Palliative care should be an important component in the management of drug resistant tuberculosis (DRTB); however, it is not given much importance. Even in the current scenario, many patients and their caregivers consider multidrug-resistant and extensively drug-resistant tuberculosis (TB) as a terminal illness and considering it almost as a death sentence, this group of patients also require palliative care. There is a misconception about considering palliative care as a treatment component in the terminal stage of an illness where curative treatment has no role in improving the survival of the patient. However, the real meaning of palliative care is to relieve suffering in all stages of the disease and is not limited to end-of-life care only. Palliative care in DRTB aims to improve the quality of life, intractable symptoms and physical, psychosocial and spiritual suffering of patients as well as their caregivers. There is an imminent need to train all TB healthcare workers regarding basic palliative care and integrate palliative care into the TB healthcare system.
{"title":"Palliative Care in Drug Resistance Tuberculosis: An Overlooked Component in Management","authors":"Deependra Kumar Rai, Priya Sharma","doi":"10.25259/ijpc_141_2022","DOIUrl":"https://doi.org/10.25259/ijpc_141_2022","url":null,"abstract":"Palliative care should be an important component in the management of drug resistant tuberculosis (DRTB); however, it is not given much importance. Even in the current scenario, many patients and their caregivers consider multidrug-resistant and extensively drug-resistant tuberculosis (TB) as a terminal illness and considering it almost as a death sentence, this group of patients also require palliative care. There is a misconception about considering palliative care as a treatment component in the terminal stage of an illness where curative treatment has no role in improving the survival of the patient. However, the real meaning of palliative care is to relieve suffering in all stages of the disease and is not limited to end-of-life care only. Palliative care in DRTB aims to improve the quality of life, intractable symptoms and physical, psychosocial and spiritual suffering of patients as well as their caregivers. There is an imminent need to train all TB healthcare workers regarding basic palliative care and integrate palliative care into the TB healthcare system.","PeriodicalId":13319,"journal":{"name":"Indian Journal of Palliative Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135041627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives: Access to palliative care is limited, especially in rural India. Children needing care by palliative teams may themselves be patients, or siblings and children of patients. Armed forces families face characteristic lifestyle challenges – frequent transfers, living in difficult and remote areas, serving personnel staying apart from families for long periods – very different from issues faced by civilians. Military service increases the risk of psychosocial burden for serving personnel as well as families. Most depend on private and state medical services for palliative care so it is important for the palliative community to understand their issues. This study aimed to explore the issues related to children – faced by armed forces families when caring for patients in palliative care. Material and Methods: Qualitative study based on thematic analysis of semi-structured interviews with caregivers – either serving personnel or their dependents, in three centres. Results: Analysis of the 15 interviews showed that armed forces families face complex challenges related to children when caring for the palliative patient due to frequent movement, lack of paediatric palliative services in far-flung areas, disruption of the continuity of care, social isolation, language, and cultural barriers when living in non-native areas, inability to build and access family and community support and financial burden due to restrictive reimbursement policies. Conclusion: Although medical and administrative support within the organisation provides a cushion, wives have to manage alone in the father’s prolonged absence, and safety is a concern for children when living outside the campuses and serving personnel report guilt, anger, and helplessness at not being present when needed. Awareness of these issues can enable palliative workers to provide more meaningful support tailored to the needs of service families.
