palliative Care Overview Making Decisions About End-of-Life Care DNR/DNI/AND ...

  4. Palliative Care

    MedlinePlus

    Palliative care is treatment of the discomfort, symptoms, and stress of serious illness. It provides relief from distressing symptoms ... of the medical treatments you're receiving. Hospice care, care at the end of life, always includes ...

  5. Palliative Chemotherapy.

    PubMed

    Matzo, Marianne

    2016-06-01

    This article is the first in a series on palliative care developed in collaboration with the Hospice and Palliative Nurses Association (HPNA; http://hpna.advancingexpertcare.org). The HPNA aims to guide nurses in preventing and relieving suffering and in giving the best possible care to patients and families, regardless of the stage of disease or the need for other therapies. The HPNA offers education, certification, advocacy, leadership, and research. PMID:27227867

  6. Safety and Palliative Efficacy of Single-Dose 8-Gy Reirradiation for Painful Local Failure in Patients With Stage IV Non-Small Cell Lung Cancer Previously Treated With Radical Chemoradiation Therapy

    SciTech Connect

    Topkan, Erkan; Yildirim, Berna Akkus; Guler, Ozan Cem; Parlak, Cem; Pehlivan, Berrin; Selek, Ugur

    2015-03-15

    Purpose: To investigate the safety and efficacy of single-dose 8-Gy palliative chest reirradiation (CRI) in metastatic non-small cell lung cancer (M-NSCLC) patients with painful thoracic failures (TF) within the previous radiation portal. Patients and Methods: We retrospectively analyzed the clinical data of 78 M-NSCLC patients who received single-dose 8-Gy CRI for painful TF after concurrent chemoradiation therapy to a total radiation dose of 52 to 66 Gy between 2007 and 2012. Primary endpoints included significant pain relief (SPR) defined as a ≥2 point decrement in the Visual Analogue Scale for Pain inventory (VAS-P), time to pain relief, and duration of pain control. Secondary objectives were survival and prognostic factors. Results: Treatment was well tolerated, with only 5.1% grade 3 pneumonitis and 1.3% grade 2 esophagitis. Pre-CRI median and post-CRI minimum VAS-P were 7 and 3 (P<.001), respectively. SPR was noted in 67 (85.9%) patients, and only 3 (3.9%) scored progressive pain. Median time to lowest VAS-P and duration of pain control were 27 days and 6.1 months, respectively. Median overall survival (OS) was 7.7 months, and the 1-year OS rate was 26.5%. On multivariate analyses, lower Eastern Cooperative Oncology group score (1-2; P<.001), absence of anemia (P=.001), and fewer metastatic sites (1-2; P<.001) were found to be associated with longer OS. Conclusions: Single-dose 8-Gy CRI provides safe, effective, and durable pain palliation for TF in radically irradiated M-NSCLC patients. Because of its convenience, lower cost, and higher comfort, the present protocol can be considered an appropriate option for patients with limited life spans.

  7. A Freeze-Dried Kit for the Preparation of (188)Re-HEDP for Bone Pain Palliation: Preparation and Preliminary Clinical Evaluation.

    PubMed

    Mallia, Madhava B; Shinto, Ajit Sugunan; Kameswaran, Mythili; Kamaleshwaran, Koramadai Karuppusamy; Kalarikal, Radhakrishnan; Aswathy, K K; Banerjee, Sharmila

    2016-05-01

    (188)Re-HEDP is an established radiopharmaceutical used for pain palliation in patients with osseous metastasis. Considering commercial availability of (188)W/(188)Re generator, the accessibility to a lyophilized kit would make preparation of this radiopharmaceutical feasible at the hospital radiopharmacy having access to a generator. A protocol for the preparation of a single-vial lyophilized hydroxyethane 1,1-diphosphonic acid (HEDP) kit was developed and its consistency was checked by preparing six batches. Each sterile lyophilized kit prepared as per the protocol contained 9 mg of HEDP, 3 mg of gentisic acid, and 4 mg of SnCl2.2H2O. Randomly selected kits from all six batches were subjected to thorough quality control tests that were passed by all batches. (188)Re-HEDP could be prepared by addition of 1 mL of freshly eluted Na(188)ReO4 (up to 3700 MBq) containing 1 μmol of carrier ReO4(-) (perrhenate) and heating at 100°C for 15 minutes. (188)Re-HEDP with >95% radiochemical purity could be consistently prepared using the lyophilized kits. Sterile (188)Re-HEDP prepared using the lyophilized kit was evaluated in patients with osseous metastasis. Post-therapy images of the patient were compared with (99m)Tc-MDP bone scan and found to be satisfactory. The bone-to-background as well as tumor-to-normal bone uptake ratio was found to be significant. All patients who received therapy reported significant pain relief within a week to 10 days post-administration of (188)Re-HEDP. PMID:27183437

  8. The growth of palliative care.

    PubMed

    Strand, Jacob J; Mansel, J Keith; Swetz, Keith M

    2014-06-01

    Palliative care specialists focus on meeting the needs of patients with serious and/or life-threatening illnesses. These physicians have expertise in managing complex pain and nonpain symptoms, providing psychosocial and spiritual support to patients and their families, and communicating about complex topics and advance care planning. The American Board of Medical Specialties has allowed 10 of its member boards to co-sponsor certification in Hospice and Palliative Medicine. Thus, physicians from specialties ranging from pediatrics to surgery now practice hospice and palliative medicine. At the core of this field, however, are physicians who trained as internists and are boarded by the American Board of Internal Medicine. This article discusses the central principles of palliative care and explores its growth in two areas: oncology and critical care medicine. PMID:25029799

  9. Patterns of Practice in Palliative Radiotherapy for Painful Bone Metastases: Impact of a Regional Rapid Access Clinic on Access to Care

    SciTech Connect

    Wu, Jackson S.Y.; Kerba, Marc; Wong, Rebecca K.S.; Mckimmon, Erin; Eigl, Bernhard; Hagen, Neil A.

    2010-10-01

    Purpose: External beam radiotherapy (RT) is commonly indicated for the palliation of symptomatic bone metastases, but there is evidence of underutilization of this treatment modality in palliative care for cancer populations. This study was conducted to investigate factors that influenced the use of palliative RT services at a regional comprehensive cancer center. Methods and Materials: A cohort of patients with radiographically confirmed bone metastases and first-time users of palliative RT between 2003 and 2005 was retrospectively reviewed from the time of initial diagnosis of bone metastases to death or last follow-up. Type of radiation treatment service provider used (rapid access or routine access) and patient-, tumor-, and treatment-related factors were analyzed for their influences on the number of treatment courses given over the duration of disease. Results: A total of 887 patients received 1,354 courses of palliative RT for bone metastases at a median interval of 4.0 months between courses. Thirty-three percent of patients required more than one RT course. Increased age and travel distance reduced the likelihood and number of treatment courses, while service through a rapid access clinic was independently associated with an increase in subsequent use of palliative RT. Conclusions: A rapid access service model for palliative RT facilitated access to RT. Travel distance and other factors remained substantial barriers to use of palliative RT services. The pattern of practice suggests an unmet need for symptom control in patients with bone metastases.

  10. Palliation: Hilar cholangiocarcinoma

    PubMed Central

    Goenka, Mahesh Kr; Goenka, Usha

    2014-01-01

    Hilar cholangiocarcinomas are common tumors of the bile duct that are often unresectable at presentation. Palliation, therefore, remains the goal in the majority of these patients. Palliative treatment is particularly indicated in the presence of cholangitis and pruritus but is often also offered for high-grade jaundice and abdominal pain. Endoscopic drainage by placing stents at endoscopic retrograde cholangio-pancreatography (ERCP) is usually the preferred modality of palliation. However, for advanced disease, percutaneous stenting has been shown to be superior to endoscopic stenting. Endosonography-guided biliary drainage is emerging as an alternative technique, particularly when ERCP is not possible or fails. Metal stents are usually preferred over plastic stents, both for ERCP and for percutaneous biliary drainage. There is no consensus as to whether it is necessary to place multiple stents within advanced hilar blocks or whether unilateral stenting would suffice. However, recent data have suggested that, contrary to previous belief, it is useful to drain more than 50% of the liver volume for favorable long-term results. In the presence of cholangitis, it is beneficial to drain all of the obstructed biliary segments. Surgical bypass plays a limited role in palliation and is offered primarily as a segment III bypass if, during a laparotomy for resection, the tumor is found to be unresectable. Photodynamic therapy and, more recently, radiofrequency ablation have been used as adjuvant therapies to improve the results of biliary stenting. The exact technique to be used for palliation is guided by the extent of the biliary involvement (Bismuth class) and the availability of local expertise. PMID:25232449

  11. Oral Ketamine in the Palliative Care Setting: A Review of the Literature and Case Report of a Patient With Neurofibromatosis Type 1 and Glomus Tumor-Associated Complex Regional Pain Syndrome

    PubMed Central

    Soto, Eliezer; Stewart, Douglas R.; Mannes, Andrew J.; Ruppert, Sarah L.; Baker, Karen; Zlott, Daniel; Handel, Daniel; Berger, Ann M.

    2014-01-01

    Ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist, has been shown to be effective not only for its anesthetic properties but also for the analgesic and opiate-sparing effects. However, data on efficacy and safety of oral ketamine for the treatment of neuropathic or cancer pain syndromes is limited with most of the evidence based on small clinical trials and anecdotal experiences. In this review, we will analyze the clinical data on oral ketamine in the palliative care setting. After an extensive search using five major databases, a total of 19 relevant articles were included. No official clinical guidelines for the use of oral ketamine in this patient population were found. Studies on oral ketamine for cancer and neuropathic pain have shown mixed results which could be partially due to significant differences in hepatic metabolism. In addition, we will include a case report of a 38-year-old female with neurofibromatosis type 1 (NF1) with history of chronic, severe pain in her fingertips secondary to multiple glomus tumors which evolved into CRPS resistant to multiple therapies but responsive to oral ketamine. Based on our experience with oral ketamine, this drug should be administered after an intravenous trial to monitor response and side effects in patients with an adequate functional status. However, patients in the palliative care and hospice setting, especially the one at the end of their lives, may also benefit from oral ketamine even if an intravenous trial is not feasible. PMID:21803784

  12. Oral ketamine in the palliative care setting: a review of the literature and case report of a patient with neurofibromatosis type 1 and glomus tumor-associated complex regional pain syndrome.

    PubMed

    Soto, Eliezer; Stewart, Douglas R; Mannes, Andrew J; Ruppert, Sarah L; Baker, Karen; Zlott, Daniel; Handel, Daniel; Berger, Ann M

    2012-06-01

    Ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist, has been shown to be effective not only for its anesthetic properties but also for the analgesic and opiate-sparing effects. However, data on efficacy and safety of oral ketamine for the treatment of neuropathic or cancer pain syndromes is limited with most of the evidence based on small clinical trials and anecdotal experiences. In this review, we will analyze the clinical data on oral ketamine in the palliative care setting. After an extensive search using five major databases, a total of 19 relevant articles were included. No official clinical guidelines for the use of oral ketamine in this patient population were found. Studies on oral ketamine for cancer and neuropathic pain have shown mixed results which could be partially due to significant differences in hepatic metabolism. In addition, we will include a case report of a 38-year-old female with neurofibromatosis type 1 (NF1) with history of chronic, severe pain in her fingertips secondary to multiple glomus tumors which evolved into CRPS resistant to multiple therapies but responsive to oral ketamine. Based on our experience with oral ketamine, this drug should be administered after an intravenous trial to monitor response and side effects in patients with an adequate functional status. However, patients in the palliative care and hospice setting, especially the one at the end of their lives, may also benefit from oral ketamine even if an intravenous trial is not feasible. PMID:21803784

  13. External beam radiotherapy for palliation of painful bone metastases: pooled data bioeffect dose response analysis of dose fractionation

    NASA Astrophysics Data System (ADS)

    Naveen, T.; Supe, Sanjay S.; Ganesh, K. M.; Samuel, Jacob

    2009-01-01

    Bone metastases develop in up to 70% of newly diagnosed cancer patients and result in immobility, anxiety, and depression, severely diminishing the patients quality of life. Radiotherapy is a frequently used modality for bone metastasis and has been shown to be effective in reducing metastatic bone pain and in some instances, causing tumor shrinkage or growth inhibition. There is controversy surrounding the optimal fractionation schedule and total dose of external beam radiotherapy, despite many randomized trials and overviews addressing the issue. This study was undertaken to apply BED to clinical fractionation data of radiotherapeutic management of bone metastases in order to arrive at optimum BED values for acceptable level of response rate. A computerised literature search was conducted to identify all prospective clinical studies that addressed the issue of fractionation for the treatment of bone metastasis. The results of these studies were pooled together to form the database for the analysis. A total of 4111 number of patients received radiation dose ranging from 4 to 40.5 Gy in 1 to 15 fractions with dose per fraction ranging from 2 to 10 Gy. Single fraction treatments were delivered in 2013 patients and the dose varied from 4 to 10 Gy. Multifraction treatments were delivered in 2098 patients and the dose varied from 15 to 40.5 Gy. The biological effective dose (BED) was evaluated for each fractionation schedule using the linear quadratic model and an α/β value of 10 Gy. Response rate increased significantly beyond a BED value of 14.4 Gy (p < 0.01). Based on our analysis and indications from the literature about higher retreatment and fracture rate of single fraction treatments, minimum BED value of 14.4 Gy is recommended.

  14. Palliative care in advanced dementia.

    PubMed

    Merel, Susan E; Merel, Susan; DeMers, Shaune; Vig, Elizabeth

    2014-08-01

    Because neurodegenerative dementias are progressive and ultimately fatal, a palliative approach focusing on comfort, quality of life, and family support can have benefits for patients, families, and the health system. Elements of a palliative approach include discussion of prognosis and goals of care, completion of advance directives, and a thoughtful approach to common complications of advanced dementia. Physicians caring for patients with dementia should formulate a plan for end-of-life care in partnership with patients, families, and caregivers, and be prepared to manage common symptoms at the end of life in dementia, including pain and delirium. PMID:25037291

  15. Pain

    MedlinePlus

    ... realize you have a medical problem that needs treatment. Once you take care of the problem, pain ... Fortunately, there are many ways to treat pain. Treatment varies depending on the cause of pain. Pain ...

  16. [Palliative Radiotherapy for Bone Metastases].

    PubMed

    Nagakura, Hisayasu

    2015-11-01

    Bone metastasis is associated with many symptoms such as bone pain, pathological fracture, and spinal cord compression. Especially, pain secondary to bone metastases is a serious problem in many patients with metastatic cancer. Radiotherapy can provide remarkable pain relief, reduce the requirement for analgesic drugs, and prevent pathological fracture or spinal cord compression with few complications in most patients. Many randomized controlled trials have shown equivalent extent of pain relief between single-fraction and multiple-fraction regimens. Reirradiation of painful bone metastases is effective for palliation of pain in non-responders or patients with recurrent pain after an initial satisfactory response to a previous radiation therapy. Systemic administration of radioisotopes is an important palliative care option for painful multifocal bone metastases detected on nuclear imaging; however, the application of this option depends on the histologic features of the tumor and distribution of the metastases. Metastatic spinal cord compression is the most frequent oncologic emergency and necessitates timely and appropriate treatment. External beam radiotherapy is commonly used for the treatment of metastatic spinal cord compression. Surgical decompression and stabilization should be considered for metastatic spinal cord compression or pathological fracture in select patients. Postoperative radiotherapy should be administered to patients who have undergone surgical intervention for bone metastases. For patients at a high risk for oncologic emergency, optimal prophylactic management is highly recommended. PMID:26602393

  17. Palliative Care in Rural Minnesota: Findings from Stratis Health's Minnesota Rural Palliative Care Initiative.

    PubMed

    McKinley, Deb; Shearer, Janelle; Weng, Karla

    2016-01-01

    Palliative care, which involves managing symptoms, controlling pain and addressing stress caused by a chronic or terminal illness, has been shown to keep patients out of the hospital and allow them to stay home and live more comfortably with their illness. Typically, it is provided by an interdisciplinary team led by a physician trained in palliative medicine. Rural areas have not always had access to such specialists. Yet, today, rural health care organizations are finding ways to create palliative care programs that meet the needs of their chronically ill and aging populations. This article describes a six-year initiative led by Stratis Health to advance palliative care in rural Minnesota. It highlights the work of FirstLight Health System in Mora and describes Stratis Health's Rural Palliative Care Measurement Pilot Project, an effort to develop and test measures for evaluating rural palliative care programs. PMID:26897897

  18. What is palliative care?

    MedlinePlus

    Comfort care; End of life - palliative care; Hospice - palliative care ... The goal of palliative care is to help patients with serious illnesses feel better. It prevents or treats symptoms and side effects of disease ...

  19. What is palliative care?

    MedlinePlus

    Comfort care; End of life - palliative care; Hospice - palliative care ... The goal of palliative care is to help people with serious illnesses feel better. It prevents or treats symptoms and side effects of disease and ...

  20. Rawlsian Justice and Palliative Care.

    PubMed

    Knight, Carl; Albertsen, Andreas

    2015-10-01

    Palliative care serves both as an integrated part of treatment and as a last effort to care for those we cannot cure. The extent to which palliative care should be provided and our reasons for doing so have been curiously overlooked in the debate about distributive justice in health and healthcare. We argue that one prominent approach, the Rawlsian approach developed by Norman Daniels, is unable to provide such reasons and such care. This is because of a central feature in Daniels' account, namely that care should be provided to restore people's opportunities. Daniels' view is both unable to provide pain relief to those who need it as a supplement to treatment and, without justice-based reasons to provide palliative care to those whose opportunities cannot be restored. We conclude that this makes Daniels' framework much less attractive. PMID:25689627

  1. Current trends in palliative heart care.

    PubMed

    Shi, Rongyun

    2016-02-01

    Palliative care is an alternate therapeutic approach that involves specialised medical care of a patient diagnosed with serious life threatening illness like heart failure (HF). The prime aim of the palliative care is to provide patient with relief from the symptoms, pain, physical stress, and mental stress of the diagnosed disease. The palliative care helps in improving the quality of life for both the patient and the family. Advanced HF is a disease process that carries a high burden of symptoms, suffering, and death. Palliative care can complement traditional care to improve symptom amelioration, patient-caregiver communication, emotional support, and medical decision making. The present review summarized all the available on alternative palliative approaches provided to heart patient by a team of physicians, nurses and other healthcare professionals. PMID:25926080

  2. Palliative or Comfort Care

    MedlinePlus

    ... or efforts to cure your illness. Medicare, Medicaid, Veterans Health Administration benefits, and private health insurance cover many palliative care services. Many hospitals provide palliative care, and it ...

  3. [Palliative care - also in geriatrics?].

    PubMed

    Sandgathe Husebø, B; Husebø, S

    2001-10-01

    Red Cross Clinic is the largest geriatric center in Norway (240 beds). Major parts of the center are: long time geriatric ward (215 beds), rehabilitation and acute ward (25 beds), day clinic (45 patients) and a teaching and research unit. A palliative care unit (10 beds) will be opened in spring 2000. In mai 1998 a national project: Palliative care for the elderly was opened at our center. The projects main goal is to develop and support proper palliative care to all severe ill and dying patients in Norway. In a prospective study we examined 179 consecutive deaths between 1998 and 1999. Average age was 84.5. Major symptom problems were pain, dyspnoea, death-rattle and anxiety. In the last 24 hours 83% of the patients received opioids, 67% of the cases morphine (mean daily dosage 31.8 mg). 37% of the patients received scopolamine (mean daily dosage 0.8 mg), 12% benzodiazepines and 3% of the patients haloperidol. 152 (85%) of the deaths were expected, 27 (15%) unexpected. In 137 patients (77%) open, honest, frank communication with patient or their nearest kin regarding the imminent death was possible. In our experience it is a myth that the relatives want doctors to practise "maximal therapy". All old patients in geriatric clinics and nursing homes need palliative care. We have found no international textbooks of geriatrics with chapters on palliative care or textbooks on palliative care with chapters on the elderly. They need doctors and nurses who are properly trained and educated in palliative care. In most countries in Europe this training and education is not provided. PMID:11810376

  4. Things Philippine.

    ERIC Educational Resources Information Center

    Ongteco, Belen C.

    Presented in this booklet are brief descriptions of items and activities that are symbolic of Filipino culture. Some of the items and activities described include traditional Philippine clothing, a traditional fan, games and toys, eating utensils, and a native shopping bag. A biographical sketch of Dr. Jose Rizal, the "martyr of the Filipino…

  5. [Practical pain control in pediatric oncology. Recommendations of the German Society of Pediatric Oncology and Hematology, the German Association for the Study of Pain, the German Society of Palliative Care, and the Vodafone Institute of Children's Pain Therapy and Palliative Care].

    PubMed

    Zernikow, B; Schiessl, C; Wamsler, C; Janssen, G; Griessinger, N; Fengler, R; Nauck, F

    2006-02-01

    In pediatric oncology, optimal pain control is still a challenge. A structured pain history and the regular scoring of pain intensity using age-adapted measuring tools are hallmarks of optimal pain control. Psychological measures are as important as drug therapy in the prophylaxis or control of pain, especially when performing invasive procedures. Pain control is oriented toward the WHO multistep therapeutic schedule. On no account should the pediatric patient have to climb up the "analgesic ladder" - strong pain requires the primary use of strong opioids. Give opioids preferably by the oral route and by the clock - short-acting opioids should be used to treat breakthrough pain. Alternatives are i.v. infusion, patient-controlled analgesia, and transdermal applications. Constipation is the adverse effect most often seen with (oral) opioid therapy. Adverse effects should be anticipated, and prophylactic treatment should be given consistently. The assistance of pediatric nurses is of the utmost importance in pediatric pain control. Nurses deliver the basis for rational and effective pain control by scoring pain intensity and documenting drug administration as well as adverse effects. The nurses' task is also to prepare the patient for and monitor the patient during painful procedures. It is the responsibility of both nurse and doctor to guarantee emergency intervention during sedation whenever needed. In our guideline we comment on drug selection and dosage, pain measurement tools, and documentation tools for the purpose of pain control. Those tools may be easily integrated into daily routine. PMID:16421708

  6. Palliative care in chronic obstructive pulmonary disease.

    PubMed

    Lilly, Evan J; Senderovich, Helen

    2016-10-01

    Chronic obstructive pulmonary disease (COPD) is the only major worldwide cause of mortality that is currently increasing in prevalence. Furthermore, COPD is incurable, and the only therapy that has been shown to increase survival is oxygen therapy in selected patients. Compared to patients with cancer, patients with COPD experience similar levels of pain, breathlessness, fatigue, depression, and anxiety and have a worse quality of life but have comparatively little access to palliative care. When these patients do receive palliative care, they tend to be referred later than patients with cancer. Many disease, patient-, and provider-related factors contribute to this phenomenon, including COPD's unpredictable course, misperceptions of palliative care among patients and physicians, and lack of advance care planning discussions outside of crisis situations. A new paradigm for palliative care would introduce palliative treatments alongside, rather than at the exclusion of disease-modifying interventions. This integrated approach would circumvent the issue of difficult prognostication in COPD, as any patient would receive individualized palliative interventions from the time of diagnosis. These points will be covered in this review, which discusses the challenges in providing palliative care to COPD patients, the strategies to mitigate the challenges, management of common symptoms, and the evidence for integrated palliative care models as well as some suggestions for future development. PMID:27481751

  7. Children’s palliative care now! Highlights from the second ICPCN conference on children’s palliative care, 18–21 May 2016, Buenos Aires, Argentina

    PubMed Central

    Downing, J; Kiman, R; Boucher, S; Nkosi, B; Steel, B; Marston, C; Lascar, E; Marston, J

    2016-01-01

    The International Children’s Palliative Care Network held its second international conference on children’s palliative care in Buenos Aires, Argentina, from the 18th–21st May 2016. The theme of the conference was ‘Children’s Palliative Care…. Now!’ emphasising the need for palliative care for children now, as the future will be too late for many of them. Six pre-conference workshops were held, addressing issues connected to pain assessment and management, adolescent palliative care, ethics and decision-making, developing programmes, the basics of children’s palliative care, and hidden aspects of children’s palliative care. The conference brought together 410 participants from 40 countries. Plenary, concurrent, and poster presentations covered issues around the status of children’s palliative care, genetics, perinatal and neonatal palliative care, the impact of children’s palliative care and the experiences of parents and volunteers, palliative care as a human right, education in children’s palliative care, managing complex pain in children, spiritual care and when to initiate palliative care. The ‘Big Debate’ explored issues around decision-making and end of life care in children, and gave participants the opportunity to explore a sensitive and thought provoking topic. At the end of the conference, delegates were urged to sign the Commitment of Buenos Aires which called for governments to implement the WHA resolution and ensure access to palliative care for neonates, children and their families, and also commits us as palliative care providers to share all that we can and collaborate with each other to achieve the global vision of palliative care for all children who need it. The conference highlighted the ongoing issues in children’s palliative care and participants were continually challenged to ensure that children can access palliative care NOW. PMID:27610193

  8. Children's palliative care now! Highlights from the second ICPCN conference on children's palliative care, 18-21 May 2016, Buenos Aires, Argentina.

    PubMed

    Downing, J; Kiman, R; Boucher, S; Nkosi, B; Steel, B; Marston, C; Lascar, E; Marston, J

    2016-01-01

    The International Children's Palliative Care Network held its second international conference on children's palliative care in Buenos Aires, Argentina, from the 18th-21st May 2016. The theme of the conference was 'Children's Palliative Care…. Now!' emphasising the need for palliative care for children now, as the future will be too late for many of them. Six pre-conference workshops were held, addressing issues connected to pain assessment and management, adolescent palliative care, ethics and decision-making, developing programmes, the basics of children's palliative care, and hidden aspects of children's palliative care. The conference brought together 410 participants from 40 countries. Plenary, concurrent, and poster presentations covered issues around the status of children's palliative care, genetics, perinatal and neonatal palliative care, the impact of children's palliative care and the experiences of parents and volunteers, palliative care as a human right, education in children's palliative care, managing complex pain in children, spiritual care and when to initiate palliative care. The 'Big Debate' explored issues around decision-making and end of life care in children, and gave participants the opportunity to explore a sensitive and thought provoking topic. At the end of the conference, delegates were urged to sign the Commitment of Buenos Aires which called for governments to implement the WHA resolution and ensure access to palliative care for neonates, children and their families, and also commits us as palliative care providers to share all that we can and collaborate with each other to achieve the global vision of palliative care for all children who need it. The conference highlighted the ongoing issues in children's palliative care and participants were continually challenged to ensure that children can access palliative care NOW. PMID:27610193

  9. Palliative care in the ambulatory geriatric practice.

    PubMed

    Finucane, Thomas E; Nirmalasari, Olivia; Graham, Antonio

    2015-05-01

    Geriatrics and palliative care often overlap. This article focuses on 2 areas where the disciplines may differ in their approach. The first is planning for extreme illness and death, with explicit acknowledgment that limiting therapy might be a good idea. This situation is likely to have a different impact in the course of a routine geriatrics visit than in a palliative care context. The second is pain management, especially chronic pain. In patients with sharply limited life expectancy, the risk/benefit equation tilts easily toward narcotic use. In frail elders working to remain independent, the calculus may be quite different. PMID:25920055

  10. Palliative Radiofrequency Ablation for Recurrent Prostate Cancer

    SciTech Connect

    Jindal, Gaurav; Friedman, Marc; Locklin, Julia Wood, Bradford J.

    2006-06-15

    Percutaneous radiofrequency ablation (RFA) is a minimally invasive local therapy for cancer. Its efficacy is now becoming well documented in many different organs, including liver, kidney, and lung. The goal of RFA is typically complete eradication of a tumor in lieu of an invasive surgical procedure. However, RFA can also play an important role in the palliative care of cancer patients. Tumors which are surgically unresectable and incompatible for complete ablation present the opportunity for RFA to be used in a new paradigm. Cancer pain runs the gamut from minor discomfort relieved with mild pain medication to unrelenting suffering for the patient, poorly controlled by conventional means. RFA is a tool which can potentially palliate intractable cancer pain. We present here a case in which RFA provided pain relief in a patient with metastatic prostate cancer with pain uncontrolled by conventional methods.

  11. Nurturing humanism through teaching palliative care.

    PubMed

    Block, S; Billings, J A

    1998-07-01

    After many years of neglect by the medical establishment, the discipline of palliative medicine is finally moving into academic health centers (AHCs). While hospice programs have cared for dying patients in the community for years with little input from mainstream medicine, palliative care is gaining a foothold in AHCs, challenging these centers to integrate the hospice approach with biomedicine. The discipline of palliative care promises to be a rich source of learning and growth for physicians-in-training. Teaching about palliative care affirms two essential but vulnerable dimensions of the practice of medicine--the importance of relationship-centered care and the value of doctoring as a source of meaning and growth for physicians. In addition to fostering fundamental humanistic learning, palliative medicine is an excellent vehicle for teaching basic but often neglected clinical competencies, including pain and symptom control, communication, and working as part of a health care team. Because palliative care settings offer extraordinary learning opportunities, the authors recommend that clinical experiences in palliative care be integrated into the core curricula of all medical schools as well as appropriate residency programs. PMID:9679465

  12. Palliative Care in Cancer

    MedlinePlus

    ... palliative care is beneficial? Yes. Research shows that palliative care and its many components are beneficial to patient and family health and well-being. A number of studies in recent years have shown that patients who ...

  13. Esophagus Cancer: Palliative Therapy

    MedlinePlus

    ... your doctor about cancer of the esophagus? Palliative therapy for cancer of the esophagus Palliative therapy is ... therapy Electrocoagulation Laser ablation Argon plasma coagulation Radiation therapy External-beam radiation can often help relieve some ...

  14. [Recommendations for the palliative care of dying neonates].

    PubMed

    Cignacco, E; Stoffel, L; Raio, L; Schneider, H; Nelle, M

    2004-08-01

    Neonates and infants have the highest mortality rate in the pediatric patient population, but there is a paucity of data about their palliative care. Most neonate deaths occur during the first week of life so it is mostly the staff of NICUS's and obstetrical wards who are confronted with the palliative care of dying neonates. Clinical experience shows that many aspects of care in palliative situations are not well known to the health care providers. This is especially true for pain assessment and pain treatment during the dying process. A search of the literature on this subject resulted in only a few publications; hence, this article basically describes clinical experience in the palliative care of neonates. In this article some recommendations for decision-making and standardization of palliative care for dying neonates are presented. PMID:15326558

  15. Distress, Stress and Solidarity in Palliative Care.

    ERIC Educational Resources Information Center

    deMontigny, Johanne

    1993-01-01

    Notes that role of psychologist on palliative care unit is to be there for terminally ill, their friends, and their families, both during the dying and the bereavement and for the caregiver team. Focuses on work of decoding ordinary words which for many patients hide painful past. Stresses necessity to remain open to unexpected. (Author/NB)

  16. Pain Symptoms Associated with Opioid Use among Vulnerable Persons with HIV: An exploratory study with implications for palliative care and opioid abuse prevention.

    PubMed

    Knowlton, Amy R; Nguyen, Trang Q; Robinson, Allysha C; Harrell, Paul T; Mitchell, Mary M

    2015-01-01

    Current or former injection drug users with human immunodeficiency virus (HIV) are at high risk for pain, which adversely affects their quality of life and may increase their risk for illicit drug use or relapse. We explored associations between pain symptoms and substance use among injection-drug-using study participants with HIV who had histories of heroin use. Using generalized estimating equations and controlling for prior substance use, we found that pain in each six-month period was associated with the use of heroin and prescription opioids, but not the use of nonopioid drugs or alcohol. Routine clinical assessment and improved management of pain symptoms may be needed for persons with HIV and a history of injection drug use, particularly those with chronic pain, for whom there is increased risk for heroin use. PMID:26856123

  17. NIH Research on Treating Pain | NIH MedlinePlus the Magazine

    MedlinePlus

    ... the NIH Clinical Center. The NIH Pain and Palliative Care Service conducts studies in pain and symptom management, quality of life, complementary therapies, and palliative medicine outcomes. Hospice care is end-of-life ...

  18. The Use of Massage Therapy for Reducing Pain, Anxiety, and Depression in Oncological Palliative Care Patients: A Narrative Review of the Literature

    PubMed Central

    Falkensteiner, Maria; Mantovan, Franco; Müller, Irene; Them, Christa

    2011-01-01

    A considerable number of cancer patients use complementary medicine therapies in order to alleviate different symptoms such as pain, anxiety, and depression, occurring in connection with cancer. This paper explores the question to what extent massage therapies are able to reduce the amount of pain, anxiety, and depression. For this purpose, a systematic literature analysis was carried out in the electronic databases and specialist journals. There is already evidence that massage therapies can influence the symptoms of pain, anxiety, and depression in a positive way. PMID:22007330

  19. Palliative care in India: Situation assessment and future scope.

    PubMed

    Kar, S S; Subitha, L; Iswarya, S

    2015-01-01

    Palliative care is an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through prevention and relief of suffering by means of early identification, assessment and treatment of pain, and other problems - physical, psychosocial, and spiritual. It is estimated that in India the total number of people who need palliative care is likely to be 5.4 million people a year. Though palliative care services have been in existence for many years, India ranks at the bottom of the Quality of Death index in overall score. However there has been steady progress in the past few years through community-owned palliative care services. One of the key objectives of the National Programme for prevention and control of cancer, diabetes, cardiovascular diseases, and stroke is to establish and develop capacity for palliative and rehabilitative care. Community models for the provision of home-based palliative care is possible by involving community caregivers and volunteers supervised by nurses trained in palliative care. Training of medical officers and health care professionals, and sensitization of the public through awareness campaigns are vital to improve the scope and coverage of palliative care. Process of translating palliative care plan into action requires strong leadership, competent management, political support and integration across all levels of care. PMID:26837989

  20. [Providing regular relief; considerations for palliative care in the Netherlands].

    PubMed

    Crul, B J; van Weel, C

    2001-10-20

    Over the last few decades the attention devoted to the palliative aspects of medicine, particularly those in hospital care, has declined due to the emphasis on medical technology. In Anglo-Saxon countries a review of this development resulted in structured palliative care that benefited terminally ill patients with a progressive fatal disease, especially cancer patients. Due to increasing national and international criticism of both the practice of euthanasia (assumed to be too liberal) and the lack of attention devoted to structured palliative care in the Netherlands, the Dutch government decided to improve the structure of palliative care. The government's viewpoint is based on the assumption that good palliative care that includes adequate pain control benefits patient care and might eventually lead to fewer requests for euthanasia. The improvements to palliative care should be realised by means of improvements in the structure, training and knowledge. Six academic medical clusters have been designated as Centres for the Development of Palliative Care (Dutch acronym: COPZ) for a 5-year period. Each COPZ must develop the various aspects needed to improve palliative care within the region it serves and ensure that its activities are carefully coordinated with those in the other centres. Research will focus on measuring the efficacy of palliative care as well as ethical and epidemiological aspects. A government committee will assess the appropriateness of the activities undertaken by each of the centres. PMID:11695096

  1. Palliative care and neurology

    PubMed Central

    Boersma, Isabel; Miyasaki, Janis; Kutner, Jean

    2014-01-01

    Palliative care is an approach to the care of patients and families facing progressive and chronic illnesses that focuses on the relief of suffering due to physical symptoms, psychosocial issues, and spiritual distress. As neurologists care for patients with chronic, progressive, life-limiting, and disabling conditions, it is important that they understand and learn to apply the principles of palliative medicine. In this article, we aim to provide a practical starting point in palliative medicine for neurologists by answering the following questions: (1) What is palliative care and what is hospice care? (2) What are the palliative care needs of neurology patients? (3) Do neurology patients have unique palliative care needs? and (4) How can palliative care be integrated into neurology practice? We cover several fundamental palliative care skills relevant to neurologists, including communication of bad news, symptom assessment and management, advance care planning, caregiver assessment, and appropriate referral to hospice and other palliative care services. We conclude by suggesting areas for future educational efforts and research. PMID:24991027

  2. Motion monitoring in palliative care using unobtrusive bed sensors.

    PubMed

    Holtzman, M; Goubran, R; Knoefel, F

    2014-01-01

    Palliative care needs are growing with the aging population. Ambient sensors offer patients comfortable and discreet point-of-care monitoring. In this study, two palliative care participants were monitored in a sensorized bed. Motion monitoring by a two-tier gross and fine movement detector provided accurate detection and classification of movement, compared to annotations by an observer. However, ascribing the motion to the patient rather than caregivers or visitors would require supplemental sensors. Motion was indicative of pain, with 13% of time spent moving while in pain versus 3% while not noted as in pain. PMID:25571304

  3. Palliative care in patients with heart failure.

    PubMed

    McIlvennan, Colleen K; Allen, Larry A

    2016-01-01

    Despite advances in cardiac therapy, heart failure (HF) remains a progressive, highly symptomatic, and deadly disease that places great demands on patients, caregivers, and healthcare systems. Palliative care is a multidisciplinary approach to care that focuses on communication, shared decision making, and advance care planning; provides relief from pain and other distressing symptoms; integrates psychological and spiritual aspects of care; and offers a support system to help families cope during illness and bereavement. Palliative care has applications across the stages of heart failure, including early in the course of illness, often in conjunction with other therapies that are intended to prolong life. However, the incorporation of palliative care into the management of heart failure has been suboptimal for several reasons: uncertainty in the disease trajectory, failure to reward communication between healthcare providers and patients, siloed care, lack of knowledge, overlay of comorbidity and frailty, life saving devices with complex trade-offs, and a limited evidence base. This review will summarize the current literature on the emerging role of palliative care in patients with heart failure and the challenges and opportunities for its integration into routine care. It will discuss current initiatives and future directions of the collaborative relationship between the palliative care and heart failure disciplines. PMID:27079896

  4. Palliative medicine in Britain.

    PubMed

    Doyle, Derek

    In Britain, Palliative Medicine was recognized as a subspecialty of Internal Medicine exactly 20 years after Cicely Saunders founded St Christopher's, at exactly the same time that government was at last recognizing the worth and the needs of general practice. Both had far-reaching effects and implications for patients, doctors, and the future of medicine. For Palliative Medicine it meant units wishing to train specialists going through a rigorous selection process; the development of an equally rigorous training program for the doctors who had already gained a higher qualification before starting Palliative Medicine, demonstrating the need for and benefits of palliative medicine to the sceptics in the profession and, now, continuing to recruit the staff for the steadily increasing number of new services. Today there are more Palliative Medicine consultants/specialists than there are oncologists and neurologists combined, with Hospital Palliative Care Teams in every major hospital and cancer center. With nine Chairs in Palliative Medicine, there is now a drive for research and professional education. The specialty faces major challenges, however, ranging from training to care for patients with non-malignant disease to enabling patients to die in the place of their choice-something that rarely happens today; from defining what is distinctive or unique about palliative medicine to clarifying the respective place of general practice and the specialty. Most would agree that the biggest challenge for the young, thriving specialty is how to share its principles with other doctors wherever they work. PMID:18051021

  5. Retroperitoneal Endodermal Sinus Tumor Patient with Palliative Care Needs

    PubMed Central

    Kashyap, Surbhi

    2016-01-01

    This article is a case reflection of a personal encounter on the palliative care treatment required after the removal of a complicated case of a primary extra-gonadal retro-peritoneal endodermal sinus tumor (yolk sac tumor). This reflection is from the perspective of a recently graduated MD student who spent one month with an Indian pain management and palliative care team at the Institute Rotary Cancer Hospital (IRCH), All India Institute of Medical Sciences (AIIMS), New Delhi PMID:26962288

  6. An interdisciplinary and collaborative initiative in palliative care research

    PubMed Central

    Desa, Veena; Danjoux, Cyril; Matyas, Yvette; Fitch, Margaret; Husain, Amna; Horvath, Nina; Myers, Jeff; Clemons, Mark; Hux, Janet E; Barnes, Elizabeth A

    2009-01-01

    The scale and complexity of palliative care increasingly demands that researchers move beyond their own discipline and explore interdisciplinary collaboration. At a Palliative Care Research Retreat held in January 2006 at the Toronto Sunnybrook Regional Cancer Centre, researchers from multiple care settings with the center and from other Toronto hospitals came together with the vision of becoming Canadian leaders in palliative care research. As a result of this retreat, five interdisciplinary groups were formed to pursue research in the areas of pain and symptom management, access to services, translational research, education, and communication. An overview of the retreat and direction of research for each group is provided. PMID:21197289

  7. Integrating palliative care with usual care of diabetic foot wounds.

    PubMed

    Dunning, Trisha

    2016-01-01

    Palliative care is a philosophy and a system for deciding care and can be used alone or integrated with usual chronic disease care. Palliative care encompasses end-of-life care. Palliative care aims to enhance quality of life, optimize function and manage symptoms including early in the course of chronic diseases. The purposes of this article are to outline palliative care and discuss how it can be integrated with usual care of diabetic foot wounds. Many people with diabetes who have foot wounds also have other comorbidities and diabetes complications such as cardiovascular and renal disease and depression, which affect medicine and other treatment choices, functional status, surgical risk and quality of life. Two broad of diabetic foot disease exist: those likely to heal but who could still benefit from integrated palliative care such as managing pain and those where healing is unlikely where palliation can be the primary focus. People with diabetes can die suddenly, although the life course is usually long with periods of stable and unstable disease. Many health professionals are reluctant to discuss palliative care or suggest people to document their end-of-life care preferences. If such preferences are not documented, the person might not achieve their desired death or place of death and health professionals and families can be confronted with difficult decisions. Palliative care can be integrated with usual foot care and is associated with improved function, better quality of life and greater patient and family satisfaction. PMID:26813620

  8. Transforming children's palliative care-from ideas to action: highlights from the first ICPCN conference on children's palliative care.

    PubMed

    Downing, J; Marston, J; Muckaden, Ma; Boucher, S; Cardoz, M; Nkosi, B; Steel, B; Talawadekar, P; Tilve, P

    2014-01-01

    The International Children's Palliative Care Network (ICPCN) held its first international conference on children's palliative care, in conjunction with Tata Memorial Centre, in Mumbai, India, from 10-12 February 2014. The theme of the conference, Transforming children's palliative care-from ideas to action, reflected the vision of the ICPCN to live in a world where every child who needs it, can access palliative care, regardless of where they live. Key to this is action, to develop service provision and advocate for children's palliative care. Three pre-conference workshops were held on 9 February, aimed at doctors, nurses, social workers, and volunteers, and focused around the principles of children's palliative care, and in particular pain and symptom management. The conference brought together 235 participants representing 38 countries. Key themes identified throughout the conference included: the need for advocacy and leadership; for education and research, with great strides having been taken in the development of an evidence base for children's palliative care, along with the provision of education; the importance of communication and attention to spirituality in children, and issues around clinical care, in particular for neonates. Delegates were continually challenged to transform children's palliative care in their parts of the world and the conference culminated in the signing of the ICPCN Mumbai Declaration. The Declaration calls upon governments around the world to improve access to quality children's palliative care services and made a call on the Belgian government not to pass a bill allowing children to be euthanised in that country. The conference highlighted many of the ongoing developments in children's palliative care around the world, and as she closed the conference, Joan Marston (ICPCN CEO) challenged participants to take positive action and be the champions that the children need, thus transforming children's palliative care. PMID:24761156

  9. Radionuclide Treatment with 153Sm-EDTMP is Effective for the Palliation of Bone Pain in the Context of Extensive Bone Marrow Metastases: A Case Report

    PubMed Central

    Kairemo, Kalevi; Rasulova, Nigora; Suslaviciute, Justina; Alanko, Tuomo

    2014-01-01

    Radionuclide therapy is widely used as an effective modality in the management of bone pain. The main indication for this treatment is symptomatic bone metastases, confirmed by bone scintigraphy. We present a case of small cell lung cancer (SCLC) stage T4N2M1b, with a good metabolic response to systemic therapy and radiotherapy of the primary tumor and locoregional disease, which became metabolically less active and remarkably smaller in size (reduction to 1/6 of the original volume). In spite of the good overall response, the patient developed a syndrome with severe bone pain and had progression in the bone marrow metastases, confirmed by 18F-FDG PET/CT. The patient received 153Sm-EDTMP treatment with a good clinical response. However, in the whole body bone scan with the therapeutic dose, there was no visual evidence of bone metastasis. Retrospectively, by drawing the region of interest, it was possible to identify one metastatic site. The possible mechanisms of the efficacy of this treatment modality, in this specific setting, are also discussed. PMID:27408870

  10. [Palliative care in neurology].

    PubMed

    Provinciali, Leandro; Tarquini, Daniela; De Falco, Fabrizio A; Carlini, Giulia; Zappia, Mario; Toni, Danilo

    2015-07-01

    Palliative care in neurology is characterized by the need of taking into account some distinguishing features which supplement and often differ from the general palliative approach to cancer or to severe organ failures. Such position is emphasized by a new concept of palliative assistance which is not limited to the "end of life" stage, as it was the traditional one, but is applied along the entire course of progressive, life-limiting, and disabling conditions. There are various reasons accounting for a differentiation of palliative care in neurology and for the development of specific expertise; the long duration of the advanced stages of many neurological diseases and the distinguishing features of some clinical problems (cognitive disorders, psychic disorders, etc.), in addition to the deterioration of some general aspects (nutrition, etc.), make the general criteria adopted for cancer, severe respiratory, hepatic or renal failures and heart failure inadequate. The neurological diseases which could benefit from the development of a specific palliative approach are dementia, cerebrovascular diseases, movement disorders, neuromuscular diseases, severe traumatic brain injury, brain cancers and multiple sclerosis, as well as less frequent conditions. The growing literature on palliative care in neurology provides evidence of the neurological community's increasing interest in taking care of the advanced and terminal stages of nervous system diseases, thus encouraging research, training and updating in such direction. This document aims to underline the specific neurological requirements concerning the palliative assistance. PMID:26228722

  11. Pediatric palliative care.

    PubMed

    Moody, Karen; Siegel, Linda; Scharbach, Kathryn; Cunningham, Leslie; Cantor, Rabbi Mollie

    2011-06-01

    Progress in pediatric palliative care has gained momentum, but there remain significant barriers to the appropriate provision of palliative care to ill and dying children, including the lack of properly trained health care professionals, resources to finance such care, and scientific research, as well as a continued cultural denial of death in children. This article reviews the epidemiology of pediatric palliative care, special communication concerns, decision making, ethical and legal considerations, symptom assessment and management, psychosocial issues, provision of care across settings, end-of-life care, and bereavement. Educational and supportive resources for health care practitioners and families, respectively, are included. PMID:21628042

  12. Spirituality and Palliative Care

    PubMed Central

    Broeckaert, Bert

    2011-01-01

    This paper shows how palliative care developed as a reaction to the compartimentalized technical approach of modern medicine. But what does it mean if we say palliative care wants to treat patients as whole persons? A few pitfalls need to avoided. All disciplines involved in palliative care should act within the limits of their own specific professional role. Physicians and nurses should certainly not force patients into spiritual or religious discussions or practices. They should understand that religion and spirituality also influence the ethical (and thus medical) choices people make, respect their own conscience and worldview too and cultivate conscious compassion. PMID:21811369

  13. The Philippines: Historical Overview.

    ERIC Educational Resources Information Center

    Shackford, Julie; Aquino, Belinda A., Ed.