{"title":"Issues Related to Children-Faced by Armed Forces Families When Caring for Patients in Palliative Care – A Qualitative Study","authors":"Savita Butola, Damini Butola","doi":"10.25259/ijpc_58_2023","DOIUrl":"https://doi.org/10.25259/ijpc_58_2023","url":null,"abstract":"Objectives: Access to palliative care is limited, especially in rural India. Children needing care by palliative teams may themselves be patients, or siblings and children of patients. Armed forces families face characteristic lifestyle challenges – frequent transfers, living in difficult and remote areas, serving personnel staying apart from families for long periods – very different from issues faced by civilians. Military service increases the risk of psychosocial burden for serving personnel as well as families. Most depend on private and state medical services for palliative care so it is important for the palliative community to understand their issues. This study aimed to explore the issues related to children – faced by armed forces families when caring for patients in palliative care. Material and Methods: Qualitative study based on thematic analysis of semi-structured interviews with caregivers – either serving personnel or their dependents, in three centres. Results: Analysis of the 15 interviews showed that armed forces families face complex challenges related to children when caring for the palliative patient due to frequent movement, lack of paediatric palliative services in far-flung areas, disruption of the continuity of care, social isolation, language, and cultural barriers when living in non-native areas, inability to build and access family and community support and financial burden due to restrictive reimbursement policies. Conclusion: Although medical and administrative support within the organisation provides a cushion, wives have to manage alone in the father’s prolonged absence, and safety is a concern for children when living outside the campuses and serving personnel report guilt, anger, and helplessness at not being present when needed. Awareness of these issues can enable palliative workers to provide more meaningful support tailored to the needs of service families.","PeriodicalId":13319,"journal":{"name":"Indian Journal of Palliative Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135868861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kalpana Balakrishna, Thendral Ramasamy, Meenakshi V. Venketeswaran
Objectives: Critically ill cancer patients in the intensive care unit (ICU) did not have any palliative care (PC) intervention as there was no PC referral from the ICU. The project aimed to initiate PC referral for at least 50% of progressive palliative intent cancer patients in intensive care to enhance communication with patients and caregivers. We included PC physicians, oncologists, and psychologists in the team for this project. Material and Methods: We used the A3 problem-solving method of quality improvement (QI) and also used the Plan Do Check Act process. The first baseline assessment over 6 months of ICU deaths of patients who could have benefited from PC referral was collected; this made us realise that PC could have been initiated for some patients. Process maps of patient admission into the ICU and the process of their discharge were constructed. Analysis of root causes that were barriers to referral was examined. We made a PC trigger tool after team consultations and consensus and started using it to initiate PC referrals. PC discharge protocol was also initiated. Educational discussions were held with residents and nurses to ensure the continued use of the trigger tool. Results: PC referral from intensive care slowly went up from 0% to beyond 50% by November 2019 and reached over 70% by March 2020; patients getting discharged had details of PC centres near their homes. Conclusion: Structured QI process and introducing the PC trigger tool led to the outcome of 50% PC referral for critically ill patients in ICU.
{"title":"Initiation of Palliative Care Referral from the Intensive Care Unit for Advanced Stage Metastatic Cancer Patients: A Quality Improvement Process from a Tertiary Referral Cancer Institute from South India","authors":"Kalpana Balakrishna, Thendral Ramasamy, Meenakshi V. Venketeswaran","doi":"10.25259/ijpc_267_2022","DOIUrl":"https://doi.org/10.25259/ijpc_267_2022","url":null,"abstract":"Objectives: Critically ill cancer patients in the intensive care unit (ICU) did not have any palliative care (PC) intervention as there was no PC referral from the ICU. The project aimed to initiate PC referral for at least 50% of progressive palliative intent cancer patients in intensive care to enhance communication with patients and caregivers. We included PC physicians, oncologists, and psychologists in the team for this project. Material and Methods: We used the A3 problem-solving method of quality improvement (QI) and also used the Plan Do Check Act process. The first baseline assessment over 6 months of ICU deaths of patients who could have benefited from PC referral was collected; this made us realise that PC could have been initiated for some patients. Process maps of patient admission into the ICU and the process of their discharge were constructed. Analysis of root causes that were barriers to referral was examined. We made a PC trigger tool after team consultations and consensus and started using it to initiate PC referrals. PC discharge protocol was also initiated. Educational discussions were held with residents and nurses to ensure the continued use of the trigger tool. Results: PC referral from intensive care slowly went up from 0% to beyond 50% by November 2019 and reached over 70% by March 2020; patients getting discharged had details of PC centres near their homes. Conclusion: Structured QI process and introducing the PC trigger tool led to the outcome of 50% PC referral for critically ill patients in ICU.","PeriodicalId":13319,"journal":{"name":"Indian Journal of Palliative Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135820112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Contemporary medical ethics requires providing healthcare services in accordance with the patient’s values, preferences and interests based on the rights to self-determination and privacy. Incapacitated patients utilise these rights through substitute decision-makers in light of the substituted judgement and best interest standards. In this context, the article aims to briefly study informed consent and focus on protecting incapacitated patients’ rights and best interests. The article underscores the importance of promoting the autonomy of every patient as much as possible. However, in the case of the lack of decisional capacity and advance directives, surrogates should decide for incapacitated patients based on patients’ known/documented/expressed wishes/ preferences and best interests. Nevertheless, due to the high possibility of the misinterpretation of patients’ values, preferences and interests by surrogates as well as potential financial and social conflicts between patients and their surrogates, in the event of medical procedures with serious consequences, such as life-sustaining support, surrogates should be requested to provide convincing evidence proving that their decisions are in line with the patient’s values, preferences and interests.
{"title":"Protecting Incapacitated Patients’ Rights and Best Interests","authors":"Ercan Avci","doi":"10.25259/ijpc_173_2022","DOIUrl":"https://doi.org/10.25259/ijpc_173_2022","url":null,"abstract":"Contemporary medical ethics requires providing healthcare services in accordance with the patient’s values, preferences and interests based on the rights to self-determination and privacy. Incapacitated patients utilise these rights through substitute decision-makers in light of the substituted judgement and best interest standards. In this context, the article aims to briefly study informed consent and focus on protecting incapacitated patients’ rights and best interests. The article underscores the importance of promoting the autonomy of every patient as much as possible. However, in the case of the lack of decisional capacity and advance directives, surrogates should decide for incapacitated patients based on patients’ known/documented/expressed wishes/ preferences and best interests. Nevertheless, due to the high possibility of the misinterpretation of patients’ values, preferences and interests by surrogates as well as potential financial and social conflicts between patients and their surrogates, in the event of medical procedures with serious consequences, such as life-sustaining support, surrogates should be requested to provide convincing evidence proving that their decisions are in line with the patient’s values, preferences and interests.","PeriodicalId":13319,"journal":{"name":"Indian Journal of Palliative Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135820105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The need for palliative care is increasing due to the rising burden of non-communicable diseases and some communicable diseases. Chronic illnesses demand patient-centred care that focuses on the patient’s individual healthcare needs. Palliative care improves the patients’ and caregivers’ quality of life by providing pain and symptom relief through a holistic approach after the disease is diagnosed. Though there are various models followed in different countries, home-based palliative care is preferred by patients who wish to stay close to their loved ones at their end of life. For providing home-based care, there are certainly important elements that have to be taken care of before planning the implementation because every country has its own healthcare needs, system, and context. India is a developing country where isolated Palliative Care is practiced, hence the situation demands the need of addressing the essential elements that can be included in the protocol of home-based palliative care to enhance the quality of care. Therefore, this study aims to identify a few elements needed to provide home-based palliative care in the Indian context. A rapid review was conducted where seven studies were included that mentioned the elements of home-based palliative care. The electronic databases searched were MedLine, PubMed, and Cochrane databases of systematic reviews. The review was carried out over a period of 8 weeks in June and July 2022. Seven common essential themes were identified; (i) inter-sectoral and inter-professional cooperation, (ii) trust and safety, (iii) holistic management, (iv) non-academic palliative care, (v) spiritual care, (vi) support to caregivers, and (vii) funding and financial support. Our review of effective palliative care models explicates the essential elements for quality home-based care for patients with a terminal illness. The application of the elements must be relevant to the local context due to the huge diversity of the country.