    This book provides readings and student lessons about the Philippines. Lessons and activities follow a chronological sequence and provide a good resource for those interested in the Philippines. The materials begin with prehistoric times and continue to the presidency of Corazon Aquino. Each chapter provides background information along with a…

  14. Future of Palliative Medicine

    PubMed Central

    Bhatnagar, Sushma; Gupta, Mayank

    2015-01-01

    A ‘need-supply’ and ‘requirement-distribution mismatch’ along with a continuingneed explosion are the biggest hurdles faced by palliative medicine today. It is the need of the hour to provide an unbiased, equitable and evidence-based palliative care to those in need irrespective of the diagnosis, prognosis, social and economic status or geographical location. Palliative care as a fundamental human right, ensuring provision throughout the illness spectrum, global as well as region-specific capacity building, uniform availability of essential drugs at an affordable price, a multidisciplinary team approachand caregiver-support are some of the achievable goals for the future. This supplanted with a strong political commitment, professional dedication and ‘public-private partnerships’ are necessaryto tackle the existing hurdles and the exponentially increasing future need. For effectively going ahead it is of utmost importance to integrate palliative medicine into medical education, healthcare system and societal framework. PMID:25709197

  15. Vitamin D and patients with palliative cancer.

    PubMed

    Björkhem-Bergman, Linda; Bergman, Peter

    2016-09-01

    Vitamin D is a hormone that is synthesised in the skin in the presence of sunlight. Sufficient vitamin D levels are important-not only for a healthy skeleton-but also for a healthy immune system. Many patients with cancer have insufficient vitamin D levels, and low vitamin D levels are associated with increased 'all-cause mortality' and especially mortality due to cancer. Low vitamin D levels have also been associated with increased risk of infections, increased pain, depressive disorders and impaired quality of life. We review the role of vitamin D in the immune system, in relation to cancer disease, pain and depression. We have recently performed an observational study in 100 patients with palliative cancer in Sweden. The main result was that low vitamin D levels were associated with higher opioid dose, that is, more pain. We also describe a case report where vitamin D supplementation resulted in radically decreased opioid dose, less pain and better well-being. Vitamin D supplementation is not connected with any adverse side effects and is easy to administrate. Thus, we hypothesise that vitamin D-supplementation to patients with palliative cancer might be beneficial and could improve their well-being, decrease pain and reduce susceptibility to infections. However, more clinical studies in this field are needed before firm conclusions can be drawn. PMID:27084421

  16. 'Good palliative care' orders.

    PubMed

    Maddocks, I

    1993-01-01

    A Select Committee of the Parliament of South Australia, considering revisions to legislation governing care of the dying, did not support allowing doctors to assist suicide. They recommended that no liability attach to the provision of reasonable palliative care which happens to shorten life. The Committee affirmed the suggestion that positive open orders to provide 'good palliative care' should replace 'do not resuscitate' orders. PMID:7506978

  17. [Radioprotection and environmental pollution by the use of the radionuclides 89Sr, 186Re, and 153Sm for pain palliation in metastatic bone diseases. Related calculations].

    PubMed

    Sbonias, Evangelos

    2005-01-01

    Due to the fact that the existing commercial analgesic drugs are not able to reduce effectively the pain caused by the metastatic bone disease, the use of radiopharmaceuticals with avidity to selectively localize in the metastatic skeletal sites, such as strondium-89 chloride (89Sr-Cl2), rhenium-186-hydroxy ethylene diphosphonate (186Re-HEDP), and samarium-153-ethylene diamine tetramethylene (153Sm-EDTMP), is widely accepted. However this medical application may be dangerous for the occupied personnel and more for general public, if radioactive waste is not properly disposed. In the following article we try to estimate the degree and the significance of that risk. For that reason we discuss the physical properties of these radionuclides and their distribution in the body of the patient. We conclude that 89Sr is not harmful for the physician, the attending personnel or those who live with the patient, because it radiates beta-radiation, while its gamma-radiation is negligeable. The radionuclides 186Re and 153Sm besides beta-radiation, also emit a perceptible amount of gamma-radiation. It has been shown that the exposure to gamma-radiation from these radionuclides of the physician, the attending personnel or those who live with the patient is very low as compared to the internationally accepted radioprotection limits. However the environmental contamination per treatment by either of these three radionuclides is not negligeable in comparison to the national and international accepted limits. Patients that are not in good clinical condition may pose an additional contamination danger to those attending them. For limiting radiocontamination, the annual number of treatments by the above three previous radionuclides, should be considered according to the ALARA principle in relation with the correct handling of these patients, and also considering the fundamentals of radioprotection. PMID:16142246

  18. Frequently Asked Questions (Palliative Care: Conversations Matter)

    MedlinePlus

    ... Questions Frequently Asked Questions: What is pediatric palliative care? Pediatric palliative (pal-lee-uh-tiv) care is ... for patients and families. Who provides pediatric palliative care? Every palliative care team is different. The team ...

  19. [eLearning service for home palliative care].

    PubMed

    Sakuyama, Toshikazu; Komatsu, Kazuhiro; Inoue, Daisuke; Fukushima, Osamu

    2008-12-01

    In order to support the home palliative care learning, we made the eLearning service for home palliative care (beta version) and tried to teach the palliative care to the medical staffs in the community. The various learners (such as nurses, pharmacists and the like) accessed to the online learning and used this eLearning service. After the learners finished eLearning for home palliative care, some questionnaires were distributed to the learners and analyzed by us. The analysis of questionnaires revealed that almost all were satisfied with our eLearning services. Especially the learners were not only interested in using the skills of opioids and the management of pain control, but they had a good cognition for the usage of opioids. PMID:20443298

  20. Victoria BGY palliative care model--a new model for the 1990s.

    PubMed

    Downing, G M; Braithwaite, D L; Wilde, J M

    1993-01-01

    If, as palliative care practitioners, we ensure that distressing symptoms such as pain, vomiting, dyspnea, confusion, and pre-death restlessness are fully controlled (note "fully"), then most people are deeply appreciative and continue to live until they die, confident that whatever happens, their worth, desires, and comfort are secure. Credibility (Latin, fides dignus) is remaining true and reliable to what was agreed. Patients registering with palliative care generally desire comfort, which can only occur when palliative care physicians and programs are capable and willing to apply all three types of palliation discussed here--the BGY model. PMID:7510798

  1. Philippine Astronomy Convention 2009 Abstract: Philippine Ethnoastronomy

    NASA Astrophysics Data System (ADS)

    Ambrosio, D. L.

    2009-03-01

    Ethnoastronomy refers to the system of beliefs and practices of ethno-linguistic groups regarding astronomical and meteorological phenomena which form part of the upper world in their three-world view of the universe. For the Philippines, the study is relevant in the investigation of Philippine pre-colonial society and culture. It is also important in showing the diversity, commonality, richness and depth of what would be referred to later on as Philippine cultures. Through this study, various Philippine groups which are usually neglected in the writing of history are brought to the forefront to share in the limelight with mainstream groups in tracing the development of this society and culture. The study focuses on the indigenous world view, beliefs, knowledge and practices regarding the sun, the moon, the eclipse and the stars. It shows how astronomical, as well as meteorological, phenomena influence the way people look at the world and the way they think, behave and live. Beliefs and knowledge regarding these phenomena inform their everyday life then and now as they continuously engage in agriculture, fishing, hunting, and trading, in observing various rituals, in building a house, and even in securing good fortune in any undertaking.

  2. Hospice and Palliative Nurses Association

    MedlinePlus

    ... How to Submit an Abstract Writing Educational Objectives Palliative Care APRN Fellowships HPNF Chapter Education Grants HPNF Individual ... HPNA Chapters Content Experts Position Statements Fellow in Palliative Care Nursing HPNF and Project on Death in America ...

  3. HIFU for Palliative Treatment of Pancreatic Cancer.

    PubMed

    Khokhlova, Tatiana D; Hwang, Joo Ha

    2016-01-01

    Pancreatic cancer is one of the deadliest malignancies, with only a 6 % 5-year survival rate and over 50 % of patients being diagnosed at the advanced stage. Current therapies are ineffective, and the treatment of patients with advanced disease is palliative. In the past decade, HIFU ablation has emerged as a modality for palliative treatment of pancreatic tumors. Multiple preclinical and non-randomized clinical trials have been performed to evaluate the safety and efficacy of this procedure. Substantial tumor-related pain reduction was achieved in most cases after HIFU treatment and few significant side effects were observed. In addition, some studies indicate that combination of HIFU ablation with chemotherapy may provide a survival benefit. This chapter summarizes the pre-clinical and clinical experience obtained to date in HIFU treatment of pancreatic tumors and discusses the challenges, limitations and new approaches in this modality. PMID:26486333

  4. [Importance of Anesthesiologists in the Work of a Palliative Care Team].

    PubMed

    Hozumi, Jun; Sumitani, Masahiko

    2016-03-01

    World Health Organization has proposed that palliative medicine should be applied early in the course of the malignant diseases. Regrettably, however, palliative care has been usually provided to patients with the advanced stage of cancer, as terminal care. Recently, palliative medicine begins at the time when patients are diagnosed with cancer. In response to changes in clinical settings of palliative medicine, anesthesiologists, with substantial experience in interdisciplinary pain management, can utilize their advantages in providing palliative medicine to cancer patients: 1) use of opioid analgesics; 2) considering the biopsychosocial model of pain; 3) helping patients live as actively as possible until death; and 4) helping the family cope with the patient's illness and their own bereavement. PMID:27097502

  5. Palliative Therapy for Gallbladder Cancer

    MedlinePlus

    ... based on the extent of gallbladder cancer Palliative therapy for gallbladder cancer Palliative therapy is treatment given to help control or reduce ... to advance quickly, doctors try to use palliative therapies that are less likely to affect a person’s ...

  6. [Latest pain management for painful bony metastases].

    PubMed

    Ikenaga, Masayuki

    2006-04-01

    Pain management for painful bony metastases is the most important problem for symptom relief of terminally-ill cancer patients. Pathological fractures often decrease the activity of daily life (ADL) of patients, and cause deterioration of the quality of life (QOL) and prognosis. Basically pharmacological therapies of the World Health Organization (WHO) method are essential for symptom relief from cancer pain. This article provides the latest pain managements (palliative irradiation, bisphosphonate, orthopedic surgery, percutaneous vertebroplasty and radiopharmaceutical therapy) of bony metastases, and mentions the indications and the problems of these interventions. In consideration to prognosis, the QOL and patient's needs, medical staffs have to perform multidisciplinary approach for providing suitable palliative care. PMID:16582515

  7. The Nurses' Knowledge and Attitudes towards the Palliative Care

    ERIC Educational Resources Information Center

    Ayed, Ahmad; Sayej, Sumaya; Harazneh, Lubna; Fashafsheh, Imad; Eqtait, Faeda

    2015-01-01

    Background: Palliative care (PC) is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness through the prevention and relief of suffering by means of early identification, impeccable assessment and treatment of pain and other problems like physical, psychosocial and…

  8. Palliative Care for Extremely Premature Infants and Their Families

    ERIC Educational Resources Information Center

    Boss, Renee D.

    2010-01-01

    Extremely premature infants face multiple acute and chronic life-threatening conditions. In addition, the treatments to ameliorate or cure these conditions often entail pain and discomfort. Integrating palliative care from the moment that extremely premature labor is diagnosed offers families and clinicians support through the process of defining…

  9. [Use of music in palliative care].

    PubMed

    Skrbina, Dijana; Simunović, Dubravka; Santek, Vjerocka; Njegovan-Zvonarević, Tatjana

    2011-12-01

    Man is mortal, which means that as the earthly body perishes being, final. Disease and death will always be an inevitable and integral part of human experience. The way in which we try to identify and respond to the unique and individual needs of the dying is an indication of our maturity as a society. The number of people requiring palliative care is growing. Palliative care does not intend to either accelerate or postpone death she emphasizes the life and looks at dying as a normal process. It is an active form of care for patients with advanced, progressive illness, with the aim of suppressing pain and other symptoms in addition to providing psychological, social and spiritual support which ensures the best possible quality of life for patients and their families. Therefore requires a coordinated and interdisciplinary contribution team. The variety of professions in a team, and determine the needs of patients should be ready to provide physical, psychological, social and spiritual support using methods that result from an interdisciplinary, collaborative team approach. Development of a holistic approach and awareness in the medical and allied professions has led to a renewal of interest in the inclusion of music and other expressive media in contemporary concepts of palliative care, which are consistent with problem areas, clinical manifestations and the needs of patients. Music offers a direct and uncomplicated medium of intimacy, living in a man who listens to her, has a place where words lose their power. Music is like our existence, constantly polarizing and emotionally stimulating, as it touches the medium of the earliest layers of our becoming. The use of music in palliative care has proved very effective for a variety of effects that music creates in patients. These effects are achieved through the use of various musical techniques, such as musical improvisation, songwriting, receiving creative techniques, guided by imagination and music. These techniques

  10. Palliative Care in Heart Failure.

    PubMed

    Hupcey, Judith E; Kitko, Lisa; Alonso, Windy

    2015-12-01

    The number of patients with heart failure is growing; the associated morbidity and mortality remains dismal. Advance care planning, end-of-life conversations, and palliative care referrals are appropriate, but do not occur regularly. Palliative care focuses on patients and families from diagnosis, to hospice, death, and bereavement. It is delivered as basic palliative care by all providers and by specialty-certified palliative care specialists. Nurses are well-positioned to provide basic. Nurses are also instrumental in initiating referrals to the specialized palliative care team as the patient's needs become too complex or the disease progresses and the patient approaches the end of life. PMID:26567500

  11. Prescription Pattern of Analgesic Drugs for Patients Receiving Palliative Care in a Teaching Hospital in India

    PubMed Central

    Menezes, Vishma Hydie; Nair, Shoba N; Soumya, MS; Tarey, SD

    2016-01-01

    Background: Drugs used in the palliative care unit for managing symptoms are major contributors toward the expenditure occurring in palliative care. This study was conducted to understand the prescription pattern of analgesic drugs in the patients who are receiving palliative care in a teaching hospital in India by a retrospective study of case records. Methods: Case record based, retrospective, descriptive study was conducted at the Pain and Palliative Care Department of St. John's Medical College Hospital, Bengaluru. Case record files of all patients referred to Pain and Palliative Care Department for the treatment of pain in the year of 2012 were studied. Patients’ age, gender, diagnoses, numerical pain rating scale (0–10), drugs prescribed, dosage, frequency, route of administration were recorded. The difference in drug utilization between the genders was done using Chi-square test. Data were collected from 502 patients of which 280 (56%) were males and 222 (44%) were females. Twelve percent of patients had mild pain (1–3), 34% had moderate pain (4–6), and 54% had severe pain (7–10). The most commonly used analgesic drugs were opioids (47%), followed by nonsteroidal anti-inflammatory drugs (36%). The opioids used were tramadol (56%), and morphine (38%). Ninety percent of patients with numerical pain scale more than 6 received morphine. There was no difference in analgesic drug utilization with regards to gender. Prescription pattern differed depending on the severity of pain. Opioids were the most commonly used drugs for pain management. Conclusion: The study shows that prescription pattern in palliative care unit of this hospital was in accordance with WHO pain management guidelines. The study showed the current trend in prescription of analgesic drugs in the teaching hospital where the study was conducted. PMID:26962282

  12. Music therapy in the context of palliative care in Tanzania.

    PubMed

    Hartwig, Rebecca

    2010-10-01

    There has been much written to support music therapy as an adjunct in managing pain and anxiety in palliative care patients in Western societies, but little written on its use in developing countries. In light of increasing numbers of terminally ill patients in Tanzania owing to HIV/AIDS and cancer, limited access to opioids, and a growing interest in palliative care support, this study looks at the application of music in this context. The study reviews the history and principles of therapeutic music and outlines its role in palliative care. A qualitative study was conducted by questionnaire of 17 professionals involved in home-based palliative care in Tanzania. Findings include beliefs about the power of music, how music is being used to bring comfort to the dying patient, and the most important aspects of helpful music to many Tanzanian palliative care patients. Music can powerfully affect body, mind and spirit. It is vocal music, which is an accepted therapeutic music tool used to bring comfort to the palliative care patient and their family members. Finally, music is an active and participatory activity in Tanzanian culture, even for the dying. PMID:20972382

  13. Fine-tuning Philippine transactions

    SciTech Connect

    Vitale, R.

    1994-11-01

    Expanding the power generation and distribution capability of the Philippines remains a top priority of the Philippine government. It is therefore not surprising that a number of the most significant legislative initiatives approved by the Philippine legislature in the past few years have been designed to encourage these activities in particular. There are several recent, significant statutes that will affect both power and non-power projects undertaken in the Philippines.

  14. Palliative Care in the Emergency Department.

    PubMed

    McEwan, Alyssia; Silverberg, Joshua Z

    2016-08-01

    As the geriatric population increases in the United States, there is an increase in number of visits to emergency departments for end-of-life and palliative care. This provides the emergency physician with a unique opportunity to alleviate and prevent further suffering in this vulnerable population. Competency in communication strategies that support shared decision making and familiarity with medicolegal terminology increase physician confidence about addressing complaints at the end of life. Familiarity with evidence-based recommendations for symptom management of pain at the end of life aids the emergency physician in creating a positive experience for the patient and their loved ones. PMID:27475020

  15. The perspectives on including palliative care in the Indian undergraduate physiotherapy curriculum.

    PubMed

    Veqar, Zubia

    2013-04-01

    According to the guidelines which were published by WHO in 2008, palliative care has been defined as "An approach that improves the quality of life of the patients and their families who face the problems which are associated with life-threatening illnesses, through the prevention and relief of suffering by means of an early identification, an impeccable assessment and the treatment of pain and other problems, physical, psychosocial and spiritual". The intervention which is provided as a part of the palliative care has to be provided by health professionals who strictly work as a part of multidisciplinary team and have been specifically trained to an optimal level of competency in the field. The impairment of the physical function and pain are two key problem areas in palliative care, which a physiotherapist deals with. Is a physiotherapist who is trained in India, trained to work as an efficient member of the team in this field? THIS ARTICLE DEALS WITH THE FOLLOWING: What is palliative care and what is its importance?A multidisciplinary approach to palliative careThe scenario of palliative care in IndiaThe role of physiotherapy in palliative care.The current scenario of physiotherapy education vis a vis palliative care. PMID:23730677

  16. Palliative care in patients with lung cancer

    PubMed Central

    Farbicka, Paulina

    2013-01-01

    Lung cancer accounts for 12% of all cancers and has the highest annual rate of mortality in men and women. The overall aim is cure or prolongation of life without evidence of disease. Almost 60% of patients at the moment of diagnosis are not eligible for radical treatment. Therefore soothing and supportive treatment is the only treatment of choice. Patients with lung cancer who have symptoms of dyspnea, chronic cough, severe pain, exhaustion and cachexia syndrome, fear and depression and significantly reduced physical and intellectual activities are qualified for inpatient or home palliative care. Knowledge about various methods used in palliative treatment allows one to alleviate symptoms that occur in an advanced stage of disease with an expected short survival period. Methods of oncological treatment that are often used in patients with advanced lung cancer include radiotherapy and chemotherapy. Drawing attention to the earlier implementation of palliative care is an objective of research carried out during recent years. Advances in surgical and conservative treatment of these patients have contributed to better outcomes and longer survival time. PMID:24596508

  17. Palliative care for people with dementia: a literature review.

    PubMed

    Lillyman, Sue; Bruce, Mary

    2016-02-01

    With growing numbers of people dying with, and from, dementia there is a need for professionals and health-care organisations to review the access to and provision of palliative care. This literature review has identified several key themes in relation to the person dying with dementia including: diagnosis of the dying phase, appropriate timing of referral to specialist palliative care services; ethical decisions in relation to medication and nutrition; the environment; undertreatment especially, for pain relief; over and burdensome treatment interventions; carer involvement; collaborative working and advance decision making. PMID:26926347

  18. Transforming children’s palliative care—from ideas to action: highlights from the first ICPCN conference on children’s palliative care

    PubMed Central

    Downing, J; Marston, J; Muckaden, MA; Boucher, S; Cardoz, M; Nkosi, B; Steel, B; Talawadekar, P; Tilve, P

    2014-01-01

    The International Children’s Palliative Care Network (ICPCN) held its first international conference on children’s palliative care, in conjunction with Tata Memorial Centre, in Mumbai, India, from 10–12 February 2014. The theme of the conference, Transforming children’s palliative care—from ideas to action, reflected the vision of the ICPCN to live in a world where every child who needs it, can access palliative care, regardless of where they live. Key to this is action, to develop service provision and advocate for children’s palliative care. Three pre-conference workshops were held on 9 February, aimed at doctors, nurses, social workers, and volunteers, and focused around the principles of children’s palliative care, and in particular pain and symptom management. The conference brought together 235 participants representing 38 countries. Key themes identified throughout the conference included: the need for advocacy and leadership; for education and research, with great strides having been taken in the development of an evidence base for children’s palliative care, along with the provision of education; the importance of communication and attention to spirituality in children, and issues around clinical care, in particular for neonates. Delegates were continually challenged to transform children’s palliative care in their parts of the world and the conference culminated in the signing of the ICPCN Mumbai Declaration. The Declaration calls upon governments around the world to improve access to quality children’s palliative care services and made a call on the Belgian government not to pass a bill allowing children to be euthanised in that country. The conference highlighted many of the ongoing developments in children’s palliative care around the world, and as she closed the conference, Joan Marston (ICPCN CEO) challenged participants to take positive action and be the champions that the children need, thus transforming children

  19. Palliation and supportive care in radiation medicine.

    PubMed

    Janjan, Nora

    2006-02-01

    The treatment of bone metastases represents a paradigm for evaluating palliative care in terms of symptom relief, toxicities of therapy, and the financial burden to the patient, caregivers, and society. Despite enormous expenditures to treat metastases, patients continue to sustain symptoms of the disease, and uninterrupted aggressive therapies are pursued until death that incur toxicity in approximately 25% of patients. This approach is inconsistent with the goals of palliative care, which should efficiently provide comfort using antineoplastic therapies or supportive care approaches to the patient with the fewest treatment-related side effects, recognizing that the patient will die of the disease.The development of therapies such as bisphosphonates is important in advancing options for palliative care; however, clinical trials demonstrating the efficacy of bisphosphonates have not addressed important issues for clinical practice. The primary study endpoints should primarily address pertinent patient outcomes such as pain relief rather than asymptomatic radiographic findings. These studies should define clear indications of when to start and stop the therapy, the appropriate patient populations to receive the therapy, and the cost effectiveness of the treatment relative to other available therapies such as radiation. Cost-utility analyses, which account for a broader domain of cost effectiveness, need to be performed as part of clinical trials, especially for palliative care endpoints. Clinical trials that include these criteria are critical to future practice guideline development. As health care resources continue to become more limited, the criteria for care must be better defined to avoid administration of therapy with limited benefit. Leadership must come from the specialty as clinical trials and clinical practice increasingly interface with health care policy. Goals of therapy must remain clear for the benefit of the individual and all patients. PMID

  20. Pulmonary medicine and palliative care.

    PubMed

    Tucakovic, M; Bascom, R; Bascom, P B

    2001-04-01

    Gynaecological malignancies affect the respiratory system both directly and indirectly. Malignant pleural effusion is a poor prognostic factor: management options include repeated thoracentesis, chemical pleurodesis, symptomatic relief of dyspnoea with oxygen and morphine, and external drainage. Parenchymal metastases are typically multifocal and respond to chemotherapy, with a limited role for pulmonary metastatectomy. Pulmonary tumour embolism is frequently associated with lymphangitic carcinomatosis, and is most common in choriocarcinoma. Thromboembolic disease, associated with the hypercoagulable state of cancer, is treated with anticoagulation. Inferior vena cava filter placement is indicated when anticoagulation cannot be given, or when emboli recur despite adequate anticoagulation. Palliative care has a major role for respiratory symptoms of gynaecological malignancies. Treatable causes of dyspnoea include bronchospasm, fluid overload and retained secretions. Opiates are effective at relieving dyspnoea associated with effusions, metatases, and lymphangitic tumour spread. Non-pharmacological therapies include energy conservation, home redesign, and dyspnoea relief strategies, including pursed lip breathing, relaxation, oxygen, circulation of air with a fan, and attention to spiritual suffering. Identification and treatment of gastroesophageal reflux, sinusitis, and asthma can improve many patients' coughs. Chest wall pain responds to local radiotherapy, nerve blocks or systemic analgesia. Case examples illustrate ways to address quality of life issues. PMID:11358403

  1. Palliative care and pulmonary rehabilitation.

    PubMed

    Janssen, Daisy J A; McCormick, James R

    2014-06-01

    Numerous barriers exist to the timely introduction of palliative care in patients with advanced chronic obstructive pulmonary disease (COPD). The complex needs of patients with advanced COPD require the integration of curative-restorative care and palliative care. Palliative care and pulmonary rehabilitation are both important components of integrated care for patients with chronic respiratory diseases. Pulmonary rehabilitation provides the opportunity to introduce palliative care by implementing education about advance care planning. Education about advance care planning addresses the information needs of patients and can be an effective strategy to promote patient-physician discussion about these issues. PMID:24874135

  2. Overcoming the Obstacles in Promoting Hospice Palliative Care--Sharing Experiences of the Taiwan Changhua Christian Hospital.

    PubMed

    Tsai, Pei-Yu

    2015-01-01

    Hospice palliative care for terminal patients is necessary, yet challenges are on the way worldwide. This study demonstrated that hospice palliative care has been quickly developed in Taiwan due to the support of the National Health Insurance system, the promotion by civil societies and religious groups, patient's legal right for DNR, easier access to pain killers through medical prescription, and well-planned hospice staff training programs. This paper introduces how hospice consultation is provided by a comprehensive hospice palliative team at Changhua Christian Hospital to establish trust and cooperation with the medical team, and to improve hospice-palliative care referral and utilization rates. PMID:26867341

  3. Country Profiles, The Philippines.

    ERIC Educational Resources Information Center

    Concepcion, Mercedes B.

    A profile of the Philippines is sketched in this paper. Emphasis is placed on the nature, scope, and accomplishments of population activities in the country. Topics and sub-topics include: location and description of the country; population (size, growth patterns, age structure, urban/rural distribution, ethnic and religious composition,…

  4. A comprehensive review of palliative care in patients with cancer.

    PubMed

    Jaiswal, Reena; Alici, Yesne; Breitbart, William

    2014-02-01

    One of the most challenging roles for the psychiatrist is to help guide terminally ill patients physically, psychologically and spiritually through the dying process. Patients with advanced cancer, and other life-threatening medical illnesses are at increased risk for developing major psychiatric complications and have an enormous burden of both physical as well as psychological symptoms. In fact, surveys suggest that psychological symptoms such as depression, anxiety, and hopelessness are as frequent, if not more so, than pain and other physical symptoms in palliative care settings. Psychiatrists have a unique role and opportunity to offer competent and compassionate palliative care to those with life-threatening illness. In this article we provide a comprehensive review of basic concepts and definitions of palliative care and the experience of dying, and the role of the psychiatrist in palliative care including assessment and management of common psychiatric disorders in the terminally ill, with an emphasis on suicide and desire for hastened death. Psychotherapies developed for use in palliative care settings, and management of grief and bereavement are also reviewed. PMID:24716503

  5. Palliative care, double effect and the law in Australia.

    PubMed

    White, B P; Willmott, L; Ashby, M

    2011-06-01

    Care and decision-making at the end of life that promotes comfort and dignity is widely endorsed by public policy and the law. In ethical analysis of palliative care interventions that are argued potentially to hasten death, these may be deemed to be ethically permissible by the application of the doctrine of double effect, if the doctor's intention is to relieve pain and not cause death. In part because of the significance of ethics in the development of law in the medical sphere, this doctrine is also likely to be recognized as part of Australia's common law, although hitherto there have been no cases concerning palliative care brought before a court in Australia to test this. Three Australian States have, nonetheless, created legislative defences that are different from the common law with the intent of clarifying the law, promoting palliative care, and distinguishing it from euthanasia. However, these defences have the potential to provide less protection for doctors administering palliative care. In addition to requiring a doctor to have an appropriate intent, the defences insist on adherence to particular medical practice standards and perhaps require patient consent. Doctors providing end-of-life care in these States need to be aware of these legislative changes. Acting in accordance with the common law doctrine of double effect may not provide legal protection. Similar changes are likely to occur in other States and Territories as there is a trend towards enacting legislative defences that deal with the provision of palliative care. PMID:21707893

  6. Occupational health and safety issues among nurses in the Philippines.

    PubMed

    de Castro, A B; Cabrera, Suzanne L; Gee, Gilbert C; Fujishiro, Kaori; Tagalog, Eularito A

    2009-04-01

    Nursing is a hazardous occupation in the United States, but little is known about workplace health and safety issues facing the nursing work force in the Philippines. In this article, work-related problems among a sample of nurses in the Philippines are described. Cross-sectional data were collected through a self-administered survey during the Philippine Nurses Association 2007 convention. Measures included four categories: work-related demographics, occupational injury/illness, reporting behavior, and safety concerns. Approximately 40% of nurses had experienced at least one injury or illness in the past year, and 80% had experienced back pain. Most who had an injury did not report it. The top ranking concerns were stress and overwork. Filipino nurses encounter considerable health and safety concerns that are similar to those encountered by nurses in other countries. Future research should examine the work organization factors that contribute to these concerns and strengthen policies to promote health and safety. PMID:19438081

  7. Occupational Health and Safety Issues Among Nurses in the Philippines

    PubMed Central

    de Castro, A. B.; Cabrera, Suzanne L.; Gee, Gilbert C.; Fujishiro, Kaori; Tagalog, Eularito A.

    2009-01-01

    Nursing is a hazardous occupation in the United States, but little is known about workplace health and safety issues facing the nursing work force in the Philippines. In this article, work-related problems among a sample of nurses in the Philippines are described. Cross-sectional data were collected through a self-administered survey during the Philippine Nurses Association 2007 convention. Measures included four categories: work-related demographics, occupational injury/illness, reporting behavior, and safety concerns. Approximately 40% of nurses had experienced at least one injury or illness in the past year, and 80% had experienced back pain. Most who had an injury did not report it. The top ranking concerns were stress and overwork. Filipino nurses encounter considerable health and safety concerns that are similar to those encountered by nurses in other countries. Future research should examine the work organization factors that contribute to these concerns and strengthen policies to promote health and safety. PMID:19438081

  8. Innovative palliative care in Edmonton.

    PubMed Central

    Fainsinger, R. L.; Bruera, E.; MacMillan, K.

    1997-01-01

    PROBLEM BEING ADDRESSED: Access to palliative care in Edmonton has been hampered by uneven development, poor distribution of services, and more recently, economic restraints. Family physicians' involvement in palliative care has been hindered by the variety of access points, poor coordination, and inadequate reimbursement for time-consuming and difficult patient care situations. OBJECTIVE OF PROGRAM: To provide high-quality palliative care throughout Edmonton in all settings, with patients able to move easily throughout the components of the program; to lower costs by having fewer palliative care patients die in acute care facilities; and to ensure that family physicians receive support to care for most patients at home or in palliative care units. MAIN COMPONENTS OF PROGRAM: The program includes a regional office, home care, and consultant teams. A specialized 14-bed palliative care unit provides acute care. Family physicians are the primary caregivers in the 56 palliative continuing care unit beds. CONCLUSIONS: This program appears to meet most of the need for palliative care in Edmonton. Family physicians, with support from consulting teams, have a central role. Evaluation is ongoing; an important issue is how best to support patients dying at home. Images p1984-a p1986-a PMID:9386885

  9. Knowledge and attitude of final - year medical students in Germany towards palliative care - an interinstitutional questionnaire-based study

    PubMed Central

    2011-01-01

    Background To care for terminally ill and dying patients requires a thorough medical education, encompassing skills, knowledge, and attitudes in the field of palliative care. Undergraduate medical students in Germany will receive mandatory teaching in palliative care in the near future driven by recent changes in the Medical Licensure Act. Before new curricula can be implemented, the knowledge of medical students with respect to palliative care, their confidence to handle palliative care situations correctly, their therapeutic attitude, and their subjective assessment about previous teaching practices have to be better understood. Method We designed a composite, three-step questionnaire (self estimation of confidence, knowledge questions, and opinion on the actual and future medical curriculum) conducted online of final - year medical students at two universities in Germany. Results From a total of 318 enrolled students, 101 responded and described limited confidence in dealing with specific palliative care issues, except for pain therapy. With regard to questions examining their knowledge base in palliative care, only one third of the students (33%) answered more than half of the questions correctly. Only a small percentage of students stated they had gained sufficient knowledge and experience in palliative care during their studies, and the vast majority supported the introduction of palliative care as a mandatory part of the undergraduate curriculum. Conclusion This study identifies medical students' limited confidence and knowledge base in palliative care in 2 German universities, and underlines the importance of providing a mandatory palliative care curriculum. PMID:22112146

  10. Access to palliative care: insights into ground realities post-2014 amendment to NDPS Act.

    PubMed

    Rajagopal, M R

    2016-01-01

    Medical practice today is disease-focused, ignoring the universally accepted definition of health as not just the absence of disease, but the promotion of complete physical, social and mental well-being. Generations of doctors in India have not studied modern pain management, and palliative care is practically unknown in most parts of the country, causing patients to be rejected by hospitals and doctors when they need help the most. The draconian Narcotic Drugs and Psychotropic Substances (NDPS) Act of 1985, outdated medical and nursing education, lack of public awareness and lack of clear governmental policy are responsible for this sorry state of affairs. The development of a community-oriented palliative care network eventually led to the formulation of a state palliative care policy in Kerala. The acceptance of palliative care as a medical specialty by the Medical Council of India and introduction of a postgraduate degree course in palliative medicine in 2010, the development of a National Programme for Palliative Care in 2012 by the Ministry of Health of the Government of India, and the amendment of the NDPS Act in 2014 have been major positive developments which have the potential to change the current state of affairs. However, these recent achievements represent but one step in the right direction. An improvement in palliative care education, a realistic palliative care policy and implementation of the NDPS Amendment Act are necessary for doing away with the gross, needless violation of the human right to life with dignity. PMID:26826658

  11. Palliative Care Training and Research: The Development in Europe and the Bologna Experience

    PubMed Central

    Bolognesi, Deborah; Brighi, Nicole; Muciarelli, Pier-Angelo; Biasco, Guido

    2013-01-01

    Development of palliative care (PC) culture spur the need of proper and formal training. Palliative medicine is not fully recognized as an academic medical discipline due to its humanistic influences, and studies show that physicians declare to be not prepared to provide care and pain management to dying patients. Nowadays, despite leading countries in PC being considered more innovative than other countries,such as Italy, facts show that the achievement of acknowledged discipline went through a long process. In Italy,professionals from about 450 PC units and organizations need to receive a proper and homogeneous training. In Italy, palliative medicine official certification is an undergoing process advocated by a few organizations and in Bologna the Academy of the Sciences of Palliative Medicine operates since 2007 with the defined mission of developing PC culture, also within the University. In order to be as much effective in pursuing its mission, the Academy has strengthened several international cooperation programs and today is leader in PC professional training and research in Italy. The recent law and its feasibility is fastening the process of development of Palliative Care Culture in Italy even if training is not properly regulated and official certification for physician is under evaluation. In Europe, the European Association of Palliative Care is stressing the need for training programs in palliative medicine and the outcomes of the dedicated task force on official certification and specialty in Palliative Medicine will remarkably force policy makers and national councils to officially recognize the discipline. PMID:23766591

  12. Palliative care training and research: the development in europe and the bologna experience.

    PubMed

    Bolognesi, Deborah; Brighi, Nicole; Muciarelli, Pier-Angelo; Biasco, Guido

    2013-01-01

    Development of palliative care (PC) culture spur the need of proper and formal training. Palliative medicine is not fully recognized as an academic medical discipline due to its humanistic influences, and studies show that physicians declare to be not prepared to provide care and pain management to dying patients. Nowadays, despite leading countries in PC being considered more innovative than other countries,such as Italy, facts show that the achievement of acknowledged discipline went through a long process. In Italy,professionals from about 450 PC units and organizations need to receive a proper and homogeneous training. In Italy, palliative medicine official certification is an undergoing process advocated by a few organizations and in Bologna the Academy of the Sciences of Palliative Medicine operates since 2007 with the defined mission of developing PC culture, also within the University. In order to be as much effective in pursuing its mission, the Academy has strengthened several international cooperation programs and today is leader in PC professional training and research in Italy. The recent law and its feasibility is fastening the process of development of Palliative Care Culture in Italy even if training is not properly regulated and official certification for physician is under evaluation. In Europe, the European Association of Palliative Care is stressing the need for training programs in palliative medicine and the outcomes of the dedicated task force on official certification and specialty in Palliative Medicine will remarkably force policy makers and national councils to officially recognize the discipline. PMID:23766591

  13. Tongonani geothermal power development, Philippines

    SciTech Connect

    Minson, A.A.C.; Fry, T.J.; Kivell, J.A.

    1985-01-01

    This paper describes the features, design and construction of a 112 MWe geothermal power project, representing the first stage development of the substantial geothermal resources of the central Philippine region. The project has been undertaken by the Philippine Government. The National Powe Corporation is responsible for generation and distribution facilities and the Philippine National Oil Company Energy Development Corporation is responsible for controlled delivery of steam to the powe station.

  14. Improving Palliative Cancer Care.

    PubMed

    Del Ferraro, Catherine; Ferrell, Betty; Van Zyl, Carin; Freeman, Bonnie; Klein, Linda

    2014-01-01

    Over a decade ago, the Institute of Medicine (IOM) presented Ensuring Quality Cancer Care in the United States, with recommendations for change (IOM, 1999). However, barriers to integrating palliative care (PC) to achieve high-quality care in cancer still remain. As novel therapeutic agents evolve, patients are living longer, and advanced cancer is now considered a chronic illness. In addition to complex symptom concerns, patients and family caregivers are burdened with psychological, social, and spiritual distress. Furthermore, data show that PC continues to be underutilized and inaccessible, and current innovative models of integrating PC into standard cancer care lack uniformity. The aim of this article is to address the existing barriers in implementing PC into our cancer care delivery system and discuss how the oncology advanced practice nurse plays an essential role in providing high-quality cancer care. We also review the IOM recommendations; highlight the work done by the National Consensus Project in promoting quality PC; and discuss a National Cancer Institute-funded program project currently conducted at a National Comprehensive Cancer Center, "Palliative Care for Quality of Life and Symptoms Concerns in Lung Cancer," which serves as a model to promote high-quality care for patients and their families. PMID:26114013

  15. Integrating Palliative Care into Primary Care.

    PubMed

    Gorman, Rosemary D

    2016-09-01

    Improved quality of life, care consistent with patient goals of care, and decreased health care spending are benefits of palliative care. Palliative care is appropriate for anyone with a serious illness. Advances in technology and pharmaceuticals have resulted in increasing numbers of seriously ill individuals, many with a high symptom burden. The numbers of individuals who could benefit from palliative care far outweighs the number of palliative care specialists. To integrate palliative care into primary care it is essential that resources are available to improve generalist palliative care skills, identify appropriate patients and refer complex patients to specialist palliative care providers. PMID:27497014

  16. [Palliative care in pediatrics, ethics and relations with the patient].

    PubMed

    Friedel, Marie

    2014-01-01

    The extension of the Belgian law on euthanasia to minors during the course of 2014 raises questions with regard to the needs of children in the context of paediatric palliative care. These needs concern essentially the focus given to the interrelations between the child, their family and the caregiving team as well as to the relief of the physical, psychological and spiritual pain. Ethical guidelines help to fuel the discussions surrounding professional practices. PMID:25608370

  17. The global state of palliative care-progress and challenges in cancer care.

    PubMed

    Reville, Barbara; Foxwell, Anessa M

    2014-07-01

    All persons have a right to palliative care during cancer treatment and at the end-of-life. The World Health Organization (WHO) defines palliative care as a medical specialty that addresses physical, psychological, social, legal, and spiritual domains of care by an interdisciplinary team of professional and lay health care providers. Widespread adoption of this universal definition will aid policy development and educational initiatives on a national level. The need for palliative care is expanding due to the aging of the world's population and the increase in the rate of cancer in both developed and developing countries. However, in one third of the world there is no access to palliative care for persons with serious or terminal illness. Palliative care improves symptoms, most frequently pain, and improves quality of life for patients and their families, especially in the terminal disease phase. Accessibility to palliative care services, adequately trained health care professionals, availability of essential medicines, and gaps in education vary greatly throughout the world. Pain management is an integral concept in the practice of palliative care; however, opioiphobia, insufficient supply of opioids, and regulatory restrictions contribute to undue suffering for millions. Ongoing advocacy efforts call for increased awareness, palliative care integration with cancer care, and public and professional education. Enacting necessary change will require the engagement of health ministries and the recognition of the unique needs and resources of each country. The aim of this review is to examine progress in palliative care development and explore some of the barriers influencing cancer care across the globe. PMID:25841689

  18. Team networking in palliative care.

    PubMed

    Spruyt, Odette

    2011-01-01

    "If you want to travel quickly, go alone. But if you want to travel far, you must go together". African proverb. The delivery of palliative care is often complex and always involves a group of people, the team, gathered around the patient and those who are close to them. Effective communication and functional responsive systems of care are essential if palliative care is to be delivered in a timely and competent way. Creating and fostering an effective team is one of the greatest challenges for providers of palliative care. Teams are organic and can be life giving or life sapping for their members. PMID:21811361

  19. Trends in Philippine Library History.

    ERIC Educational Resources Information Center

    Hernandez, Vicente S.

    This paper divides Philippine library history into three periods, establishing a relationship between historical events and library trends. During the Spanish period, modern library trends were introduced through the establishment of the Sociedad Economica in 1780, but did not influence Philippine library culture until the later part of the 19th…

  20. [Palliative care for glioblastoma].

    PubMed

    Dieudonné, Nathalie; De Micheli, Rita; Hottinger, Andreas

    2016-04-27

    Patients with glioblastoma have a limited life expectancy and an impaired quality of life and they should be offered palliative care soon after the diagnosis is established. Still, only a quarter of patients aged over 65 return home or medical institution after completing treatments. Home care must be promoted by coordinating assistance and care, combining disciplines such as physiotherapy and ergotherapy, medical and nursing care and psychosocial support. Patients are at risk of mood, personality and behavioural disorders. Limited awareness of these troubles and their physical limitations alter their capacity of rehabilitation and social relationships. Isolation of relatives, exhaustion and misunderstandings should be prevented. The therapeutic goals should be discussed and determined upstream to anticipate difficulties and questions concerning end of life. PMID:27281945

  1. 38 CFR 3.41 - Philippine service.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2011-07-01 2011-07-01 false Philippine service. 3.41..., Compensation, and Dependency and Indemnity Compensation General § 3.41 Philippine service. (a) For a Regular Philippine Scout or a member of one of the regular components of the Philippine Commonwealth Army...

  2. 38 CFR 3.41 - Philippine service.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Philippine service. 3.41..., Compensation, and Dependency and Indemnity Compensation General § 3.41 Philippine service. (a) For a Regular Philippine Scout or a member of one of the regular components of the Philippine Commonwealth Army...

  3. 38 CFR 3.41 - Philippine service.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2013-07-01 2013-07-01 false Philippine service. 3.41..., Compensation, and Dependency and Indemnity Compensation General § 3.41 Philippine service. (a) For a Regular Philippine Scout or a member of one of the regular components of the Philippine Commonwealth Army...

  4. 38 CFR 3.41 - Philippine service.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2012-07-01 2012-07-01 false Philippine service. 3.41..., Compensation, and Dependency and Indemnity Compensation General § 3.41 Philippine service. (a) For a Regular Philippine Scout or a member of one of the regular components of the Philippine Commonwealth Army...

  5. 38 CFR 3.41 - Philippine service.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2014-07-01 2014-07-01 false Philippine service. 3.41..., Compensation, and Dependency and Indemnity Compensation General § 3.41 Philippine service. (a) For a Regular Philippine Scout or a member of one of the regular components of the Philippine Commonwealth Army...

  6. Palliative care - shortness of breath

    MedlinePlus

    ... to control shortness of breath: Call your doctor, palliative care team, or hospice nurse for advice Call 911 ... Bicanovsky L. Comfort care: symptom control in the dying. In: Walsh ... . 1st ed. Philadelphia, PA: Elsevier Saunders; 2008:chap 181.

  7. Spirituality in geriatric palliative care.

    PubMed

    Puchalski, Christina M

    2015-05-01

    This article presents an overview of spirituality as an essential domain of geriatrics palliative care, and provides guidelines for clinicians to diagnose spiritual distress and to integrate spirituality into their clinical practice. PMID:25920059

  8. Center to Advance Palliative Care

    MedlinePlus

    ... Learn More Overview Palliative in Practice Blog Report Card getpalliativecare.org Topics Topics of Interest CAPC ensures ... and Families Payer-Provider PCLC Pediatric Policy Report Card Seminar Membership Membership CAPC makes sure you never ...

  9. Posthumous Reproduction and Palliative Care

    PubMed Central

    Quinn, Gwendolyn; Bower, Bethanne; Zoloth, Laurie

    2011-01-01

    Abstract Posthumous reproduction is an issue fraught with legal, ethical, religious, and moral debate. The involvement of the hospice and palliative care community in this debate may be peripheral due to the fact that other health care professionals would be actually delivering the services. However, the hospice and palliative care community are more likely to treat patients considering posthumous reproduction as they near the end of their lives. This article provides the hospice and palliative care community with a review of the medical, ethical, and legal considerations associated with posthumous reproduction. Having knowledge of these issues, and a list of available resources, will be useful if hospice and palliative care staff find themselves facing a patient or family that is considering posthumous reproduction. PMID:21711126

  10. HIFU for palliative treatment of pancreatic cancer

    PubMed Central

    Khokhlova, Tatiana D.

    2011-01-01

    High intensity focused ultrasound (HIFU) is a novel non-invasive modality for ablation of various solid tumors including uterine fibroids, prostate cancer, hepatic, renal, breast and pancreatic tumors. HIFU therapy utilizes mechanical energy in the form of a powerful ultrasound wave that is focused inside the body to induce thermal and/or mechanical effects in tissue. Multiple preclinical and non-randomized clinical trials have been performed to evaluate the safety and efficacy of HIFU for palliative treatment of pancreatic tumors. Substantial tumor-related pain reduction was achieved in most cases after HIFU treatment, and no significant side-effects were observed. This review provides a description of different physical mechanisms underlying HIFU therapy, summarizes the clinical experience obtained to date in HIFU treatment of pancreatic tumors, and discusses the challenges, limitations and new approaches in this modality. PMID:22811848

  11. [Palliative Care for Non-cancer Patients].

    PubMed

    Ikegaki, Junichi

    2016-03-01

    Although palliative care has been developed and implemented as care for cancer pain, it is holistic care for suffering that includes physical, psychosocial and spiritual pain of life-threatening illness. It turned out that non-cancer patients in the end-stage are also suffering from various pain that should be treated as cancer patients. Trajectories of illness in non-cancer patients are with more gradual decline than those of cancer patients with steady progression and it is often difficult to make decision about end-of-life. The purpose of advance care planning was originally to help describe legal documents. This process is proved to contribute to improving QOL of patients and their families to discuss preference, hope, economic problems, spiritual question as well as medical treatment In Japan guideline of decision making process in end-of-life stage has been established. A program of communication training in end-of-life discussion has been made. Under current situation some comments on the role of anesthesiologists are also mentioned. PMID:27097506

  12. Cultural and religious considerations in pediatric palliative care

    PubMed Central

    WIENER, LORI; MCCONNELL, DENICE GRADY; LATELLA, LAUREN; LUDI, ERICA

    2012-01-01

    about death (truth telling), the meaning of pain and suffering, the meaning of death and dying, and location of end-of-life care. Significance of results The review of the literature provides insight into the influence of religion and how culture informs lifestyle and shapes the experiences of illness, pain, and end-of-life care. Recommendations for providing culturally sensitive end-of-life care are offered through the framework outlined in the Initiative for Pediatric Palliative Care Quality Improvement Project of 2002. Cultural traditions are dynamic, never static, and cannot be generalized to all families. Guidelines to aid in approaches to palliative care are provided, and providers are encouraged to define these important differences for each family under their care. PMID:22617619

  13. [Palliative care in non-cancer, chronic, progressive diseases].

    PubMed

    Radványi, Ildikó; Nagy, Lajos; Balogh, Sándor; Csikós, Ágnes

    2015-10-18

    Malignant and other chronic diseases cause the death of 2.5 million people in Europe annually. It is anticipated that this number will grow due to the aging of the European population. The death of a significant proportion of patients having progressive chronic disease is preceded by an extended end of life stadium. In this stage the patients have severe symptoms and pain that necessitate their symptomatic treatment and palliative care. The assessment of the life expectancy of patients, estimation of the prognosis of their illness and, therefore, selection of patients with a need of intensified palliative care often pose difficulties. This paper provides a summary on the basic elements of "good palliative care". It introduces the most frequent models for the procession of chronic diseases and those indicators that help practicing doctors to recognise easier patients with a need of intensified palliative care, and as a result provides more adequate medical attendance that is better suited to the specific needs of the patients. PMID:26551310

  14. [Palliative care: an approach based on the professional health categories].

    PubMed

    Hermes, Hélida Ribeiro; Lamarca, Isabel Cristina Arruda

    2013-09-01

    Palliative care has emerged as a humanitarian philosophy of caring for terminally ill patients, alleviating their pain and suffering. This care involves the action of an interdisciplinary team, in which all the professional recognize the limits of their performance will help the terminally ill patient to die with dignity. This article deals with the issue of death and dying, both from the traditional and the contemporary standpoint, and how palliative care have been treated in the job categories of medicine, social work, psychology and nursing. The methodology of this study consists of a literature review of articles in the SciELO database, electronic journals and technical books related to the topic. Analysis of the articles revealed a shortage of subjects that deal with the theme of death in professional curricula, as well as few palliative care services in Brazilian society and barriers faced by this new approach to the terminal patient. This research aims to broaden the discussion of palliative care in public health, and provide information for future studies that will address the theme. PMID:23989564

  15. Sustainable practice improvements: impact of the Comprehensive Advanced Palliative Care Education (CAPCE) program.

    PubMed

    Harris, Diane; Hillier, Loretta M; Keat, Nancy

    2007-01-01

    This paper describes an education program designed to improve palliative care practice through the development of workplace hospice palliative care resources (PCRs), and its impact on knowledge transfer and longer-term changes to clinical practice. Evaluation methods included pre- and post-program questionnaires, and a survey of learners' (n=301) perceptions of program learning strategies. Interviews (n=21) were conducted with a purposeful sample of PCRs and representatives from their work sites. Ratings of the sessions indicated that they were relevant to learners' clinical practice. At follow up, the majority of learners (83%) continued to serve as PCRs. Many positive effects were identified, including enhanced pain and symptom management, staff education, and development of care policies and guidelines. Management support, particularly the prioritization of palliative care and staff development, were factors facilitating sustained implementation. These findings highlight the importance of multimodal learning strategies and supportive work environments in the development of PCRs to enhance palliative care practice. PMID:18251444

  16. Palliative care communication curriculum: what can students learn from an unfolding case?

    PubMed

    Goldsmith, Joy; Wittenberg-Lyles, Elaine; Shaunfield, Sara; Sanchez-Reilly, Sandra

    2011-06-01

    Limited attention to palliative care communication training is offered to medical students. In this work, we pursued unfolding case responses and what they indicated about student tendencies to use palliative care communication as well as what medical students can learn from their own reflective practice about palliative care. Findings showed an overwhelming trend for students to avoid palliative care communication or inclusion of topics including advance directives, place of care, family support, and dying. Instead, students relied heavily on the SPIKES protocol, communication that was strategically vague and ambiguous, and discussions that centered on specialty care and referral. In reflecting on their own case study responses, students noted an absence of direct communication about prognosis, no coordination of care, late hospice entry, and patient pain resulting from communication inefficacies. Future research should focus on the development of formal and adaptive curriculum structures to address these communication needs. PMID:21071434

  17. Country watch: the Philippines.

    PubMed

    1993-01-01

    The bold, rational approach to condom use brought by Dr. Juan Flavier, Secretary of the Department of Health (DOH), to the Philippines has dramatically increased awareness about AIDS as well as the levels of condom promotion and acceptance. Dr. Flavier became Secretary of the Department in July 1992. Since then, the attention to AIDS-related issues in the Filipino media has dramatically increased. With the moral and tangible support of the President and the Cabinet, and against the platitudes of religious leaders and some senators, Dr. Flavier created media hype over condoms which led to an increase in AIDS awareness from 12% to 86% in little over 1 year. The Secretary is so popular that he received more than 200 speaking invitations/month. December was proclaimed National AIDS Awareness month in 1992 by the DOH and includes special AIDS education and condom distribution activities. An AIDS hotline is operational in Manila; condoms are now openly advertised in the media; and an express door-to-door delivery service has even been launched by a condom distributor. The decision of a 23-year old woman living with AIDS to go public has also helped DOH efforts. Finally, city ordinances in some areas require hotels and motels to provide customers with condoms or make them accessible, and condoms have become part of the standard equipment of the Philippine Armed Forces. PMID:12345381

  18. Where there is no morphine: The challenge and hope of palliative care delivery in Tanzania

    PubMed Central

    Dean, Mervyn; Hartwig, Kari; Mmbando, Paul Z.; Sayed, Abduraoof; de Vries, Elma

    2014-01-01

    Abstract Background In Tanzania, a country of 42 million, access to oral morphine is rare. Aim To demonstrate the effectiveness of palliative care teams in reducing patients’ pain and in increasing other positive life qualities in the absence of morphine; and to document the psychological burden experienced by their clinical providers, trained in morphine delivery, as they observed their patients suffering and in extreme pain. Setting One hundred and forty-five cancer patients were included from 13 rural hospitals spread across Tanzania. Method A mixed method study beginning with a retrospective quantitative analysis of cancer patients who were administered the APCA African POS tool four times. Bivariate analyses of the scores at time one and four were compared across the domains. The qualitative arm included an analysis of interviews with six nurses, each with more than five years’ palliative care experience and no access to strong opioids. Results Patients and their family caregivers identified statistically significant (p < 0.001) improvements in all of the domains. Thematic analysis of nurse interviews described the patient and family benefits from palliative care but also their great distress when ‘bad cases’ arose who would likely benefit only from oral morphine. Conclusion People living with chronic cancer-related pain who receive palliative care experience profound physical, spiritual and emotional benefits even without oral morphine. These results demonstrate the need for continued advocacy to increase the availability of oral morphine in these settings in addition to palliative care services. PMID:26245417

  19. Palliative social media.

    PubMed

    Taubert, Mark; Watts, Gareth; Boland, Jason; Radbruch, Lukas

    2014-03-01

    The uses of social media have become ubiquitous in contemporary society at an astonishingly fast-paced rate. The internet and in particular platforms such as Facebook, Twitter and YouTube are now part of most people's vocabulary and are starting to replace many face-to-face interactions. The online world, in particular, is alive with discussions, comments and anecdotes about the topics of illness, disease, hospitals, death and dying. The topic of death and dying had in the not too distant past been seen as taboo, but willingness and need to talk openly about it appears to be on the increase. In parallel to this, many public awareness campaigns are highlighting society's need to be more prepared for dying and death. This will have a significant impact on the way terminally ill patients and their families approach the last years, months and weeks of their lives and how they might expect palliative health and social care professionals working with them through these difficult periods to interact with them. We pay particular attention to the areas of digital posterity creation and memorialisation within the wider holistic context of end-of-life care. PMID:24644766

  20. Heel Pain in Recreational Runners.

    ERIC Educational Resources Information Center

    Bazzoli, Allan S.; Pollina, Frank S.

    1989-01-01

    Provides physicians with the signs, symptoms, and management of heel/sole pain in recreational runners (usually due to plantar fasciitis, Achilles tendinitis, and calcaneal stress fractures). Remedies involve palliative treatment of symptoms, correction of underlying biomechanical problems, and flexibility exercises. (SM)

  1. Aging trends -- the Philippines.

    PubMed

    Biddlecom, A E; Domingo, L J

    1996-03-01

    This report presents a description of the trends in growth of the elderly population in the Philippines and their health, disability, education, work status, income, and family support. The proportion of elderly in the Philippines is much smaller than in other Southeast Asian countries, such as Singapore and Malaysia. The elderly population aged over 65 years increased from 2.7% of total population in 1990 to 3.6% in 1990. The elderly are expected to comprise 7.7% of total population in 2025. The proportion of elderly is small due to the high fertility rate. Life expectancy averages 63.5 years. The aged dependency ratio will double from 5.5 elderly per 100 persons aged 15-64 years in 1990 to 10.5/100 in 2025. A 1984 ASEAN survey found that only 11% of elderly rated their health as bad. The 1990 Census reveals that 3.9% were disabled elderly. Most were deaf, blind, or orthopedically impaired. 16% of elderly in the ASEAN survey reported not seeing a doctor even when they needed to. 54% reported that a doctor was not visited due to the great expense. In 1980, 67% of men and 76% of women aged over 60 years had less than a primary education. The proportion with a secondary education in 2020 is expected to be about 33% for men and 33% for women. 66.5% of men and 28.5% of women aged over 60 years were in the formal labor force in 1990. Women were less likely to receive cash income from current jobs or pensions. 65% of earnings from older rural people was income from agricultural production. 60% of income among urban elderly was from children, and 23% was from pensions. Family support is provided to the elderly in the form of coresidence. In 1988, 68% of elderly aged over 60 years lived with at least one child. Retirement or nursing homes are uncommon. The Philippines Constitution states that families have a duty to care for elderly members. PMID:12292274

  2. Palliative Care: What You Should Know

    MedlinePlus

    ... Palliative care is provided by a team of doctors, nurses, and other specialists who work together with a ... help you. 3 ? Ask for it! Tell your doctors, nurses, family and caregivers that you want palliative care. ...

  3. Is Palliative Care Right for You?

    MedlinePlus

    ... medical care Understanding the pros and cons (benefits/burdens) of treatments (e.g., dialysis, additional cancer treatments, ... the Media For Clinicians For Policymakers For Family Caregivers What Is Palliative Care Definition Pediatric Palliative Care ...

  4. Pediatric Palliative Care: A Personal Story

    MedlinePlus Videos and Cool Tools

    ... count__/__total__ Find out why Close Pediatric Palliative Care: A Personal Story NINRnews Subscribe Subscribed Unsubscribe 250 ... and her family. The story demonstrates how palliative care can positively influence a patient's and family's experience ...

  5. Ambitious Philippine alternative energy plans

    SciTech Connect

    Not Available

    1981-09-07

    The Philippines is to spend $5.4 billion over the next ten years for the development of alternative sources of energy. These would include the development of fuel woods and other biomass, and the commercialization of a coconut/diesel-oil fuel. It is hoped that the Philippines' dependence on imported oil will be reduced from about 80% today to around 50% by the end of the decade.

  6. Country watch: Philippines.

    PubMed

    Mercado Carreon, L

    1998-01-01

    The Asian Regional Conference on Gender and Communication, held in the Philippines, developed a plan of action to improve the portrayal of women in the mass media. Even in developing countries with traditional attitudes toward women, pornographic-type images are used to boost product sales. The conference's recommendations address the challenges posed by globalization of the media, commercialization of local media, and the increased violation of women's human rights in the media and the question of who has control over the media. After the conference, ISIS Maila assembled a report, "Status of Women and Media: Focus on Violence Against Women," which will be presented at a forum held during the 1998 meeting of the United Nations Commission on the Status of Women. Gender justice for women in the media requires collaboration among media specialists, women's groups, researchers, nongovernmental organizations, and local and regional networks. PMID:12348696

  7. Pediatric palliative care

    PubMed Central

    Benini, Franca; Spizzichino, Marco; Trapanotto, Manuela; Ferrante, Anna

    2008-01-01

    The WHO defines pediatric palliative care as the active total care of the child's body, mind and spirit, which also involves giving support to the family. Its purpose is to improve the quality of life of young patients and their families, and in the vast majority of cases the home is the best place to provide such care, but for cultural, affective, educational and organizational reasons, pediatric patients rarely benefit from such an approach. In daily practice, it is clear that pediatric patients experience all the clinical, psychological, ethical and spiritual problems that severe, irreversible disease and death entail. The international literature indicates a prevalence of incurable disease annually affecting 10/10,000 young people from 0 to 19 years old, with an annual mortality rate of 1/10,000 young people from birth to 17 years old. The needs of this category of patients, recorded in investigations conducted in various parts of the world, reveal much the same picture despite geographical, cultural, organizational and social differences, particularly as concerns their wish to be treated at home and the demand for better communications between the professionals involved in their care and a greater availability of support services. Different patient care models have been tested in Italy and abroad, two of institutional type (with children staying in hospitals for treating acute disease or in pediatric hospices) and two based at home (the so-called home-based hospitalization and integrated home-based care programs). Professional expertise, training, research and organization provide the essential foundations for coping with a situation that is all too often underestimated and neglected. PMID:19490656

  8. Study of Nurses’ Knowledge about Palliative Care: A Quantitative Cross-sectional Survey

    PubMed Central

    Prem, Venkatesan; Karvannan, Harikesavan; Kumar, Senthil P; Karthikbabu, Surulirajan; Syed, Nafeez; Sisodia, Vaishali; Jaykumar, Saroja

    2012-01-01

    Context: Studies have documented that nurses and other health care professionals are inadequately prepared to care for patients in palliative care. Several reasons have been identified including inadequacies in nursing education, absence of curriculum content related to pain management, and knowledge related to pain and palliative care. Aims: The objective of this paper was to assess the knowledge about palliative care amongst nursing professionals using the palliative care knowledge test (PCKT). Settings and Design: Cross-sectional survey of 363 nurses in a multispecialty hospital. Materials and Methods: The study utilized a self-report questionnaire- PCKT developed by Nakazawa et al., which had 20 items (statements about palliative care) for each of which the person had to indicate ‘correct’, ‘incorrect’, or ‘unsure.’ The PCKT had 5 subscales (philosophy- 2 items, pain- 6 items, dyspnea- 4 items, psychiatric problems- 4 items, and gastro-intestinal problems- 4 items). Statistical Analysis Used: Comparison across individual and professional variables for both dimensions were done using one-way ANOVA, and correlations were done using Karl-Pearson's co-efficient using SPSS version 16.0 for Windows. Results: The overall total score of PCKT was 7.16 ± 2.69 (35.8%). The philosophy score was 73 ± .65 (36.5%), pain score was 2.09 ± 1.19 (34.83%), dyspnea score was 1.13 ± .95 (28.25%), psychiatric problems score was 1.83 ± 1.02 (45.75%), and gastro-intestinal problems score was 1.36 ± .97 (34%). (P = .00). The female nurses scored higher than their male counterparts, but the difference was not significant (P > .05). Conclusions: Overall level of knowledge about palliative care was poor, and nurses had a greater knowledge about psychiatric problems and philosophy than the other aspects indicated in PCKT. PMID:23093828

  9. Chronic Pain

    MedlinePlus

    ... adults. Common chronic pain complaints include headache, low back pain, cancer pain, arthritis pain, neurogenic pain (pain resulting ... Institute of Neurological Disorders and Stroke (NINDS). Low Back Pain Fact Sheet Back Pain information sheet compiled by ...

  10. Interaction of palliative care and primary care.

    PubMed

    Ghosh, Amrita; Dzeng, Elizabeth; Cheng, M Jennifer

    2015-05-01

    Primary care physicians are often the first medical providers patients seek out, and are in an excellent position to provide primary palliative care. Primary palliative care encompasses basic skills including basic evaluation and management of symptoms and discussions about goals of care and advance care planning. Specialty palliative care consultation complements primary care by assisting with complex psychosocial-spiritual patient and family situations. This article reviews primary palliative care skill sets and criteria for when to consider referring patients to specialty palliative care and hospice services. PMID:25920056

  11. Best practices for pediatric palliative cancer care: a primer for clinical providers.

    PubMed

    Levine, Deena; Lam, Catherine G; Cunningham, Melody J; Remke, Stacy; Chrastek, Jody; Klick, Jeffrey; Macauley, Robert; Baker, Justin N

    2013-09-01

    Cancer is the leading cause of disease-related death in children and adolescents. Pediatric patients with cancer suffer greatly at the end of life. However, palliative care interventions can reduce suffering and significantly improve the care of these patients and their families. A large percentage of pediatric deaths occur outside of the hospital setting where pediatric palliative resources may not be readily available. Patients in the home setting may be cared for by community hospice programs, which are typically staffed for adult populations. Increasingly, nonpediatric providers are asked to provide palliative care for children and adolescents at the end of life, yet they receive little formal training in this area. This review focuses on the principles of best practice in the provision of palliative care for children and adolescents with cancer. Our intent is to aid clinical providers in delivering optimal care to this patient population. Topics unique to pediatric palliative care that are addressed include: providing pain and symptom management in the broad pediatric range from neonate to adolescent; caring for and interacting with developmentally distinct groups; engaging in shared decision making with parents and adolescents; providing accommodations for prognoses that are often more uncertain than in adult patients; and delivering concurrent disease-directed therapy with palliative care. PMID:24400391

  12. Aberrant Opioid Use and Urine Drug Testing in Outpatient Palliative Care.

    PubMed

    Arthur, Joseph A; Haider, Ali; Edwards, Tonya; Waletich-Flemming, Jessica; Reddy, Suresh; Bruera, Eduardo; Hui, David

    2016-07-01

    Aberrant opioid use is a public health issue, which has not been adequately described in the palliative care literature. With the increasing integration of palliative care into oncologic care, palliative care clinicians are seeing patients earlier in the disease trajectory, and therefore, more outpatients with chronic pain requiring chronic opioid therapy. This may have resulted in a concomitant rise in the number of patients with aberrant opioid use. In this article, we report on two patients with aberrant opioid-related behavior seen at our palliative care clinic. A high suspicion of opioid abuse, misuse, or diversion based on certain behavioral cues necessitated the ordering of a urine drug test (UDT). The tests helped the medical team to confirm an already existing pattern of maladaptive opioid use. In both cases, we provided ample opioid education and implemented effective strategies to address their aberrant opioid use. These cases suggest the need for palliative care clinicians to develop strategies to effectively address this issue in our field of medicine. It also highlights the usefulness of UDT in the outpatient palliative care setting. PMID:27171327

  13. [Nutritional problems in palliative medicine].

    PubMed

    Ollenschläger, G

    2000-09-01

    Malnutrition is a frequent problem in the palliative care of the seriously ill and dying. Want of appetite and los of weight are direct symptoms of patients with consumptive infectional diseases (AIDS, TBC) as well as cancer or geriatric patients. Severe malnutrition significantly contributes to a loss of quality of life and increases morbidity of palliative patients. The subjective well-being of seriously ill patients is heavily influenced by want of appetite and loss of weight. Patients often find want of appetite and the incapability to eat as pressing as the physical impairment caused by the disease. Therefore the sole aim of palliative dietotherapy has to be to strengthen the general physical and mental condition of the patient. A specific training of home care staff and relatives of seriously ill patients in dealing sensitively with this problem of care is desirable. Above all, in-patient treatment of affected patients for the sole purpose of feeding has to be avoided. Aggressive dietotherapeutic interventions, especially artificial feeding, should be refrained from as far as possible in the terminal phase. Only if the prognosis of a patient in palliative treatment is improving contrary to expectations are strategies of curative dietotherapy valid. PMID:11048342

  14. Hearing Loss in Palliative Care

    PubMed Central

    Jain, Nelia; Wallhagen, Margaret L.

    2015-01-01

    Abstract Background: Age-related hearing loss is remarkably common, affecting more than 60% of adults over the age of 75. Moreover, hearing loss has detrimental effects on quality of life and communication, outcomes that are central to palliative care. Despite its high prevalence, there is remarkably little written on the impact of hearing loss in the palliative care literature. Objective: The objective was to emphasize its importance and the need for further study. We use a case as a springboard for discussing what is known and unknown about the epidemiology, presentation, screening methodologies, and treatment strategies for age-related hearing loss in palliative care. Discussion: The case describes a 65-year-old man with acute myelogenous leukemia (AML) that has progressed despite treatment. No concerns are raised about communication challenges during conversations between the palliative care team and the patient in his quiet room. However, in the midst of a family meeting, shortly after discussing prognosis, the patient reports that he cannot hear what anyone is saying. Conclusion: We describe simple methods of screening patients for hearing loss, and suggest that practical approaches should be used universally in patient encounters. These include facing the patient, pitching one's voice low, using a pocket talker, and creating a hearing-friendly environment when planning a family or group meeting. PMID:25867966

  15. On the palliative care unit.

    PubMed

    Selwyn, Peter A

    2016-06-01

    As a physician working in palliative care, the author is often privileged to share special moments with patients and their families at the end of life. This haiku poem recalls one such moment in that precious space between life and death, as an elderly woman, surrounded by her adult daughters, takes her last breath. (PsycINFO Database Record PMID:27270255

  16. Palliative Care: A Holistic Discipline.

    PubMed

    Greer, Steven; Joseph, Marie

    2016-03-01

    Although mind and body are inextricably interwoven, psychological factors have received insufficient attention within medicine. The biomedical model though necessary is not sufficient. In medicine and particularly in palliative care, a holistic biopsychosocial approach is required. A number of examples from clinical practice in a hospice setting are presented. PMID:26631259

  17. Infomarkers for Transition to Goals Consistent with Palliative Care in Dying Patients

    PubMed Central

    Yao, Yingwei; Stifter, Janet; Ezenwa, Miriam O.; Lodhi, Muhammad; Khokhar, Ashfaq; Ansari, Rashid; Keenan, Gail M.; Wilkie, Diana J.

    2015-01-01

    Objective Electronic health records (EHRs) may contain infomarkers that identify patients near the end of life for whom it would be appropriate to shift care goals to palliative care. Discovery and use of such infomarkers could be used to conduct effectiveness research that ultimately could help to reduce the monumental costs for dying care. Our aim was to identify changes in the plans of care that represented infomarkers, which signaled the transition of care goals from non-palliative care goals to those consistent with palliative care. Methods Using an existing electronic health record database generated during a two-year, longitudinal study of 9 diverse medical-surgical units from 4 Midwest hospitals and a known group approach, we evaluated the patient care episodes for 901 patients who died (mean age=74.5±14.6 years). We used ANOVA and Tukey’s post-hoc tests to compare patient groups. Results We identified 11 diagnoses, including Death Anxiety and Anticipatory Grieving, whose addition to the care plan, some of which also occurred with removal of non-palliative care diagnoses, represent infomarkers of transition to palliative care goals. There were four categories of patients, those who had: no infomarkers on plans (n=507); infomarkers added on the admission plan (n=194); infomarkers added on a post admission plan (minor transitions, n=109), and infomarkers added and non-palliative care diagnoses removed on a post admission plan (major transition, n=91). Age, length of stay, and pain outcomes differed significantly for these four categories of patients. Significance of Results EHRs contain pertinent infomarkers that if confirmed in future studies could be used for timely referral to palliative care for improved focus on comfort outcomes and to identify palliative care subjects from data repositories for to conduct big data research, comparative effectiveness studies, and health services research. PMID:25711431

  18. Nerve blocks for chronic pain.

    PubMed

    Hayek, Salim M; Shah, Atit

    2014-10-01

    Nerve blocks are often performed as therapeutic or palliative interventions for pain relief. However, they are often performed for diagnostic or prognostic purposes. When considering nerve blocks for chronic pain, clinicians must always consider the indications, risks, benefits, and proper technique. Nerve blocks encompass a wide variety of interventional procedures. The most common nerve blocks for chronic pain and that may be applicable to the neurosurgical patient population are reviewed in this article. This article is an introduction and brief synopsis of the different available blocks that can be offered to a patient. PMID:25240668

  19. Geothermal development in the Philippines

    SciTech Connect

    Elizagaque, R.F.; Tolentino, B.S.

    1982-06-01

    The development of geothermal resources and energy in the Philippines is discussed. Philippine National Oil Company-Energy Development Corporation initiated the first semi-commercial generation of geothermal power in July 1977 with the installation of a 3MWe plant. By 1980 the country had 440 MWe on line at Mak-Ban and Tiwi. This placed the Philippines second after the US among countries using geothermal energy for power generation. Before the end of 1981, PNOC-EDC added 6 additional MWe of geothermal power generating capacity to increase the total to 446 MWe. As part of the five-year National Energy Development Programme covering the period 1981-1985, additional power plants will be installed in various project areas to increase the share of geothermal power generation from the present 9.8% to 18.6% of the nationwide power-generation total, or the equivalent of 16.6 million barrels of oil per year. (MJF)

  20. The impact of an aging population on palliative care.

    PubMed

    O'Brien, Tony

    2013-12-01

    By 2050, it is predicted that 26% of the population will be aged 80 and over. Although older people have much to contribute, one challenging aspect of an aging population is the increasing rate of dementia. Palliative care is now included as part of the care pathway of a wide variety of nonmalignant diseases. The European Association for Palliative Care (EAPC) and the European Union Geriatric Medicine Society (EUGMS) have jointly called for every older citizen with chronic disease to be offered the best possible palliative care approach wherever they are cared for. This report is adapted from paineurope 2013; Issue 2, ©Haymarket Medical Publications Ltd., and is presented with permission. paineurope is provided as a service to pain management by Mundipharma International LTD. and is distributed free of charge to healthcare professionals in Europe. Archival issues can be accessed via the website: http://www.paineurope.com at which European health professionals can register online to receive copies of the quarterly publication. PMID:24303834

  1. PALLIATIVE CARE FOR OLDER ADULTS: STATE OF THE ART IN LEBANON.

    PubMed

    Abu-Saad Huijer, Huda; Saab, Mohammad; Hajjar, Ramzi

    2016-01-01

    Palliative care (PC) for older adults constitutes an important human rights challenge and a major public health care priority due to the aging of the population and the lack of health care services addressing the needs of the older people. In Lebanon, the surge in the number of older people with complex needs is unmatched by any increase in the services offered to them. PC in Lebanon is still under- developed and is subject to a number of challenges. These challenges are alarming and must be overcome through introducing health care providers to basic PC principles as recommended by the National Committee for Pain Relief and Palliative Care (NCPRPC). PMID:27169163

  2. Palliative Care Education: Focusing on Care and Not Just Disease | Division of Cancer Prevention

    Cancer.gov

    At the Institute for Palliative Medicine (IPM) in San Diego, medical residents are re-tooling for one of the most essential aspects of medicine: caring for seriously ill patients. “The goal is to teach them the core competencies in palliative care,” explained Dr. Charles von Gunten, the institute’s provost. These competencies include pain management, good communication skills, and the ability to provide patients with psychosocial and spiritual assessments and to work in interdisciplinary teams in hospitals, as well as through hospice and in nursing homes, he said. |

  3. Smartphone applications in palliative homecare.

    PubMed

    Dhiliwal, Sunil R; Salins, Naveen

    2015-01-01

    Smartphone applications in healthcare delivery are a novel concept and is rapidly gaining ground in all fields of medicine. The modes of e-communications such as e-mail, short message service (SMS), multimedia messaging service (MMS) and WhatsApp in palliative care provides a means for quick tele-consultation, information sharing, cuts the waiting time and facilitates initiation of the treatment at the earliest. It also forms a means of communication with local general practitioner and local health care provider such that continuity of the care is maintained. It also minimizes needless transport of the patient to hospital, prevents needless hospitalization and investigations and minimizes cost and logistics involved in the care process. The two case studies provided highlights the use of smartphone application like WhatsApp in palliative care practice and demonstrates its utility. PMID:25709195

  4. [Legal basics in palliative care].

    PubMed

    Putz, Wolfgang

    2016-03-01

    The German legal framework concerning end of life decisions is based on two pillars: the medical standards and the patient's autonomy. Every medical treatment, including life-saving and palliative measures, requires medical indication and, crucially, the patient's consent. Without the patient's consent even medically indicated treatment is prohibited.In other cases, complying with the patient's wishes, doctors have to treat symptoms the best they can. This includes palliative sedation accepting that the indicated medication may shorten life.It is prohibited to actively kill a patient to shorten his suffering. Assisting a suicide is only permitted if the suicide decision is made freely and on the patient's own responsibility. Businesslike suicide assistance is prohibited. PMID:26983108

  5. Smartphone Applications in Palliative Homecare

    PubMed Central

    Dhiliwal, Sunil R; Salins, Naveen

    2015-01-01

    Smartphone applications in healthcare delivery are a novel concept and is rapidly gaining ground in all fields of medicine. The modes of e-communications such as e-mail, short message service (SMS), multimedia messaging service (MMS) and WhatsApp in palliative care provides a means for quick tele-consultation, information sharing, cuts the waiting time and facilitates initiation of the treatment at the earliest. It also forms a means of communication with local general practitioner and local health care provider such that continuity of the care is maintained. It also minimizes needless transport of the patient to hospital, prevents needless hospitalization and investigations and minimizes cost and logistics involved in the care process. The two case studies provided highlights the use of smartphone application like WhatsApp in palliative care practice and demonstrates its utility. PMID:25709195

  6. Integration of legal aspects and human rights approach in palliative care delivery-the Nyeri Hospice model.

    PubMed

    Musyoki, David; Gichohi, Sarafina; Ritho, Johnson; Ali, Zipporah; Kinyanjui, Asaph; Muinga, Esther

    2016-01-01

    Palliative care is patient and family-centred care that optimises quality of life by anticipating, preventing, and treating suffering. Open Society Foundation public health program (2011) notes that people facing life-threatening illnesses are deeply vulnerable: often in severe physical pain, worried about death, incapacitation, or the fate of their loved ones. Legal issues can increase stress for patients and families and make coping harder, impacting on the quality of care. In the absence of a clear legal provision expressly recognising palliative care in Kenya, providers may face numerous legal and ethical dilemmas that affect the availability, accessibility, and delivery of palliative care services and commodities. In order to ensure positive outcomes from patients, their families, and providers, palliative care services should be prioritised by all and includes advocating for the integration of legal support into those services. Palliative care service providers should be able to identify the various needs of patients and their families including specific issues requiring legal advice and interventions. Access to legal services remains a big challenge in Kenya, with limited availability of specialised legal services for health-related legal issues. An increased awareness of the benefits of legal services in palliative care will drive demand for easily accessible and more affordable direct legal services to address legal issues for a more holistic approach to quality palliative care. PMID:27563351

  7. Integration of legal aspects and human rights approach in palliative care delivery—the Nyeri Hospice model

    PubMed Central

    Musyoki, David; Gichohi, Sarafina; Ritho, Johnson; Ali, Zipporah; Kinyanjui, Asaph; Muinga, Esther

    2016-01-01

    Palliative care is patient and family-centred care that optimises quality of life by anticipating, preventing, and treating suffering. Open Society Foundation public health program (2011) notes that people facing life-threatening illnesses are deeply vulnerable: often in severe physical pain, worried about death, incapacitation, or the fate of their loved ones. Legal issues can increase stress for patients and families and make coping harder, impacting on the quality of care. In the absence of a clear legal provision expressly recognising palliative care in Kenya, providers may face numerous legal and ethical dilemmas that affect the availability, accessibility, and delivery of palliative care services and commodities. In order to ensure positive outcomes from patients, their families, and providers, palliative care services should be prioritised by all and includes advocating for the integration of legal support into those services. Palliative care service providers should be able to identify the various needs of patients and their families including specific issues requiring legal advice and interventions. Access to legal services remains a big challenge in Kenya, with limited availability of specialised legal services for health-related legal issues. An increased awareness of the benefits of legal services in palliative care will drive demand for easily accessible and more affordable direct legal services to address legal issues for a more holistic approach to quality palliative care. PMID:27563351

  8. [Malignant wounds in palliative care].

    PubMed

    Fromantin, Isabelle; Rollot, Florence; Nicodeme, Marguerite; Kriegel, Iréne

    2015-01-01

    In the alsence of effective cancer treatment, malignant wounds evolve. The decisions taken by the multi-disciplinary team with regard to their care vary depending on whether the patient is in the initial, advanced or terminal phase of palliative care. Modern dressings can be used to control bleeding, odours and drainage. The aim is to control the symptoms and improve the quality of life, until its end. PMID:26027186

  9. Music therapy in palliative care.

    PubMed Central

    Munro, S.; Mount, B.

    1978-01-01

    Initial observations regarding the use of music therapy at one hospital in the palliative care of patients with advanced malignant disease are presented. In the hands of a trained music therapist, music has proven to be a potent tool for improving the quality of life. The diversity of its potential is particularly suited to the deversity of the challenges - physical, psychosocial and spiritual - that these patients present. Images FIG. 1 PMID:84704

  10. Intracerebroventricular opioids for intractable pain

    PubMed Central

    Raffa, Robert B; Pergolizzi, Joseph V

    2012-01-01

    When pain is refractory to systemic opioid and non-opioid analgesic therapy and palliative chemoradiation or ablative or stimulant neurosurgical procedures are not possible, palliative treatment becomes limited, particularly if the patient wishes to be at home at the end of life. Intracerebroventricular (ICV) infusion of morphine in the home setting might be presented as an option. The present article reviews the basic and clinical evidence of the efficacy and safety of ICV administration of opioids. Information was gathered from various bibliographic sources, including PubMed and others, and summarized and evaluated to assess the efficacy and safety of ICV opioids for pain relief. Results from ICV infusion of morphine into terminally ill patients refractory to other pain treatments have been reported since the early 1980s. Good efficacy has been achieved for the vast majority of patients, without serious development of analgesic tolerance. There have also been a low incidence of adverse effects, such as constipation and respiratory depression, and a significant retention of alertness associated with this route of administration. Intracerebroventricular infusion of opioid analgesics thus appears to be a safe and effective therapy for the palliative treatment of refractory pain. PMID:22295988

  11. Palliative Care: Video Tells a Mother's Story of Caring Support

    MedlinePlus

    ... this page please turn JavaScript on. Feature: Palliative Care Video Tells a Mother's Story of Caring Support ... the treatment …" Frequently Asked Questions What is palliative care, and when is it provided? Palliative care combines ...

  12. Palliative Care Doula: an innovative model.

    PubMed

    Lentz, Judy C

    2014-01-01

    Walking the journey of serious illness is very difficult and stressful for patients and families. A universal principle of palliative care is caring for the patient/ family unit. This article introduces a model for the Palliative Care Doula for experienced and advanced practice palliative care nurses to support patients and families during the traumatic and vulnerable period of end-of-life care. PMID:25296488

  13. Palliative Care in Musculoskeletal Oncology.

    PubMed

    Gulia, Ashish; Byregowda, Suman; Panda, Pankaj Kumar

    2016-01-01

    Patients in advanced stages of illness trajectories with local and widespread musculoskeletal incurable malignancies, either treatment naive or having recurrence are referred to the palliative care clinic to relieve various disease-related symptoms and to improve the quality of life. Palliative care is a specialized medicine that offers treatment to the disease-specific symptoms, places emphasis on the psychosocial and spiritual aspects of life and help the patients and their family to cope with advance stage cancer in a stronger and reasonable way. The overall outcome of musculoskeletal malignancies has improved with the advent of multidisciplinary management. Even then these tumors do relapse and leads to organ failures and disease-specific deaths in children and young adults in productive age group thus requiring an integrated approach to improve the supportive/palliative care needs in end-stage disease. In this article, we would like to discuss the spectrum of presentation of advanced musculoskeletal malignancies, skeletal metastasis, and their management. PMID:27559251

  14. Palliative Care in Musculoskeletal Oncology

    PubMed Central

    Gulia, Ashish; Byregowda, Suman; Panda, Pankaj Kumar

    2016-01-01

    Patients in advanced stages of illness trajectories with local and widespread musculoskeletal incurable malignancies, either treatment naive or having recurrence are referred to the palliative care clinic to relieve various disease-related symptoms and to improve the quality of life. Palliative care is a specialized medicine that offers treatment to the disease-specific symptoms, places emphasis on the psychosocial and spiritual aspects of life and help the patients and their family to cope with advance stage cancer in a stronger and reasonable way. The overall outcome of musculoskeletal malignancies has improved with the advent of multidisciplinary management. Even then these tumors do relapse and leads to organ failures and disease-specific deaths in children and young adults in productive age group thus requiring an integrated approach to improve the supportive/palliative care needs in end-stage disease. In this article, we would like to discuss the spectrum of presentation of advanced musculoskeletal malignancies, skeletal metastasis, and their management. PMID:27559251

  15. [Complementary therapy in palliative medicine].

    PubMed

    Hübner, J; Stoll, C

    2011-01-01

    Even in the palliative context complementary therapy has a high value for patients and their relatives. In contrast to the methods of conventional medicine naturopathy as a holistic system has positive meanings for patients and their family. Complementary medicine in the palliative setting can be used as a supportive therapy in carefully selected cases. Doctors and patients should be careful regarding effect and side effects and should make sure that supportive therapy is given adequately and in effective doses. Complementary therapy should not be used in order to avoid the question of life and death. An adequate approach to the topic is mandatory, which acknowledges the needs of patients but also looks for their safety. Patients following alternative therapies sometimes neglect helpful therapeutic options. Carefully providing information on these therapies is mandatory. Physicians should avoid losing patients' confidence in their competence and attention in their final course of disease. Also in palliative medicine a sensitive approach to the topic of complementary medicine is mandatory, which accounts for the eligible wishes of patients and their relatives but puts the patients safety first. PMID:21181106

  16. Palliative Care in Lung Cancer.

    PubMed

    Shinde, Arvind M; Dashti, Azadeh

    2016-01-01

    Lung cancer is the most common cancer worldwide and is the leading cause of cancer death for both men and women in the USA. Symptom burden in patients with advanced lung cancer is very high and has a negative impact on their quality of life (QOL). Palliative care with its focus on the management of symptoms and addressing physical, psychosocial, spiritual, and existential suffering, as well as medically appropriate goal setting and open communication with patients and families, significantly adds to the quality of care received by advanced lung cancer patients. The Provisional Clinical Opinion (PCO) of American Society of Clinical Oncology (ASCO) as well as the National Cancer Care Network's (NCCN) clinical practice guidelines recommends early integration of palliative care into routine cancer care. In this chapter, we will provide an overview of palliative care in lung cancer and will examine the evidence and recommendations with regard to a comprehensive and interdisciplinary approach to symptom management, as well as discussions of goals of care, advance care planning, and care preferences. PMID:27535397

  17. Scientists Investigate Recent Philippine Landslide

    NASA Astrophysics Data System (ADS)

    Lagmay, Alfredo Mahar A.; Ong, John Burtkenley T.; Fernandez, Dan Ferdinand D.; Lapus, Mark R.; Rodolfo, Raymond S.; Tengonciang, Arlene Mae P.; Soria, Janneli Lea A.; Baliatan, Eden G.; Quimba, Zareth L.; Uichanco, Christopher L.; Paguican, Engielle Mae R.; Remedio, Armelle Reca C.; Lorenzo, Genevieve Rose H.; Avila, Francia B.; Valdivia, Waldemar

    2006-03-01

    A massive landslide devastated the community of Barangay Guinsaugon, Municipality of St. Bernard, Southern Leyte Province, Philippines, at about 10:30 local time on 17 February. The landslide occurred along the steep fault scarp of the Philippine Fault Zone (PFZ) (Figure 1a), a large and active tectonic structure that traverses the entire length of the Philippines [Allen, 1962]. Barangay Guinsaugon is located at the foot of the scarp, directly in the path of the downward moving mass of earth. As of 24 February, the landslide caused 122 confirmed deaths; 1,328 people still are missing. To assist in the search and rescue operations that followed the landside, a team of geologists and physicists from the University of Philippines (UP-Diliman, Quezon City) and Ateneo de Manila University conducted an investigation of this area on 21-25 February. The UP-Ateneo team provided technical advice on the geology, which included the identification of the type and characteristics of the landslide.

  18. Philippine Programme Initiates Local Empowerment.

    ERIC Educational Resources Information Center

    Malone, Mary

    1995-01-01

    Describes a public health program for mothers and children developed by UNICEF workers in the Philippines that incorporates literacy and environmental awareness along with the usual focus on immunizations, nutrition, and clean water. The program contained an organic gardening project intended to empower women at the local level. (LZ)

  19. College Choice in the Philippines

    ERIC Educational Resources Information Center

    Tan, Christine Joy

    2009-01-01

    This descriptive and correlational study examined the applicability of major U.S. college choice factors to Philippine high school seniors. A sample of 226 students from a private school in Manila completed the College Choice Survey for High School Seniors. Cronbach's alpha for the survey composite index was 0.933. The purposes of this…

  20. Center stage in the Philippines

    SciTech Connect

    Meade, W. )

    1993-03-01

    At present, early 5,000 MW of private power capacity is operating or under development in the Philippines. Projects include oil- and coal-fired, geothermal, and hydroelectric projects under a variety of financing and ownership arrangements. If all projects and solicitations come to fruition, more than 80% of new capacity added through the year 2000 will be privately owned.

  1. Palliative Dental Care- A Boon for Debilitating

    PubMed Central

    Chintamaneni, Raja Lakshmi; Mpv, Prabhat; Gummadapu, Sarat; Salvadhi, Shyam Sundar

    2014-01-01

    World Health Organization defines “palliative care” as the active total care of patients whose disease is not responding to curative treatment. Palliative care actually deals with patients at the terminal end stage of the disease. We always face a question why a dentist should be in a palliative team? What is the exact role of dentist? Dental treatment may not always be strenuous and curative, but also can focus on improving quality of life of the patient. Hence forth the present paper enlightens the importance of dentist role in palliative team. PMID:25121074

  2. Turkish healthcare professionals' views on palliative care.

    PubMed

    Turgay, Gulay; Kav, Sultan

    2012-01-01

    The concept of modern palliative care has been disseminating slowly in Turkey and has recently been included in the National Cancer Control Program. The aim of this study was to explore healthcare professionals' knowledge and views of palliative care. It was conducted at three hospitals with a sample of 369 healthcare professionals working in adult clinics. Data were collected via open-ended questions and 16 statements from healthcare professionals on their views of palliative care. Most respondents stated that there was a lack of in-service/continuing education in palliative care, and more than half said they had not received any education in palliative care. A majority stated that the meaning and goal of palliative care is "improving the quality of life of a patient who is in the terminal stage." Lack of awareness of palliative care and a lack of educational resources in that field are the most frequently reported barriers to the development of palliative care in Turkey. Palliative care should be included in curricula for healthcare professionals and in-service education programs should be established. PMID:23413762

  3. Palliative dental care- a boon for debilitating.

    PubMed

    Mulk, Bhavana Sujana; Chintamaneni, Raja Lakshmi; Mpv, Prabhat; Gummadapu, Sarat; Salvadhi, Shyam Sundar

    2014-06-01

    World Health Organization defines "palliative care" as the active total care of patients whose disease is not responding to curative treatment. Palliative care actually deals with patients at the terminal end stage of the disease. We always face a question why a dentist should be in a palliative team? What is the exact role of dentist? Dental treatment may not always be strenuous and curative, but also can focus on improving quality of life of the patient. Hence forth the present paper enlightens the importance of dentist role in palliative team. PMID:25121074

  4. [Nursing in palliative care to children and adolescents with cancer: integrative literature review].