{"title":"Essential Elements of Home-based Palliative Care Model: A Rapid Review","authors":"Mousami Kirtania, Ajitha Katta","doi":"10.25259/ijpc_227_2022","DOIUrl":"https://doi.org/10.25259/ijpc_227_2022","url":null,"abstract":"The need for palliative care is increasing due to the rising burden of non-communicable diseases and some communicable diseases. Chronic illnesses demand patient-centred care that focuses on the patient’s individual healthcare needs. Palliative care improves the patients’ and caregivers’ quality of life by providing pain and symptom relief through a holistic approach after the disease is diagnosed. Though there are various models followed in different countries, home-based palliative care is preferred by patients who wish to stay close to their loved ones at their end of life. For providing home-based care, there are certainly important elements that have to be taken care of before planning the implementation because every country has its own healthcare needs, system, and context. India is a developing country where isolated Palliative Care is practiced, hence the situation demands the need of addressing the essential elements that can be included in the protocol of home-based palliative care to enhance the quality of care. Therefore, this study aims to identify a few elements needed to provide home-based palliative care in the Indian context. A rapid review was conducted where seven studies were included that mentioned the elements of home-based palliative care. The electronic databases searched were MedLine, PubMed, and Cochrane databases of systematic reviews. The review was carried out over a period of 8 weeks in June and July 2022. Seven common essential themes were identified; (i) inter-sectoral and inter-professional cooperation, (ii) trust and safety, (iii) holistic management, (iv) non-academic palliative care, (v) spiritual care, (vi) support to caregivers, and (vii) funding and financial support. Our review of effective palliative care models explicates the essential elements for quality home-based care for patients with a terminal illness. The application of the elements must be relevant to the local context due to the huge diversity of the country.","PeriodicalId":13319,"journal":{"name":"Indian Journal of Palliative Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135325761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gloria Melissa Pacheco-Feijoó, Jose Percy Amado-Tineo, Ricardo Plancarte-Sánchez, Carlos Contreras Valdivia, José M. López-Millán
Objectives: The management of chronic pain among patients with abdominal cancer is complex; against that, the neurolysis of the celiac plexus (CPN) is the best technique at the moment t o determine the efficacy and safety in the treatment of chronic pain secondary to oncological pathology of the upper abdomen. Material and Methods: This was a systematic review of controlled clinical trials between 2000 and 2021, in the sources MEDLINE/PubMed, Cochrane, Scopus, Web of Science, and Google Scholar. Three independent evaluators analysed the results of the bibliographical research. The quality of the studies was assessed with the Jadad scale and the mean difference (95% confidence interval) and heterogeneity of the studies (I2) were calculated with Review Manager 5.3. Results: Seven hundred and forty-four publications were identified, including 13 studies in the qualitative synthesis and three studies in the quantitative synthesis. No difference was found in the decrease in pain intensity between 1 and 12 weeks after the intervention, comparing the experimental group with the control ( P > 0.05). The adverse effects related to neurolysis were not serious and transitory, mentioning the most frequent adverse effects and reporting a percentage between 21% and 67% (with 17% for echoendoscopic neurolysis and 49% for percutaneous neurolysis). Conclusion: Celiac plexus neurolysis for the treatment of severe chronic pain secondary to oncological pathology in the upper hemiabdomen produces similar pain relief as conventional pharmacological analgesic treatment. It is a safe analgesic technique since the complications are mild and transitory.