    PubMed

    da Costa, Thailly Faria; Ceolim, Maria Filomena

    2010-12-01

    Pediatric palliative care is a challenge for nursing because it requires emotional balance and knowledge about its specific features. This study is an integrative literature review that aims to identify nursing actions in palliative care for children and adolescents with cancer, considering peculiarities of the disease and dying process. The review was performed by searching for articles indexed in Biblioteca Virtual da Adolescência (Adolec), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) and PubMed databases from January 2004 till May 2009. From 29 references found, six met inclusion criteria. Results show teamwork, home care, pain management, dialogue, family support and particularities of childhood cancer fundamental tools for nursing in palliative care. The complexity of care in this situation requires solidarity, compassion, support and relieving suffering. PMID:21805890

  5. Radiation therapy for the palliation of multiple myeloma

    SciTech Connect

    Leigh, B.R.; Kurtts, T.A.; Mack, C.F.; Matzner, M.B.; Shimm, D.S. )

    1993-04-02

    This study reviews the experience at the University of Arizona in an effort to define the minimum effective radiation dose for durable pain relief in the majority of patients with symptomatic multiple myeloma. The records of 101 patients with multiple myeloma irradiated for palliation at the University of Arizona between 1975 and 1990 were reviewed. Three hundred sixteen sites were treated. Ten sites were asymptomatic, including six hemibody fields with advanced disease unresponsive to chemotherapy and four local fields with impending pathological fractures. Three hundred six evaluable symptomatic sites remained. The most common symptom was bone pain. Other symptoms included neurological impairment with a palpable mass. Total tumor dose ranged from 3.0 to 60 Gy, with a mean of 25 Gy. Symptom relief was obtained in 297 of 306 evaluable symptomatic sites (97%). Complete relief of symptoms was obtained in 26% and partial relief in 71%. Symptom relief was obtained in 92% of sites receiving a total dose less than 10 Gy (n = 13) and 98% of sites receiving 10 Gy or more (n = 293). No dose-response could be demonstrated. The likelihood of symptom relief was not influenced by the location of the lesion or the use of concurrent chemotherapy. Of the 297 responding sites, 6% (n = 19) relapsed after a median symptom-free interval of 16 months. Neither the probability of relapse nor the time to relapse was related to the radiation dose. Retreatment of relapsing sites provided effective palliation in all cases. Radiation therapy is effective in palliating local symptoms in multiple myeloma. A total dose of 10 Gy should provide durable symptom relief in the majority of patients. 16 refs., 3 figs., 4 tabs.

  6. Philippine president announces population policy.

    PubMed

    1970-02-01

    President Ferdinand Marcos of the Philippines has announced a national policy for family planning, following his recent reelection for a second term of office. Under the policy adopted by the President, the Philippine Government is committed to undertake and encourage programs to provide information and advice for couples wishing to space or limit their child-bearing activities. The Presidential Commission on Population, in a report based on recommendations drawn up after more than 20 meetings by the 22 members, and states that the unfettered population growth will gravely hamper efforts to improve living standards for Filipinos and will block the attainment of national development goals. However, the Commission emphasized that the program will be educational and persuasive, not coercive. Family planning services have been growing rapidly in the Philippines over the past few years as a result of the initiative of several pioneer organizations assisted by the IPPF. President Marcos' government signed the United Nations Declaration on Population in 1967 and in January 1969 he established The Commission on Population. The Philippine press has consistently backed the campaign for widespread availability of family planning services. The Western Pacific Region of the World Health Organization, under it's Director, Dr. Francisco Dy, which has its headquarters in Manila, has its headquarters in Manila, has fostered a regional interest through its technical discussions and the training of field personnel. Depthnews recently reported that the latest Philippine demographic survey asserts that Filipina women are bearing children so fast that the country will hold on to the undisputed title of possessing the highest birth rate in Asia. The growth rate is 3.5%, and the average completed size of a Filipino family is 6.8 children. This swift rate of growth will boost the 1969 population of 37.1 million to 38.4 at the end of this decade. It is noted that unless curbed, it will

  7. Voluntary palliated starvation: a lawful and ethical way to die?

    PubMed

    White, Ben; Willmott, Lindy; Savulescu, Julian

    2014-12-01

    Increasingly, individuals want control over their own destiny. This includes the way in which they die and the timing of their death. The desire for self-determination at the end of life is one of the drivers for the ever-increasing number of jurisdictions overseas that are legalising voluntary euthanasia and/or assisted suicide, and for the continuous attempts to reform State and Territory law in Australia. Despite public support for law reform in this field, legislative change in Australia is unlikely in the near future given the current political landscape. This article argues that there may be another solution which provides competent adults with control over their death and to have any pain and symptoms managed by doctors, but which is currently lawful and consistent with prevailing ethical principles. "Voluntary palliated starvation" refers to the process which occurs when a competent individual chooses to stop eating and drinking, and receives palliative care to address pain, suffering and symptoms that may be experienced by the individual as he or she approaches death. The article argues that, at least in some circumstances, such a death would be lawful for the individual and doctors involved, and consistent with principles of medical ethics. PMID:25715538

  8. Outpatient Palliative Care for Chronic Obstructive Pulmonary Disease: A Case Series

    PubMed Central

    Yount, Susan; Szmuilowicz, Eytan; Rosenberg, Sharon R.; Kalhan, Ravi

    2014-01-01

    Abstract Background: Patients with chronic obstructive pulmonary disease (COPD) have well-documented symptoms that affect quality of life. Professional societies recommend palliative care for such patients, but the optimal way of delivering this care is unknown. Objective: To describe an outpatient palliative medicine program for patients with COPD. Design: Retrospective case series. Setting/Subjects: Thirty-six patients with COPD followed in a United States academic outpatient palliative medicine clinic. Measurements: Descriptive analysis of sociodemographic data, disease severity and comorbidities, treatments, hospitalizations, mortality, topic discussion, and symptom assessment. Results: Thirty-six patients (representing 5% of the total number of patients with COPD seen in a specialty pulmonary clinic) were seen over 11 months and followed for 2 years. Seventy-seven percent of patients were Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 3–4 and 72% were on oxygen at home. No patients had documented advanced directives at the initial visit but documentation increased to 61% for those who had follow-up appointments. The most commonly documented topics included symptoms (100%), social issues (94%), psychological issues (78%), and advance care planning (75%). Of symptoms assessed, pain was the least prevalent (51.6%), and breathlessness and fatigue were the most prevalent (100%). Symptoms were often undertreated prior to the palliative care appointment. During the 3-year study period, there were 120 hospital admissions (median, 2) and 12 deaths (33%). Conclusions: The patients with COPD seen in the outpatient palliative medicine clinic had many comorbid conditions, severe illness, and significant symptom burden. Many physical and psychological symptoms were untreated prior to the palliative medicine appointment. Whether addressing these symptoms through a palliative medicine intervention affects outcomes in COPD is unknown but represents an

  9. Palliative and end of life care for people living with dementia in care homes: part 1.

    PubMed

    Mitchell, Gary; Agnelli, Joanne; McGreevy, Jessie; Diamond, Monica; Roble, Herlindina; McShane, Elaine; Strain, Joanne

    2016-06-22

    The terms palliative and end of life care are often used interchangeably and healthcare practitioners may perceive that palliative care is only appropriate during the terminal stages of an illness. This article, the first of two parts, provides healthcare practitioners with an overview of the concept of palliative care. It explains how this can be differentiated from end of life care and how it should be commenced in a timely manner, so that people who are living with dementia can contribute to the planning of their future care and death. The policies and tools used in the provision of palliative and end of life care are discussed, including advance care planning and The Gold Standards Framework. The article is framed in a care home context; there is little research about how to optimise palliative care for people living with dementia in care homes. The second part of this article will discuss end of life care and the best practices for providing end of life care, including nutrition and hydration, oral hygiene, pain management and spiritual care. PMID:27332611

  10. Endoscopic palliation of advanced esophageal cancer

    PubMed Central

    Mocanu, A; Bârla, R; Hoara, P; Constantinoiu, S

    2015-01-01

    Esophageal cancer represents one of the most aggressive digestive tumors, with a survival rate at 5 years of only 10%. Globally, during the last three decades, there has been an increasing incidence of the esophageal cancer, approx. 400,000 new esophageal cancers being currently diagnosed annually. This represents the eighth leading cause of cancer incidence and the sixth leading cause of cancer death overall. Taking into account the population’s global aging and thus, the increase in the number of patients who will not bear surgery, PCT and radiation, or the fact that they do not want it especially because of deficiencies and associated pathology, the endoscopic ablative techniques with palliation purposes represent the alternative. If we refer to the Western Europe countries and North America, we notice an increase of esophageal adenocarcinoma rate versus squamous cancer. As for the Asian region, referring in particular to China and Japan, 9 out of 10 esophageal cancers are squamous cell carcinomas. For at least half of the patients with EC (esophageal cancer) there is no hope of healing because of the advanced regional malignant invasion (T3-4, N+, M+) with no chemo and radiotherapy response, poor preoperative patients’ conditions or systemic metastasis. The low life expectancy does not justify the risky medical procedures, the goal of the therapy consisting in the improvement of the quality of life by eliminating dysphagia (reestablishing oral feeding) which represents the most common complication of EC, the respiratory tract complication caused by eso-tracheal fistulas or by eliminating chest pain. To treat dysphagia, which is the main target of palliation, combined methods like endoscopic, chemo and radio-therapy, can be used, each one with indications, benefits and risks. Abbreviations: SEPS = self expanding plastic stent, SREMS = self expanding metal stent, EBRT = Endoscopic brachy radiotherapy, EUS = Ultra sound endoscopy, CT = Computer tomograph, UGE

  11. Clinical Outcome of Palliative Radiotherapy for Locally Advanced Symptomatic Gastric Cancer in the Modern Era

    PubMed Central

    Tey, Jeremy; Choo, Bok Ai; Leong, Cheng Nang; Loy, En Yun; Wong, Lea Choung; Lim, Keith; Lu, Jiade Jay; Koh, Wee Yao

    2014-01-01

    Abstract The purpose of this study was to report the outcomes of patients with symptomatic locally advanced/recurrent gastric cancer treated with radiotherapy (RT) using modern 3-dimensional conformal techniques. We retrospectively reviewed patients who had palliative RT for index symptoms of gastric bleeding, pain, and obstruction. Study endpoints included symptom response, median survival, and treatment toxicity. Of 115 patients with median age of 77 years, 78 (67.8%) patients had metastatic disease at the time of treatment. Index symptoms were gastric bleeding, pain, and obstruction in 89.6%, 9.2%, and 14.3% of patients, respectively. Dose fractionation regimen ranged from 8-Gy single fraction to 40 Gy in 16 fractions. One hundred eleven patients (93.3%) were computed tomography (CT) planned. Median follow-up was 85 days. Response rates for bleeding, pain, and obstruction were 80.6% (83/103), 45.5% (5/11), and 52.9% (9/17), respectively, and median duration of response was 99 days, 233 days, and 97 days, respectively. Median survival was 85 days. Actuarial 12-month survival was 15.3%. There was no difference in response rates between low (≤39 Gy) and high (>39 Gy) biologically effective dose (BED) regimens (α/β ratio = 10). Median survival was significantly longer in patients who responded to RT compared with patients who did not (113.5 vs 47 days, P < 0.001). Three patients (2.6%) had grade 3 Common Toxicity Criteria equivalent toxicity (nausea/vomiting/anorexia). External beam RT delivered using 3-dimensional conformal techniques is highly effective and well tolerated in the local palliation of gastric cancer, with palliation lasting the majority of patient’s lives. Short (≤39 Gy BED) RT schedules are adequate for effective symptom palliation. A phase II study of palliative gastric RT is ongoing. PMID:25396330

  12. Palliation of Dysphagia in Carcinoma Esophagus

    PubMed Central

    Ramakrishnaiah, Vishnu Prasad Nelamangala; Malage, Somanath; Sreenath, G.S.; Kotlapati, Sudhakar; Cyriac, Sunu

    2016-01-01

    Esophageal carcinoma has a special place in gastrointestinal carcinomas because it contains two main types, namely, squamous cell carcinoma and adenocarcinoma. Carcinoma esophagus patients require some form of palliation because of locally advanced stage or distant metastasis, where it cannot be subjected to curable treatment with surgery and chemoradiation. Many modalities of palliation of dysphagia are available, but the procedure with least morbidity, mortality, and long-term palliation of dysphagia needs to be chosen for the patient. This study aims to discuss the recent trends in palliation of dysphagia with promising results and the most suitable therapy for palliation of dysphagia in a given patient. A total of 64 articles that were published between years 2005 and 2015 on various modes of palliation of dysphagia in carcinoma esophagus were studied, which were mainly randomized and prospective studies. Through this study, we conclude that stents are the first choice of therapy for palliation, which is safe and cost-effective, and they can be combined with either radiotherapy or chemotherapy for long-term palliation of dysphagia with good quality of life. Radiotherapy can be used as a second-line treatment modality. PMID:27279758

  13. Integrating palliative care into comprehensive cancer care.

    PubMed

    Abrahm, Janet L

    2012-10-01

    While there are operational, financial, and workforce barriers to integrating oncology with palliative care, part of the problem lies in ourselves, not in our systems. First, there is oncologists' "learned helplessness" from years of practice without effective medications to manage symptoms or training in how to handle the tough communication challenges every oncologist faces. Unless they and the fellows they train have had the opportunity to work with a palliative care team, they are unlikely to be fully aware of what palliative care has to offer to their patients at the time of diagnosis, during active therapy, or after developing advanced disease, or may believe that, "I already do that." The second barrier to better integration is the compassion fatigue many oncologists develop from caring for so many years for patients who, despite the oncologists' best efforts, suffer and die. The cumulative grief oncologists experience may go unnamed and unacknowledged, contributing to this compassion fatigue and burnout, both of which inhibit the integration of oncology and palliative care. Solutions include training fellows and practicing oncologists in palliative care skills (eg, in symptom management, psychological disorders, communication), preventing and treating compassion fatigue, and enhancing collaboration with palliative care specialists in caring for patients with refractory distress at any stage of disease. As more oncologists develop these skills, process their grief, and recognize the breadth of additional expertise offered by their palliative care colleagues, palliative care will become integrated into comprehensive cancer care. PMID:23054873

  14. Palliative care - fluid, food, and digestion

    MedlinePlus

    ... J. Martin, MD, MPH, ABIM Board Certified in Internal Medicine and Hospice and Palliative Medicine, Atlanta, GA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team. Related MedlinePlus Health Topics Palliative Care Browse the Encyclopedia A.D. ...

  15. Surgical palliative care in Haiti.

    PubMed

    Huffman, Joan L

    2011-04-01

    Palliative care in itself has many challenges; these challenges are compounded exponentially when placed in the setting of a mass casualty event, such as the 2010 Haiti earthquake. Haiti itself was an austere environment with very little infrastructure before the disaster. US surgeons, intensivists, and nurses worked hand in hand with other international providers and Haitian volunteers to provide the best care for the many. Improvisation and teamwork as well as respect for the Haitian caregivers were crucial to their successes. Sisyphean trials lie ahead. Haiti and its people must not be forgotten. PMID:21419263

  16. Endoscopic palliation of tracheobronchial malignancies.

    PubMed Central

    Hetzel, M R; Smith, S G

    1991-01-01

    The prognosis for tracheobronchial tumours remains poor. Most patients can be offered only palliation. When the main symptom is breathlessness or refractory haemoptysis from a large airway tumour endoscopic treatment may be very effective. Over the last decade most attention has focused on the neodymium YAG laser. This often produces dramatic effects but has some important limitations. In the last few years better techniques for stenting and intrabronchial radiotherapy (brachytherapy) have also been developed. This article discusses the range of techniques now available and aims to help clinicians decide which patients may benefit from referral to centres providing these techniques. Images PMID:1712516

  17. Philippines' downstream sector poised for growth

    SciTech Connect

    Not Available

    1992-05-11

    This paper reports that the Philippines' downstream sector is poised for sharp growth. Despite a slip in refined products demand in recent years, Philippines products demand will rebound sharply by 2000, East-West Center (EWC), Honolulu, predicts. Philippines planned refinery expansions are expected to meet that added demand, EWC Director Fereidun Fesharaki says. Like the rest of the Asia-Pacific region, product specifications are changing, but major refiners in the area expect to meet the changes without major case outlays. At the same time, Fesharaki says, push toward deregulation will further bolster the outlook for the Philippines downstream sector.

  18. Philippine campaign boosts child immunizations.

    PubMed

    Manuel-santana, R

    1993-03-01

    In 1989, USAID awarded the Philippines a 5-year, US $50 million Child Survival Program targeting improvement in immunization coverage of children, prenatal care coverage for pregnant women, and contraceptive prevalence. Upon successful completion of performance benchmarks at the end of each year, USAID released monies to fund child survival activities for the following year. This program accomplished a major program goal, which was decentralization of health planning. The Philippine Department of Health soon incorporated provincial health planning. The Philippine Department of Health soon incorporated provincial health planning in its determination of allocation of resources. Social marketing activities contributed greatly to success in achieving the goal of boosting the immunization coverage rate for the 6 antigens listed under the Expanded Program for Immunization (51%-85% of infants, 1986-1991). In fact, rural health officers in Tarlac Province in Central Luzon went from household to household to talk to mothers about the benefits of immunizing a 1-year-old child, thereby contributing greatly to their achieving a 95% full immunization coverage rate by December 1991. Social marketing techniques included modern marketing strategies and multimedia channels. They first proved successful in metro Manila which, at the beginning of the campaign, had the lowest immunization rate of all 14 regions. Every Wednesday was designated immunization day and was when rural health centers vaccinated the children. Social marketing also successfully publicized oral rehydration therapy (ORT), breast feeding, and tuberculosis control. Another contributing factor to program success in child survival activities was private sector involvement. For example, the Philippine Pediatric Society helped to promote ORT as the preferred treatment for acute diarrhea. Further, the commercial sector distributed packets of oral rehydration salts and even advertised its own ORT product. At the end of 2

  19. The Philippines geothermal success story

    NASA Astrophysics Data System (ADS)

    Birsic, R. J.

    1980-09-01

    Geothermal electrical plants currently in operation in the Philippines are presented. Following a brief review of the geographical and energy situation of the nation, attention is given to the first 55,000-kW unit of the Tiwi Geothermal Electric Plant, which commenced operation in January 1979, the portable 3,000-kE Leyte Geothermal Pilot Plant, which commenced operation in July, 1977 as the first geothermal power plant in the country, the Makiling-Banahaw (Mak-Ban) Geothermal Power Plant, the first 55,000-kW unit of which began operation in May, 1979 and the second 55,000-kW unit of the Tiwi plant, which came into service in June, 1979, thus making the Philippines the fourth largest producer of geothermal electricity in the world. Factors favoring the use of geothermal plants in developing nations are pointed out, including low capital costs, no foreign exchange costs for fuel, small units, and little environmental impact, and the start-up of two more plants, the second 55,000-kW unit at Mak-Ban in September 1979 and the third Tiwi unit in January 1980, are noted. It is predicted that in 1981, when the Philippines is expected to become the largest user of geothermal energy from hot-water fields, it will have a total capacity of 552 MW from the Mak-Ban, Tiwi and Leyte sites. Further areas with geothermal potential are also pointed out.

  20. Integrating Palliative Care into the Pediatric Intensive Care Unit A Report from the IPAL-ICU (Improving Palliative Care in the ICU) Advisory Board

    PubMed Central

    Boss, Renee; Nelson, Judith; Weissman, David; Campbell, Margaret; Curtis, Randall; Frontera, Jennifer; Gabriel, Michelle; Lustbader, Dana; Mosenthal, Anne; Mulkerin, Colleen; Puntillo, Kathleen; Ray, Daniel; Bassett, Rick; Brasel, Karen; Hays, Ross

    2014-01-01

    Objective This review highlights the benefits that patients, families and clinicians can expect to realize when palliative care service is intentionally incorporated into the PICU, focusing on pain and symptom management, enhancing quality of life, communication and decision-making, length of stay and sites of care, and grief and bereavement. Data Sources MEDLINE Data Synthesis and Conclusions The American Academy of Pediatrics suggests that palliative care should begin at the time of a potentially life-limiting diagnosis and continue throughout the disease trajectory, regardless of the expected outcome. Although the PICU is often used for short term postoperative stabilization, PICU clinicians also care for many chronically ill children with complex underlying conditions and others receiving intensive care for prolonged periods. Integrating palliative care delivery into the PICU is rapidly becoming the standard for high quality care of critically ill children. Interdisciplinary ICU staff can take advantage of the growing resources for continuing education in pediatric palliative care principles and interventions. PMID:25080152

  1. [Influence of music on the quality of life of palliative cancer patients].

    PubMed

    Polt, Günter; Fink, Margit; Schieder, Helga; Tanzmeister, Silke

    2014-05-01

    A small prospective, multicentre study examined the effect of a perceptual acoustic stimulus (music) on quality of life of palliative cancer patients with special reference to pain.14 test subjects (m = 4, w = 10; age 67.6 (SD = 9.7)) in stationary or mobile care situation were included. The current therapy has not been modified.Each subject received a CD with 12 songs, an information folder, a guide to using the CD as well as a questionnaire.The offered music therapy was experienced by all study participants (100 %) as helpful. The effect was seen differently in psychological, physical, spiritual, and social quality of life. The pain was reduced nociable in 11 out of 14 participants.From the experience of the autors we demand to offer and enable music therapy in palliative care to each patient, but also adapt to their individual needs. PMID:24723126

  2. Groin pain

    MedlinePlus

    Pain - groin; Lower abdominal pain; Genital pain; Perineal pain ... Common causes of groin pain include: Pulled muscle, tendon, or ligaments in the leg: This problem often occurs in people who play sports such as ...

  3. Multidisciplinary Team Contributions Within a Dedicated Outpatient Palliative Radiotherapy Clinic: A Prospective Descriptive Study

    SciTech Connect

    Pituskin, Edith; Fairchild, Alysa; Dutka, Jennifer; Gagnon, Lori; Driga, Amy; Tachynski, Patty; Borschneck, Jo-Ann; Ghosh, Sunita

    2010-10-01

    Purpose: Patients with bone metastases may experience pain, fatigue, and decreased mobility. Multiple medications for analgesia are often required, each with attendant side effects. Although palliative-intent radiotherapy (RT) is effective in decreasing pain, additional supportive care interventions may be overlooked. Our objective was to describe the feasibility of multidisciplinary assessment of patients with symptomatic bone metastases attending a dedicated outpatient palliative RT clinic. Methods and Materials: Consecutive patients referred for RT for painful bone metastases were screened for symptoms and needs relevant to their medications, nutritional intake, activities of daily living, and psychosocial and spiritual concerns from January 1 to December 31, 2007. Consultations by appropriate team members and resulting recommendations were collected prospectively. Patients who received RT were contacted by telephone 4 weeks later to assess symptom outcomes. Results: A total of 106 clinic visits by 82 individual patients occurred. As determined by screening form responses, the clinical Pharmacist, Occupational Therapist, Registered Dietician and Social Worker were consulted to provide assessments and recommendations within the time constraints presented by 1-day palliative RT delivery. In addition to pain relief, significant improvements in tiredness, depression, anxiety, drowsiness and overall well-being were reported at 4 weeks. Conclusions: Systematic screening of this population revealed previously unmet needs, addressed in the form of custom verbal and written recommendations. Multidisciplinary assessment is associated with a high number of recommendations and decreased symptom distress. Our findings lend strong support to the routine assessment by multiple supportive care professionals for patients with advanced cancer being considered for palliative RT.

  4. Symptom burden, palliative care need and predictors of physical and psychological discomfort in two UK hospitals

    PubMed Central

    2013-01-01

    Background The requirement to meet the palliative needs of acute hospital populations has grown in recent years. With increasing numbers of frail older people needing hospital care as a result of both malignant and non-malignant conditions, emphasis is being placed upon understanding the physical, psychological and social burdens experienced by patients. This study explores the extent of burden in two large UK hospitals, focusing upon those patients who meet palliative care criteria. Furthermore, the paper explores the use of palliative services and identifies the most significant clinical diagnostic and demographic factors which determine physical and psychological burden. Methods Two hospital surveys were undertaken to identify burden using the Sheffield Profile for Assessment and Referral to Care (SPARC). The Gold Standards Framework (GSF) is used to identify those patients meeting palliative care criteria. Participants were identified as being in-patients during a two-week data collection phase for each site. Data was gathered using face-to-face interviews or self-completion by patients or a proxy. Descriptive analyses highlight prevalence and use of palliative care provision. Binary logistic regression assesses clinical diagnostic predictor variables of physical and psychological burden. Results The sample consisted of 514 patients and elevated physical, psychological and social burden is identified amongst those meeting palliative care criteria (n = 185). Tiredness (34.6%), pain (31.1%), weakness (28.8%) and psychological discomfort (low mood 19.9%; anxiety 16.1%) are noted as being prevalent. A small number of these participants accessed Specialist Palliative Care (8.2%). Dementia was identified as a predictor of physical (OR 3.94; p < .05) and psychological burden (OR 2.88; p < .05), being female was a predictor of psychological burden (OR 2.00; p < .05). Conclusion The paper highlights elevated levels of burden experienced by patients with

  5. Palliation of symptoms in non-small cell lung cancer: a study by the Yorkshire Regional Cancer Organisation Thoracic Group.

    PubMed Central

    Muers, M F; Round, C E

    1993-01-01

    BACKGROUND--Although most treatment for non-small cell lung cancer is palliative, data on the adequacy of symptom control are scanty and there has been little discussion about the appropriate indices. METHODS--Two hundred and eighty nine unselected patients presenting sequentially to six specialists were studied; 242 cases were confirmed histologically and all were managed as non-small cell lung cancer. At presentation and two monthly for one year or until death each of 12 symptoms was graded by a physician at a clinic interview on a four point scale as absent, mild, moderate, or severe. For each symptom a palliative index (median duration of control/median duration of survival) was calculated, where control was defined as an improvement in symptoms of any severity by one grade or more. RESULTS--Sixty four (22%) patients had surgery, 15 (5%) radical and 107 (37%) palliative radiotherapy, and 103 (36%) best supportive care. Analysis showed that most symptoms inexorably worsened with time. The palliation index for haemoptysis was 86%, chest pain 73%, cough 34%, and breathlessness 30%; for systemic symptoms it was 54% for anorexia and 47% for malaise. Palliation was poor in many patients after surgery. Breathlessness was a particular problem in the group having best supportive care. CONCLUSIONS--The frequency of most symptoms in non-small cell lung cancer increases inexorably with time until malaise and anorexia are almost universal. Haemoptysis and chest pain are better palliated than cough and breathlessness. Present treatments fail to give adequate palliation for many patients, and the emphasis in future therapeutic studies should be on the relief of the more severe symptoms. PMID:7685550

  6. Undergraduate medical education in palliative medicine: the first step in promoting palliative care in Lebanon.

    PubMed

    Naccache, Nicole; Abou Zeid, Hicham; Nasser Ayoub, Eliane; Antakly, Marie-Claire

    2008-01-01

    Effective delivery of high-quality palliative care requires effective interprofessional team working by skilled healthcare professionals. Palliative care is therefore highly suitable for sowing the seeds of interprofessional team working in early professional undergraduate medical education. Integrating palliative medicine in undergraduate medical education curricula seems to be a must. In this review, we present as an example the Palliative and End-of-Life Care Curriculum (PEOLC) used in Canada for undergraduate medical education and underline the need for such a national curriculum in Lebanon. One must keep in mind that medical education does not stop at the end of the medical school, ongoing learning needs exist. Continuous medical education in palliative care should also be emphasized; the overall goal is promoting palliative medicine. Respecting and protecting human dignity is the right of every patient. PMID:19534074

  7. Palliative care provision for people with intellectual disabilities: interviews with specialist palliative care professionals in London.

    PubMed

    Tuffrey-Wijne, I; McEnhill, L; Curfs, L; Hollins, S

    2007-09-01

    Growing numbers of people with intellectual disabilities (ID) are in need of palliative care, but there is inequity of access to palliative care services for this group. This study investigates the issues and difficulties arising for palliative care staff in providing care for people with ID. Semi-structured interviews were conducted with 32 palliative care professionals in London. Factors affecting palliative care provision for people with ID included social issues (home situation and family issues), emotional and cognitive issues (fear, patient understanding, communication, cooperation and capacity to consent), problems with assessment, and the impact on staff and other patients. An underlying theme was the need to take more time and to build trust. Despite the challenges, many palliative care staff managed the care of people with ID well. The importance of collaboration with carers and ID services is highlighted. Further studies are needed to investigate how widespread the problems are. PMID:17846089

  8. Utilization of geothermal energy in the Philippines

    SciTech Connect

    Rivero, L.U.; De La Salle Univ, M.

    1981-01-01

    A history of the exploration of the geothermal resources as well as the construction of the geothermal power plants in the Philippines is given. The cost and the viability of such plants under Philippine conditions are presented. The necessity of a planned development around the geothermal plant, such as heat-consuming industries, is stressed. 15 refs.

  9. The Philippine "Hip Hop Stick Dance"

    ERIC Educational Resources Information Center

    Lewis, Lisa

    2012-01-01

    This article introduces a dance that blends the traditional cultural heritage of the Philippines with modern music and moves. "Hip Hop Stick Dance" incorporates Tinikling (the Philippine national dance) and Arnis (a Filipino style of martial arts) to create a contemporary combination of rhythm, dance, and fitness. It was designed to introduce…

  10. Drama-in-Schools in the Philippines

    ERIC Educational Resources Information Center

    Pañares, Alice A.; Cabangon, Maria Gloriosa S.

    2016-01-01

    Drama in the Philippines has been an integral part of the lives of Filipinos. Drama-in-schools came about with the establishment of the formal school system during the Spanish and American period of colonisation of the Philippines. With the establishment of the public schools system, the American teachers introduced drama in the schools, as part…

  11. Raising the Bar for the Care of Seriously Ill Patients: Results of a National Survey to Define Essential Palliative Care Competencies for Medical Students and Residents

    PubMed Central

    Schaefer, Kristen G.; Chittenden, Eva H.; Sullivan, Amy M.; Periyakoil, Vyjeyanth S.; Morrison, Laura J.; Carey, Elise C.; Sanchez-Reilly, Sandra; Block, Susan D.

    2014-01-01

    Purpose Given the shortage of palliative care specialists in the U.S., to ensure quality of care for patients with serious, life-threatening illness, generalist-level palliative care competencies need to be defined and taught. The purpose of this study was to define essential competencies for medical students and internal medicine and family medicine (IM/FM) residents through a national survey of palliative care experts. Method Proposed competencies were derived from existing Hospice and Palliative Medicine fellowship competencies, and revised to be developmentally appropriate for students and residents. In spring 2012, the authors administered a web-based, national cross-sectional survey of palliative care educational experts to assess ratings and rankings of proposed competencies and competency domains. Results The authors identified 18 comprehensive palliative care competencies for medical students and IM/FM residents, respectively. Over 95% of survey respondents judged the competencies as comprehensive and developmentally appropriate (survey response rate=72%, 71/98). Using predefined cut-off criteria, experts identified 7 medical student and 13 IM/FM resident competencies as essential. Communication and pain/symptom management were rated as the most critical domains. Conclusions This national survey of palliative care experts defines comprehensive and essential palliative care competencies for medical students and IM/FM residents that are specific, measurable, and can be used to report educational outcomes; provide a sequence for palliative care curricula in undergraduate and graduate medical education; and highlight the importance of educating medical trainees in communication and pain management. Next steps include seeking input and endorsement from stakeholders in the broader medical education community. PMID:24979171

  12. Health care interactional suffering in palliative care.

    PubMed

    Beng, Tan Seng; Guan, Ng Chong; Jane, Lim Ee; Chin, Loh Ee

    2014-05-01

    A secondary analysis of 2 qualitative studies was conducted to explore the experiences of suffering caused by interactions with health care providers in the hospital setting. Interview transcripts from 20 palliative care patients and 15 palliative care informal caregivers in University Malaya Medical Centre were thematically analyzed. The results of health care interactional suffering were associated with themes of attention, understanding, communication, competence, and limitation. These 5 themes may serve as a framework for the improvement in interaction skills of health care providers in palliative care. PMID:23689367

  13. Specialist Pediatric Palliative Care Prescribing Practices: A Large 5-year Retrospective Audit

    PubMed Central

    Damani, Anuja; Salins, Naveen; Ghoshal, Arunangshu; Muckaden, MaryAnn

    2016-01-01

    Introduction: There is a gradual increasing trend in childhood cancers in India and pediatric palliative care in India is an emerging specialty. Prescribing pain and symptom control drugs in children with cancer requires knowledge of palliative care formulary, dosing schedules, and prescription guidelines. This study is a retrospective audit of prescribing practices of a specialist palliative care service situated in a tertiary cancer center. Methods: A total of 1135 medication records of children receiving specialist pediatric palliative care services were audited for 5 years (2010–2014) to evaluate prescribing practices in children with advanced cancer. Results: A total of 51 types of drugs were prescribed with an average of 4.2 drugs per prescription. 66.9% of the prescriptions had paracetamol, and 33.9% of the prescriptions had morphine. Most common nonsteroidal anti-inflammatory drugs prescribed was ibuprofen (23.9%), and more than 50% of the prescriptions had aperients. The most commonly prescribed aperient was a combination of liquid paraffin and sodium-picosulfate. Dexamethasone was prescribed in 51.9% of patients and in most cases this was part of oral chemotherapy regimen. Generic names in prescription were used only in 33% of cases, and adverse effects of the drugs were documented in only 9% of cases. In 25% of cases, noncompliance to the WHO prescription guidelines was seen, and patient compliance to prescription was seen in 40% of cases. Conclusions: Audit of the prescribing practices in specialist pediatric palliative care service shows that knowledge of pediatric palliative care formulary, rational drug use, dosing, and prescribing guidelines is essential for symptom control in children with advanced life-limiting illness. Noncompliance to WHO prescribing guidelines in one fourth of cases and using nongeneric names in two-thirds of prescription indicates poor prescribing practices and warrants prescriber education. Prescription noncompliance by

  14. End of Life Care Policy for the Dying: Consensus Position Statement of Indian Association of Palliative Care

    PubMed Central

    Macaden, Stanley C; Salins, Naveen; Muckaden, Maryann; Kulkarni, Priyadarshini; Joad, Anjum; Nirabhawane, Vivek; Simha, Srinagesh

    2014-01-01

    EXECUTIVE SUMMARY Purpose: To develop an End of Life Care (EOLC) Policy for patients who are dying with an advanced life limiting illness. To improve the quality of care of the dying by limiting unnecessary therapeutic medical interventions, providing access to trained palliative care providers, ensuring availability of essential medications for pain and symptom control and improving awareness of EOLC issues through education initiatives. Evidence: A review of Country reports, observational studies and key surveys demonstrates that EOLC in India is delivered ineffectively, with a majority of the Indian population dying with no access to palliative care at end of life and essential medications for pain and symptom control. Limited awareness of EOLC among public and health care providers, lack of EOLC education, absent EOLC policy and ambiguous legal standpoint are some of the major barriers in effective EOLC delivery. Recommendations: Access to receive good palliative and EOLC is a human right. All patients are entitled to a dignified death. Government of India (GOI) to take urgent steps towards a legislation supporting good EOLC, and all hospitals and health care institutions to have a working EOLC policyProviding a comprehensive care process that minimizes physical and non physical symptoms in the end of life phase and ensuring access to essential medications for pain and symptom controlPalliative care and EOLC to be part of all hospital and community/home based programsStandards of palliative and EOLC as established by appropriate authorities and Indian Association of Palliative Care (IAPC) met and standards accredited and monitored by national and international accreditation bodiesAll health care providers with direct patient contact are urged to undergo EOLC certification, and EOLC training should be incorporated into the curriculum of health care education. PMID:25191002

  15. The role of palliative radiation therapy in symptomatic locally advanced gastric cancer

    SciTech Connect

    Tey, Jeremy . E-mail: Jeremy_Tey@mail.nhg.com.sg; Back, Michael F.; Shakespeare, Thomas P.; Mukherjee, Rahul K.; Lu, Jiade J.; Lee, Khai Mun; Wong, Lea Choung; Leong, Cheng Nang; Zhu Ming

    2007-02-01

    Purpose: To review the outcome of palliative radiotherapy (RT) alone in patients with symptomatic locally advanced or recurrent gastric cancer. Methods and Materials: Patients with symptomatic locally advanced or recurrent gastric cancer who were managed palliatively with RT at Cancer Institute, Singapore were retrospectively reviewed. Study end points included symptom response, median survival, and treatment toxicity (retrospectively scored using the Common Toxicity Criteria v3.0 [CTC]). Results: Between November 1999 and December 2004, 33 patients with locally advanced or recurrent gastric cancer were managed with palliative intent using RT alone. Median age was 76 years (range, 38-90 years). Twenty-one (64%) patients had known distant metastatic disease at time of treatment. Key index symptoms were bleeding (24 patients), obstruction (8 patients), and pain (8 patients). The majority of patients received 30 Gy/10 fractions (17 patients). Dose fractionation regimen ranged from an 8-Gy single fraction to 40 Gy in 16 fractions. Median survival was 145 days, actuarial 12-month survival 8%. A total of 54.3% of patients (13/24) with bleeding responded (median duration of response of 140 days), 25% of patients (2/8) with obstruction responded (median duration of response of 102 days), and 25% of patients (2/8) with pain responded (median duration of response of 105 days). No obvious dose-response was evident. One Grade 3 CTC equivalent toxicity was recorded. Conclusion: External beam RT alone is an effective and well tolerated modality in the local palliation of gastric cancer, with palliation lasting the majority of patients' lives.

  16. Palliative Treatment of Malignant Colorectal Strictures with Metallic Stents

    SciTech Connect

    Paul Diaz, Laura; Pinto Pabon, Isabel; Fernandez Lobato, Rosa; Montes Lopez, Carmen

    1999-01-15

    Purpose: To assess the effectiveness and safety of self-expanding metallic stents as a primary palliative treatment for inoperable malignant colorectal strictures. Methods: Under radiological guidance 20 self-expanding metallic Wallstents were implanted in 16 consecutive patients with colorectal stenoses caused by malignant neoplasms, when surgical treatment of the condition had been ruled out. The patients were followed up clinically for 1-44 months, until death or termination of this study. Results: The stents were successfully implanted in all cases and resolved the clinical obstruction in all the patients except one, who underwent subsequent colostomy. During follow-up of the remaining 15 patients, clinical complications arising from the procedure were pain (two patients), minor rectal bleeding (one patient), and severe rectal bleeding (one patient) (26%). There were three cases of stent migration and three cases of stent occlusion, and reintervention by us was necessary in 20% of cases (3/15). The mean life span following the procedure was 130 days, and none of the patients exhibited clinical symptoms of obstruction at the time of death (12 patients) or termination of the study (3 patients). Conclusion: Deployment of metallic stents under radiologic guidance is an effective alternative as a primary palliative measure in malignant colorectal obstruction, though the possible clinical complications and need for repeat intervention during follow-up should be taken into account.

  17. The Relationship of Cancer Symptom Clusters to Depressive Affect in the Initial Phase of Palliative Radiation

    PubMed Central

    Francoeur, Richard Benoit

    2007-01-01

    Research on comorbidity across cancer symptoms, including pain, fatigue, and depression, could suggest if crossover effects from symptom-specific interventions are plausible. Secondary analyses were conducted on a survey of 268 cancer patients with recurrent disease from a northeastern U.S. city who were initiating palliative radiation for bone pain. Moderator regression analyses predicted variation in depressive affect that could be attributed to symptom clusters. Patients self-reported difficulty controlling each physical symptom over the past month on a Likert scale and depressive symptoms on a validated depression measure (Center for Epidemiologic Studies-Depression [CES-D]) over the past week on a four-category scale. An index of depressive affect was based on items of negative and positive affect from the CES-D. In predicting depressive affect, synergistic interactions of pain with fever, fatigue, and weight loss suggest separate pathways involving pain. A similar interaction with fever occurs when nausea was tested in place of pain. Further, the interaction between pain and fatigue is similar in form to the interaction between difficulty breathing and fatigue (when sleep is not a problem). Follow-up to the latter interaction reveals: 1) additional moderation by hypertension and palliative radiation to the hip/pelvis; and 2) a similar cluster not involving hypertension when appetite problems and weight loss were tested in place of fatigue. The significance and form of these interactions are remarkably consistent. Similar sickness mechanisms could be generating: 1) pain and nausea during fever; 2) pain and fatigue during weight loss; and 3) pain and breathing difficulty when fatigue is pronounced. Crossover effects from symptom-specific interventions appear promising. PMID:15733806

  18. The Island Hospice model of palliative care

    PubMed Central

    Khumalo, Thembelihle; Maasdorp, Valerie

    2016-01-01

    There has been a substantial increase in cancer detections in Africa over years, and it has also been noted that higher number of individuals are affected by the later stages of cancer that lead to death. When it comes to cancer care, Zimbabwe is no exception with its ongoing palliative care related research, though still in its infancy. The need for advanced and more accessible palliative care to assist the vulnerable has been intensified by this increase in cancer prevalence. Island Hospice, which is a centre of excellence in palliative care has varying elements of the models that it employs to engage those most in need of palliative assistance, especially children and financially-challenged individuals. PMID:27563349

  19. American Academy of Hospice and Palliative Medicine

    MedlinePlus

    ... Getting Involved Communities Advanced Lung Disease Forum Psychiatry, Psychology, Mental Health Forum Social Work Forum SIG Instructions ... HPM Lecture Series Research Scholars Mentoring Scholarship About History Position Statements Access to Palliative Care and Hospice ...

  20. National Hospice and Palliative Care Organization

    MedlinePlus

    ... Strategic Planning for Hospice Hospice Policy and Advocacy Healthcare Reform and Innovation Inspirational Address Booking Policies Contact NHPCO ... Webinar Registration MP4 Recordings Pay for CE/CME Online Learning E-OL Courses Interdisciplinary Team Palliative Care ...

  1. The Island Hospice model of palliative care.

    PubMed

    Khumalo, Thembelihle; Maasdorp, Valerie

    2016-01-01

    There has been a substantial increase in cancer detections in Africa over years, and it has also been noted that higher number of individuals are affected by the later stages of cancer that lead to death. When it comes to cancer care, Zimbabwe is no exception with its ongoing palliative care related research, though still in its infancy. The need for advanced and more accessible palliative care to assist the vulnerable has been intensified by this increase in cancer prevalence. Island Hospice, which is a centre of excellence in palliative care has varying elements of the models that it employs to engage those most in need of palliative assistance, especially children and financially-challenged individuals. PMID:27563349

  2. Training Advanced Practice Palliative Care Nurses.

    ERIC Educational Resources Information Center

    Sherman, Deborah Witt

    1999-01-01

    Describes the role and responsibilities of advanced-practice nurses in palliative care and nursing's initiative in promoting high-quality care through the educational preparation of these nurses. (JOW)

  3. Parents' perceptions of a pediatric palliative program.

    PubMed

    Sheetz, M Joan; Bowman, Mary-Ann Sontag

    2013-05-01

    Reports of family satisfaction with pediatric palliative care have been limited. This knowledge is critical for both program development and furthering understanding of needs. The purpose of this study was to assess parents' perceptions about whether a pediatric palliative care program was providing key elements of pediatric palliative care as described in the literature and to assess parental satisfaction with services. Data were collected from 65 parents, using a tool developed for the project, whose children died while receiving services from Rainbow Kids Palliative Care, a program of Primary Children's Medical Center, and the Department of Pediatrics, University of Utah, Salt Lake City, Utah. Respondents reported that the Rainbow Kids team had provided emotional support, helped with decision making and communication, and that their children's symptoms were managed. Furthermore, parent respondents expressed high levels of satisfaction with services from the Rainbow Kids team. PMID:22696532

  4. The Philippines: a public awakening.

    PubMed

    de Castro, L D

    1990-01-01

    This is the last of a set of three articles concerning "bioethics on the Pacific Rim." In his discussion of bioethical issues in the Philippines, de Castro focuses primarily on: (a) the impact of Roman Catholicism on the public debate over topics such as abortion, contraception, and population policy, and (b) the issue of justice in the allocation of the country's inadequate health resources. He notes progress on two fronts: recently enacted legislation regulating physician prescribing practices will improve access by the poor to prescription drugs, and national guidelines on biomedical research provide for the establishment of a National Ethics Committee dominated by nonphysicians. PMID:2318625

  5. Lahars of Mount Pinatubo, Philippines

    USGS Publications Warehouse

    Newhall, Christopher G.; Stauffer, Peter H.; Hendley, James W., II

    1997-01-01

    On June 15, 1991, Mount Pinatubo in the Philippines exploded in the second largest volcanic eruption on Earth this century. This eruption deposited more than 1 cubic mile (5 cubic kilometers) of volcanic ash and rock fragments on the volcano's slopes. Within hours, heavy rains began to wash this material down into the surrounding lowlands in giant, fast-moving mudflows called lahars. In the next four rainy seasons, lahars carried about half of the deposits off the volcano, causing even more destruction in the lowlands than the eruption itself.

  6. Home Inotropes and Other Palliative Care.

    PubMed

    Ginwalla, Mahazarin

    2016-07-01

    Heart failure is a leading case of morbidity and mortality worldwide, and patients with advanced heart failure have limited options without any available cure. These options mainly include cardiac transplantation or mechanical circulatory support device implantation. Chronic home inotropes are an option in these patients for a variety of indications. This report discusses the use of chronic home inotropes in palliated heart failure patients and reviews the role of palliative care management in end-stage heart failure. PMID:27371519

  7. Medical use of marijuana in palliative care.

    PubMed

    Johannigman, Suzanne; Eschiti, Valerie

    2013-08-01

    Marijuana has been documented to provide relief to patients in palliative care. However, healthcare providers should use caution when discussing medical marijuana use with patients. This article features a case study that reveals the complexity of medical marijuana use. For oncology nurses to offer high-quality care, examining the pros and cons of medical marijuana use in the palliative care setting is important. PMID:23899972

  8. Outpatient palliative care effectiveness: both patients and caregivers can gain.

    PubMed

    Antoniu, Sabina

    2013-10-01

    Outpatient palliative care services are increasing in their effectiveness worldwide, because they can better focus on both patients' and caregivers' needs at all stages of the disease requiring this type of interventions. This was demonstrated before by various studies that,however, were performed mostly on patients with malignancies and thatyielded encouraging results about the severity of the symptoms and about the burden of care in the caregivers. In this analysis performed on a mixture of patients with malignant and nonmalignant diseases, Groh et al. demonstrate that the outpatient team intervention was able to reduce the severity of symptoms such as pain or digestive symptoms and were able to minimize the burden of care of the primary caregivers. PMID:24138644

  9. [Ethics and palliative care in patients with advanced cancer].

    PubMed

    Tenorio-González, Francisco

    2005-01-01

    Recent research in both the biology of cancer and the treatment of patients has increased the life expectancy of cancer patients with recurrence and who have a longer survival rate. Cancer is no longer considered a lethal but a chronic disease. More patients survive, but above all there are more patients with recurrences thus increasing the need for physical or psychological treatment of patients with longer lives. The American Cancer Society reported in 1992 that in the U.S. more than 8 million people survived between 4 and 5 years. This produces both an ethical and medical challenge for treatment of cancer patients. This paper reviews the actual criteria for palliative care: treatment for pain and the ethical and psychological treatment of advanced cancer patients and their families. PMID:16454965

  10. Consensus statement on palliative lung radiotherapy: third international consensus workshop on palliative radiotherapy and symptom control.

    PubMed

    Rodrigues, George; Macbeth, Fergus; Burmeister, Bryan; Kelly, Karie-Lynn; Bezjak, Andrea; Langer, Corey; Hahn, Carol; Movsas, Benjamin

    2012-01-01

    The purpose of this work is to disseminate a consensus statement on palliative radiotherapy (RT) of lung cancer created in conjunction with the Third International Lung Cancer Consensus Workshop. The palliative lung RT workshop committee agreed on 5 questions relating to (1) patient selection, (2) thoracic external-beam radiation therapy (XRT) fractionation, (3) endobronchial brachytherapy (EBB), (4) concurrent chemotherapy (CC), and (5) palliative endpoint definitions. A PubMed search for primary/cross-referenced practice guidelines, consensus statements, meta-analyses, and/or systematic reviews was conducted. Final consensus statements were created after review and discussion of the available evidence. The following summary statements reflect the consensus of the international working group. 1. Key factors involved in the decision to deliver palliative RT include performance status, tumor stage, pulmonary function, XRT volume, symptomatology, weight loss, and patient preference. 2. Palliative thoracic XRT is generally indicated for patients with stage IV disease with current/impending symptoms and for patients with stage III disease treated for palliative intent. 3. There is no evidence to routinely recommend EBB alone or in conjunction with other palliative maneuvers in the initial palliative management of endobronchial obstruction resulting from lung cancer. 4. There is currently no evidence to routinely recommend CC with palliative-intent RT. 5. Standard assessment of symptoms and health-related quality of life (QOL) using validated questionnaires should be carried out in palliative RT lung cancer trials. Despite an expanding literature, continued prospective randomized investigations to better define the role of XRT, EBB, and CC in the context of thoracic palliation of patients with lung cancer is needed. PMID:21729656

  11. [The perspectives on palliative nursing education].

    PubMed

    Hu, Wen-Yu; Yeh, Mei Chang

    2015-04-01

    The numbers of people who suffer from age-related and chronic diseases have been increased worldwide. This has lead to an increased emphasis in the medical community on end of life care. This paper references the processes followed overseas in developing palliative care education programs as well as the domestic experiences promoting the hospitalization, home care, and "share care" models of palliative care. Particular emphasis is given to considerations of cultural diversity in palliative care. The aim of this paper is to elaborate on the prevalent clinical end-of-life care issues that are faced in Taiwan, to cultivate core capabilities in end-of-life care, to elicit the current status and development of formal nursing education, and to promote continuing education in palliative care. Kern formulated a six-step approach to curriculum development in education and the details has been discussed . Finally, this paper reflects on the current bottlenecks, challenges, and expectations related to palliative care curriculum development in order to help medical professionals further put humanistic and social care into practice, increase ethical reflection in end of life care and nursing competency, and encourage the creation of localized textbooks / multimedia e-teaching materials. The fostering of "patient-centered, family unit and the social-cultural contexture" for palliative care professionals and the ability to respond to the needs of terminal patients and patients with chronic diseases are critical to increasing the quality of Taiwan healthcare. PMID:25854945

  12. Palliative care reimagined: a needed shift.

    PubMed

    Abel, Julian; Kellehear, Allan

    2016-03-01

    Palliative care, since its inception over 60 years ago, has set the standard of how to care for people who are dying. Key features among these standards have been the professional development of clinical specialisms such as palliative medicine and palliative nursing; the essential addition of the multidisciplinary team to these two new specialisms that included social, spiritual and allied health workers-an outgrowth of the recognition that routine work with the dying, their carers, and the bereaved required more than solely clinical skills; and the unique partnership with communities that yielded the volunteer movement within palliative care. Professional, evidence-based symptom management and the importance of supportive care in its widest possible sense were and remain the cornerstones of the modern palliative care approach. However, the majority of people with terminal illnesses do not have access to palliative care teams, whose main focus of care remains patients with cancer. In the context outlined above this paper therefore poses two key questions: how can we provide an equitable level of care for all people irrespective of diagnosis and how can we increase the range and quality of non-medical/nursing supportive care in a context of diminishing resources? We argue that an important opportunity and solution can be found by adopting the principles of a public health approach to end-of-life care. PMID:26832803

  13. Ethical issues in palliative care.

    PubMed

    Randall, F M

    1999-10-01

    The relief of suffering is one of the aims of health care. Pain relief is a moral obligation in health care, not an optional extra. Doctors have moral obligations to strive to relieve pain, to be competent in basic pain control, and to endeavour to give patients an adequate understanding of their illness and painkillers. The most common moral problem in pain control in terminally ill patients is the conflict between the obligation to relieve suffering and the obligation to prolong life. The law prohibits intentionally causing the death of another person. Debates follow as to what constitutes an intention to cause death, and what actually constitutes a cause of death. At present, doctors are legally permitted to give sedatives and analgesics to terminally ill patients with the intention of relieving suffering, even if life is shortened. The moral principle of the 'double effect' relates to this and is explained. It relies on a distinction between intended and foreseen effects of treatment. Some people dispute the distinction between intended and foreseen effects and claim that the principle of double effect allows doctors who intend euthanasia to carry it out under cover of the law. This debate is explored in the article. Finally, is it ever morally justifiable to end the patient's life on the grounds that this is the only way to end pain? Even if it is, should euthanasia be legalised? A brief comment on these issues, and the roles of law and morality, are made. PMID:10522743

  14. Chinese Herbal Medicine for Symptom Management in Cancer Palliative Care

    PubMed Central

    Chung, Vincent C.H.; Wu, Xinyin; Lu, Ping; Hui, Edwin P.; Zhang, Yan; Zhang, Anthony L.; Lau, Alexander Y.L.; Zhao, Junkai; Fan, Min; Ziea, Eric T.C.; Ng, Bacon F.L.; Wong, Samuel Y.S.; Wu, Justin C.Y.

    2016-01-01

    Abstract Use of Chinese herbal medicines (CHM) in symptom management for cancer palliative care is very common in Chinese populations but clinical evidence on their effectiveness is yet to be synthesized. To conduct a systematic review with meta-analysis to summarize results from CHM randomized controlled trials (RCTs) focusing on symptoms that are undertreated in conventional cancer palliative care. Five international and 3 Chinese databases were searched. RCTs evaluating CHM, either in combination with conventional treatments or used alone, in managing cancer-related symptoms were considered eligible. Effectiveness was quantified by using weighted mean difference (WMD) using random effect model meta-analysis. Fourteen RCTs were included. Compared with conventional intervention alone, meta-analysis showed that combined CHM and conventional treatment significantly reduced pain (3 studies, pooled WMD: −0.90, 95% CI: −1.69 to −0.11). Six trials comparing CHM with conventional medications demonstrated similar effect in reducing constipation. One RCT showed significant positive effect of CHM plus chemotherapy for managing fatigue, but not in the remaining 3 RCTs. The additional use of CHM to chemotherapy does not improve anorexia when compared to chemotherapy alone, but the result was concluded from 2 small trials only. Adverse events were infrequent and mild. CHM may be considered as an add-on to conventional care in the management of pain in cancer patients. CHM could also be considered as an alternative to conventional care for reducing constipation. Evidence on the use of CHM for treating anorexia and fatigue in cancer patients is uncertain, warranting further research. PMID:26886628

  15. Pain management and health care policy.

    PubMed

    Naccache, Nicole; Abou Zeid, Hicham; Nasser Ayoub, Eliane; Antakly, Marie-Claire

    2008-01-01

    Opioid analgesics are essential for the management of moderate to severe pain. In spite of their documented effectiveness, opioids are often underutilized, a factor which has contributed significantly to the undertreatment of pain. Many countries have developed true national policies on cancer pain and palliative care, and in others only guidelines for care have been developed. Ideally, national policies facilitate and legislate not only a patient's right to care, but also the necessary components of education and drug availability which are so critical for the appropriate achievement of public health programs. PMID:19534079

  16. Occupational health in the Philippines.

    PubMed

    Torres, Elma B; Greaves, Ian A; Gapas, Joselito L; Ong, Teresita T

    2002-01-01

    The practice of occupational health and safety (OHS) in the Philippines is shaped by both success and failures. Government initiatives have achieved specific goals, particularly in providing better access by local industries to technical services and manpower development. However, the ability to sustain these achievements has been constrained by lack of adequate resources, both financial and human. Large-scale industrial establishments have better success in the implementation of OHS programs in their organizations. Small- and medium-scale enterprises suffer from limited resources to invest in measures for the health and safety of workers. Similarly, the government has little influence on the health and safety conditions migrant workers experience in another nation. The informal sector is the most deprived in terms of access to OHS measures. The deprivation may be alleviated by economic solutions, as their existence is a result of economic situations. Occupational health development in the Philippines is progressing and will be strengthened by better regulation, by increasing awareness among all sector workers of the importance of OHS, and by adequately building up the capacity of government and vital human resources. PMID:12028954

  17. Advances in diagnosis, treatment and palliation of cholangiocarcinoma: 1990-2009

    PubMed Central

    Aljiffry, Murad; Walsh, Mark J; Molinari, Michele

    2009-01-01

    Several advances in diagnosis, treatment and palliation of cholangiocarcinoma (CC) have occurred in the last decades. A multidisciplinary approach to this disease is therefore recommended. CC is a relatively rare tumor and the main risk factors are: chronic inflammation, genetic predisposition and congenital abnormalities of the biliary tree. While the incidence of intra-hepatic CC is increasing, the incidence of extra-hepatic CC is trending down. The only curative treatment for CC is surgical resection with negative margins. Liver transplantation has been proposed only for selected patients with hilar CC that cannot be resected who have no metastatic disease after a period of neoadjuvant chemo-radiation therapy. Magnetic resonance imaging/magnetic resonance cholangiopancreatography, positron emission tomography scan, endoscopic ultrasound and computed tomography scans are the most frequently used modalities for diagnosis and tumor staging. Adjuvant therapy, palliative chemotherapy and radiotherapy have been relatively ineffective for inoperable CC. For most of these patients biliary stenting provides effective palliation. Photodynamic therapy is an emerging palliative treatment that seems to provide pain relief, improve biliary patency and increase survival. The clinical utility of other emerging therapies such as transarterial chemoembolization, hepatic arterial chemoinfusion and high intensity intraductal ultrasound needs further study. PMID:19750567

  18. The PERS(2) ON score for systemic assessment of symptomatology in palliative care: a pilot study.

    PubMed

    Masel, E K; Berghoff, A S; Schur, S; Maehr, B; Schrank, B; Simanek, R; Preusser, M; Marosi, C; Watzke, H H

    2016-07-01

    The comprehensive assessment of symptoms is the basis for effective, individualised palliative treatment. Established scoring systems provide in-depth information but are often lengthy and hence unsuitable. We introduce the PERS(2) ON score as a short and practically feasible score to evaluate symptom burden. Fifty patients admitted to a Palliative Care Unit rated seven items, i.e. pain, eating (loss of appetite/weight loss), rehabilitation (physical impairment), social situation (possibility for home care), suffering (anxiety/burden of disease/depression), O2 (dyspnoea) and nausea/emesis, on a scale ranging from 0 (absence) to 10 (worst imaginable), resulting in a score ranging from 0 to 70. Assessments were performed at admission, 7 days after admission and at the day of discharge. Symptom intensity scores were calculated, and change over time was evaluated. A significant improvement was observed from the PERS²ON score between admission and 7 days (P < 0.001; paired t-test). Significant improvement from baseline evaluation to evaluation on the day of discharge was observed (P = 0.001; paired t-test). This study provides initial evidence that the PERS²ON score is both feasible and sensitive to changes of the most prominent symptoms in palliative care. It may be useful in clinical practice to direct palliative treatment strategies and provide targeted symptom management. PMID:26564404

  19. Failing the failing heart: a review of palliative care in heart failure.

    PubMed

    Shah, Ankit B; Morrissey, Ryan P; Baraghoush, Afshan; Bharadwaj, Parag; Phan, Anita; Hamilton, Michele; Kobashigawa, Jon; Schwarz, Ernst R

    2013-01-01

    Heart failure (HF) is the most common reason for hospital admission for patients older than 65 years. With an aging population and improving survival in heart failure patients, the number of people living with HF continues to grow. As this population increases, the importance of treating symptoms of fatigue, dyspnea, pain, and depression that diminish the quality of life in HF patients becomes increasingly important. Palliative care has been shown to help alleviate these symptoms and improve patients' satisfaction with the care they receive. Despite this growing body of evidence, palliative care consultation remains underutilized and is not standard practice in the management of HF. With an emphasis on communication, symptom management, and coordinated care, palliative care provides an integrated approach to support patients and families with chronic illnesses. Early communication with patients and families regarding the unpredictable nature of HF and the increased risk of sudden cardiac death enables discussions around advanced care directives, health care proxies, and deactivation of permanent pacemakers or implantable cardioverter defibrillators. Cardiologists and primary care physicians who are comfortable initiating these discussions are encouraged to do so; however, many fear destroying hope and are uncertain how to discuss end-of-life issues. Thus, in order to facilitate these discussions and establish an appropriate relationship, we recommend that patients and families be introduced to a palliative care team at the earliest appropriate time after diagnosis. PMID:23651985

  20. Palliative radiotherapy for advanced malignancies in a changing oncologic landscape: guiding principles and practice implementation.

    PubMed

    Jones, Joshua A; Simone, Charles B

    2014-07-01

    Radiotherapy can provide safe, cost-effective, efficient palliation of various symptoms of advanced cancer with minimal side effects. Radiotherapy can palliate pain related to bone metastases and growing visceral metastases or primary cancers, neurologic symptoms related to brain and spine metastases, other symptoms including cough and dyspnea from advanced cancers in the lung, bleeding from various internal and external tumors, and obstructive symptoms. Palliative radiotherapy should be offered in the context of a multidisciplinary oncology team including medical oncologists, palliative care clinicians and various surgical and interventional subspecialists. The prescription of radiotherapy should balance the convenience and fewer side effects associated with short, hypofractionated courses of radiotherapy with the potential greater durability associated with longer courses of radiotherapy in patients with more prolonged life expectancies. The judicious use of advanced techniques in radiotherapy, including intensity-modulated radiotherapy and stereotactic radiotherapy (SRT), may be warranted in select patients, and they can potentially improve symptom control and durability but are associated with increased technical and economic costs. PMID:25841695

  1. Palliative cancer care in Middle Eastern countries: accomplishments and challenges †

    PubMed Central

    Silbermann, M.; Arnaout, M.; Daher, M.; Nestoros, S.; Pitsillides, B.; Charalambous, H.; Gultekin, M.; Fahmi, R.; Mostafa, K.A.H.; Khleif, A.D.; Manasrah, N.; Oberman, A.

    2012-01-01

    Background In larger parts of the Middle East palliative care is still misunderstood among health professionals, cancer patients and the public at large. One reason to that is because the term does not obviously communicate the intent of this clinical discipline, which is lending better quality of life while combating cancer. Further, culture, tradition and religion have contributed to this misgiving and confusion especially at the terminal stage of the disease. Methods The Middle East Cancer Consortium jointly with the American Society of Clinical Oncology, the American Oncology Nursing Society, the San Diego Hospice Center for Palliative Medicine and the Children's Hospital & Clinics of Minnesota initiated a series of training courses and workshops in the Middle East to provide updated training to physicians, nurses, social workers and psychologists from throughout the region with basic concepts of palliative care and pain managements in adults and children cancers. Results During the past 6 years hundreds of professionals took part in these educational and training activities, thereby creating the core of trained caregivers who start to make the change in their individual countries. Conclusions The outcome of consecutive training activities can overcome geopolitical instabilities, and yield a genuine change in approach of both regulators, medical administrators, medical staff and the public; as to the important contribution of palliative care services to the welfare of the patient and his/her family. PMID:22628412

  2. Quality Measures for Palliative Care in Patients With Cancer: A Systematic Review

    PubMed Central

    Kamal, Arif H.; Gradison, Margaret; Maguire, Jennifer M.; Taylor, Donald; Abernethy, Amy P.

    2014-01-01

    Purpose: Quality assessment is a critical component of determining the value of medical services, including palliative care. Characterization of the current portfolio of measures that assess the quality of palliative care delivered in oncology is necessary to identify gaps and inform future measure development. Methods: We performed a systematic review of MEDLINE/PubMed and the gray literature for quality measures relevant to palliative care. Measures were categorized into National Quality Forum domains and reviewed for methodology of development and content. Measures were additionally analyzed to draw summative conclusions on scope and span. Results: Two hundred eighty-four quality measures within 13 measure sets were identified. The most common domains for measure content were Physical Aspects of Care (35%) and Structure and Processes of Care (22%). Of symptom-related measures, pain (36%) and dyspnea (26%) were the most commonly addressed. Spiritual (4%) and Cultural (1%) Aspects of Care were least represented domains. Generally, measures addressed processes of care, did not delineate benchmarks for success, and often did not specify intended interventions to address unmet needs. This was most evident regarding issues of psychosocial and spiritual assessment and management. Conclusion: Within a large cohort of quality measures for palliative, care is often a focus on physical manifestations of disease and adverse effects of therapy; relatively little attention is given to the other aspects of suffering commonly observed among patients with advanced cancer, including psychological, social, and spiritual distress. PMID:24917264

  3. 78 FR 53152 - Submission for OMB Review; Comment Request: Palliative Care: Conversations Matter Evaluation

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-28

    ... HUMAN SERVICES National Institutes of Health Submission for OMB Review; Comment Request: Palliative Care... requested in writing. Proposed Collection: Palliative Care: Conversations Matter Evaluation, -0925-New... Information Collection: NINR developed Palliative Care: Conversations Matter, a pediatric palliative...

  4. 78 FR 35942 - Proposed Collection; Comment Request: Palliative Care: Conversations Matter Evaluation

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-14

    ... HUMAN SERVICES National Institutes of Health Proposed Collection; Comment Request: Palliative Care.... Proposed Collection Palliative Care: Conversations Matter Evaluation -0925--New--National Institute of... developed Palliative Care: Conversations Matter, a pediatric palliative care campaign to address...

  5. Philippines (country/area statements).

    PubMed

    1985-09-01

    According to this statement presented to the Committee on Population of the UN Economic and Social Commission for Asia and the Pacific, the 1980 Philippine census enumerated 48.1 million persons, a more than 6-fold increase over the 7.6 million of 1903. The 1913-39 average intercensal growth rate of 2.22% declined during World War II but soared to 3.06% from 1948-60. The growth rate was 2.71% between 1975-80. The median age was 20.2 in 1903, 16.9 in 1970 and 18.6 in 1980. The crude birth rate declined from 46.0/1000 in 1960 to 34.8 in 1975, while the crude death rate declined from 13.7/1000 in 1960 to 9.3 in 1975. The average age of Filipino women at marriage increased from 23.2 in 1975 to 24 in 1978, causing a decline of the total fertility rate from 5.89 to 4.70. The infant mortality rate was expected to decline from 59.3 in 1983 to 54.2 in 1987. The Philippines was still 63% rural in 1980 despite the concentration of urban growth in Manila. As of 1983, the Philippine Overseas Employment Administration had processed 434,207 employment contracts, of which 65.5% were for production process workers, transport equipment operators, and laborers, 15.3% were for service workers, and 13.9% were for professional and technical workers. The Philippine Family Planning program aims to reduce population growth from an estimated 2.54% in 1983 to 1.92% by 1993 and to achieve replacement level fertility by 2010. As a result of the 1978 review of the Philippine Population Programme, the focus is now on longterm planning to ensure more significant and perceptible demographic impact of development programs and policies. The Population Education Program aims to inculcate values supporting family planning in the areas of family size and welfare, responsible parenthood, and delayed marriage, while the Adolescent Fertility Program seeks to reduce the incidence of early marriage and pregnancy. 3496 clinics, hospitals, and sterilization centers provide family planning and related services

  6. Enhancing Palliative Care Education in Medical School Curricula: Implementation of the Palliative Education Assessment Tool.

    ERIC Educational Resources Information Center

    Wood, Emily B.; Meekin, Sharon Abele; Fins, Joseph J.; Fleischman, Alan R.

    2002-01-01

    Evaluated a project to catalyze New York State medical schools to develop and implement strategic plans for curricular change to enhance palliative care education. Found that the project's process of self-assessment and curriculum mapping with the Palliative Education Assessment Tool, along with strategic planning for change, appears to have…

  7. Palliative Care in Advanced Lung Disease: The Challenge of Integrating Palliation Into Everyday Care.

    PubMed

    Rocker, Graeme M; Simpson, A Catherine; Horton, Robert

    2015-09-01

    The tendency toward "either/or" thinking (either cure or comfort) in traditional biomedical care paradigms does little to optimize care in advancing chronic illness. Calls for improved palliation in chronic lung disease mandate a review of related care gaps and current clinical practices. Although specialist palliative services have their advocates, adding yet another element to an already fragmented, often complex, care paradigm can be a challenge. Instead, we propose a more holistic, patient-centered approach based on elements fundamental to palliative and best care practices generally and integrated as needed across the entire illness trajectory. To support this approach, we review the concept of primary palliative care competencies, identify vulnerability specific to those living with advanced COPD (an exemplar of chronic lung disease), and describe the need for care plans shaped by patient-centered communication, timely palliative responsiveness, and effective advance care planning. A costly systemic issue in the management of chronic lung disease is patients' increasing dependency on episodic ED care to deal with preventable episodic crises and refractory dyspnea. We address this issue as part of a proposed model of care that provides proactive, collaborative case management and the appropriate and carefully monitored use of opioids. We encourage and support a renewed primary care resolve to integrate palliative approaches to care in advanced lung disease that, in concert with judicious referral to appropriate specialist palliative care services, is fundamental to what should be a more sustainable systematic improvement in palliative care delivery. PMID:25742140

  8. Flank pain

    MedlinePlus

    Pain - side; Side pain ... Flank pain can be a sign of a kidney problem. But, since many organs are in this area, other causes are possible. If you have flank pain and fever , chills, blood in the urine, or ...

  9. Chronic Pain

    MedlinePlus

    ... your pain. Medicines used for chronic pain include pain relievers, antidepressants, and anticonvulsants. Different types of medicines help ... If your doctor recommends an over-the-counter pain reliever, read and follow the instructions on the box. ...

  10. Palliative Care Among Chumash People

    PubMed Central

    2005-01-01

    Chumash Healers used breathing therapy and counseling to keep patients involved in daily life and to avoid depression. Heat therapy, massage and pain medications were used to help with pain. Another primary function of the Healer was to help the patient sleep as normally as possible, possibly using mugwort or momoy. Nutrition was considered by Healers in treating their patients. The overall concern of the Healer was to help maintain the daily routine of village life during the normal process of the death of a village member. PMID:15937554

  11. Osteoarthritis: From Palliation to Prevention

    PubMed Central

    Chu, Constance R.; Millis, Michael B.; Olson, Steven A.

    2014-01-01

    Osteoarthritis is a leading cause of disability. The traditional focus on late-stage osteoarthritis has not yielded effective disease-modifying treatments. Consequently, current clinical care focuses on palliation until joint replacement is indicated. A symposium format was used to examine emerging strategies that support the transformation of the clinical approach to osteoarthritis from palliation to prevention. Central to this discussion are concepts for diagnosis and treatment of pre-osteoarthritis, meaning joint conditions that increase the risk of accelerated development of osteoarthritis. The presentation of translational and clinical research on three common orthopaedic conditions—anterior cruciate ligament tear, intra-articular fracture, and hip dysplasia—were used to illustrate these ideas. New information regarding the use of novel quantitative magnetic resonance imaging (MRI) in the form of ultrashort echo time enhanced T2* (UTE-T2*) mapping to evaluate the potential for articular cartilage to heal subsurface damage in a mechanically sound environment was presented. These data indicate that improved diagnostics can both identify cartilage at risk and evaluate the effectiveness of early treatment strategies. With use of a new mouse model for intra-articular fracture, it was shown that inflammation correlated to fracture severity and that super-healer mice avoided early posttraumatic osteoarthritis in part through an enhanced ability to dampen inflammation. These findings suggest that there is a role for acute and sustained anti-inflammatory treatment in the prevention of osteoarthritis. For long-term treatment, contemporary gene-therapy approaches may offer an effective means for sustained intra-articular delivery of anti-inflammatory and other bioactive agents to restore joint homeostasis. To illustrate the potential of early treatment to prevent or delay the onset of disabling osteoarthritis, the positive clinical effects on articular cartilage and

  12. Palliative and end-of-life care for people living with dementia in care homes: part 2.

    PubMed

    Mitchell, Gary; Agnelli, Joanne; McGreevy, Jessie; Diamond, Monica; Roble, Herlindina; McShane, Elaine; Strain, Joanne

    2016-06-29

    This article, the second of two, provides healthcare practitioners with an overview of best practice in palliative and end-of-life care, including nutrition, hydration, oral hygiene and pain management. Communication and spiritual care are discussed, as well as care after death. Providing support and education for families is an important aspect of palliative and end-of-life care. Care home nurses should ensure that the person living with dementia is at the centre of decision making, and provide care that is inclusive of their needs and wishes. The article is framed in a care home context; there is little research about how to optimise palliative care for people living with dementia in care homes. PMID:27353937

  13. Pain relief is a human right.

    PubMed

    Daher, Michel

    2010-01-01

    potential legal liability. 4. Doctors who are notable or willing to ensure adequate analgesia must refer to a colleague who has this expertise. 5. Pain management must be a compulsory component of continuing medical education. For too long, pain and its management have been prisoners of myth, irrationality, ignorance, and cultural bias. We are confident that the Pain Relief and Palliative Care Working Group under the auspices of the Lebanese Cancer Society is the main promoter of Palliative Care in Lebanon whose main goal is to relieve suffering and improve quality of life of the cancer patients, and advocate pain relief as a human right. PMID:20590358

  14. Burden of stroke in the Philippines.

    PubMed

    Loo, Keat Wei; Gan, Siew Hua

    2013-02-01

    Based on disability-adjusted life-years, stroke is the second leading cause of death and among the top five diseases with the greatest burden. Although two community-based studies have been conducted to determine the prevalence of stroke in the Philippines, the incidence has not been nationally recorded to date. The prevalence ranged from 1·9% to 6·59%, and 'Wiihabilitation', a rehabilitation stroke therapy, is widely practiced. A clinical trial for stroke rehabilitation using the Chinese Medicine NeuroAid®, which consists of several herbs, is ongoing in many hospitals across the Philippines. Due to their ready availability, phytomedicines are widely used, especially in the rural areas, for the treatment of hypertension, diabetes mellitus, and hypercholesterolemia, which are predisposing factors for stroke in the Philippines. Due to the increasing number of stroke cases annually, the government of the Philippines should emphasize primary and secondary prevention strategies. PMID:22568853

  15. Bringing electricity reform to the Philippines

    SciTech Connect

    Fe Villamejor-Mendoza, Maria

    2008-12-15

    Electricity reforms will not translate to competition overnight. But reforms are inching their way forward in institutions and stakeholders of the Philippine electricity industry, through regulatory and competition frameworks, processes, and systems promulgated and implemented. (author)

  16. Hefty tests buoy Philippine oil sector

    SciTech Connect

    Not Available

    1992-04-13

    This paper reports that Alcorn International Inc., Houston, has disclosed a test of another hefty oil flow off Philippines. Alcorn last month completed its third high flowing delineation well in the West Linapacan area off Palawan Island. Development of West Linapacan field will help boost lagging Philippines oil production, which fell 31% in 1991 from 1990 levels. Philippines Office of Energy Affairs (OEA) also outlined other aspects of the country's oil and gas activity in 1991. Recent drilling successes have redirected the country's focus north to the West Linapacan area from older Northwest Palawan oil fields. Meantime, two geophysical survey and exploration contracts (GSECs) were awarded in 1991, and two service contracts (SCs) were relinquished during the year. Several seismic program were completed last year, and in agreement between Australia and Philippines will yield added seismic data during the next 3 years.

  17. Methodologic issues in palliative care psychosocial research.

    PubMed

    Cassileth, B R; Lusk, E J

    1989-12-01

    The conduct of psychosocial research with palliative care patients or staff presents a major investigative challenge. The fragility of patients and their physical or cognitive limitations severely curtail the types of studies that are possible and the research methods that can be applied. A major limitation is that randomization, a critical experimental design feature, is rarely possible or ethical as a means of evaluating palliative care. However, even given the practical limitations of constructing a randomized experimental design, methodologically acceptable studies are possible, and methodologically inappropriate approaches can be avoided. Case reports (anecdotal studies) produce data that cannot be generalized to other patients. Single-test, no control group studies should be avoided for similar reasons. Acceptable research techniques that are feasible in the palliative care setting are renewed: careful research questions and associated hypotheses; determining appropriate sample sizes; developing comparison groups; selecting and evaluating an appropriate interview guide or questionnaire; avoiding interviewing bias, and so on. Moreover, it is necessary for the professional standing of palliative care that the exchange of information between palliative care staff and other health professionals be based upon scientifically sound studies. PMID:2614590

  18. Palliative care and the QALY problem.

    PubMed

    Hughes, Jonathan

    2005-12-01

    Practitioners of palliative care often argue for more resources to be provided by the state in order to lessen its reliance on charitable funding and to enable the services currently provided to some of those with terminal illnesses to be provided to all who would benefit from it. However, this is hard to justify on grounds of cost-effectiveness, since it is in the nature of palliative care that the benefits it brings to its patients are of short duration. In particular, palliative care fares badly under a policy of QALY-maximisation, since procedures which prevent premature death (provided the life is of reasonable quality) or improve quality of life for those with longer life expectancy will produce more QALYs. This paper examines various responses to this problem and argues that in order to justify increased resources for palliative care its advocates must reject the 'atomistic' view of the value of life implicit in the QALY approach in favour of a 'holistic' or 'narrative' account. This, however, has implications which advocates of palliative care may be reluctant to embrace. PMID:16435466

  19. Palliative radiotherapy: current status and future directions.

    PubMed

    Sharma, Sonam; Hertan, Lauren; Jones, Joshua

    2014-12-01

    For nearly 100 years, palliative radiotherapy has been a time-efficient, effective treatment for patients with metastatic or advanced cancer in any area where local tumors are causing symptoms. Short courses including a single fraction of radiotherapy may be effective for symptom relief with minimal side effects and maximization of convenience for patient and family. With recent advances in imaging, surgery, and other local therapies as well as systemic cancer therapies, palliative radiotherapy has been used frequently in patients who may not yet have symptoms of advanced or metastatic cancer. In this setting, more prolonged radiotherapy courses and advanced radiotherapy techniques including intensity-modulated radiotherapy (IMRT) or stereotactic radiotherapy (SRT) may be useful in obtaining local control and durable palliative responses. This review will explore the use of radiotherapy across the spectrum of patients with advanced and metastatic cancer and delineate an updated, rational approach for the use of palliative radiotherapy that incorporates symptoms, prognosis, and other factors into the delivery of palliative radiotherapy. PMID:25499634

  20. Palliative care needs at different phases in the illness trajectory: a survey study in patients with cancer.

    PubMed

    Beernaert, K; Pardon, K; Van den Block, L; Devroey, D; De Laat, M; Geboes, K; Surmont, V; Deliens, L; Cohen, J

    2016-07-01

    Despite the growing consensus on the benefits of initiating palliative care early in the disease trajectory, it remains unclear at what point palliative care needs emerge. This study investigates quality of life and unmet palliative care needs at three phases in the cancer trajectory, curative, life-prolonging and most advanced (prognosis <6 months/no further disease-modifying treatment). We collected self-reported data from 620 patients with cancer in the University Hospital of Ghent, Belgium. They completed a questionnaire on quality of life (using the EORTC QLQ-C30) and unmet care needs within the domains of palliative care. We used European reference values of the EORTC QLQ-C30 to compare the mean scores with a norm group. The groups further on in the cancer trajectory reported statistically and clinically poorer functioning compared with earlier phases, also when controlled for the effects of sex, age or type of cancer. Higher symptom burdens for fatigue, pain, dyspnoea and appetite loss were found in groups further into the trajectory, p < .001. Patients in the curative phase experienced physical symptoms and had clinically worse functioning than a European reference group. This paper demonstrates the ongoing need for oncologists to address the broader palliative care needs of patients from diagnosis onwards. PMID:27271354

  1. Improving comfort and communication in the ICU: a practical new tool for palliative care performance measurement and feedback

    PubMed Central

    Nelson, J E; Mulkerin, C M; Adams, L L; Pronovost, P J

    2006-01-01

    Objective To develop a practical set of measures for routine monitoring, performance feedback, and improvement in the quality of palliative care in the intensive care unit (ICU). Design Use of an interdisciplinary iterative process to create a prototype “bundle” of indicators within previously established domains of ICU palliative care quality; operationalization of indicators as specified measures; and pilot implementation to evaluate feasibility and baseline ICU performance. Setting The national Transformation of the Intensive Care Unit program developed in the United States by VHA Inc. Patients Critically ill patients in ICUs for 1, >3, and >5 days. Measurements and main results Palliative care processes including identification of patient preferences and decision making surrogates, communication between clinicians and patients/families, social and spiritual support, and pain assessment and management, as documented in medical records. Application is triggered by specified lengths of ICU stay. Pilot testing in 19 ICUs (review of >100 patients' records) documented feasibility, while revealing opportunities for quality improvement in clinician‐patient/family communication and other key components of ICU palliative care. Conclusions The new bundle of measures is a prototype for routine measurement of the quality of palliative care in the ICU. Further investigation is needed to confirm associations between measured processes and outcomes of importance to patients and families, as well as other aspects of validity. PMID:16885251

  2. European Association for Palliative Care (EAPC) framework for palliative sedation: an ethical discussion

    PubMed Central

    2010-01-01

    Background The aim of this paper is to critically discuss some of the ethically controversial issues regarding continuous deep palliative sedation at the end of life that are addressed in the EAPC recommended framework for the use of sedation in palliative care. Discussion We argue that the EAPC framework would have benefited from taking a clearer stand on the ethically controversial issues regarding intolerable suffering and refractory symptoms and regarding the relation between continuous deep palliative sedation at the end of life and euthanasia. It is unclear what constitutes refractory symptoms and what the relationship is between refractory symptoms and intolerable suffering, which in turn makes it difficult to determine what are necessary and sufficient criteria for palliative sedation at the end of life, and why. As regards the difference between palliative sedation at the end of life and so-called slow euthanasia, the rationale behind stressing the difference is insufficiently demonstrated, e.g. due to an overlooked ambiguity in the concept of intention. It is therefore unclear when palliative sedation at the end of life amounts to abuse and why. Conclusions The EAPC framework would have benefited from taking a clearer stand on some ethically controversial issues regarding intolerable suffering and refractory symptoms and regarding the relation between continuous deep palliative sedation at the end of life and euthanasia. In this text, we identify and discuss these issues in the hope that an ensuing discussion will clarify the EAPC's standpoint. PMID:20836861

  3. [Advanced malignant soft tissue tumors: plastic reconstructive options for palliative treatment].

    PubMed

    Vogt, P M; Jokuszies, A

    2010-12-01

    Plastic and reconstructive procedures for the oncological treatment of malignant tumors in the head and neck region, trunk and extremities are primarily curative. Less is known about the treatment options of plastic surgery in patients with locally advanced or incurable tumors. Therefore superficial, mostly exulcerated and superinfected tumors are treated with a palliative approach. A plethora of symptoms drastically restricts the quality of life in patients with advanced cancer. Pain, oozing of blood and bacterial superinfection with fetidness compromise the patient's general condition, self-esteem and activity. Many patients suffer from increasing isolation. A stage-adapted and plastic-reconstructive approach aiming at reducing the tumor mass and closing ulcerating wounds provides a considerable benefit especially in these patients. In this article a variety of treatment options regarding palliative resections and plastic reconstructive procedures and the disease alleviating benefits for patients with incurable tumors are presented. PMID:19949764

  4. Adjusting Bowel Regimens When Prescribing Opioids in Women Receiving Palliative Care in the Acute Care Setting.

    PubMed

    Gonzales, Lucia K; Delmastro, Margaret A; Boyd, Denise M; Sterling, Melvyn L; Aube, Patricia A; Le, Rosemary N; Traucht, Lisa; Quinal, Leonida R; Georges, Jane M; Glaser, Dale N

    2016-08-01

    In palliative medicine, constipation is the third most common symptom after pain and anorexia, causing some patients to discontinue opioid therapy. Women experience higher incidence of constipation than men. The prevalence of infrequent bowel movements (<3 times/wk) and adherence to an established bowel regimen among women receiving opioids were studied. Referral to the palliative care team decreased the prevalence of infrequent bowel movements from 72% to 45%, and algorithm adherence increased from 38% to 78%. Education of oncology nurses decreased the prevalence of infrequent bowel movements among patients with cancer from 71% to 60%, and algorithm adherence increased from 0% to 10%. Patients benefit from stool softeners and stimulants when receiving opioids. PMID:25964648

  5. Palliative combined treatment for unresectable cutaneous basosquamous cell carcinoma of the head and neck.

    PubMed

    Deganello, A; Gitti, G; Struijs, B; Paiar, F; Gallo, O

    2013-10-01

    A case is presented of a patient with a skin basosquamous cell carcinoma of the frontal region infiltrating the cerebral tissue and with a widespread unresectable regional metastatic ulceration of the left parotid region. The patient underwent combined palliative treatment: surgical coverage of the ulceration by means of a pectoralis mayor flap transposition and radiotherapy. After 18 months of follow-up, no signs of tumour progression were noted, the patient is currently free from pain, no increase in trismus was seen, and a slight gain in weight was recorded. Unresectable cancer is mainly treated by concurrent chemoradiation; radiotherapy, however, is contraindicated in deep neoplastic ulcerations with exposure of large vessels. The data reported suggest that surgical coverage of an unresectable neoplastic ulcer is feasible, and combined with early administration of radiation permits a palliative approach in an otherwise untreatable condition. PMID:24227904

  6. Pattern of Referral of Noncancer Patients to Palliative Care in the Eastern Province of Saudi Arabia

    PubMed Central

    Ghanem, Hafez M; Shaikh, Rawabi M; Alia, Ahmad M Abou; Al-Zayir, Amani S; Alsirafy, Samy A

    2011-01-01

    Aim: The palliative care (PC) needs of patients with noncancer life-threatening illnesses are comparable to that of cancer patients. This report describes the contribution of noncancer patients to the population of PC patients in a tertiary care hospital in the Eastern Province of Saudi Arabia. Materials and Methods: This is a retrospective review of the “palliative care inpatient database” of 21 months. Results: From 474 patients, 20 (4.2%) had a noncancer diagnosis. The main reason for the referral of noncancer patients was pain control. The most prevalent diagnoses were sickle cell disease (SCD) in 6 (30%) patients and peripheral arterial disease (PAD) in 5 (25%). Conclusions: These findings suggest that the PC needs of noncancer patients are largely unmet in our region. Further efforts are necessary to advance noncancer PC in Saudi Arabia. The PC needs of patients with SCD and PAD need to be addressed in future research. PMID:22346049

  7. Pediatric Palliative Care: A Reflection on Terminology

    PubMed Central

    Bergstraesser, Eva

    2013-01-01

    The definition of palliative care is the cornerstone of a medical subspecialty that plays a particular role for all who need it, for all who practice it, and increasingly for those who try to understand it. The difficulties around the definition and terminology arise from problems in separating it from other concepts such as supportive care, constructs such as “palliative care is only about dying”, or, in children, the rather vague use of terms like life-threatening and life-limiting diseases. These weaknesses have been recognized and important steps have been taken. This review discusses current definitions as well as efforts to overcome their weaknesses and make the term palliative care—for both children and adults—more intelligible. PMID:25278760

  8. Respect for persons, autonomy and palliative care.

    PubMed

    Woods, Simon

    2005-01-01

    This paper explores some of the values that underpin health care and how these relate more specifically to the values and ethics of palliative care. The paper focuses on the concept of autonomy because autonomy has emerged as a foundational concept in contemporary health care ethics and because this is an opportunity to scratch the surface of this concept in order to reveal something of its complexity, a necessary precaution when applying the concept to the context of palliative care. The paper begins with a theoretical discussion of autonomy exploring an aspect of its contemporary meaning and relevance to health care. The second part of the paper focuses more closely on how the principle of respect for autonomy can be applied in the context of palliative care. In this section an ethical framework is employed to explore a practical application of this principle within a broader context of respect for persons. PMID:16215803

  9. Palliative radiotherapy for bone metastases from lung cancer: Evidence-based medicine?

    PubMed Central

    Fairchild, Alysa

    2014-01-01

    To review current recommendations for palliative radiotherapy for bone metastases secondary to lung cancer, and to analyze surveys to examine whether global practice is evidence-based, English language publications related to best practice palliative external beam radiotherapy (EBRT) for bone metastases (BM) from lung cancer were sought via literature search (2003-2013). Additional clinical practice guidelines and consensus documents were obtained from the online Standards and Guidelines Evidence Directory. Eligible survey studies contained hypothetical case scenarios which required participants to declare whether or not they would administer palliative EBRT and if so, to specify what dose fractionation schedule they would use. There is no convincing evidence of differential outcomes based on histology or for spine vs non-spine uncomplicated BM. For uncomplicated BM, 8Gy/1 is widely recommended as current best practice; this schedule would be used by up to 39.6% of respondents to treat a painful spinal lesion. Either 8Gy/1 or 20Gy/5 could be considered standard palliative RT for BM-related neuropathic pain; 0%-13.2% would use the former and 5.8%-52.8% of respondents the latter (range 3Gy/1-45Gy/18). A multifraction schedule is the approach of choice for irradiation of impending pathologic fracture or spinal cord compression and 54% would use either 20Gy/5 or 30Gy/10. Survey results regarding management of complicated and uncomplicated BM secondary to lung cancer continue to show a large discrepancy between published literature and patterns of practice. PMID:25493222

  10. How common is medical training in palliative care? A postal survey of general practitioners.

    PubMed Central

    Barclay, S; Todd, C; Grande, G; Lipscombe, J

    1997-01-01

    BACKGROUND: General practitioners (GPs) have a central role in palliative care, yet research continues to reveal room for improvement in symptom control at home. There is a need to evaluate how well-prepared GPs are for this task of caring for the dying at home. AIM: To evaluate the training in palliative care GPs have received throughout their careers. METHOD: Postal survey of 450 randomly selected East Anglian GP principals, investigating training in five areas of palliative care (pain control, control of other symptoms, communication skills, bereavement care, use of syringe driver), as clinical students, junior hospital doctors, GP trainees (registrars), and GP principals. RESULTS: A response rate of 86.7% was obtained. While GPs were clinical students, training was uncommon, (32% reported no training in pain control, and 58% no training in bereavement care), although there has been a significant increase in more recent years. Training as junior doctors was particularly uncommon (over 70% report no training in communication skills or bereavement care); there was some evidence of an increase in more recent years. During the GP trainee year, training was much more common. For GP principals, most areas had been covered, although over 20% reported no training in communication skills and bereavement care. During the community-based years as trainee and principal, training was significantly more common than during the hospital-based years of training as clinical student and junior doctor. CONCLUSIONS: There is a continuing need for medical education in palliative care. Particular attention should be paid to the basic medical education of clinical students and the training of junior doctors, especially regarding communication skills and bereavement care. PMID:9463980

  11. Compassion fatigue in pediatric palliative care providers.

    PubMed

    Rourke, Mary T

    2007-10-01

    The experience of compassion fatigue is an expected and common response to the professional task of routinely caring for children at the end of life. Symptoms of compassion fatigue often mimic trauma reactions. Implementing strategies that span personal, professional, and organizational domains can help protect health care providers from the damaging effects of compassion fatigue. Providing pediatric palliative care within a constructive and supportive team can help caregivers deal with the relational challenges of compassion fatigue. Finally, any consideration of the toll of providing pediatric palliative care must be balanced with a consideration of the parallel experience of compassion satisfaction. PMID:17933615

  12. Endoscopic palliation of malignant biliary strictures

    PubMed Central

    Salgado, Sanjay M; Gaidhane, Monica; Kahaleh, Michel

    2016-01-01

    Malignant biliary strictures often present late after the window for curative resection has elapsed. In such patients, the goal of therapy is typically focused on palliation. While historically, palliative measures were performed surgically, the advent of endoscopic intervention offers minimally invasive options to provide relief of symptoms, improve quality of life, and in some cases, increase survival of these patients. Some of these therapies, such as endoscopic biliary decompression, have become mainstays of treatment for decades, whereas newer modalities, including radiofrequency ablation, and photodynamic therapy offer additional options for patients with incurable biliary malignancies. PMID:26989459

  13. Palliative Home Care: A Designer's Perspective.

    PubMed

    Bhatnagar, Tigmanshu

    2015-01-01

    The purpose for this observational research was to understand how Can Support provides palliative care at home and analyze its strengths and weaknesses in various socioeconomic scenarios for future development. In the period of 2 weeks, patients and their caregivers were silently observed in their natural surroundings during home care visits in order to listen their problems, identify the pattern of questions for the home care team, their natural way of storytelling, organizational techniques for medicines and medical reports, care givers lives, patient journey, etc. Such observations have enabled the understanding of the phenomena of home palliative care and have led to the identification of certain influential variables of the practice. PMID:26009683

  14. [Hypnosis and touch-massage to relieve pain at the end of life].