目的:腹部肿瘤患者慢性疼痛的处理是复杂的;因此，腹腔神经丛松解术(CPN)是目前确定治疗上腹部肿瘤病理继发慢性疼痛的疗效和安全性的最佳技术。材料和方法:这是一项2000年至2021年间对照临床试验的系统综述，来源为MEDLINE/PubMed、Cochrane、Scopus、Web of Science和Google Scholar。三位独立评估人员分析了书目研究的结果。采用Jadad量表评估研究质量，使用Review Manager 5.3计算研究的平均差值(95%置信区间)和异质性(I2)。结果:共收录文献744篇，其中定性综合文献13篇，定量综合文献3篇。干预后1周至12周，实验组与对照组疼痛强度的降低无明显差异(P >0.05)。与神经松解术相关的不良反应并不严重，也不是短暂的，最常见的不良反应发生率在21%到67%之间(超声内镜下神经松解术为17%，经皮神经松解术为49%)。结论:腹腔神经丛松解术治疗上半腹部肿瘤病理继发的严重慢性疼痛，其镇痛效果与常规药物镇痛相似。这是一种安全的镇痛技术，因为并发症轻微且短暂。
{"title":"Efficacy and Safety of Celiac Plexus Neurolysis in the Treatment of Chronic Pain Secondary to Oncological Pathology of the Upper Hemiabdomen: A Systematic Review and Meta-Analysis","authors":"Gloria Melissa Pacheco-Feijoó, Jose Percy Amado-Tineo, Ricardo Plancarte-Sánchez, Carlos Contreras Valdivia, José M. López-Millán","doi":"10.25259/ijpc_203_2022","DOIUrl":"https://doi.org/10.25259/ijpc_203_2022","url":null,"abstract":"Objectives: The management of chronic pain among patients with abdominal cancer is complex; against that, the neurolysis of the celiac plexus (CPN) is the best technique at the moment t o determine the efficacy and safety in the treatment of chronic pain secondary to oncological pathology of the upper abdomen. Material and Methods: This was a systematic review of controlled clinical trials between 2000 and 2021, in the sources MEDLINE/PubMed, Cochrane, Scopus, Web of Science, and Google Scholar. Three independent evaluators analysed the results of the bibliographical research. The quality of the studies was assessed with the Jadad scale and the mean difference (95% confidence interval) and heterogeneity of the studies (I2) were calculated with Review Manager 5.3. Results: Seven hundred and forty-four publications were identified, including 13 studies in the qualitative synthesis and three studies in the quantitative synthesis. No difference was found in the decrease in pain intensity between 1 and 12 weeks after the intervention, comparing the experimental group with the control ( P > 0.05). The adverse effects related to neurolysis were not serious and transitory, mentioning the most frequent adverse effects and reporting a percentage between 21% and 67% (with 17% for echoendoscopic neurolysis and 49% for percutaneous neurolysis). Conclusion: Celiac plexus neurolysis for the treatment of severe chronic pain secondary to oncological pathology in the upper hemiabdomen produces similar pain relief as conventional pharmacological analgesic treatment. It is a safe analgesic technique since the complications are mild and transitory.","PeriodicalId":13319,"journal":{"name":"Indian Journal of Palliative Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135511724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nishtha Singhal, Stephen Rajan Samuel, Vijaya K. Kumar, Harsha Prasad, M. V. Saraswathy
Objectives: The study aims to assess the proportion and magnitude of chemotherapy-induced peripheral neuropathy (CIPN) and other common complications reported in children with acute lymphoblastic leukaemia (ALL)/ acute lymphoblastic lymphoma (LBL) undergoing chemotherapy. Material and Methods: The study included children between 5 and 18 years old with ALL/LBL undergoing chemotherapy in Tertiary Care Hospitals, Mangalore. The study was conducted using various instruments, including paediatric-modified total neuropathy scale for CIPN, handheld dynamometer for muscle strength, bioimpedance analyser for muscle mass, timed up-and-go test for physical performance, and national comprehensive cancer network (NCCN) guidelines for scoring cancer-related fatigue at 3-time points. The collected data were analysed by IBM Statistical Package for the Social Sciences version 29 using Z-scores with standard deviation for distinct ALL/LBL types. In addition, the Paired t -test compared the baseline outcome to the 3 rd and 6 th time points. Results: The study evaluated 25 children with ALL undergoing chemotherapy based on the UKALL 2003 protocol during their maintenance phase. The study found that 25 children experienced CIPN, with changes in sensory and pin sensibility scores at 3 and 6 months. The study found a significant change in handgrip strength, body mass index, and muscle mass at 3 months, with no significant change in physical performance over time. Fatigue scores increased from baseline to 3 months, with significant changes observed for the 7–12 years age group at 3 months but not for the 5–6 years age group at 6 months. Conclusion: Children with ALL/LBL undergoing chemotherapy experience CIPN and other side effects such as sarcopenia and fatigue. The study highlights the potential benefits of physiotherapy interventions and supportive care strategies aimed at managing the adverse effects of chemotherapy in children with ALL/LBL.