    PubMed

    Bioy, Antoine; Moreaux, Thierry; Pasturel, Agnès; Wood, Chantal

    2011-01-01

    The treatment of pain in palliative care requires specific expertise. "Complementary" methods, such as hypnosis or "Toucher-Massage", for example, not only have an effect on the prevention and treatment of pain, but also contribute to the overall support of the patient. PMID:22026211

  15. Guideline for Prescribing Opioids for Chronic Pain.

    PubMed

    Centers For Disease Control And Prevention Public Health Service U S Department Of Health And Human Services

    2016-06-01

    Improving the way opioids are prescribed through clinical practice guidelines can ensure patients have access to safer, more effective chronic pain treatment while reducing the number of people who misuse, abuse, or overdose from these drugs. The Centers for Disease Control and Prevention (CDC) developed and published the Guideline for Prescribing Opioids for Chronic Pain to provide recommendations for the prescribing of opioid pain medication for patients 18 and older in primary care settings. Recommendations focus on the use of opioids in treating chronic pain (pain lasting longer than 3 months or past the time of normal tissue healing) outside of active cancer treatment, palliative care, and end-of-life care. PMID:27301691

  16. Back Pain

    MedlinePlus

    ... Back Pain Find a Clinical Trial Journal Articles Back Pain March 2015 Handout on Health: Back Pain This publication is for people who have back ... to discuss them with your doctor. What Is Back Pain? Back pain is an all-too-familiar problem ...

  17. The palliative care clinical nurse consultant: an essential link.

    PubMed

    O'Connor, Margaret; Chapman, Ysanne

    2008-01-01

    This study describes the role of acute hospital palliative care nurse consultants and makes recommendations about future directions for the role development of this role. While the palliative care nurse consultant role is accepted in the acute setting there is little evidence or literature about what contributes to the success of this role. A three-phase study was undertaken to describe the role of palliative care nurse consultants in acute hospitals in Melbourne, Australia. The first phase of the three-phase study, involving in-depth qualitative interviews with the palliative care nurse consultants, is reported in this article. Using open-ended semi-structured questions, 10 palliative care nurse consultants were interviewed using open-ended questions about aspects of their role and the interviews were thematically analysed. Four main themes were identified that clarified the role; being the internal link; being the lynch pin; being responsive and being challenged. The palliative care nurse consultants were the first point of introduction to palliative care and thus they saw a significant role in introducing the concept of palliative care to those requiring palliative care, their families and others. They are an important link between the settings of care required by people accessing palliative care-acute, in-patient palliative care and community care. The palliative care nurse consultants saw themselves in leadership positions that in some ways defy boundaries, because of the inherent complexity and diversity of the role. The palliative care nurse consultants' role appears to be pivotal in providing expert advice to staff and people requiring palliative care, and connecting palliative care services both within the hospital and to external services. PMID:19112925

  18. Effectiveness of topical administration of opioids in palliative care: a systematic review.

    PubMed

    LeBon, Beata; Zeppetella, Giovambattista; Higginson, Irene J

    2009-05-01

    The discovery of peripheral opioid receptors has become the scientific basis for topical use of opioids in malignant and nonmalignant ulcers and oropharyngeal mucositis. This systematic review aimed to assess the quality of published literature and to examine whether topical opioids are effective in controlling pain in palliative care settings. After a systematic literature review, 19 studies (six randomized controlled trials [RCTs] and 13 case reports) met the inclusion criteria for the review. Eighteen studies favored topical opioids in pain relief, as evidenced by reductions in post-treatment pain scores, but time to onset and duration of analgesia varied widely. Because of the heterogeneity of the studies, meta-analysis was not possible. Despite clear clinical benefits described in small RCTs, there is a deficiency of higher-quality evidence on the role of topical opioids, and more robust primary studies are required to inform practice recommendations. N-of-1 trials should be encouraged for specific clinical circumstances. PMID:19321297

  19. Biofield therapies for symptom management in palliative and end-of-life care.

    PubMed

    Henneghan, Ashley M; Schnyer, Rosa N

    2015-02-01

    Terminally ill patients experience negative symptoms at end of life (EOL) that hinder well-being and quality of life (QOL). Current intervention strategies are not always effective or feasible. A focused literature review to evaluate the use of biofield therapies (ie, Therapeutic Touch, Healing Touch, and Reiki) to manage the symptoms in EOL revealed no studies on the use these therapies, specifically in this population. Evidence from studies on relevant populations (patients with cancer, elderly patients, and patients experiencing chronic pain), which addressed the outcomes relevant to palliative and EOL care (EOLC; pain levels, changes in psychological symptoms, well-being, and QOL), supports the use of biofield therapies in relieving pain, improving QOL and well-being, and reducing psychological symptoms of stress. Further research to assess the use of biofield therapies in EOLC is clearly needed. PMID:24259404

  20. 78 FR 57620 - Trade Mission to Philippines and Malaysia

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-19

    ... FR 22237, April 15, 2013, regarding the education industry trade mission to Manila, Philippines and... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF COMMERCE International Trade Administration Trade Mission to Philippines and Malaysia AGENCY: International...

  1. [Single-dose palliative radiotherapy in inoperable non-small-cell lung carcinoma].

    PubMed

    Scolaro, T; Bacigalupo, A; Giudici, S; Guenzi, M; Vitale, V

    1995-12-01

    The treatment of choice for advanced inoperable non-small cell lung cancer (NSCLC) is radiation therapy. Palliative radiotherapy schedules vary considerably in different centers, but a 30-Gy dose given in ten fractions over two weeks is a typical standard schedule. Our study was aimed at investigating whether a shorter course of only one 10-Gy fraction allows good palliation in the treatment of inoperable NSCLC patients whose main symptoms are related to an intrathoracic lesion. Patients of both sexes and any age, untreated with radiotherapy, with inoperable and histologically or cytologically proved NSCLC were examined. Seventeen patients, too advanced for radical "curative" radiotherapy and whose main symptoms were related to primary intrathoracic lesions, entered the study even though they had metastases. On admission, 76% (13/17) of patients had cough 76% (13/17) dyspnea, 70.7% (12/17) chest pain and 23.6% (4/17) hemoptysis. They received a single dose of 10 Gy, delivered with an 18-Mv linear accelerator via anteroposteriorly opposing portals without spinal cord shielding. Treatment volume usually included the macroscopically detected lesion identified with a CT simulator. Palliation of symptoms was achieved in high rates of patients: 46% for cough, 69% for dyspnea, 83% for pain and 75% for hemoptysis. These results were obtained within one month of treatment. Unfortunately, palliation of symptoms did not last long, decreasing to 42% within two months of the end of treatment and to 32% at three months. Four patients were retreated, one patient three months and three patients two months after the end of radiotherapy. Ten Gy to the target volume were administered as retreatment with spinal cord shielding. Side-effects were mild: nausea in 3 patients (17%), vomiting in one patient (5%) and grade-II dysphagia in two patients were observed and classified according to WHO criteria. Pain increased 24 hours after radiotherapy in five patients. We can conclude that

  2. Back Pain

    MedlinePlus

    ... BACK PAIN? There are many possible causes of low back pain, including stretched (strained) muscles, torn or stretched (sprained) ... appear to be at an increased risk for low back pain in comparison to the general population (estimates range ...

  3. Neck pain

    MedlinePlus

    ... Alternative Names Pain - neck; Neck stiffness; Cervicalgia; Whiplash Images Neck pain Whiplash Location of whiplash pain References ... pubmed/19272509 . Read More Diskectomy Foraminotomy Laminectomy Spinal fusion Patient Instructions Spine surgery - discharge Update Date 3/ ...

  4. Pain Relievers

    MedlinePlus

    Pain relievers are medicines that reduce or relieve headaches, sore muscles, arthritis, or other aches and pains. There ... also have a slightly different response to a pain reliever. Over-the-counter (OTC) medicines are good for ...

  5. Elbow pain

    MedlinePlus

    Pain - elbow ... Elbow pain can be caused by many problems. A common cause in adults is tendinitis . This is inflammation and ... a partial dislocation ). Other common causes of elbow pain are: Bursitis -- inflammation of a fluid-filled cushion ...

  6. Eye pain

    MedlinePlus

    Ophthalmalgia; Pain - eye ... Pain in the eye can be an important symptom of a health problem. Make sure you tell your health care provider if you have eye pain that does not go away. Tired eyes or ...

  7. Heel pain

    MedlinePlus

    Pain - heel ... Heel pain is most often the result of overuse. Rarely, it may be caused by an injury. Your heel ... on the heel Conditions that may cause heel pain include: When the tendon that connects the back ...

  8. Wrist pain

    MedlinePlus

    Pain - wrist; Pain - carpal tunnel; Injury - wrist; Arthritis - wrist; Gout - wrist; Pseudogout - wrist ... Carpal tunnel syndrome: A common cause of wrist pain is carpal tunnel syndrome . You may feel aching, ...

  9. Depression, Pain, and Pain Behavior.

    ERIC Educational Resources Information Center

    Keefe, Francis J.; And Others

    1986-01-01

    Examined the degree to which depression predicted pain and pain behavior. The Beck Depression Inventory was administered to 207 low back pain patients. Depression and physical findings were the most important predictors of pain and pain behavior. Depression proved significant even after controlling for important demographic and medical status…

  10. Assessing and Responding to Palliative Care Needs in Rural Sub-Saharan Africa: Results from a Model Intervention and Situation Analysis in Malawi

    PubMed Central

    Kalanga, Noel; Keck, James W.; Wroe, Emily B.; Phiri, Atupere; Mayfield, Alishya; Chingoli, Felix; Beste, Jason A.; Tengatenga, Listern; Bazile, Junior

    2014-01-01

    Introduction Palliative care is rarely accessible in rural sub-Saharan Africa. Partners In Health and the Malawi government established the Neno Palliative Care Program (NPCP) to provide palliative care in rural Neno district. We conducted a situation analysis to evaluate early NPCP outcomes and better understand palliative care needs, knowledge, and preferences. Methods Employing rapid evaluation methodology, we collected data from 3 sources: 1) chart review of all adult patients from the NPCP’s first 9 months; 2) structured interviews with patients and caregivers; 3) semi-structured interviews with key stakeholders. Results The NPCP enrolled 63 patients in its first 9 months. Frequent diagnoses were cancer (n = 50, 79%) and HIV/AIDS (n = 37 of 61, 61%). Nearly all (n = 31, 84%) patients with HIV/AIDS were on antiretroviral therapy. Providers registered 112 patient encounters, including 22 (20%) home visits. Most (n = 43, 68%) patients had documented pain at baseline, of whom 23 (53%) were treated with morphine. A majority (n = 35, 56%) had ≥1 follow-up encounter. Mean African Palliative Outcome Scale pain score decreased non-significantly between baseline and follow-up (3.0 vs. 2.7, p = 0.5) for patients with baseline pain and complete pain assessment documentation. Providers referred 48 (76%) patients for psychosocial services, including community health worker support, socioeconomic assistance, or both. We interviewed 36 patients referred to the NPCP after the chart review period. Most had cancer (n = 19, 53%) or HIV/AIDS (n = 10, 28%). Patients frequently reported needing income (n = 24, 67%) or food (n = 22, 61%). Stakeholders cited a need to make integrated palliative care widely available. Conclusions We identified a high prevalence of pain and psychosocial needs among patients with serious chronic illnesses in rural Malawi. Early NPCP results suggest that comprehensive palliative care can be provided in rural

  11. Kenya Hospices and Palliative Care Association: integrating palliative care in public hospitals in Kenya

    PubMed Central

    Ali, Zipporah

    2016-01-01

    Background In Kenya, cancers as a disease group rank third as a cause of death after infectious and cardiovascular diseases. It is estimated that the annual incidence of cancer is about 37,000 new cases with an annual mortality of 28,000 cases (Kenya National Cancer Control Strategy 2010). The incidence of non-communicable diseases accounts for more than 50% of total hospital admissions and over 55% of hospital deaths (Kenya National Strategy for the Prevention and Control of Non Communicable Diseases 2015–2020). The prevalence of HIV is 6.8 (KIAS 2014). Most of these patients will benefit from palliative care services, hence the need to integrate palliative care services in the public healthcare system. Method The process of integrating palliative care in public hospitals involved advocacy both at the national level and at the institutional level, training of healthcare professionals, and setting up services within the hospitals that we worked with. Technical support was provided to each individual institution as needed. Results Eleven provincial hospitals across the country have now integrated palliative care services (Palliative Care Units) and are now centres of excellence. Over 220 healthcare providers have been trained, and approximately, over 30,000 patients have benefited from these services. Oral morphine is now available in the hospital palliative care units. Conclusion As a success of the pilot project, Kenya Hospices and Palliative Care Association (KEHPCA) is now working with the Ministry of Health Kenya to integrate palliative care services in 30 other county hospitals across the country, thus ensuring more availability and access to more patients. Other developing countries can learn from Kenya’s successful experience.

  12. 76 FR 60007 - TRICARE Demonstration Project for the Philippines

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-28

    ... of the Secretary TRICARE Demonstration Project for the Philippines AGENCY: Department of Defense... TRICARE demonstration project for the Philippines. SUMMARY: This notice is to advise interested parties of... Philippines.'' The purpose of this demonstration is to validate an alternative approach to...

  13. Research sensitivities to palliative care patients.

    PubMed

    Addington-Hall, J

    2002-09-01

    This paper considers the methodological challenges of researching the health care experiences of palliative care patients and their families. Difficulties in defining a 'palliative care patient' are highlighted, and the question of whether there are specific ethical issues when researching palliative care explored. Methodological issues are discussed, including the negotiation of access via health professionals, the choice of appropriate data collection methods and tools, the consequences of high attrition rates and the use of retrospective surveys of bereaved relatives. Key areas for research are identified. These include patients' and families' experiences of research participation, the impact of being approached on those who decline, how the characteristics of those who participate differ from those who do not and the likely impact of this on findings. Research is also needed into patient and family motivations for participation, and whether and how these change as the disease progresses. To ensure that the voices of palliative care patients and their families are heard by both service providers and policy-makers, research in this area needs to address the methodological challenges raised in this paper, as well as continuing to explore users' views. PMID:12296842

  14. Palliative Care Enrichment in Geropsychology Fellowships.

    ERIC Educational Resources Information Center

    Strauss, Gerald; Nelson, Barbara J.

    1996-01-01

    Interviews with 6 of 10 Veterans' Affairs programs offering postdoctoral fellowships in geropsychology indicated that only 30% included palliative care or hospice training, despite the fact that the veteran population is likely to have an increasing need for terminal illness care. (SK)

  15. Palliative Care for the Seriously Ill

    PubMed Central

    Kelley, Amy S.; Morrison, R. Sean

    2015-01-01

    Palliative care is the interdisciplinary specialty focused on improving quality of life for persons with serious illness and their families. Over the past decade,1 the field has undergone substantial growth and change, including an expanded evidence base, new care-delivery models, innovative payment mechanisms, and increasing public and professional awareness. PMID:26287850

  16. [The role of laughter in palliative care].

    PubMed

    Bégnon, Julie; Vigneron, Sylvie

    2015-03-01

    A team has studied the impact of laughter in palliative care. For the majority of caregivers, laughter is perceived as a complementary tool for supporting patients, but many are reluctant to use it. Patients, for their part, are receptive to it. Used in the correct doses, laughter can enrich care. PMID:26145138

  17. [Palliative care day hospital and nursing coordination].

    PubMed

    Teillet, Fabienne

    2015-11-01

    The palliative care day hospital is still underdeveloped in France, unlike in Anglo-Saxon countries. Its main mission is to help improve the quality of life at home of the patient suffering from a serious and progressive disease. It offers an inter-disciplinary and global approach in which the nurse's role is quite specific. PMID:26567073

  18. The Quality Imperative for Palliative Care

    PubMed Central

    Kamal, Arif H.; Hanson, Laura C.; Casarett, David J.; Dy, Sydney M.; Pantilat, Steven Z.; Lupu, Dale; Abernethy, Amy P.

    2015-01-01

    Palliative medicine must prioritize the routine assessment of the quality of clinical care we provide. This includes regular assessment, analysis, and reporting of data on quality. Assessment of quality informs opportunities for improvement and demonstrates to our peers and ourselves the value of our efforts. In fact, continuous messaging of the value of palliative care services is needed to sustain our discipline; this requires regularly evaluating the quality of our care. As the reimbursement mechanisms for health care in the United States shift from fee-for-service to fee-for-value models, palliative care will be expected to report robust data on quality of care. We must move beyond demonstrating to our constituents (including patients and referrers), “here is what we do,” and increase the focus on “this is how well we do it” and “let’s see how we can do it better.” It is incumbent on palliative care professionals to lead these efforts. This involves developing standardized methods to collect data without adding additional burden, comparing and sharing our experiences to promote discipline-wide quality assessment and improvement initiatives, and demonstrating our intentions for quality improvement on the clinical frontline. PMID:25057987

  19. Pediatric Palliative Care at a Glance

    MedlinePlus

    ... can care start? • Receive services, like art or music therapy • Find ways to relax and play Palliative ... Nurses • Child life specialists • Respite providers • Art and music therapists • Chaplains • Case managers • Counselors • Home health aides • ...

  20. The quality imperative for palliative care.

    PubMed

    Kamal, Arif H; Hanson, Laura C; Casarett, David J; Dy, Sydney M; Pantilat, Steven Z; Lupu, Dale; Abernethy, Amy P

    2015-02-01

    Palliative medicine must prioritize the routine assessment of the quality of clinical care we provide. This includes regular assessment, analysis, and reporting of data on quality. Assessment of quality informs opportunities for improvement and demonstrates to our peers and ourselves the value of our efforts. In fact, continuous messaging of the value of palliative care services is needed to sustain our discipline; this requires regularly evaluating the quality of our care. As the reimbursement mechanisms for health care in the U.S. shift from fee-for-service to fee-for-value models, palliative care will be expected to report robust data on quality of care. We must move beyond demonstrating to our constituents (including patients and referrers), "here is what we do," and increase the focus on "this is how well we do it" and "let us see how we can do it better." It is incumbent on palliative care professionals to lead these efforts. This involves developing standardized methods to collect data without adding additional burden, comparing and sharing our experiences to promote discipline-wide quality assessment and improvement initiatives, and demonstrating our intentions for quality improvement on the clinical frontline. PMID:25057987

  1. [Early diagnosis of metastatic spinal tumor is a key for effective palliative radiotherapy in patients with lung cancer].

    PubMed

    Isono, Hisayo; Kemmoku, Tomoko; Nakamura, Yusuke; Onose, Akira; Matsumoto, Yuka; Watanabe, Rinako; Haraguchi, Mizuha; Kasajima, Masashi; Takaya, Saho; Ishihara, Mikiko; Karigane, Daiki; Nagata, Hiroshi

    2011-12-01

    Patients with metastatic spinal tumor are the largest in number among the patients with bone tumor. It causes a severe bone pain, pathological fracture and spinal cord compression. Thus it harshly hampers patient's quality of life. We report 3 patients with lung cancer whose initial manifestation was metastatic spinal tumor. We treated the 3 patients with palliative radiotherapy and medication. Although the severe pain has improved on a numerical rating scale(NRS), but performance status(PS)and activity of daily living(ADL)of the 3 patients got worse because the disease was progressed and complicated. Generally, PS of cancer patients found by bone matastasis is low. However, it is difficult to take an effective treatment, which leads to ADL improvement. There are many choices for treating metastatic bone tumors including pain control, bisphosphonate administration, radiation therapy, strontium radiotherapy, bone cement, palliative surgery and orthotics. In addition, a development of molecular target drugs, such as Denosmab, is expected as future modality of palliative care. In conclusion, we should detect a bone metastasis in the patient with lung cancer as early as possible, and select an appropriate treatment in collaboration with each specialist for achieving the ADL and PS improvement. PMID:22189323

  2. Pain Behind Bars: The Epidemiology of Pain in Older Jail Inmates in a County Jail

    PubMed Central

    Ahalt, Cyrus; Stijacic-Cenzer, Irena; Smith, Alexander K.; Goldenson, Joe; Ritchie, Christine S.

    2014-01-01

    Abstract Background: The number of older jail inmates in poor health is increasing rapidly. Among older adults, pain is common and leads to greater acute care use. In jail, pain management is complicated by concerns about misuse and diversion. A lack of data about the prevalence and management of pain in older jail inmates limits our ability to develop optimal palliative care strategies for this population. Objective: To describe the prevalence of and factors associated with pain and analgesic use in a population of older jail inmates. Design: Cross-sectional study. χ2 tests assessed association between characteristics, pain, and analgesic use. Setting/Subjects: Two hundred ten jail inmates age 55 or older. Measurements: “Severe frequent pain” defined as “severe or very severe” pain experienced “frequently or constantly” using the validated Memorial Symptom Assessment Scale. Medical conditions, substance use, and analgesic treatment determined through self-report and jail medical records. Results: Participants' mean age was 59 years; 69% had multimorbidity; 75% reported any pain; 39% reported severe frequent pain. Report of severe frequent pain was associated with multimorbidity, functional impairment, and pre-jail acute care use (p<0.05), but not with substance use (57% versus 56%, p=0.89). Within a week of their interview, most participants with severe frequent pain had received an analgesic (87%) and many received an opioid (70%). Conclusion: High rates of pain in a rapidly growing population of older jail inmates with multimorbidity and functional impairment suggest that jails are an important site for assessing symptom burden and developing appropriate palliative care interventions. PMID:25265035

  3. Kirkland gets license in hot Philippines area

    SciTech Connect

    Kirkland, A.S.

    1992-08-03

    This paper reports that Kirkland As, Oslo, has received a geophysical survey and exploration contract (GSEC) in a sizzling exploration and development theater off the Philippines. The license covers about 6,000 sq miles of undisputed waters, with depths mostly less than 300 ft, and lies in the Reed Bank area off Northwest Palawan Island, where several major oil and gas strikes have been made recently. Kirkland has 1 year in which to carry out its seismic work commitment. The terms of the GSEC then give an option to drill one well in a 6 month period. Once the results have been analyzed, the company can either drill another well or enter into a service contract for the license. Kirkland has a 65% share in the license, with the remainder split between Philippine companies Philodrill Corp., Beguet Mining Corp. subsidiary Petrofields, and Seafront Resources Corp. The Philippines is one of Kirkland's main areas of activity, the Kirkland Commercial Manager Ralph Baxter.

  4. Psychologic issues in palliative care.

    PubMed

    Gibson, Christopher A; Lichtenthal, Wendy; Berg, Amy; Breitbart, William

    2006-03-01

    As medical science progresses and the life spans of patients with serious illnesses increase, the process that leads to death is becoming more feared than death itself. This fear is particularly intense in technologically advanced cultures with access to advanced medical care. The lives of patients who previously would have died rapidly are now often extended. As a result, images of suffering, such as dying in isolation and experiencing great pain, often are at the forefront of concerns about those struggling with terminal illnesses. This article provides medical practitioners with an overview of the issues and symptoms common in terminal illness, to help them work most effectively with their mental health colleagues. PMID:16487896

  5. A Simple and Effective Daily Pain Management Method for Patients Receiving Radiation Therapy for Painful Bone Metastases

    SciTech Connect

    Andrade, Regiane S.; Proctor, Julian W.; Slack, Robert; Marlowe, Ursula; Ashby, Karlotta R.; Schenken, Larry L.

    2010-11-01

    Purpose: The incidence of painful bone metastases increases with longer survival times. Although external beam radiation therapy (EBRT) is an effective palliative treatment, it often requires several days from the start of treatment to produce a measurable reduction in pain scores and a qualitative amelioration of patient pain levels. Meanwhile, the use of analgesics remains the best approach early on in the treatment course. We investigated the role of radiation therapists as key personnel for collecting daily pain scores to supplement assessments by physician and oncology nursing staff and manage pain more effectively during radiation treatment. Methods and Materials: Daily pain scores were obtained by the radiation therapists for 89 patients undertaking a total of 124 courses of EBRT for bone metastases and compared with pretreatment pain scores. The majority of patients (71%) were treated to 30 Gy (range, 20-37.5) in 10 fractions (range, 8-15 fractions). Results: One hundred nineteen treatment courses (96%) were completed. Pain scores declined rapidly to 37.5%, 50%, and 75% of the pretreatment levels by Days 2, 4, and 10, respectively. Pain was improved in 91% of patients with only 4% of worse pain at the end of treatment. Improved pain scores were maintained in 83% of patients at 1-month follow-up, but in 35% of them, the pain was worse than at the end of treatment. Conclusions: Collection of daily pain scores by radiation therapists was associated with an effective reduction in pain scores early on during EBRT of painful osseous metastases.

  6. Rice hull energy uses in the Philippines

    SciTech Connect

    Waddle, D.B.

    1985-01-01

    As a rice producing country, the Philippines produces a tremendous amount of rice hulls which when converted to energy could displace a substantial amount of imported energy. Realizing this possibility needs a thorough evaluation of both resources and demand characteristics of particular industry where immediate applicability of technical option awaits. This document presents the Philippines' past activities in fuelizing rice hulls and future action plans where its economic relevance could be enhanced. Descriptions of four power plants are included with the author's analysis of their probable market impact and projections of future applications.

  7. Decentralization, democratization, and health: the Philippine experiment.

    PubMed

    Langran, Irene V

    2011-01-01

    In 1991, the Philippines joined a growing list of countries that reformed health planning through decentralization. Reformers viewed decentralization as a tool that would solve multiple problems, leading to more meaningful democracy and more effective health planning. Today, nearly two decades after the passage of decentralization legislation, questions about the effectiveness of the reforms persist. Inadequate financing, inequity, and a lack of meaningful participation remain challenges, in many ways mirroring broader weaknesses of Philippine democracy. These concerns pose questions regarding the nature of contemporary decentralization, democratization, and health planning and whether these three strategies are indeed mutually enforcing. PMID:22073430

  8. The southern termination of the Philippine Trench

    NASA Astrophysics Data System (ADS)

    Nichols, Gary; Hall, Robert; Milsom, John; Masson, Doug; Parson, Lindsay; Sikumbang, Nafrizal; Dwiyanto, Bambang; Kallagher, Helen

    1990-11-01

    Recent studies of the southern end of the Philippine Trench using GLORIA sidescan sonar and single channel seismic data and geological studies on the island of Halmahera suggest that the trench is in the process of propagating south and that some of the ESE-WNW convergence is transferred via a broad NE-SW zone of dextral strike-slip across northern Halmahera into the Molucca Sea Collision Zone. NE-SW ridges and lineaments on the seafloor can be traced into major faults and structural trends on land. The bathymetric expression of the Philippine Trench is lost where it meets an oceanic plateau on the Philippine Sea Plate. This elevated and probably thickened plateau appears to have inhibited any further propagation of the trench southwards. To the north of the plateau there is a well-developed accretionary prism, but to the south deformation of sediments on the seafloor is less intense. A prominent ridge, with sediments passively banked up against it marks the southern limit of deformation associated with the Philippine Trench. To the south lies the eastern Halmahera-Waigeo Ophiolite Terrane, an area of shallow water and islands underlain by ophiolitic basement between Halmahera and the Sorong Fault Zone. There are no bathymetric or structural features to indicate any form of active link between the Philippine Trench and the Sorong Fault through or along the northern side of this ophiolite terrane. There is no earthquake evidence for any form of fault linking the Philippine Trench to either the Palau Trench or the Sorong Fault, but there are numerous earthquake epicentres reported between the southern end of the trench and the Molucca Sea. The island of Halmahera is considered to lie in a diffuse boundary zone at the margin of the Philippine Sea Plate. Continued collision of the opposing arcs in the Molucca Sea will ultimately prevent further E-W convergence between Halmahera and Sulawesi. It is predicted that either the Philippine Trench will propagate south along

  9. Alcorn wells bolster Philippines oil production

    SciTech Connect

    Not Available

    1992-09-21

    This paper reports that Alcorn International Inc., Houston, is producing about 16,500 b/d of oil from West Linapacan A field in the South China Sea off the Philippines. The field's current production alone is more than fivefold the Philippines' total average oil flow of 3,000 b/d in 1991. It's part of a string of oil and gas strikes off Palawan Island that has made the region one of the hottest exploration/development plays in the Asia-Pacific theater.

  10. Combined cycle comes to the Philippines

    SciTech Connect

    1995-03-01

    The first combined cycle power station in the Philippines has gone into operation at National Power Corporation`s (NPC) Limay Bataan site, some 40 km west of Manila. The plant comprises two 300 MW blocks in 3+3+1 configuration, based on ABB Type GT11N gas turbines. It was built by a consortium of ABB, with their Japanese licensee Kawasaki Heavy Industries, and Marubeni Corporation. This paper discusses Philippine power production, design and operation of the Limay Bataan plant, and conversion of an existing turbine of the nuclear plant project that was abandoned earlier, into a combined cycle operation. 6 figs.

  11. Back Pain

    MedlinePlus

    ... Awards Enhancing Diversity Find People About NINDS NINDS Back Pain Information Page Condensed from Low Back Pain Fact ... en Español Additional resources from MedlinePlus What is Back Pain? Acute or short-term low back pain generally ...

  12. Pelvic Pain

    MedlinePlus

    Pelvic pain occurs mostly in the lower abdomen area. The pain might be steady, or it might come and go. If the pain is severe, it might get in the way ... re a woman, you might feel a dull pain during your period. It could also happen during ...

  13. Factors influencing palliative care. Qualitative study of family physicians' practices.

    PubMed Central

    Brown, J. B.; Sangster, M.; Swift, J.

    1998-01-01

    OBJECTIVE: To examine factors that influence family physicians' decisions to practise palliative care. DESIGN: Qualitative method of in-depth interviews. SETTING: Southwestern Ontario. PARTICIPANTS: Family physicians who practise palliative care on a full-time basis, who practise on a part-time basis, or who have retired from active involvement in palliative care. METHOD: Eleven in-depth interviews were conducted to explore factors that influence family physicians' decisions to practise palliative care and factors that sustain their interest in palliative care. All interviews were audiotaped and transcribed verbatim. The analysis strategy used a phenomenological approach and occurred concurrently rather than sequentially. All interview transcriptions were read independently by the researchers, who then compared and combined their analyses. Final analysis involved examining all interviews collectively, thus permitting relationships between and among central themes to emerge. MAIN OUTCOME FINDINGS: The overriding theme was a common philosophy of palliative care focusing on acceptance of death, whole person care, compassion, communication, and teamwork. Participants' philosophies were shaped by their education and by professional and personal experiences. In addition, participants articulated personal and systemic factors currently affecting their practice of palliative care. CONCLUSIONS: Participants observed that primary care physicians should be responsible for their patients' palliative care within the context of interdisciplinary teams. For medical students to be knowledgeable and sensitive to the needs of dying patients, palliative care should be given higher priority in the curriculum. Finally, participants argued compellingly for transferring the philosophy of palliative care to the overall practice of medicine. PMID:9612588

  14. Clinical Management of Pain in Advanced Lung Cancer

    PubMed Central

    Simmons, Claribel P.L.; MacLeod, Nicholas; Laird, Barry J.A.

    2012-01-01

    Lung cancer is the most common cancer in the world and pain is its most common symptom. Pain can be brought about by several different causes including local effects of the tumor, regional or distant spread of the tumor, or from anti-cancer treatment. Patients with lung cancer experience more symptom distress than patients with other types of cancer. Symptoms such as pain may be associated with worsening of other symptoms and may affect quality of life. Pain management adheres to the principles set out by the World Health Organization’s analgesic ladder along with adjuvant analgesics. As pain can be caused by multiple factors, its treatment requires pharmacological and non-pharmacological measures from a multidisciplinary team linked in with specialist palliative pain management. This review article examines pain management in lung cancer. PMID:23115483

  15. How useful are systematic reviews for informing palliative care practice? Survey of 25 Cochrane systematic reviews

    PubMed Central

    Wee, Bee; Hadley, Gina; Derry, Sheena

    2008-01-01

    Background In contemporary medical research, randomised controlled trials are seen as the gold standard for establishing treatment effects where it is ethical and practical to conduct them. In palliative care such trials are often impractical, unethical, or extremely difficult, with multiple methodological problems. We review the utility of Cochrane reviews in informing palliative care practice. Methods Published reviews in palliative care registered with the Cochrane Pain, Palliative and Supportive Care Group as of December 2007 were obtained from the Cochrane Database of Systematic Reviews, issue 1, 2008. We reviewed the quality and quantity of primary studies available for each review, assessed the quality of the review process, and judged the strength of the evidence presented. There was no prior intention to perform any statistical analyses. Results 25 published systematic reviews were identified. Numbers of included trials ranged from none to 54. Within each review, included trials were heterogeneous with respect to patients, interventions, and outcomes, and the number of patients contributing to any single analysis was generally much lower than the total included in the review. A variety of tools were used to assess trial quality; seven reviews did not use this information to exclude low quality studies, weight analyses, or perform sensitivity analysis for effect of low quality. Authors indicated that there were frequently major problems with the primary studies, individually or in aggregate. Our judgment was that the reviewing process was generally good in these reviews, and that conclusions were limited by the number, size, quality and validity of the primary studies. We judged the evidence about 23 of the 25 interventions to be weak. Two reviews had stronger evidence, but with limitations due to methodological heterogeneity or definition of outcomes. No review provided strong evidence of no effect. Conclusion Cochrane reviews in palliative care are well

  16. Custom Ocular Prosthesis: A Palliative Approach

    PubMed Central

    Thakkar, Prachi; Patel, JR; Sethuraman, Rajesh; Nirmal, Narendra

    2012-01-01

    The goal of palliative care is the achievement of the best quality of life for patients and their families. Eyes are generally the first features of the face to be noticed. Loss of an eye is a traumatic event which has a crippling effect on the psychology of the patient. Several ocular and orbital disorders require surgical intervention that may result in ocular defects. An ocular prosthesis is fabricated to restore the structure, function, and cosmetics of the defects created by such conditions. Although an implant eye prosthesis has a superior outcome, due to economic factors it may not be a feasible option for all patients. Therefore, a custom-made ocular prosthesis is a good alternative. This case report presents a palliative treatment for a patient with an enucleated eye by fabricating a custom ocular prosthesis which improved his psychological, physical, social, functional, emotional and spiritual needs. PMID:22837616

  17. Palliative care in COPD: an unmet area for quality improvement.

    PubMed

    Vermylen, Julia H; Szmuilowicz, Eytan; Kalhan, Ravi

    2015-01-01

    COPD is a leading cause of morbidity and mortality worldwide. Patients suffer from refractory breathlessness, unrecognized anxiety and depression, and decreased quality of life. Palliative care improves symptom management, patient reported health-related quality of life, cost savings, and mortality though the majority of patients with COPD die without access to palliative care. There are many barriers to providing palliative care to patients with COPD including the difficulty in prognosticating a patient's course causing referrals to occur late in a patient's disease. Additionally, physicians avoid conversations about advance care planning due to unique communication barriers present with patients with COPD. Lastly, many health systems are not set up to provide trained palliative care physicians to patients with chronic disease including COPD. This review analyzes the above challenges, the available data regarding palliative care applied to the COPD population, and proposes an alternative approach to address the unmet needs of patients with COPD with proactive primary palliative care. PMID:26345486

  18. The Role of Psychology in Pediatric Palliative Care.

    PubMed

    Edlynn, Emily; Kaur, Harpreet

    2016-07-01

    Pediatric medicine increasingly has recognized the value of integrating behavioral health in medical care, but this trend has not yet extended to pediatric palliative care. Results from a recent survey of pediatric palliative care programs across the United States indicate that team composition almost never included a psychologist. This article presents a model of collaborative care to optimize the integration of psychosocial and medical aspects of treatment in pediatric palliative care, delineating how a psychologist adds to this model. This article argues that psychology brings specialized skills in assessment, intervention, and research that fit with the premise of palliative care as a holistic approach that relieves symptoms. Systematic inclusion of psychologists on pediatric palliative care teams may help to improve effectiveness of services as well as extend the knowledge base of mental health in pediatric palliative care. PMID:27008276

  19. Geothermal developments in the Philippines, 1980

    SciTech Connect

    Finn, D.F.X.

    1980-09-01

    The Philippines installed a 3MW geothermal in 1977, 55 MW in 1978, and 165 MW in 1979 and proposes to install 223 MW during 1980 to bring it's total installed geothermal generating capacity to 446 MW. An additional 223 MW geothermal has been proven and a goal of 1261 MW has been set for 1989 from eight geothermal fields.

  20. OUTLINE OF VOCATIONAL TRAINING IN THE PHILIPPINES.

    ERIC Educational Resources Information Center

    Australian Dept. of Labour and National Service, Perth.

    THE PHILIPPINES HAVE A POPULATION OF 32 MILLION OF WHICH 60 PERCENT ARE ENGAGED IN AGRICULTURE. RECENT ECONOMIC DEVELOPMENT HAS INVOLVED INCREASING STABILITY TO PROVIDE A BASIS FOR GROWTH. THE EDUCATION SYSTEM IS BASED ON A 6-YEAR ELEMENTARY AND A 4-YEAR SECONDARY SCHOOL COURSE. SECONDARY EDUCATION IS PROVIDED AT EITHER A GENERAL SCHOOL OR A…

  1. Ethnicity and Education in the Philippines.

    ERIC Educational Resources Information Center

    Sharma, C. L.

    The population of the Republic of the Philippines is largely composed of common racial stock except for a small minority of ethnic Chinese. Ethnic differences are largely on the basis of language and religion. Over 90 percent of the people are Christians, mostly Roman Catholics, approximately 5 percent are Muslims, and the remainder adhere to the…

  2. Outbreak of Henipavirus Infection, Philippines, 2014

    PubMed Central

    Ching, Paola Katrina G.; de los Reyes, Vikki Carr; Sucaldito, Maria Nemia; Tayag, Enrique; Columna-Vingno, Alah Baby; Malbas, Fedelino F.; Bolo, Gilbert C.; Sejvar, James J.; Eagles, Debbie; Playford, Geoffrey; Dueger, Erica; Kaku, Yoshihiro; Morikawa, Shigeru; Kuroda, Makoto; Marsh, Glenn A.; McCullough, Sam

    2015-01-01

    During 2014, henipavirus infection caused severe illness among humans and horses in southern Philippines; fatality rates among humans were high. Horse-to-human and human-to-human transmission occurred. The most likely source of horse infection was fruit bats. Ongoing surveillance is needed for rapid diagnosis, risk factor investigation, control measure implementation, and further virus characterization. PMID:25626011

  3. Philippines: Asia Pacific energy series: Country report

    SciTech Connect

    Hoffman, S.

    1988-11-01

    The purpose of this report is to present an overview of Philippines energy planning and policy and to analyze its energy resources and economic developments. Geography, population, geothermal reserves, coal, oil industry, electricity, and renewable energy are the major topics included in the report. A chapter is focused on national economy and energy policy. 40 tabs., 2 figs.

  4. Hiligaynon Lessons. PALI Language Texts: Philippines.

    ERIC Educational Resources Information Center

    Motus, Cecile L.

    A collection of 54 lessons in Hiligaynon, one of the major languages of the Philippines, is divided into 12 units, each lesson intended for about 4 to 5 hours of classroom instruction. A brief grammar summary introduces each unit. A structural content note begins each lesson within the units, followed by microdialogues (two to four lines)…

  5. Game Theory, People Power and Philippine Politics.

    ERIC Educational Resources Information Center

    Lee-Chua, Queena N.

    2000-01-01

    Delineates two illustrative game-theoretic applications to Philippine politics: (1) People Power Revolution in the mid-1980s and (2) conflict over Spratly Islands in the mid-1990s. Uses zero-sum games to model these two events, and elementary matrix theory to determine pure strategies and locate equilibrium points. Includes recommendations for…

  6. Renewing Elementary Science in the Philippines

    ERIC Educational Resources Information Center

    Hernandez, Dolores F.

    1978-01-01

    Describes the elementary science curriculum reform movement in the Philippines. Whereas past textbooks were adaptations of U.S. texts, the second generation textbooks are more in keeping with Philippino needs. Structure of discipline is now stressed less than society's needs. Population, conservation, health and sanitation, green revolution, and…

  7. People of Philippines: Building Bridges of Understanding.

    ERIC Educational Resources Information Center

    Brigham Young Univ., Provo, UT. Language Research Center.

    The purpose of this communication learning aid is to help Americans become more effective in understanding and communicating with people of another culture. This publication discusses some differences encountered in the Philippines in such things as food, laws, customs, religion, language, dress and basic attitudes. It is designed to prepare the…

  8. Situation Report [--Fiji, Indonesia, Israel, and Philippines].

    ERIC Educational Resources Information Center

    International Planned Parenthood Federation, London (England).

    This is a series of four situation reports prepared by the International Planned Parenthood Federation for informational and consultative purposes. The countries reported on are Fiji, Indonesia, Israel, and the Philippines. Some of the latest statistical figures for each country are listed. They are area, population and growth rate, birth, death,…

  9. Researching English in the Philippines: Bibliographical Resources

    ERIC Educational Resources Information Center

    Bautista, Ma. Lourdes S.

    2004-01-01

    The academic literature on issues related to the Philippine English language and literature is substantial. This bibliography surveys relevant work on such related fields as the sociology of language and language planning, Bilingualism, bilingual education, and languages in education, language attitudes, code-switching and code-mixing, Philippine…

  10. Wind Energy Resource Atlas of the Philippines

    SciTech Connect

    Elliott, D.; Schwartz, M.; George, R.; Haymes, S.; Heimiller, D.; Scott, G.; McCarthy, E.

    2001-03-06

    This report contains the results of a wind resource analysis and mapping study for the Philippine archipelago. The study's objective was to identify potential wind resource areas and quantify the value of those resources within those areas. The wind resource maps and other wind resource characteristic information will be used to identify prospective areas for wind-energy applications.

  11. Philippines Wind Energy Resource Atlas Development

    SciTech Connect

    Elliott, D.

    2000-11-29

    This paper describes the creation of a comprehensive wind energy resource atlas for the Philippines. The atlas was created to facilitate the rapid identification of good wind resource areas and understanding of the salient wind characteristics. Detailed wind resource maps were generated for the entire country using an advanced wind mapping technique and innovative assessment methods recently developed at the National Renewable Energy Laboratory.

  12. Philippine Astronomy Convention 2009 Abstract: IYA 2009

    NASA Astrophysics Data System (ADS)

    Divinagracia, P. P.

    2009-03-01

    The International Year of Astronomy 2009 is a global effort initiated by the International Astronomical Union (IAU) and the United Nations Educational, Scientific and Cultural Organization (UNESCO) to help the citizens of the world rediscover their place in the Universe through the day and nighttime sky and, thereby, engage a personal sense of wonder and discovery. The vision of the IYA celebration is for everyone to realize the impact of astronomy and other fundamental sciences on our daily lives, and understand how scientific knowledge can contribute to a more equitable and peaceful society. Various global projects were initiated to help achieve the goals of the IYA 2009. An opening ceremony was held last January 15 to 16, 2009 at the UNESCO Headquarters at Paris, France to mark the beginning of the IYA celebrations. Attendance for the said ceremony was by invitation only. In the Philippines, Dr. Cynthia Celebre, Chief of the Space Sciences and Astronomy Section of the Philippine Atmospheric, Geophysical and Astronomical Services Administration, and the Single Point of Contact in the Philippines for the IYA, and I, as the student representative of the Philippines, were invited to attend the opening ceremony. We also participated in a symposium with the theme "The Role of Astronomy in Society and Culture" which was also held at the UNESCO Headquarters at Paris, France last January 19 to 23 this year.

  13. Palliative Care: Increasing the quality of life for patients and families… | NIH MedlinePlus the Magazine

    MedlinePlus

    ... this page please turn JavaScript on. Feature: Palliative Care Palliative Care: Increasing the quality of life for patients and ... Past Issues / Spring 2014 Table of Contents Palliative Care: Conversations Matter™ for Sick Children "Palliative Care: Conversations ...

  14. [Palliative care needs in advanced chronic illness].

    PubMed

    Tripodoro, Vilma A; Rynkiewicz, María C; Llanos, Victoria; Padova, Susana; De Lellis, Silvina; De Simone, Gustavo

    2016-01-01

    About 75% of population will die from one or more chronic progressive diseases. From this projection WHO urged countries to devise strategies for strengthening palliative treatment as part of comprehensive care. In Catalonia, Spain, direct measurement of the prevalence of these patients with NECPAL CCOMS-ICO© tool was 1.5% of the population. This tool is an indicative, not dichotomous, quali-quantitative multifactorial evaluation to be completed by the treating physician. In Argentina there is no information on these patients. Our goal was to explore and characterize the proportion of chronically ill patients in palliative care needs, by NECPAL CCOMS-ICO© tool, in an accessible population of the City of Buenos Aires. General hospitals of the Health Region 2 (Piñero, álvarez and Santojanni) and its program areas were surveyed. In Health Region 1, we surveyed the Udaondo gastroenterology hospital. A total of 53 physicians (704 patients) were interviewed. It was identified that 29.5% of these patients were affected by advanced chronic diseases; 72.1% of them were NECPAL positive, younger (median 64) than in others studies, and more than 98% presented high levels of comorbidity. Palliative care demand (31.4%) and needs (52.7%) were recorded. Specific indicators of fragility, progression, severity and kind of chronic disease were described. The main finding was to identify, with an instrument not based on mortality that, in Buenos Aires City, 1 in 3 patients with chronic diseases could die in the next year and had palliative care needs. PMID:27295702

  15. Using Skype to support palliative care surveillance.

    PubMed

    Jones, Jacqueline

    2014-02-01

    The aim of this article is to demonstrate how a novel yet important tool can facilitate family involvement in person-centred care, despite geographical distance. The author presents a case study as an in-depth example of the use of Skype in the context of palliative care at home. Skype enhanced family surveillance and symptom management, augmented shared decision making, provided a space for virtual bedside vigil, and ultimately provided the rapport necessary for optimal end of life care. PMID:24471549

  16. Is Response to Radiotherapy in Patients Related to the Severity of Pretreatment Pain?

    SciTech Connect

    Kirou-Mauro, Andrea; Hird, Amanda; Wong, Jennifer; Sinclair, Emily; Barnes, Elizabeth A.; Tsao, May; Danjoux, Cyril; Chow, Edward

    2008-07-15

    Purpose: The primary objective of this study was to determine whether there is a relationship between the severity of pretreatment pain and response to palliative radiotherapy (RT) for painful bone metastases. Methods and Materials: The database for patients with bone metastases seen at the Rapid Response Radiotherapy Program at the Odette Cancer Center from 1999 to 2006 was analyzed. The proportion of patients with mild (scores 1-4), moderate (scores 5-6), or severe (scores 7-10) pain at baseline who experienced a complete response, partial response, stable response, or progressive response after palliative RT was determined according to International Bone Metastases Consensus definitions. Results: During the 7-year study period 1,053 patients received palliative radiation for bone metastases. The median age was 68 years and the median Karnofsky performance status was 70. Of the patients, 53% had a complete or partial response at 1 month, 52% at 2 months, and 54% at 3 months post-RT. Conclusions: There was no significant difference in terms of the proportion of responders (patients with complete or partial response) and nonresponders in terms of painful bone metastases among patients presenting with mild, moderate, or severe pain. Patients with moderate pain should be referred for palliative RT.

  17. Palliative Care Eases Symptoms, Enhances Lives | NIH MedlinePlus the Magazine

    MedlinePlus

    ... of this page please turn JavaScript on. Feature: Palliative Care Palliative Care Eases Symptoms, Enhances Lives Past Issues / Spring 2014 ... pharmacists, nutritionists, and others. When do I need palliative care? Many adults and children living with serious diseases ...

  18. How to Get It -- Step 2: Meet the Palliative Care Team

    MedlinePlus

    ... the Quiz Step 3: Meet the Palliative Care Team The palliative care team will spend a lot ... learn more about palliative care? Clinician Corner: The Importance of the Family Meeting Access the Provider Directory ...

  19. Palliative care for patients with non-malignant respiratory disease.

    PubMed

    McVeigh, Clare

    2015-05-01

    Non-malignant respiratory disease is a chronic life-limiting condition that requires holistic palliative care. Patients with non-malignant respiratory disease have a range of biopsychosocial and spiritual needs, which healthcare professionals should recognise and manage effectively. Healthcare professionals have an important role in enabling the delivery of effective palliative care to this group of patients and their carers, and in recognising the many factors that may impede delivery of palliative care. PMID:25942985

  20. Metronomic palliative chemotherapy in maxillary sinus tumor

    PubMed Central

    Patil, Vijay M.; Noronh, Vanita; Joshi, Amit; Karpe, Ashay; Talreja, Vikas; Chandrasekharan, Arun; Dhumal, Sachin; Prabhash, Kumar

    2016-01-01

    Background: Metronomic chemotherapy consisting of methotrexate and celecoxib recently has shown promising results in multiple studies in head and neck cancers. However, these studies have not included patients with maxillary sinus primaries. Hence, the role of palliative metronomic chemotherapy in patients with maxillary sinus carcinoma that is not amenable to radical therapy is unknown. Methods: This was a retrospective analysis of carcinoma maxillary sinus patients who received palliative metronomic chemotherapy between August 2011 and August 2014. The demographic details, symptomatology, previous treatment details, indication for palliative chemotherapy, response to therapy, and overall survival (OS) details were extracted. SPSS version 16 was used for analysis. Descriptive statistics have been performed. Survival analysis was done by Kaplan–Meier method. Results: Five patients had received metronomic chemotherapy. The median age was 60 years (range 37–64 years). The proportion of patients surviving at 6 months, 12 months, and 18 months were 40%, 40%, and 20%, respectively. The estimated median OS was 126 days (95% confidence interval 0–299.9 days). The estimated median survival in patients with an event-free period after the last therapy of <6 months was 45 days, whereas it was 409 days in patients with an event-free period postlast therapy above 6 months (P = 0.063). Conclusion: Metronomic chemotherapy in carcinoma maxillary sinus holds promise. It has activity similar to that seen in head and neck cancers and needs to be evaluated further in a larger cohort of patients.

  1. [Implementation of palliative care in Ivory Coast].

    PubMed

    Coulibaly, J Didi-Kouko; Datie, A-M; Binlin-Dadie, R; Kouame, I; N'guessan, Zc; Barouan, M-C; Koffi, E; Coulibaly, I; Mensah, J; Yenou, H Memain; Dedomey, E; Echimane, Ka; Plo, Kj; Kouassi, B

    2009-05-01

    Ivory Coast adhered to the strategy of the primary cares of health whose leading principles served basis to the definition of the National politics of sanitary development, exposed in the National plan of sanitary development 1996-2005. The improvement of the quality of the cares is the main objective of this plan. The attack of this objective cannot make itself without the hold in account of the palliative cares that are a component of the cares for the patients affected by chronic and incurable affections, since the diagnosis until the death and even after the death. Conscious of the necessity to develop the palliative cares to improve the quality of life of the patients and their families, the ministry in charge of health, in collaboration with the partners to the development, initiated a project of development of the palliative care in Ivory Coast. It is about an innovating gait in Ivory Coast concerning politics of health. This work has for goal to present the big lines and the setting in which this politics has been put in place. PMID:19423486

  2. The oncological patient in the palliative situation.

    PubMed

    Eychmueller, Steffen; Zwahlen, Diana; Fliedner, Monica

    2014-01-01

    Palliative care approaches the patient and his or her suffering with a biopsychosocial-spiritual model. Thus, it is the strength of palliative care to complement the diagnosis driven approach of medical cancer care by a problem and resources-based assessment, participatory care plan, and patient-directed interventions. Interventions need to reflect timely prognosis, target population (the patient, the family carer, the professional), and level of trust and remaining energy. In palliative care the relevance of psycho-oncological aspects in the care of the terminally ill is considerable in the understanding of the overall suffering of patients approaching death and their loved ones and in their care and support. There is little evidence to date in terms of clinical benefit of specific psycho-oncological interventions in the last months or weeks of life, but there is evidence on effects of stress reduction and reduced anxiety if locus of control can stay within the patient as long as possible. One major difficulty in psychosocial research at the end-of-life, however, is defining patient relevant outcomes. PMID:24305769

  3. Public higher education in the Philippines

    NASA Astrophysics Data System (ADS)

    Cardozier, V. R.

    1984-06-01

    Clearly, the national government of the Philippines has decided to increase the number and comprehensiveness of its public colleges and universities. While private colleges and universities are likely to dominate higher education in the Philippines for the remainer of this century, it appears that public, tax-supported higher education will become increasingly available there. The Philippines is not a wealthy country but it is devoting a substantial portion of its national resources to public higher education. In 1983, higher education received 2.85 percent of the national budget, a figure that has been rising for years. Compared with some highly developed countries, this is not a large percentage, but for a country that has traditionally relied on private higher education, it is a major and growing investment in the public sector. While many of the better universities in the Philippines are private, many other private educational institutions are small and struggling. As their financial resources become more limited, and as less expensive, tax-supported higher education becomes increasingly available, a lot of the struggling private colleges will probably close. This process is also being hastened by actions of the government to upgrade quality, for example in the case of the many private colleges that developed after World War II. In an attempt to improve the academic quality of these marginal institutions, the Ministry of Education, Culture and Sports has been given extensive authority, and while its intrusion into private institutions has been modest by some measures, its requirements are affecting them all and will speed the demise of some. This is bound to lead to a stronger role for public higher education in the Philippines, a country that is striving diligently to improve the education and hence the quality of life of its people.

  4. Palliative care and neurology: time for a paradigm shift.

    PubMed

    Boersma, Isabel; Miyasaki, Janis; Kutner, Jean; Kluger, Benzi

    2014-08-01

    Palliative care is an approach to the care of patients and families facing progressive and chronic illnesses that focuses on the relief of suffering due to physical symptoms, psychosocial issues, and spiritual distress. As neurologists care for patients with chronic, progressive, life-limiting, and disabling conditions, it is important that they understand and learn to apply the principles of palliative medicine. In this article, we aim to provide a practical starting point in palliative medicine for neurologists by answering the following questions: (1) What is palliative care and what is hospice care? (2) What are the palliative care needs of neurology patients? (3) Do neurology patients have unique palliative care needs? and (4) How can palliative care be integrated into neurology practice? We cover several fundamental palliative care skills relevant to neurologists, including communication of bad news, symptom assessment and management, advance care planning, caregiver assessment, and appropriate referral to hospice and other palliative care services. We conclude by suggesting areas for future educational efforts and research. PMID:24991027

  5. Pain in the cancer patient: different pain characteristics CHANGE pharmacological treatment requirements.

    PubMed

    Müller-Schwefe, Gerhard; Ahlbeck, Karsten; Aldington, Dominic; Alon, Eli; Coaccioli, Stefano; Coluzzi, Flaminia; Huygen, Frank; Jaksch, Wolfgang; Kalso, Eija; Kocot-Kępska, Magdalena; Kress, Hans-Georg; Mangas, Ana Cristina; Ferri, Cesar Margarit; Morlion, Bart; Nicolaou, Andrew; Hernández, Concepción Pérez; Pergolizzi, Joseph; Schäfer, Michael; Sichère, Patrick

    2014-09-01

    Twenty years ago, the main barriers to successful cancer pain management were poor assessment by physicians, and patients' reluctance to report pain and take opioids. Those barriers are almost exactly the same today. Cancer pain remains under-treated; in Europe, almost three-quarters of cancer patients experience pain, and almost a quarter of those with moderate to severe pain do not receive any analgesic medication. Yet it has been suggested that pain management could be improved simply by ensuring that every consultation includes the patient's rating of pain, that the physician pays attention to this rating, and a plan is agreed to increase analgesia when it is inadequate. After outlining current concepts of carcinogenesis in some detail, this paper describes different methods of classifying and diagnosing cancer pain and the extent of current under-treatment. Key points are made regarding cancer pain management. Firstly, the pain may be caused by multiple different mechanisms and therapy should reflect those underlying mechanisms - rather than being simply based on pain intensity as recommended by the WHO three-step ladder. Secondly, a multidisciplinary approach is required which combines both pharmacological and non-pharmacological treatment, such as psychotherapy, exercise therapy and electrostimulation. The choice of analgesic agent and its route of administration are considered, along with various interventional procedures and the requirements of palliative care. Special attention is paid to the treatment of breakthrough pain (particularly with fast-acting fentanyl formulations, which have pharmacokinetic profiles that closely match those of breakthrough pain episodes) and chemotherapy-induced neuropathic pain, which affects around one third of patients who receive chemotherapy. Finally, the point is made that medical education should place a greater emphasis on pain therapy, both at undergraduate and postgraduate level. PMID:24841174

  6. Developing the Cambridge palliative audit schedule (CAMPAS): a palliative care audit for primary health care teams.

    PubMed Central

    Rogers, M S; Barclay, S I; Todd, C J

    1998-01-01

    BACKGROUND: Problems with the provision of palliative care have been reported. Audit is one means of improving care. Earlier audits of primary care palliative care have been initiated by general practitioners (GPs) and are predominantly retrospective record reviews. Widely applicable methods for the audit of primary care palliative care do not exist. AIM: To develop relevant palliative care standards and to devise an audit schedule (the Cambridge palliative audit schedule, CAMPAS) suitable for monitoring palliative care in diverse primary care settings. METHOD: Primary health care team (PHCT) members collaborated at all stages. Reasonable outcomes and acceptable interventions for PHCTs were identified and standards developed. Each standard was constructed to ensure uniform interpretation, and CAMPAS was structured to collect data necessary for determining whether the standards were met. RESULTS: Over 50% of PHCTs (n = 20) in the health district were recruited and trained to use CAMPAS. A total of 876 contacts with 29 patients was recorded by PHCTs using CAMPAS. Considerable inter- and intra-PHCT variation was found in the achievement of the standards. CONCLUSIONS: The favourable participation rate suggests commitment to audit and improvement in patient care. Overall, the standards were reported to be suitable. Although 100% achievement of some standards may be unrealistic, the level of attainment for many suggests that it is possible. CAMPAS has been reported to be a useful structure for recording assessments and monitoring care, as well as a usable audit schedule. As an audit tool, it identified areas in need of improvement and facilitated feed-back to participants. Future audit is required to determine whether improvements in care have been effected. PMID:9692279

  7. Palliative Treatment of Rectal Carcinoma Recurrence Using Radiofrequency Ablation

    SciTech Connect

    Mylona, Sophia Karagiannis, Georgios Patsoura, Sofia; Galani, Panagiota; Pomoni, Maria; Thanos, Loukas

    2012-08-15

    Purpose: To evaluate the safety and efficacy of CT-guided radiofrequency (RF) ablation for the palliative treatment of recurrent unresectable rectal tumors. Materials and Methods: Twenty-seven patients with locally recurrent rectal cancer were treated with computed tomography (CT)-guided RF ablation. Therapy was performed with the patient under conscious sedation with a seven- or a nine-array expandable RF electrode for 8-10 min at 80-110 Degree-Sign C and a power of 90-110 W. All patients went home under instructions the next day of the procedure. Brief Pain Inventory score was calculated before and after (1 day, 1 week, 1 month, 3 months, and 6 months) treatment. Results: Complete tumor necrosis rate was 77.8% (21 of a total 27 procedures) despite lesion location. BPI score was dramatically decreased after the procedure. The mean preprocedure BPI score was 6.59, which decreased to 3.15, 1.15, and 0.11 at postprocedure day 1, week 1, and month 1, respectively, after the procedure. This decrease was significant (p < 0.01 for the first day and p < 0.001 for the rest of the follow-up intervals (paired Student t test; n - 1 = 26) for all periods during follow-up. Six patients had partial tumor necrosis, and we were attempted to them with a second procedure. Although the necrosis area showed a radiographic increase, no complete necrosis was achieved (secondary success rate 65.6%). No immediate or delayed complications were observed. Conclusion: CT-guided RF ablation is a minimally invasive, safe, and highly effective technique for treatment of malignant rectal recurrence. The method is well tolerated by patients, and pain relief is quickly achieved.

  8. Development and Psychometric Assessment of a Spirituality Questionnaire for Indian Palliative Care Patients

    PubMed Central

    Bhatnagar, Sushma; Noble, Simon; Chaturvedi, Santosh K; Gielen, Joris

    2016-01-01

    Introduction: There are only a few studies on spirituality among palliative care patients in India. This gap in research may be caused by the absence of relevant questionnaires and scales specifically designed for Indian palliative care populations. In this study, we describe the development of such a questionnaire and explain its psychometric characteristics. Methods: We designed a questionnaire on the basis of a systematic review of the literature. After a review of the questionnaire by specialists and a subsequent pilot study, the questionnaire was amended. The final questionnaire consisted of a list of 36 spirituality items. It was administered to a sample of 300 cancer patients attending the pain clinic of a tertiary hospital in New Delhi. Results: A factor analysis led to four factors explaining 54.6% of variance: Shifting moral and religious values (Factor 1), support from religious relationship (Factor 2), existential blame (Factor 3), and spiritual trust (Factor 4). The skewness and kurtosis for Factors 1, 3, and 4 were within a tolerable range for assuming a normal distribution, but Factor 2 was skewed. The alphas showed that the four factors have an acceptable internal consistency. Statistically significant associations were observed for age and Factor 3 (P = 0.004), gender and Factor 4 (P = 0.014), marital status and Factors 3 (P = 0.002) and 4 (P = 0.001), educational level and Factors 3 (P < 0.001) and 4 (P < 0.001), and pain scores and Factors 1 (P < 0.001), 2 (P < 0.001), and 3 (P = 0.001). Conclusion: The questionnaire offers promising prospects for the study of spirituality among palliative care patients in India. PMID:26962275

  9. Quality-of-Life Assessment After Palliative Interventions to Manage Malignant Ureteral Obstruction

    SciTech Connect

    Monsky, Wayne Laurence; Molloy, Chris; Jin, Bedro; Nolan, Timothy; Fernando, Dayantha; Loh, Shaun; Li, Chin-Shang

    2013-10-15

    Purpose: Malignancies may cause urinary tract obstruction, which is often relieved with placement of a percutaneous nephrostomy tube, an internal double J nephro-ureteric stent (double J), or an internal external nephroureteral stent (NUS). We evaluated the affect of these palliative interventions on quality of life (QoL) using previously validated surveys. Methods: Forty-six patients with malignancy related ureteral obstruction received nephrostomy tubes (n = 16), double J stents (n = 15), or NUS (n = 15) as determined by a multidisciplinary team. QoL surveys were administered at 7, 30, and 90 days after the palliative procedure to evaluate symptoms and physical, social, functional, and emotional well-being. Number of related procedures, fluoroscopy time, and complications were documented. Kruskal-Wallis and Friedman's test were used to compare patients at 7, 30, and 90 days. Spearman's rank correlation coefficient was used to assess correlations between clinical outcomes/symptoms and QoL. Results: Responses to QoL surveys were not significantly different for patients receiving nephrostomies, double J stents, or NUS at 7, 30, or 90 days. At 30 and 90 days there were significantly higher reported urinary symptoms and pain in those receiving double J stents compared with nephrostomies (P = 0.0035 and P = 0.0189, respectively). Significantly greater fluoroscopy time was needed for double J stent-related procedures (P = 0.0054). Nephrostomy tubes were associated with more frequent minor complications requiring additional changes. Conclusion: QoL was not significantly different. However, a greater incidence of pain in those receiving double J stents and more frequent tube changes in those with nephrostomy tubes should be considered when choosing palliative approaches.

  10. Clinical Effectiveness of Online Training in Palliative Care of Primary Care Physicians

    PubMed Central

    Perez-Hoyos, Santiago; Agra-Varela, Yolanda

    2013-01-01

    Abstract Background Primary care physicians (PCPs) have a major responsibility in the management of palliative patients. Online palliative care (PC) education has not been shown to have a clinical impact on patients that is equal or different to traditional training. Objective This study tested the clinical effectiveness of online PC education of physicians through impact on symptom control, quality of life (QOL), caregiver satisfaction, and knowledge-attitude of physicians at 18 months of the intervention. Methods We conducted a randomized clinical trial. Subjects were 169 physicians randomly assigned to receive the online model or traditional training. Consecutive patients with advanced cancer requiring PC were included. Physicians and patients completed the Palliative Care Outcome Scale (POS), and patients the Brief Pain Inventory (BPI) and the Rotterdam Symptom Checklist (RSCL) twice, 7 to 10 days apart. Caregivers completed the SERVQUAL. Physicians' level of knowledge-attitude was measured at 18 months. Results Sixty-seven physicians enrolled 117 patients. The intervention group had reduced scores for pain, symptoms, and family anxiety. The global RSCL scale showed a difference between groups. There was no significant difference in the questionnaires used. Caregiver satisfaction was comparable between groups. Physicians in the intervention group significantly increased their knowledge without any differences in attitude. Online training was completed by 86.6% in the intervention group, whereas 13.4% in the control group accessed traditional training. Conclusions Participation in an online PC education program by PCPs improved patient scores for some symptoms and family anxiety on the POS and also showed improved global QOL. Significant differences were found in physicians' knowledge at short and long term. PMID:23987657

  11. Presenting symptoms and signs in children referred for palliative care in Malawi.

    PubMed

    Lavy, Vicky

    2007-06-01

    A study of 95 children referred for palliative care was carried out at Queen Elizabeth Central Hospital in southern Malawi, to determine the prevalence of different symptoms and signs. Seventy-seven percent of the children had HIV, 17% had cancer and 6% had a variety of other diagnoses. The commonest symptoms spontaneously presented by patients and carers were pain (27%) cough (22%) and diarrhoea (18%). Pain was significantly more common among children with cancer than those with HIV/AIDS. Cough, diarrhoea and mouth sores were significantly more common in those with HIV/AIDS. Many symptoms were not volunteered initially, but were revealed on direct questioning. This uncovered that 84% had a history of weight loss, 56% had fever and 51% had mouth sores. The commonest physical signs were wasting (76%), lymphadenopathy (40%) and oral candida (40%). Forty-seven percent of children with HIV had either lost their mother or had a mother who was sick. The wide range of physical symptoms and frequency of sickness or death in the children's mothers demonstrates the need for palliative care to be holistic, addressing the manifold physical, emotional and social problems associated with chronic and terminal illness. PMID:17656410

  12. Integrating Palliative Care Into the Care of Patients With Advanced Lung Cancer.

    PubMed

    Kapo, Jennifer M; Akgün, Kathleen M

    2015-01-01

    Lung cancer is the leading cause of death due to malignancy. Although lung cancer mortality has been decreasing in recent years, it remains substantially higher than other causes of cancer death. Median survival for patients with locally advanced non-small cell lung cancer, defined as lung cancer involving regional lymph nodes, is estimated to be approximately 10 to 17 months, and median survival for patients with metastatic disease is only 6 to 9 months. In addition, patients with advanced lung cancer often experience debilitating symptoms and poor quality of life. Pain, dyspnea, and fatigue are most frequently reported and affect at least 65% of patients with advanced lung cancer. Given this burden of symptoms and high mortality, patients and their families facing a diagnosis of advanced lung cancer are in need of support. Palliative care, with its focus on addressing the emotional, physical, and spiritual sources of suffering utilizing the expertise of an interdisciplinary team, can provide this comprehensive support. This review describes the role of supportive and palliative care integrated into the treatment of patients with a diagnosis of advanced lung cancer with sections focused on the evaluation and treatment of pain and dyspnea, approaches to challenging communication tasks, and the support of caregivers who care for patients with advanced lung cancer. PMID:26389769

  13. The increasing use of reiki as a complementary therapy in specialist palliative care.

    PubMed

    Burden, Barbara; Herron-Marx, Sandy; Clifford, Collette

    2005-05-01

    Palliative medicine and complementary therapies (CTs) have developed within the NHS as parallel philosophies of care. As a result, the last decade has seen an increase in the integration and usage of CTs, as adjunct therapies to conventional medical treatment. Documented benefits of relaxation, decreased perception of pain, reduced anxiety and improved sense of wellbeing have been shown to enable an enhanced quality of life, where curative treatment is no longer an option. Reiki is a more recent addition to the range of CTs available to cancer patients. As an energy-healing intervention it has gained in popularity as a non-invasive and non-pharmacological approach. Anecdotal evidence suggests that the profound relaxation effect has a positive impact on alleviating anxiety, stress, perception of pain and promotes a feeling of wellbeing particularly relating to the nature of psychospiritual wellbeing. However, there is very little evidence to support its application within clinical practice, and none within the specific field of specialist palliative care (SPC). This article will consider the position of reiki as an emerging CT within SPC. The function of the hospice movement, the role of CTs together with an understanding of energy healing will also be explored. Within this context, the rise in popularity of reiki and its potential benefits for SPC patients will be discussed. These considerations will then form the basis of the justification for further research in SPC. PMID:15944500

  14. Acute pain.

    PubMed

    Good, M

    1999-01-01

    The review of acute pain describes the problem of unresolved pain and its effects on the neural, autonomic, and immune systems. Conceptualizations and mechanisms of pain are reviewed as well as theories of pain management. Descriptive studies of patient and nurse factors that inhibit effective pain management are discussed, followed by studies of pharmacological and nonpharmacological interventions. Critical analysis reveals that most studies were atheoretical, and therefore, this proliferation of information lacked conceptual coherence and organization. Furthermore, the nature and extent of barriers to pain management were described, but few intervention studies have been devised, as yet, to modify the knowledge, beliefs, and attitudes of nurses and patients that are barriers to pain management. Although some of the complementary therapies have sufficient research support to be used in clinical pain management, the physiological mechanisms and outcomes need to be studied. It is critical at this time to design studies of interventions to improve assessment, decision making, attentive care, and patient teaching. PMID:10418655

  15. Abdominal pain

    MedlinePlus

    ... threatening conditions, such as colon cancer or early appendicitis , may only cause mild pain or no pain. ... Food poisoning Stomach flu Other possible causes include: Appendicitis Abdominal aortic aneurysm (bulging and weakening of the ...

  16. Pain Management

    MedlinePlus

    ... the brain played a role in producing the perception of pain. In the 19th century, physician-scientists ... they are experiencing. Discoveries of differences in pain perceptions and responses to treatment by gender has have ...

  17. Penis pain

    MedlinePlus

    ... pain. If penis pain is caused by a sexually transmitted disease, it is important for your sexual partner to ... Are you at risk for exposure to any sexually transmitted diseases? What other symptoms do you have? The physical ...

  18. Breast pain

    MedlinePlus

    Pain - breast; Mastalgia; Mastodynia; Breast tenderness ... There are many possible causes for breast pain. For example, hormone level changes from menstruation or pregnancy often cause breast tenderness. Some swelling and tenderness just before your period ...

  19. Shoulder pain

    MedlinePlus

    ... 4 muscles and their tendons, called the rotator cuff, give the shoulder its wide range of motion. Swelling, damage, or bone changes around the rotator cuff can cause shoulder pain. You may have pain ...

  20. Elbow pain

    MedlinePlus

    Pain - elbow ... Elbow pain can be caused by many problems. A common cause in adults is tendinitis . This is ... injure the tendons on the outside of the elbow. This condition is commonly called tennis elbow . Golfers ...

  1. Ribcage pain

    MedlinePlus

    ... not cause the pain in someone who has pleurisy (swelling of the lining of the lungs) or ... Inflammation of cartilage near the breastbone ( costochondritis ) Osteoporosis Pleurisy (the pain is worse when breathing deeply)

  2. Abdominal pain

    MedlinePlus

    ... water or other clear fluids. You may have sports drinks in small amounts. People with diabetes must ... pain occur? For example, after meals or during menstruation? What makes the pain worse? For example, eating, ...

  3. Back Pain

    MedlinePlus

    ... Oh, my aching back!", you are not alone. Back pain is one of the most common medical problems, ... 10 people at some point during their lives. Back pain can range from a dull, constant ache to ...

  4. Pain Assessment

    MedlinePlus

    ... as a result of the pain, and the nature of other medical and psychiatric problems, should be ... information helps the health care provider understand the nature of the pain or the potential benefits of ...

  5. Finger pain

    MedlinePlus

    Pain - finger ... Nearly everyone has had finger pain at some time. You may have: Tenderness Burning Stiffness Numbness Tingling Coldness Swelling Change in skin color Redness Many conditions, such ...

  6. Chest pain

    MedlinePlus

    ... of pain, including your heart, lungs, esophagus, muscles, ribs, tendons, or nerves. Pain may also spread to ... often occurs with fast breathing Inflammation where the ribs join the breast bone or sternum ( costochondritis ) Shingles , ...

  7. 76 FR 16858 - Proposed Information Collection (Supplemental Income Questionnaire (for Philippine Claims Only...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-25

    ... AFFAIRS Proposed Information Collection (Supplemental Income Questionnaire (for Philippine Claims Only... solicits comments on the information needed to determine Philippine claimants' eligibility for pension.... Title: Supplemental Income Questionnaire (for Philippine Claims Only), VA Form 21-0784. OMB...

  8. 76 FR 33027 - Agency Information Collection (Supplemental Income Questionnaire (For Philippine Claims Only...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-07

    ... AFFAIRS Agency Information Collection (Supplemental Income Questionnaire (For Philippine Claims Only.... 2900-0668.'' SUPPLEMENTARY INFORMATION: Title: Supplemental Income Questionnaire (For Philippine Claims... approved collection. Abstract: Claimants residing in the Philippines complete VA Form 21-0784 to...

  9. Patellofemoral Pain.

    PubMed

    Dutton, Rebecca A; Khadavi, Michael J; Fredericson, Michael

    2016-02-01

    Patellofemoral pain is characterized by insidious onset anterior knee pain that is exaggerated under conditions of increased patellofemoral joint stress. A variety of risk factors may contribute to the development of patellofemoral pain. It is critical that the history and physical examination elucidate those risk factors specific to an individual in order to prescribe an appropriate and customized treatment plan. This article aims to review the epidemiology, risk factors, diagnosis, and management of patellofemoral pain. PMID:26616176

  10. Face pain

    MedlinePlus

    Face pain may be dull and throbbing or an intense, stabbing discomfort in the face or forehead. It can occur in one or ... Pain that starts in the face may be caused by a nerve problem, injury, or infection. Face pain may also begin in other places in the body. ...

  11. The Changing Role of Palliative Care in the ICU

    PubMed Central

    Aslakson, Rebecca A.; Curtis, J. Randall; Nelson, Judith E.

    2015-01-01

    Objectives Palliative care is an interprofessional specialty as well as an approach to care by all clinicians caring for patients with serious and complex illness. Unlike hospice, palliative care is based not on prognosis but on need and is an essential component of comprehensive care for critically ill patients from the time of ICU admission. In this clinically focused article, we review evidence of opportunities to improve palliative care for critically ill adults, summarize strategies for ICU palliative care improvement, and identify resources to support implementation. Data Sources We searched the MEDLINE database from inception through January 2014. We also searched the Reference Library of The Improving Palliative Care in the ICU Project website sponsored by the National Institutes of Health and the Center to Advance Palliative Care, which is updated monthly. We hand-searched reference lists and author files. Study Selection Selected studies included all English-language articles concerning adult patients using the search terms "intensive care" or "critical care" with "palliative care," "supportive care," "end-of-life care," or "ethics." Data Extraction After examination of peer-reviewed original scientific articles, consensus statements, guidelines, and reviews resulting from our literature search, we made final selections based on author consensus. Data Synthesis Existing evidence is organized to address: 1) opportunities to alleviate physical and emotional symptoms, improve communication, and provide support for patients and families; 2) models and specific interventions for improving ICU palliative care; 3) available resources for ICU palliative care improvement; and 4) ongoing challenges and targets for future research. Key domains of ICU palliative care have been defined and operationalized as measures of quality. There is increasing recognition that effective integration of palliative care during acute and chronic critical illness may help patients and

  12. Treatment of acute, severe epigastric/chest pain in a patient with stomach cancer following gastrectomy: A case report

    PubMed Central

    ZAPOROWSKA-STACHOWIAK, IWONA; GORZELIŃSKA, LIDIA; SOPATA, MACIEJ; ŁUCZAK, JACEK

    2015-01-01

    The treatment of acute chest pain can be a challenge in palliative care. Firstly, because acute chest pain is a symptom of a paucity of diseases, which makes diagnosis difficult and time consuming, while there is also a time constraint, due to the extreme suffering of the patient. Secondly, the condition of a patient with advanced cancer disease and co-morbidities does not always allow for required diagnostic procedures. The present report describes a case of acute, severe epigastric/chest pain in a patient with dynamic disease progression, who was receiving palliative care. This study also demonstrates that the pathophysiology of pain in a terminal patient may determine the treatment strategy. The patient in the present case was a 41-year-old male, who had previously undergone gastrectomy for stomach cancer, followed by postoperative chemotherapy. The patient was treated with palliative chemotherapy for metastases to the lungs, liver and lymph nodes, which led to the development of iatrogenic peripheral neuropathy. The patient was subsequently admitted to the Palliative Medicine In-patient Unit of the University Hospital of Lord’s Transfiguration (Poznan, Poland) with the complaint of acute epigastric and chest pain. An electrocardiogram, echocardiogram, chest and abdomen computerized tomography scan, esophagoduodenoscopy and laboratory analyses were performed to determine the source of the pain. The patient was treated with morphine sulfate, metoclopramide, midazolam, diazepam, acetaminophen, ketamine, hyoscine butylbromide, propofol, dexamethasone and amoxycillin, and received parenteral nutrition. As the source of pain remained unclear, a second esophagoduodenoscopy was performed to determine a diagnosis, resulting in pain relief. Thus, in the present case, esophagoduodenoscopy was diagnostic and therapeutic. Furthermore, although the treatment of acute chest pain may be a challenge in palliative care, the present study indicates that pain treatment should be

  13. Temporomandibular pain.

    PubMed

    Prasad, S Raghavendra; Kumar, N Ravi; Shruthi, H R; Kalavathi, S D

    2016-01-01

    Temporomandibular joint pain has various medical and dental etiological factors. The etiology of the temporomandibular joint pain is enigmatic, no single etiological factor is regarded as the cause. Its distribution is also not confined to a single area. This article presents the basic etiologic factors, its epidemiology, distribution of pain, classification of patients and the psychosocial behavior of patients suffering with temporomandibular pain. As overwhelming majority of medical and dental conditions/issues related to etiology of temporomandibular pain in patients have traditionally been presented and interpreted from the clinician's point of view. PMID:27601822

  14. Temporomandibular pain

    PubMed Central

    Prasad, S Raghavendra; Kumar, N Ravi; Shruthi, HR; Kalavathi, SD

    2016-01-01

    Temporomandibular joint pain has various medical and dental etiological factors. The etiology of the temporomandibular joint pain is enigmatic, no single etiological factor is regarded as the cause. Its distribution is also not confined to a single area. This article presents the basic etiologic factors, its epidemiology, distribution of pain, classification of patients and the psychosocial behavior of patients suffering with temporomandibular pain. As overwhelming majority of medical and dental conditions/issues related to etiology of temporomandibular pain in patients have traditionally been presented and interpreted from the clinician's point of view. PMID:27601822

  15. Evidence for the use of Levomepromazine for symptom control in the palliative care setting: a systematic review

    PubMed Central

    2013-01-01

    Background Levomepromazine is an antipsychotic drug that is used clinically for a variety of distressing symptoms in palliative and end-of-life care. We undertook a systematic review based on the question “What is the published evidence for the use of levomepromazine in palliative symptom control?”. Methods To determine the level of evidence for the use of levomepromazine in palliative symptom control, and to discover gaps in evidence, relevant studies were identified using a detailed, multi-step search strategy. Emerging data was then scrutinized using appropriate assessment tools, and the strength of evidence systematically graded in accordance with the Oxford Centre for Evidence-Based Medicine’s ‘levels of evidence’ tool. The electronic databases Medline, Embase, Cochrane, PsychInfo and Ovid Nursing, together with hand-searching and cross-referencing provided the full research platform on which the review is based. Results 33 articles including 9 systematic reviews met the inclusion criteria: 15 on palliative sedation, 8 regarding nausea and three on delirium and restlessness, one on pain and six with other foci. The studies varied greatly in both design and sample size. Levels of evidence ranged from level 2b to level 5, with the majority being level 3 (non-randomized, non-consecutive or cohort studies n = 22), with the quality of reporting for the included studies being only low to medium. Conclusion Levomepromazine is widely used in palliative care as antipsychotic, anxiolytic, antiemetic and sedative drug. However, the supporting evidence is limited to open series and case reports. Thus prospective randomized trials are needed to support evidence-based guidelines. PMID:23331515

  16. Are Undergraduate Nurses Taught Palliative Care during Their Training?

    ERIC Educational Resources Information Center

    Lloyd-Williams, Mari; Field, David

    2002-01-01

    Responses from 46 of 108 nurse educators in the United Kingdom indicated that diploma students received a mean of 7.8 hours and degree students 12.2 hours of palliative care training. Although 82% believed it should be a core component, 67% had difficulty finding qualified teachers. Palliative care knowledge was not formally assessed in most…

  17. Access to palliative medicine training for Canadian family medicine residents.

    PubMed

    Oneschuk, D; Bruera, E

    1998-01-01

    The authors conducted a nine-item mail questionnaire of the 16 Canadian family medicine teaching programme directors to determine the accessibility and operation of palliative care education for their respective family medicine residents. All 16 faculties of medicine responded (100%). The survey revealed that while all universities offer elective time in palliative care only five out of 16 (31%) have a mandatory rotation. The median durations of the mandatory and elective rotations are limited to two and three-and-a-half weeks, respectively. The majority of the universities offer formal lectures in palliative care (12/16, 75%) and educational reading material (13/16, 81%), with the main format in 14/16 (87%) of the sites being case-based learning. The two most common sites for teaching to occur for the residents are the community/outpatient environment and an acute palliative care unit. Fifty-six per cent (9/16) of the universities have designated faculty positions for palliative medicine with a median number of two positions per site. Only one centre offers a specific palliative medicine examination during the rotation. Feedback from the residents regarding their respective palliative medicine programmes were positive overall. Findings from our survey indicate an ongoing need for improved education in palliative medicine at the postgraduate level. PMID:9616456

  18. Incorporating the Arts and Humanities in Palliative Medicine Education

    ERIC Educational Resources Information Center

    Marchand, Lucille R.

    2006-01-01

    The arts and humanities allow the teaching of palliative medicine to come alive by exploring what is often regarded as the most frightening outcome of the illness experience--death and dying. Palliative medicine focuses on the relief of suffering, but how can suffering be understood if the story of the patient is not told through prose, poetry,…

  19. [Extending the palliative approach across the French health system].

    PubMed

    Mino, Jean-Christophe

    2015-11-01

    The care provision for people at the end of life requires a palliative care approach to be extended across the whole healthcare system. Access to palliative care for everyone requires training for professionals, support for specialised structures and teams as well as clear political will. PMID:26567066

  20. Are family medicine residents adequately trained to deliver palliative care?

    PubMed Central

    Mahtani, Ramona; Kurahashi, Allison M.; Buchman, Sandy; Webster, Fiona; Husain, Amna; Goldman, Russell

    2015-01-01

    Objective To explore educational factors that influence family medicine residents’ (FMRs’) intentions to offer palliative care and palliative care home visits to patients. Design Qualitative descriptive study. Setting A Canadian, urban, specialized palliative care centre. Participants First-year (n = 9) and second-year (n = 6) FMRs. Methods Semistructured interviews were conducted with FMRs following a 4-week palliative care rotation. Questions focused on participant experiences during the rotation and perceptions about their roles as family physicians in the delivery of palliative care and home visits. Participant responses were analyzed to summarize and interpret patterns related to their educational experience during their rotation. Main findings Four interrelated themes were identified that described this experience: foundational skill development owing to training in a specialized setting; additional need for education and support; unaddressed gaps in pragmatic skills; and uncertainty about family physicians’ role in palliative care. Conclusion Residents described experiences that both supported and inadvertently discouraged them from considering future engagement in palliative care. Reassuringly, residents were also able to underscore opportunities for improvement in palliative care education. PMID:27035008

  1. Public health imperative of the 21st century: innovations in palliative care systems, services, and supports to improve health and well-being of older americans.

    PubMed

    Morrissey, Mary Beth; Herr, Keela; Levine, Carol

    2015-04-01

    A primary aim of federal aging and health policy must be promoting innovations in palliative care systems, services, and supports that improve the experience of growing old in America. Older adults must contend today with increasing burden over the life course often as the result of life-limiting chronic pain and chronic illnesses as well as social and economic factors beyond their control. These burdens are frequently shared with unpaid family caregivers who provide significant uncompensated medical care and social support to their loved ones. Enjoyment of the highest attainable standard of physical and mental health, recognized as a fundamental human right under international law, remains a goal for all older adults and encompasses the right to palliative care. For many older Americans, especially vulnerable subgroups who face health and pain disparities, however, this goal remains elusive. A public health strategy for implementing palliative care policy interventions will help to build age-friendly environments, assure the availability and accessibility of palliative systems of care, essential medicines, and an adequate generalist-level workforce, and sustain diffusion of innovation across all levels of health and social provision. The 2015 White House Conference on Aging must make these realignments a policy priority in order to foster social and economic development for all older Americans. PMID:26035600

  2. Restructuring the Philippine electric power industry

    SciTech Connect

    Bowden, S.; Ellis, M.

    1995-06-01

    The Philippine electricity industry has shown it can change, and change quickly. In contrast with the crises and changes imposed on it in the past, the industry now has as opportunity to forge a progressive, forward-looking strategy, This opportunity is enhanced by the force of law - the Department of Energy Act of 1992 mandates privatization of the National Power Corporation (NPC) - and by the easing of the power crisis which has significantly diminished political interference. In order to position the industry for growth and rising investment requirements and to support the growing role of the Philippine economy in international markets, that strategy must address the structural deficiencies that continue to plague the industry. By addressing structural changes that need to be made now, it can build on the impetus gained from its privatization mandate to improve accountability, increase efficiency and reduce government risk.

  3. International nurse migration: lessons from the Philippines.

    PubMed

    Brush, Barbara L; Sochalski, Julie

    2007-02-01

    Developed countries facing nursing shortages have increasingly turned to aggressive foreign nurse recruitment, primarily from developing nations, to offset their lagging domestic nurse supplies and meet growing health care demands. Few donor nations are prepared to manage the loss of their nurse workforce to migration. The sole country with an explicit nurse export policy and the world's leading donor of nurse labor - the Philippines - is itself facing serious provider maldistribution and countrywide health disparities. Examining the historical roots of Philippines nurse migration provides lessons from which other nurse exporting countries may learn. The authors discuss factors that have predicated nurse migration and policies that have eased the way. Furthermore, the authors analyze how various stakeholders influence migratory patterns, the implications of migration for nurses and the public in their care, and the challenges that future social policy and political systems face in addressing global health issues engendered by unfettered recruitment of nurses and other health workers. PMID:17470770

  4. Forestry administration and policies in the Philippines

    NASA Astrophysics Data System (ADS)

    Hyman, Eric L.

    1983-11-01

    This article begins by summarizing the importance of the forestry sector in the Philippine economy It provides an overview of the multiplicity of Philippine governmental institutions involved in forestry in 1982 Then it discusses forestry laws in the country and concludes by examining fifteen critical forest policy issues: sustained yield management; area-specific logging bans; increased use of wood wastes; revision of forest charges; unprocessed log export ban; rationalization of the forest industry, acceleration of reforestation; protection of watersheds; recognition of the social dimensions of slash- and-burn agriculture; fuelwood supply; public land classification for forestry and agriculture, development of plantations for dendrothermal electricity; multiple-use management; preservation of mangrove areas, and improvements in administration and implementation.

  5. Post Eruption Hazards at Mt. Pinatubo, Philippines

    NASA Technical Reports Server (NTRS)

    Mouginis-Mark, Peter J.

    2004-01-01

    Our project focused on the investigation of the post-eruption hazards at Mt. Pinatubo (Philippines) using remote sensing data, and field observations of the 1991 eruption deposits. Through the use of multiple satellite images, field work, and the 1996/2000 PacRim data sets, we conducted studies of the co- and post-eruption hazards of the volcano due to erosion and re-deposition of the extensive pyroclastic flow deposits. A major part of this project was the assembly and analysis of a database of over 50 high resolution (1 - 50 m/pixel) images that will facilitate this study. We collected Ikonos, SPOT, SIR-C/X-SAR, Landsat, ERS, RADARSAT, and ASTER images of the area around Mt. Pinatubo. An example of the changes that could be seen in these data is shown. Our investigation focused on a retrospective analysis of the erosion, redeposition, and re-vegetation of the 1991 pyroclastic flow deposits of Mt. Pinatubo. The primary geologic goal of our work was the analysis of the spatial distribution and volume change of the sources and sinks of materials associated with mudflow ('lahar') events. This included the measurement of river valley gradients and cross-sections using TOPSAR digital elevation data, as we are participating in the PacRim 2000 deployment to the Philippines specifically so that we can collect a second set of TOPSAR data that can then be used to create a topographic difference image of the volcano. The main results from this multi-sensor study have been published as Torres et al.. A discussion of the methodology that we used to assemble an appropriate database was included in Mouginis-Mark and Domergue-Schmidt. As part of an educational outreach effort, we also helped the Philippine Institute of Volcanology and Seismology (PHIVOLCS) in the Philippines to use NASA data to study Mt. Pinatubo and other Filipino volcanoes.

  6. Managing lymphoedema in palliative care patients.

    PubMed

    Todd, Marie

    The development of lymphoedema in advanced disease is distressing for patients and their carers and can prove difficult to manage for health-care professionals involved in their care. This article will provide an overview of co-morbidities that cancer patients face that will have an impact on the development, progression or management of lymphoedema. The principles of assessing and managing lymphoedema in palliative care patients is presented, based on the Scottish governments action plan Living and Dying Well. The need for collaboration with other members of the multi-disciplinary team to provide the seamless, patient-centred service advocated in this action plan is also presented. PMID:19377392

  7. The palliation of dyspnea in terminal disease.

    PubMed

    Zeppetella, G

    1998-01-01

    Dyspnea is a complex subjective experience that is common in terminal illness. Patients may present at any time during the course of their illness, although prevalence increases with disease progression. Dyspnea has physical, psychological, social and spiritual components; without recognizing how each of these contributes to the total suffering of dyspnea, management is unlikely to be successful. The management of dyspnea involves both pharmacological and non-pharmacological treatment. The main pharmacological palliative treatments are oxygen, opioids, and benzodiazepines, but the evidence to support these treatments is limited. More research is urgently needed to establish the efficacy of current treatments and to identify new ones. PMID:9866455

  8. Outcome measures for palliative oxygen therapy: relevance and practical utility.

    PubMed

    Antoniu, Sabina; Mihaltan, Florin

    2014-06-01

    Dyspnea is a common symptom in many advanced malignant and non-malignant diseases and often is refractory to the usual therapies. In such circumstances palliative care approaches are necessary and among them palliative care oxygen therapy can be applied although currently its effectiveness is rather uncertain. Palliative oxygen therapy can be given on either continuous basis or on demand. Often the continuous palliative oxygen therapy is seen as long-term oxygen therapy although their aims are rather different. Palliative oxygen therapy was evaluated in populations with mixed underlying diseases, with outcome measures not only the most appropriate for the setting and therefore these limitations might have influenced the overall perceived therapeutic benefit. Therefore an evaluation of this method in subsets defined based on the etiology and pathogenic mechanisms and with appropriate outcome measures would help to better define the criteria for its indication and would increase its acceptability. PMID:24741999

  9. Inadequacy of Palliative Training in the Medical School Curriculum.

    PubMed

    Chiu, Nicholas; Cheon, Paul; Lutz, Stephen; Lao, Nicholas; Pulenzas, Natalie; Chiu, Leonard; McDonald, Rachel; Rowbottom, Leigha; Chow, Edward

    2015-12-01

    This report examines the literature on palliative training in the current medical school curriculum. A literature search was conducted to identify relevant articles. Physicians and medical students both report feeling that their training in end-of-life care and in palliative issues is lacking. The literature expresses concerns about the varied and non-uniform approach to palliative care training across medical schools. The authors recommend the development of more palliative training assessment tools in order to aid in the standardization of curriculum involving end-of-life care. In addition, increased exposure to dying patients will aid students in building comfort with palliative care issues. Such a goal may be accomplished through required clerkships or other similar programs. PMID:25487030

  10. Palliative Care: A Partnership Across the Continuum of Care.

    PubMed

    Spaulding, Aaron; Harrison, Debra A; Harrison, Jeffrey P

    2016-01-01

    Palliative care services are becoming more prevalent in the United States as greater portions of the population are requiring end-of-life services. Furthermore, recent policy changes and service foci have promoted more continuity and encompassing care. This study evaluates characteristics that distinguish hospitals with a palliative care program from hospitals without such a program in order to better define the markets and environments that promote the creation and usage of these programs. This study demonstrates that palliative care programs are more likely in communities with favorable economic factors and higher Medicare populations. Large hospitals with high occupancy rates and a high case mix index use palliative care programs to better meet patient needs and improve hospital efficiency. Managerial, nursing, and policy implications are discussed relating to further usage and implementation of palliative care programs. PMID:27455361

  11. Pediatric End-of-Life Issues and Palliative Care

    PubMed Central

    Michelson, Kelly Nicole; Steinhorn, David M.

    2007-01-01

    Optimizing the quality of medical care at the end of life has achieved national status as an important health care goal. Palliative care, a comprehensive approach to treating the physical, psychosocial and spiritual needs of patients and their families facing life-limiting illnesses, requires the coordinated efforts of a multidisciplinary group of caregivers. Understanding the basic principles of palliative care can aid emergency department staff in identifying patients who could benefit from palliative care services and in managing the challenging situations that arise when such patients present to the hospital for care. In this article we present the overall philosophy of pediatric palliative care, describe key elements of quality palliative care, and identify additional referral sources readers can access for more information. PMID:18438449

  12. Challenges of Space Education in the Philippines

    NASA Astrophysics Data System (ADS)

    Sese, Rogel Mari

    The Philippines has recently started in developing and promoting space science education through the Philippine Space Science Education Program (PSSEP) of the Department of Science and Technology (DOST). However, as a developing country, there are numerous challenges in promoting space education to students and teachers. In this paper, we assessed the recent activities done by the PSSEP and demonstrate their effectiveness. In addition, we will expound on the social, political and logistical challenges of promoting space education in an archipelago such as the Philippines. We will also present the preliminary feedback and assessment of the Space Science Program (SSP), a pilot program which teaches space science as a separate subject in the basic educational system from kindergarten to high school. We will also discuss the various teaching strategies we utilized in the SSP that can be adopted depending on the needs and capabilities of the host school. Finally, we discuss the challenges of instituting a formal astronomy and space science course and the issues that needs to be addressed for an effective and sustainable program.

  13. Photovoltaic battery charging experience in the Philippines

    SciTech Connect

    Navarro, S.T. Jr.

    1997-12-01

    With the turn of the century, people in remote areas still live without electricity. Conventional electrification will hardly reach the remaining 50% of the population of the Philippines in remote areas. With photovoltaic technology, the delivery of electricity to remote areas can be sustainable. Malalison island was chosen as a project site for electrification using photovoltaic technology. With the fragile balance of ecology and seasonal income in this island, the PV electrification proved to be a better option than conventional fossil based electrification. The Solar Battery Charging Station (SBCS) was used to suit the economic and geographical condition of the island. Results showed that the system can charge as many as three batteries in a day for an average fee of $0.54 per battery. Charging is measured by an ampere-hour counter to determine the exact amount of charge the battery received. The system was highly accepted by the local residents and the demand easily outgrew the system within four months. A technical, economic and social evaluation was done. A recovery period of seven years and five months is expected when competed with the conventional battery charging in the mainland. The technical, economic, institutional and social risks faced by the project were analyzed. Statistics showed that there is a potential of 920,000 households that can benefit from PV electrification in the Philippines. The data and experiences gained in this study are valuable in designing SBCS for remote unelectrified communities in the Philippines and other developing countries.

  14. Japanese Bereaved Family Members' Perspectives of Palliative Care Units and Palliative Care: J-HOPE Study Results.

    PubMed

    Kinoshita, Satomi; Miyashita, Mitsunori; Morita, Tatsuya; Sato, Kazuki; Shoji, Ayaka; Chiba, Yurika; Miyazaki, Tamana; Tsuneto, Satoru; Shima, Yasuo

    2016-06-01

    The study purpose was to understand the perspectives of bereaved family members regarding palliative care unit (PCU) and palliative care and to compare perceptions of PCU before admission and after bereavement. A cross-sectional questionnaire survey was conducted, and the perceptions of 454 and 424 bereaved family members were obtained regarding PCU and palliative care, respectively. Family members were significantly more likely to have positive perceptions after bereavement (ranging from 73% to 80%) compared to before admission (ranging from 62% to 71%). Bereaved family members who were satisfied with medical care in the PCU had a positive perception of the PCU and palliative care after bereavement. Respondents younger than 65 years of age were significantly more likely to have negative perceptions of PCU and palliative care. PMID:25852202

  15. Regional anesthesia for an upper extremity amputation for palliative care in a patient with end-stage osteosarcoma complicated by a large anterior mediastinal mass

    PubMed Central

    Hakim, Mumin; Burrier, Candice; Bhalla, Tarun; Raman, Vidya T; Martin, David P; Dairo, Olamide; Mayerson, Joel L; Tobias, Joseph D

    2015-01-01

    Tumor progression during end-of-life care can lead to significant pain, which at times may be refractory to routine analgesic techniques. Although regional anesthesia is commonly used for postoperative pain care, there is limited experience with its use during home hospice care. We present a 24-year-old male with end-stage metastatic osteosarcoma who required anesthetic care for a right-sided above-the-elbow amputation. The anesthetic management was complicated by the presence of a large mediastinal mass, limited pulmonary reserve, and severe chronic pain with a high preoperative opioid requirement. Intraoperative anesthesia and postoperative pain management were provided by regional anesthesia using an interscalene catheter. He was discharged home with the interscalene catheter in place with a continuous local anesthetic infusion that allowed weaning of his chronic opioid medications and the provision of effective pain control. The perioperative applications of regional anesthesia in palliative and home hospice care are discussed. PMID:26442759

  16. Palliative Care in the Emergency Department

    PubMed Central

    Mierendorf, Susanne M; Gidvani, Vinita

    2014-01-01

    The Emergency Department (ED) is the place where people most frequently seek urgent care. For patients living with chronic disease or malignancy who may be in a crisis, this visit may be pivotal in determining the patients’ trajectory. There is a large movement in education of emergency medicine physicians, hospitalists, and intensivists from acute aggressive interventions to patient-goal assessment, recognizing last stages of life and prioritizing symptom management. Although the ED is not considered an ideal place to begin palliative care, hospital-based physicians may assist in eliciting the patient’s goals of care and discussing prognosis and disease trajectory. This may help shift to noncurative treatment. This article will summarize the following: identification of patients who may need palliation, discussing prognosis, eliciting goals of care and directives, symptom management in the ED, and making plans for further care. These efforts have been shown to improve outcomes and to decrease length of stay and cost. The focus of this article is relieving “patient” symptoms and family distress, honoring the patient’s goals of care, and assisting in transition to a noncurative approach and placement where this may be accomplished. PMID:24694318

  17. Endoscopic laser palliation for advanced malignant dysphagia.

    PubMed Central

    Bown, S G; Hawes, R; Matthewson, K; Swain, C P; Barr, H; Boulos, P B; Clark, C G

    1987-01-01

    Palliative treatment of malignant dysphagia aims to optimise swallowing for the maximum time possible with the minimum of general distress to these seriously ill patients. Thirty four patients considered unsuitable for surgery because of advanced malignancy, other major pathology or in whom previous surgery had been unsuccessful were treated endoscopically with the Nd YAG laser. Significant improvement was achieved in 29 (85%). On a scale of 0-4 (0 = normal swallowing; 4 = dysphagia for all fluids), mean improvement was 1.7, with 25 patients (74%) able to swallow most, or all solids after treatment. With increasing experience, the average number of treatment sessions required for each patient became less; initial time in hospital became comparable to that needed for intubation. Failures were caused by inappropriate patient selection (3), or laser related perforation (2). The mean survival in the whole group was 19 weeks (range 2-44). Eighteen patients needed further treatment for recurrent dysphagia, a mean of six weeks (range 2-15) after initial therapy. Ten of these responded, but eight eventually required insertion of a prosthetic tube. The duration of good palliation was very variable after initial laser therapy. Images Fig. 3 PMID:2443431

  18. Palliative care of First Nations people

    PubMed Central

    Kelly, Len; Linkewich, Barb; Cromarty, Helen; St Pierre-Hansen, Natalie; Antone, Irwin; Gilles, Chris

    2009-01-01

    ABSTRACT OBJECTIVE To understand cross-cultural hospital-based end-of-life care from the perspective of bereaved First Nations family members. DESIGN Phenomenologic approach using qualitative in-depth interviews. SETTING A rural town in northern Ontario with a catchment of 23 000 Ojibway and Cree aboriginal patients. PARTICIPANTS Ten recently bereaved aboriginal family members. METHODS Semi-structured interviews were conducted, audiotaped, and transcribed. Data were analyzed using crystallization and immersion techniques. Triangulation and member-checking methods were used to ensure trustworthiness. MAIN FINDINGS First Nations family members described palliative care as a community and extended family experience. They expressed the need for rooms and services that reflect this, including space to accommodate a larger number of visitors than is usual in Western society. Informants described the importance of communication strategies that involve respectful directness. They acknowledged that all hospital employees had roles in the care of their loved ones. Participants generally described their relatives’ relationships with nurses and the care the nurses provided as positive experiences. CONCLUSION Cross-cultural care at the time of death is always challenging. Service delivery and communication strategies must meet cultural and family needs. Respect, communication, appropriate environments, and caregiving were important to participants for culturally appropriate palliative care. PMID:19366951

  19. Palliative care and end-of-life planning in Parkinson's disease.

    PubMed

    Walker, Richard William

    2013-04-01

    In Parkinson's disease (PD) typical "palliative care" type symptoms, such as pain, nausea, weight loss and breathlessness can occur throughout the condition, but become more prevalent in later disease stages. Pain may be specifically related to PD, e.g. dystonic pain with wearing off, but is more commonly due to other conditions. The cause can usually be elicited by a careful history and examination, and this guides intervention, both non-pharmaceutical, and pharmaceutical. For example, dystonic pain will respond best to appropriate changes to dopaminergic medication. In later disease stages people have increasing problems with swallowing, and also cognitive impairment. Impaired swallowing may lead to aspiration pneumonia, which is a common cause of hospital admission, and also death. Decisions about interventions towards the end of life, such as insertion of percutaneous endoscopic gastrostomy (PEG) tube for nutrition, can be very challenging, particularly if, as in most cases, the person with PD has not previously expressed their views upon this while they still maintained capacity to make decisions. Advance care planning (ACP) in PD should be encouraged in relation to interventions such as PEG tubes. It may also cover issues such as preferred place of death. Over recent years lower proportions of people have been dying at home, and this is especially true for PD, but home may well be where they would have preferred to die. However, there is little evidence to guide health professionals about how, when, and by whom, ACP should be approached. PMID:23328948

  20. Fighting Chronic Pain

    MedlinePlus

    ... pain, bone pain from spread of cancer, fibromyalgia, chronic fatigue syndrome Neurologic: "Phantom limb" pain after amputation, nerve pain from diabetes Read More "Chronic Pain" Articles Easing Chronic Pain: Better Treatments and ...

  1. Low back pain - chronic

    MedlinePlus

    Nonspecific back pain; Backache - chronic; Lumbar pain - chronic; Pain - back - chronic; Chronic back pain - low ... Low back pain is common. Almost everyone has back pain at some time in their life. Often, the exact cause ...

  2. Autoantibody pain.

    PubMed

    Goebel, Andreas

    2016-06-01

    As autoantibodies bind to target tissues, Fc-region dependent inflammation can induce pain via mediators exciting nociceptors. But recently another possibility has emerged, where autoantibody binding to nociceptors can directly cause pain, without inflammation. This is thought to occur as a result of Fab-region mediated modification of nerve transduction, transmission, or neuropeptide release. In three conditions, complex regional pain syndrome, anti-voltage gated potassium channel complex autoimmunity, and chronic fatigue syndrome, all associated with no or only little inflammation, initial laboratory-, and clinical trial-results have suggested a potential role for autoantibody-mediated mechanisms. More research assessing the pathogenic roles of autoantibodies in these and other chronic pain conditions is required. The concept of autoantibody-mediated pain offers hope for the development of novel therapies for currently intractable pains. PMID:26883460

  3. Neuropathic Pain

    PubMed Central

    Costigan, Michael; Scholz, Joachim; Woolf, Clifford J.

    2009-01-01

    Neuropathic pain is triggered by lesions to the somatosensory nervous system that alter its structure and function so that pain occurs spontaneously and responses to noxious and innocuous stimuli are pathologically amplified. The pain is an expression of maladaptive plasticity within the nociceptive system, a series of changes that constitute a neural disease state. Multiple alterations distributed widely across the nervous system contribute to complex pain phenotypes. These alterations include ectopic generation of action potentials, facilitation and disinhibition of synaptic transmission, loss of synaptic connectivity and formation of new synaptic circuits, and neuroimmune interactions. Although neural lesions are necessary, they are not sufficient to generate neuropathic pain; genetic polymorphisms, gender, and age all influence the risk of developing persistent pain. Treatment needs to move from merely suppressing symptoms to a disease-modifying strategy aimed at both preventing maladaptive plasticity and reducing intrinsic risk. PMID:19400724

  4. [Palliative radiotherapy for metastatic bone tumor].

    PubMed

    Yoshida, Kenji; Hiratsuka, Junichi

    2006-04-01

    Bone metastases are one of the most common conditions requiring radiation therapy today. Its main aim is relief of bone pain, prevention of pathological bone fractures as well as its healing, with anticipated effect upon improving mobility, function, and quality of life. For localized bone pain, external beam radiation therapy (EBRT) will be successful in reducing pain in some 80% of patients. However, optimal fraction dose and total doses of EBRT required for pain relief have been unknown. According to the recent reports, carbon ion radiotherapy seems to be a safe and effective modality in the management of metastatic bone tumor not eligible for conventional EBRT. For scattered painful metastases, the systemic administration of radioisotopes is thought to be effective. PMID:16582516

  5. Acupuncture and Related Therapies for Symptom Management in Palliative Cancer Care

    PubMed Central

    Lau, Charlotte H. Y.; Wu, Xinyin; Chung, Vincent C. H.; Liu, Xin; Hui, Edwin P.; Cramer, Holger; Lauche, Romy; Wong, Samuel Y. S.; Lau, Alexander Y. L.; Sit, Regina S. T.; Ziea, Eric T. C.; Ng, Bacon F. L.; Wu, Justin C. Y.

    2016-01-01

    Abstract Available systematic reviews showed uncertainty on the effectiveness of using acupuncture and related therapies for palliative cancer care. The aim of this systematic review and meta-analysis was to summarize current best evidence on acupuncture and related therapies for palliative cancer care. Five international and 3 Chinese databases were searched. Randomized controlled trials (RCTs) comparing acupuncture and related therapies with conventional or sham treatments were considered. Primary outcomes included fatigue, paresthesia and dysesthesias, chronic pain, anorexia, insomnia, limb edema, constipation, and health-related quality of life, of which effective conventional interventions are limited. Thirteen RCTs were included. Compared with conventional interventions, meta-analysis demonstrated that acupuncture and related therapies significantly reduced pain (2 studies, n = 175, pooled weighted mean difference: −0.76, 95% confidence interval: −0.14 to −0.39) among patients with liver or gastric cancer. Combined use of acupuncture and related therapies and Chinese herbal medicine improved quality of life in patients with gastrointestinal cancer (2 studies, n = 111, pooled standard mean difference: 0.75, 95% confidence interval: 0.36–1.13). Acupressure showed significant efficacy in reducing fatigue in lung cancer patients when compared with sham acupressure. Adverse events for acupuncture and related therapies were infrequent and mild. Acupuncture and related therapies are effective in reducing pain, fatigue, and in improving quality of life when compared with conventional intervention alone among cancer patients. Limitations on current evidence body imply that they should be used as a complement, rather than an alternative, to conventional care. Effectiveness of acupuncture and related therapies for managing anorexia, reducing constipation, paresthesia and dysesthesia, insomnia, and limb edema in cancer patients is uncertain, warranting

  6. Palliative Radiotherapy for Bone Metastases: An ASTRO Evidence-Based Guideline

    SciTech Connect

    Lutz, Stephen; Berk, Lawrence; Chang, Eric; Chow, Edward; Hahn, Carol; Hoskin, Peter; Howell, David; Konski, Andre; Kachnic, Lisa; Lo, Simon; Sahgal, Arjun; Silverman, Larry; Gunten, Charles von; Mendel, Ehud; Vassil, Andrew; Bruner, Deborah Watkins; Hartsell, William

    2011-03-15

    Purpose: To present guidance for patients and physicians regarding the use of radiotherapy in the treatment of bone metastases according to current published evidence and complemented by expert opinion. Methods and Materials: A systematic search of the National Library of Medicine's PubMed database between 1998 and 2009 yielded 4,287 candidate original research articles potentially applicable to radiotherapy for bone metastases. A Task Force composed of all authors synthesized the published evidence and reached a consensus regarding the recommendations contained herein. Results: The Task Force concluded that external beam radiotherapy continues to be the mainstay for the treatment of pain and/or prevention of the morbidity caused by bone metastases. Various fractionation schedules can provide significant palliation of symptoms and/or prevent the morbidity of bone metastases. The evidence for the safety and efficacy of repeat treatment to previously irradiated areas of peripheral bone metastases for pain was derived from both prospective studies and retrospective data, and it can be safe and effective. The use of stereotactic body radiotherapy holds theoretical promise in the treatment of new or recurrent spine lesions, although the Task Force recommended that its use be limited to highly selected patients and preferably within a prospective trial. Surgical decompression and postoperative radiotherapy is recommended for spinal cord compression or spinal instability in highly selected patients with sufficient performance status and life expectancy. The use of bisphosphonates, radionuclides, vertebroplasty, and kyphoplasty for the treatment or prevention of cancer-related symptoms does not obviate the need for external beam radiotherapy in appropriate patients. Conclusions: Radiotherapy is a successful and time efficient method by which to palliate pain and/or prevent the morbidity of bone metastases. This Guideline reviews the available data to define its proper use

  7. Facial pain.

    PubMed

    Graff-Radford, Steven B

    2009-07-01

    Facial pain is a debilitating disorder if left untreated. Too often, patients are labeled as having psychopathology when face pain etiology is unclear. These patients are categorized as "atypical," "idiopathic," or "psychogenic." Cases of facial pain involving neuropathic, neurovascular, musculoskeletal, as well as intracranial and extracranial systems will be reviewed. Peripheral and central mechanisms associated with these disorders are used to provide an update of these frequently seen clinical issues. PMID:19590376

  8. Imaging Pain.

    PubMed

    Martucci, Katherine T; Mackey, Sean C

    2016-06-01

    The challenges and understanding of acute and chronic pain have been illuminated through the advancement of central neuroimaging. Through neuroimaging research, new technology and findings have allowed us to identify and understand the neural mechanisms contributing to chronic pain. Several regions of the brain are known to be of particular importance for the maintenance and amplification of chronic pain, and this knowledge provides novel targets for future research and treatment. This article reviews neuroimaging for the study of chronic pain, and in particular, the rapidly advancing and popular research tools of structural and functional MRI. PMID:27208709

  9. Availability and Utilization of Opioids for Pain Management: Global Issues

    PubMed Central

    Manjiani, Deepak; Paul, D. Baby; Kunnumpurath, Sreekumar; Kaye, Alan David; Vadivelu, Nalini

    2014-01-01

    Background Pain can significantly influence an individual's health status and can have serious negative consequences: poor nutrition, decreased appetite, abnormal sleep patterns, fatigue, and impairment of daily living activities. Pain can cause psychological impairment and decrease healing and recovery from injuries and illness. A hallmark of many chronic conditions, pain affects more patients' lives than diabetes mellitus, heart disease, and cancer combined. However, many chronic sufferers do not have access to effective pain management for a variety of reasons, including limited access, restrictions, and personal and cultural biases. Methods This review summarizes issues of access, distribution, and cultural bias with regard to opioid agents and seeks to clarify the challenges related to opioid delivery. The considerable negative physical and mental consequences of chronic pain are discussed for the general and palliative care population. Results Opioids are an effective treatment for various intractable painful conditions, but problems in global opioid access for safe and rational use in pain management contribute to unnecessary suffering. These problems persist despite increased understanding in recent years of the pathophysiology of pain. Conclusions Comprehensive guidelines for goal-directed and patient-friendly chronic opiate therapy will potentially enhance the outlook for future chronic pain management. The improvement of pain education in undergraduate and postgraduate training will benefit patients and clinicians. The promise of new medications, along with the utilization of multimodal approaches, has the potential to provide effective pain relief to future generations of sufferers. PMID:24940131

  10. Studies in Philippine Linguistics, Volume 5, Number 1.

    ERIC Educational Resources Information Center

    Otanes, Fe T., Ed.; Hale, Austin, Ed.

    A collection of seven papers developed for the 1982 Summer Institute of Linguistics of the Linguistic Society of the Philippines address aspects of the institute's research topic, the interface of the morphosyntax and discourse structure in languages of the Philippines and Sabah. They include three papers on general concerns of discourse types in…

  11. The utilization of geothermal energy in the Philippines

    NASA Astrophysics Data System (ADS)

    Rivero, L. U.

    A history of the exploration of the geothermal resources as well as the construction of the geothermal power plants in the Philippines is given. The cost and the viability of such plants under Philippine conditions are presented. The necessity of a planned development around the geothermal plant - such as heat-consuming industries - is stressed.

  12. Molecular Characterization of Chikungunya Virus, Philippines, 2011-2013.

    PubMed

    Sy, Ava Kristy; Saito-Obata, Mariko; Medado, Inez Andrea; Tohma, Kentaro; Dapat, Clyde; Segubre-Mercado, Edelwisa; Tandoc, Amado; Lupisan, Socorro; Oshitani, Hitoshi

    2016-05-01

    During 2011-2013, a nationwide outbreak of chikungunya virus infection occurred in the Philippines. The Asian genotype was identified as the predominant genotype; sporadic cases of the East/Central/South African genotype were detected in Mindanao. Further monitoring is needed to define the transmission pattern of this virus in the Philippines. PMID:27088593

  13. Fictionalized History in the Philippines: Five Narratives of Collective Amnesia

    ERIC Educational Resources Information Center

    Ortiz, Will P.

    2008-01-01

    The paper analyzes five historical fictions for children in the Batang Historyador (Young Historian) series which detail five periods in Philippine history. The books discuss the issues of child labor in precolonial Philippines, child labor and the right to education regardless of gender during the Spanish colonial period, child labor during the…

  14. Editorializing in L2: The Case of Philippine English

    ERIC Educational Resources Information Center

    Dayag, Danilo T.

    2004-01-01

    This paper examines the discourse structure of newspaper editorials in Philippine English in terms of their macrostructure and their lexico-grammatical features. Data were taken from three leading English-language newspapers in the Philippines. Toulmin's framework is used in analyzing the macrostructure of the editorials. The study posits that the…

  15. 38 CFR 3.40 - Philippine and Insular Forces.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Forces. 3.40 Section 3.40 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS... Insular Forces. (a) Regular Philippine Scouts. Service in the Philippine Scouts (except that described in paragraph (b) of this section), the Insular Force of the Navy, Samoan Native Guard, and Samoan Native...

  16. 38 CFR 3.40 - Philippine and Insular Forces.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... Forces. 3.40 Section 3.40 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS... Insular Forces. (a) Regular Philippine Scouts. Service in the Philippine Scouts (except that described in paragraph (b) of this section), the Insular Force of the Navy, Samoan Native Guard, and Samoan Native...

  17. 38 CFR 3.40 - Philippine and Insular Forces.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Forces. 3.40 Section 3.40 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS... Insular Forces. (a) Regular Philippine Scouts. Service in the Philippine Scouts (except that described in paragraph (b) of this section), the Insular Force of the Navy, Samoan Native Guard, and Samoan Native...

  18. 38 CFR 3.40 - Philippine and Insular Forces.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... Forces. 3.40 Section 3.40 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS... Insular Forces. (a) Regular Philippine Scouts. Service in the Philippine Scouts (except that described in paragraph (b) of this section), the Insular Force of the Navy, Samoan Native Guard, and Samoan Native...

  19. 38 CFR 3.40 - Philippine and Insular Forces.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... Forces. 3.40 Section 3.40 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS... Insular Forces. (a) Regular Philippine Scouts. Service in the Philippine Scouts (except that described in paragraph (b) of this section), the Insular Force of the Navy, Samoan Native Guard, and Samoan Native...

  20. Plurality in Unity: Challenges toward Religious Education in the Philippines

    ERIC Educational Resources Information Center

    Baring, Rito V.

    2011-01-01

    This article reviews the challenges provided by a plural condition toward doing religious education in the Philippines. The problem of Philippine religious education hinges on the fact that the growing plural condition in the educational system remains until now "un-discussed"; or integrated in many schools. Not much is heard about proposing a…

  1. English Language Instruction in the Philippine Basic Education Program

    ERIC Educational Resources Information Center

    Vizconde, Camilla

    2006-01-01

    The study discusses the dynamics English language instruction in the Philippine basic education curriculum. Although English enjoyed immense popularity as early as 1900s during the American entry to the country, its role in Philippine education has transformed gradually as the country undergoes political, social and economic reconstruction in the…

  2. Regulatory and Skills Requirements for Higher Education in the Philippines

    ERIC Educational Resources Information Center

    Adeyemo, Kolawole Samuel

    2015-01-01

    The provision of public resources to manage the expansion of the higher education system in the Philippines has been inadequate, and this has given rise to many private providers entering the HE domain. The proper regulation of higher education in the country is important if the Philippines is to respond to the challenge of producing the skills it…

  3. News Reporting in the Philippines: English in Print Media

    ERIC Educational Resources Information Center

    Dayag, Danilo T.

    2010-01-01

    This study aims to determine how a hostage drama in Iraq involving an overseas Filipino worker was framed in English-language newspapers in the Philippines. Data came from the July 9-25, 2004 issues of five leading English-language broadsheets in the Philippines. The study found that the event was given maximum salience and prominence by the…

  4. Molecular Characterization of Chikungunya Virus, Philippines, 2011–2013

    PubMed Central

    Sy, Ava Kristy; Saito-Obata, Mariko; Medado, Inez Andrea; Tohma, Kentaro; Dapat, Clyde; Segubre-Mercado, Edelwisa; Tandoc, Amado; Lupisan, Socorro

    2016-01-01

    During 2011–2013, a nationwide outbreak of chikungunya virus infection occurred in the Philippines. The Asian genotype was identified as the predominant genotype; sporadic cases of the East/Central/South African genotype were detected in Mindanao. Further monitoring is needed to define the transmission pattern of this virus in the Philippines. PMID:27088593

  5. Ten for the Philippines: An Elementary Teacher's Odyssey.

    ERIC Educational Resources Information Center

    Murphey, Carol E.

    1998-01-01

    Discusses the development and implementation of the National Teachers' Training Convention in the Philippines. The convention trained two thousand teachers in six days. Describes the spartan facilities that define the Philippines' educational system and various efforts to improve it, including the "Books for Barrios" project that distributes…

  6. Announcing the CDC guideline for prescribing opioids for chronic pain.

    PubMed

    Houry, Debra; Baldwin, Grant

    2016-06-01

    This guideline provides recommendations for primary care providers who are prescribing opioids for chronic pain outside of active cancer treatment, palliative care, and end-of-life care. The guideline addresses: (a) when to initiate or continue opioids for chronic pain; (b) opioid selection, dosage, duration, follow-up, and discontinuation; and (c) assessing risk and addressing harms of opioid use. This guideline is intended to improve communication between providers and patients about the risks and benefits of opioid therapy for chronic pain, improve the safety and effectiveness of pain treatment, and reduce the risks associated with long-term opioid therapy, including abuse, dependence, overdose, and death (Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain - United States, 2016. MMWR Recomm Rep 2016;65:1-49. DOI: http://dx.doi.org/10.15585/mmwr.rr6501e1.). PMID:27178083

  7. Integrating palliative care into the trajectory of cancer care.

    PubMed

    Hui, David; Bruera, Eduardo

    2016-03-01

    Over the past five decades, palliative care has evolved from serving patients at the end of life into a highly specialized discipline focused on delivering supportive care to patients with life-limiting illnesses throughout the disease trajectory. A growing body of evidence is now available to inform the key domains in the practice of palliative care, including symptom management, psychosocial care, communication, decision-making, and end-of-life care. Findings from multiple studies indicate that integrating palliative care early in the disease trajectory can result in improvements in quality of life, symptom control, patient and caregiver satisfaction, illness understanding, quality of end-of-life care, survival, and costs of care. In this narrative Review, we discuss various strategies to integrate oncology and palliative care by optimizing clinical infrastructures, processes, education, and research. The goal of integration is to maximize patient access to palliative care and, ultimately, to improve patient outcomes. We provide a conceptual model for the integration of supportive and/or palliative care with primary and oncological care. We also discuss how health-care systems and institutions need to tailor integration based on their resources, size, and the level of primary palliative care available. PMID:26598947

  8. Enhancing family physician capacity to deliver quality palliative home care

    PubMed Central

    Marshall, Denise; Howell, Doris; Brazil, Kevin; Howard, Michelle; Taniguchi, Alan

    2008-01-01

    ABSTRACT PROBLEM BEING ADDRESSED Family physicians face innumerable challenges to delivering quality palliative home care to meet the complex needs of end-of-life patients and their families. OBJECTIVE OF PROGRAM To implement a model of shared care to enhance family physicians’ ability to deliver quality palliative home care, particularly in a community-based setting. PROGRAM DESCRIPTION Family physicians in 3 group practices (N = 21) in Ontario’s Niagara West region collaborated with an interprofessional palliative care team (including a palliative care advanced practice nurse, a palliative medicine physician, a bereavement counselor, a psychosocial-spiritual advisor, and a case manager) in a shared-care partnership to provide comprehensive palliative home care. Key features of the program included systematic and timely identification of end-of-life patients, needs assessments, symptom and psychosocial support interventions, regular communication between team members, and coordinated care guided by outcome-based assessment in the home. In addition, educational initiatives were provided to enhance family physicians’ knowledge and skills. CONCLUSION Because of the program, participants reported improved communication, effective interprofessional collaboration, and the capacity to deliver palliative home care, 24 hours a day, 7 days a week, to end-of-life patients in the community. PMID:19074714

  9. 'Living choice': the commitment to tissue donation in palliative care.

    PubMed

    Wells, Joanne; Sque, Magi

    2002-01-01

    Professionals working in palliative care pride themselves on respecting patients' views and wishes. Palliative care patients are often aware that they are going to die and so the issue of what is going to happen to them after death becomes more relevant. That they should be involved in decisions about tissue donation seems obvious, yet many palliative care units do not routinely discuss donation with patients and their families. A grounded theory approach was used to develop an explanation of the low commitment to tissue donation by palliative care units. Six registered nurses and two doctors from each of two separate palliative care units participated in semi-structured, audiotaped interviews. Several themes emerged from the interviews to form a theory of why there is a low commitment to tissue donation in palliative care units. We have called the theory 'living choice'. The dominant theme of category was 'patient choice' and this pervaded and influenced 'professional role', 'donation process', 'concerns' and 'knowledge'. All these categories were contained and continuously interacted in the palliative care environment. PMID:11823746

  10. Integrating palliative care into the trajectory of cancer care

    PubMed Central

    Hui, David; Bruera, Eduardo

    2016-01-01

    Over the past five decades, palliative care has evolved from serving patients at the end of life into a highly specialized discipline focused on delivering supportive care to patients with life-limiting illnesses throughout the disease trajectory. A growing body of evidence is now available to inform the key domains in the practice of palliative care, including symptom management, psychosocial care, communication, decision-making, and end-of-life care. Findings from multiple studies indicate that integrating palliative care early in the disease trajectory can result in improvements in quality of life, symptom control, patient and caregiver satisfaction, quality of end-of-life care, survival, and costs of care. In this narrative Review, we discuss various strategies to integrate oncology and palliative care by optimizing clinical infrastructures, processes, education, and research. The goal of integration is to maximize patient access to palliative care and, ultimately, to improve patient outcomes. We provide a conceptual model for the integration of supportive and/or palliative care with primary and oncological care. We end by discussing how health-care systems and institutions need to tailor integration based on their resources, size, and the level of primary palliative care available. PMID:26598947

  11. [Ethic charter of the German Society for the Study of Pain (DGSS)].

    PubMed

    Reiter-Theil, S; Graf-Baumann, T; Kutzer, K; Müller-Busch, H C; Stutzki, R; Traue, H C; Willweber-Strumpf, A; Zimmermann, M; Zenz, M

    2008-04-01

    The German Society for the Study of Pain has formed an interdisciplinary committee to answer urgent ethical questions on the diagnosis and treatment of pain and to give an ethical orientation on the care of pain and palliative patients. The treatment of pain is a fundamental objective of medicine. Competent and adequate relief of pain in all stages of life is a basic characteristic of a humane medicine oriented to the quality and meaning of life for people. However, there are substantial deficits in all areas, especially in the knowledge of physicians and patients, in training and further education, diagnosis and therapy. Freedom from pain is a substantial element of quality of life. A central duty of all physicians is an adequate diagnosis and treatment of acute pain and thereby the prophylaxis of chronic pain. If pain persists over a longer period of time, it loses the warning function and becomes taken for granted. Alterations, disabilities and limitations of the physical, psychic and social levels are the consequences. For these patients an interdisciplinary approach is necessary by which various medical disciplines, psychologists and physiotherapists are involved and all collaborate on the diagnosis and therapy of pain. All patients have the right to sufficient and individually tailored treatment of pain. Special attention must be paid to vulnerable patient groups, such as newborns, children and adolescents, as well as aged and mentally retarded patients. For cancer patients pain relief of their tumor pain is totally in the forefront. Indications of "unbearable pain" must not lead to resignation or even be seen as an argument for legalization of "death on request". The nursing of terminally ill patients necessitates a special measure not only of clinical, but also ethical competence, communication and multiprofessional collaboration. The modern options for palliative care are real alternatives to demands for legalization of "death on request". Physician

  12. Integrating palliative care in oncologic emergency departments: Challenges and opportunities

    PubMed Central

    Elsayem, Ahmed F; Elzubeir, Hiba E; Brock, Patricia A; Todd, Knox H

    2016-01-01

    Although visiting the emergency departments (EDs) is considered poor quality of cancer care, there are indications these visits are increasing. Similarly, there is growing interest in providing palliative care (PC) to cancer patients in EDs. However, this integration is not without major challenges. In this article, we review the literature on why cancer patients visit EDs, the rates of hospitalization and mortality for these patients, and the models for integrating PC in EDs. We discuss opportunities such integration will bring to the quality of cancer care, and resource utilization of resources. We also discuss barriers faced by this integration. We found that the most common reasons for ED visits by cancer patients are pain, fever, shortness of breath, and gastrointestinal symptoms. The majority of the patients are admitted to hospitals, about 13% of the admitted patients die during hospitalization, and some patients die in ED. Patients who receive PC at an ED have shorter hospitalization and lower resource utilization. Models based solely on increasing PC provision in EDs by PC specialists have had modest success, while very limited ED-based PC provision has had slightly higher impact. However, details of these programs are lacking, and coordination between ED based PC and hospital-wide PC is not clear. In some studies, the objectives were to improve care in the communities and reduce ED visits and hospitalizations. We conclude that as more patients receive cancer therapy late in their disease trajectory, more cancer patients will visit EDs. Integration of PC with emergency medicine will require active participation of ED physicians in providing PC to cancer patients. PC specialist should play an active role in educating ED physicians about PC, and provide timely consultations. The impact of integrating PC in EDs on quality and cost of cancer care should be studied. PMID:27081645

  13. Integrating palliative care in oncologic emergency departments: Challenges and opportunities.

    PubMed

    Elsayem, Ahmed F; Elzubeir, Hiba E; Brock, Patricia A; Todd, Knox H

    2016-04-10

    Although visiting the emergency departments (EDs) is considered poor quality of cancer care, there are indications these visits are increasing. Similarly, there is growing interest in providing palliative care (PC) to cancer patients in EDs. However, this integration is not without major challenges. In this article, we review the literature on why cancer patients visit EDs, the rates of hospitalization and mortality for these patients, and the models for integrating PC in EDs. We discuss opportunities such integration will bring to the quality of cancer care, and resource utilization of resources. We also discuss barriers faced by this integration. We found that the most common reasons for ED visits by cancer patients are pain, fever, shortness of breath, and gastrointestinal symptoms. The majority of the patients are admitted to hospitals, about 13% of the admitted patients die during hospitalization, and some patients die in ED. Patients who receive PC at an ED have shorter hospitalization and lower resource utilization. Models based solely on increasing PC provision in EDs by PC specialists have had modest success, while very limited ED-based PC provision has had slightly higher impact. However, details of these programs are lacking, and coordination between ED based PC and hospital-wide PC is not clear. In some studies, the objectives were to improve care in the communities and reduce ED visits and hospitalizations. We conclude that as more patients receive cancer therapy late in their disease trajectory, more cancer patients will visit EDs. Integration of PC with emergency medicine will require active participation of ED physicians in providing PC to cancer patients. PC specialist should play an active role in educating ED physicians about PC, and provide timely consultations. The impact of integrating PC in EDs on quality and cost of cancer care should be studied. PMID:27081645

  14. The role of palliative chemotherapy in hospitalized patients

    PubMed Central

    Wheatley–Price, P.; Ali, M.; Balchin, K.; Spencer, J.; Fitzgibbon, E.; Cripps, C.

    2014-01-01

    Background Hospitalized patients with advanced cancer often have a poor performance status, which is considered a relative contraindication to cytotoxic chemotherapy. We investigated outcomes in hospitalized solid tumour oncology patients who received palliative chemotherapy (pct). Methods With ethics approval, we performed a single-institution chart review of all patients hospitalized on our oncology unit who received pct between April 2008 and January 2010. Patient demographics, reasons for admission, cancer type, prior therapy, and administered chemotherapy were recorded. The primary endpoint was median survival from date of inpatient chemotherapy until death or last known follow up. We also investigated place of discharge and whether patients received additional therapy. Results During the study period, 199 inpatients received pct. Median age was 61 years; 59% of the patients were women. Most had been admitted with dyspnea (31%) or pain (29%) as the dominant symptom. Common cancers represented were breast (23%), small-cell lung cancer (sclc, 22%), non-small-cell lung cancer (nsclc, 16%), and colorectal cancer (9%). Most patients (67%) were receiving first-line chemotherapy. Median overall survival duration was 4.5 months, and the 6-month survival rate was 41%. The longest and shortest survivals were seen in the sclc and nsclc groups (7.3 and 2.5 months respectively). Factors significantly associated with shorter survival were baseline hypoalbuminemia and therapy beyond the first line. In this cohort, 77% of patients were discharged home, and 72% received further chemotherapy. Conclusions Despite a short median survival, many patients are well enough to be discharged home and to receive further chemotherapy. The development of risk models to predict a higher chance of efficacy will have practical clinical utility. PMID:25089101

  15. Opportunities to maximize value with integrated palliative care

    PubMed Central

    Bergman, Jonathan; Laviana, Aaron A

    2016-01-01

    Palliative care involves aggressively addressing and treating psychosocial, spiritual, religious, and family concerns, as well as considering the overall psychosocial structures supporting a patient. The concept of integrated palliative care removes the either/or decision a patient needs to make: they need not decide if they want either aggressive chemotherapy from their oncologist or symptom-guided palliative care but rather they can be comanaged by several clinicians, including a palliative care clinician, to maximize the benefit to them. One common misconception about palliative care, and supportive care in general, is that it amounts to “doing nothing” or “giving up” on aggressive treatments for patients. Rather, palliative care involves very aggressive care, targeted at patient symptoms, quality-of-life, psychosocial needs, family needs, and others. Integrating palliative care into the care plan for individuals with advanced diseases does not necessarily imply that a patient must forego other treatment options, including those aimed at a cure, prolonging of life, or palliation. Implementing interventions to understand patient preferences and to ensure those preferences are addressed, including preferences related to palliative and supportive care, is vital in improving the patient-centeredness and value of surgical care. Given our aging population and the disproportionate cost of end-of-life care, this holds great hope in bending the cost curve of health care spending, ensuring patient-centeredness, and improving quality and value of care. Level 1 evidence supports this model, and it has been achieved in several settings; the next necessary step is to disseminate such models more broadly. PMID:27226721

  16. Combined brachytherapy and external beam radiation: an effective approach for palliation in esophageal cancer

    PubMed Central

    Lewis, Shirley; Agarwal, Jai Prakash; Mishra, Shagun; Mehta, Shaesta; Patil, Prachi

    2015-01-01

    Purpose Palliation of dysphagia is a challenge in advanced esophageal cancer. The addition of external beam radiotherapy (EBRT) to intraluminal brachytherapy (ILBT) has shown significant improvement in dysphagia relief and symptom scores. The aim of the present study was to evaluate the efficacy of combined use of ILBT and EBRT. Material and methods The medical records of 148 patients with advanced/metastatic esophageal cancer were screened from January 2008 to April 2014, and 74 patients were found eligible for the analysis. All patients received two fractions of 8 Gy each of ILBT, followed by EBRT. Patients were assessed for the symptom scores of dysphagia, odynophagia, regurgitation, and chest pain and weight was recorded periodically. Results For a median follow-up of 6 months, the median OS was 9.5 months (95% CI: 7.5-10.5). The median dysphagia free survival was 6 months (95% CI: 4.8-7.1). The scores for dysphagia significantly improved after completion of 1st ILBT (p = 0.000), 2nd ILBT (p = 0.000), and at 3 months after EBRT compared to ILBT (p = 0.02). Overall 47% had improvement in dysphagia scores and 35% maintained the improvement of scores till last follow up. There was significant improvement in weight after completion of ILBT (p = 0.001) and at 3 months after completion of EBRT (p = 0.00). Twenty nine (39%) patients required nasogastric (NGT) insertions and 12 (16%) needed hospitalization for supportive care. 36.4% had complications in the form of stricture (27%), fistula (5.4%), and bleeding (4%). Conclusions Palliative radiotherapy is an effective alternative for palliation of dysphagia with improvement in symptom scores being evident and sustained. The results of this clinical audit were comparable with those from the trial setting. PMID:26816502

  17. Microwave Ablation for Palliation of Bone Metastases.

    PubMed

    Kinczewski, Leigh

    2016-06-01

    Bone metastases are the most common source of pain for patients with cancer. For pain that is refractory to conventional measures, microwave ablation (MWA) is an emerging alternative therapy. Studies show that MWA is effective in reducing pain and analgesic requirements while improving function. This article describes studies of MWA that include patients with bone metastases to a variety of locations from a range of primary malignancies. Although studies are limited, MWA has proven to be well tolerated with impressive efficacy. 
. PMID:27206291

  18. Palliative Care as a Standard of Care in Pediatric Oncology.

    PubMed

    Weaver, Meaghann S; Heinze, Katherine E; Kelly, Katherine P; Wiener, Lori; Casey, Robert L; Bell, Cynthia J; Wolfe, Joanne; Garee, Amy M; Watson, Anne; Hinds, Pamela S

    2015-12-01

    The study team conducted a systematic review of pediatric and adolescent palliative cancer care literature from 1995 to 2015 using four databases to inform development of a palliative care psychosocial standard. A total of 209 papers were reviewed with inclusion of 73 papers for final synthesis. Revealed topics of urgent consideration include the following: symptom assessment and intervention, direct patient report, effective communication, and shared decision-making. Standardization of palliative care assessments and interventions in pediatric oncology has the potential to foster improved quality of care across the cancer trajectory for children and adolescents with cancer and their family members. PMID:26700928

  19. Edmonton, Canada: a regional model of palliative care development.

    PubMed

    Fainsinger, Robin L; Brenneis, Carleen; Fassbender, Konrad

    2007-05-01

    Palliative care developed unevenly in Edmonton in the 1980s and early 1990s. Health care budget cuts created an opportunity for innovative redesign of palliative care service delivery. This report describes the components that were developed to build an integrated comprehensive palliative care program, the use of common clinical assessments and outcome evaluation that has been key to establishing credibility and ongoing support. Our program has continued to develop and grow with an ongoing focus on the core areas of clinical care, education, and research. PMID:17482060

  20. Pediatric Palliative Care in the Intensive Care Unit.

    PubMed

    Madden, Kevin; Wolfe, Joanne; Collura, Christopher

    2015-09-01

    The chronicity of illness that afflicts children in Pediatric Palliative Care and the medical technology that has improved their lifespan and quality of life make prognostication extremely difficult. The uncertainty of prognostication and the available medical technologies make both the neonatal intensive care unit and the pediatric intensive care unit locations where many children will receive Pediatric Palliative Care. Health care providers in the neonatal intensive care unit and pediatric intensive care unit should integrate fundamental Pediatric Palliative Care principles into their everyday practice. PMID:26333755