目的:本研究旨在评估接受化疗的急性淋巴细胞白血病(ALL)/急性淋巴细胞淋巴瘤(LBL)患儿化疗引起的周围神经病变(CIPN)及其他常见并发症的比例和程度。材料和方法:研究对象为在芒格洛尔三级医院接受化疗的5 - 18岁ALL/LBL患儿。研究使用多种仪器进行，包括儿科改良的CIPN全神经病变量表，手持式肌肉力量测定仪，肌肉质量生物阻抗分析仪，体能计时起跑测试，以及国家综合癌症网络(NCCN)指南，用于在3个时间点对癌症相关疲劳进行评分。收集的数据由IBM Statistical Package for Social Sciences version 29使用不同ALL/LBL类型的标准偏差z分数进行分析。此外，配对t检验将基线结果与第3和第6个时间点进行比较。结果:该研究评估了25名在维持期接受UKALL 2003方案化疗的ALL儿童。研究发现，25名儿童经历了CIPN，在3个月和6个月时感觉和针敏感性评分发生了变化。研究发现，3个月后，婴儿的握力、体重指数和肌肉质量都发生了显著变化，随着时间的推移，身体表现没有显著变化。疲劳评分从基线增加到3个月，7-12岁年龄组在3个月时观察到显著变化，而6 - 6岁年龄组在6个月时没有观察到显著变化。结论:ALL/LBL患儿化疗后出现CIPN及肌肉减少、疲劳等副作用。该研究强调了物理治疗干预和支持性护理策略的潜在益处，这些策略旨在管理ALL/LBL儿童化疗的不良反应。
{"title":"Evaluation of Chemotherapy Induced Peripheral Neuropathy, Sarcopenia and Fatigue in Children with Acute Lymphoblastic Leukaemia and Lymphoma in Tertiary Care Hospital, Dakshina Kannada","authors":"Nishtha Singhal, Stephen Rajan Samuel, Vijaya K. Kumar, Harsha Prasad, M. V. Saraswathy","doi":"10.25259/ijpc_143_2023","DOIUrl":"https://doi.org/10.25259/ijpc_143_2023","url":null,"abstract":"Objectives: The study aims to assess the proportion and magnitude of chemotherapy-induced peripheral neuropathy (CIPN) and other common complications reported in children with acute lymphoblastic leukaemia (ALL)/ acute lymphoblastic lymphoma (LBL) undergoing chemotherapy. Material and Methods: The study included children between 5 and 18 years old with ALL/LBL undergoing chemotherapy in Tertiary Care Hospitals, Mangalore. The study was conducted using various instruments, including paediatric-modified total neuropathy scale for CIPN, handheld dynamometer for muscle strength, bioimpedance analyser for muscle mass, timed up-and-go test for physical performance, and national comprehensive cancer network (NCCN) guidelines for scoring cancer-related fatigue at 3-time points. The collected data were analysed by IBM Statistical Package for the Social Sciences version 29 using Z-scores with standard deviation for distinct ALL/LBL types. In addition, the Paired t -test compared the baseline outcome to the 3 rd and 6 th time points. Results: The study evaluated 25 children with ALL undergoing chemotherapy based on the UKALL 2003 protocol during their maintenance phase. The study found that 25 children experienced CIPN, with changes in sensory and pin sensibility scores at 3 and 6 months. The study found a significant change in handgrip strength, body mass index, and muscle mass at 3 months, with no significant change in physical performance over time. Fatigue scores increased from baseline to 3 months, with significant changes observed for the 7–12 years age group at 3 months but not for the 5–6 years age group at 6 months. Conclusion: Children with ALL/LBL undergoing chemotherapy experience CIPN and other side effects such as sarcopenia and fatigue. The study highlights the potential benefits of physiotherapy interventions and supportive care strategies aimed at managing the adverse effects of chemotherapy in children with ALL/LBL.","PeriodicalId":13319,"journal":{"name":"Indian Journal of Palliative Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135511587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives: Unrelieved pain significantly affects the quality of life of cancer patients. In rural settings, cancer patients do not have information or knowledge about how to control their pain because of a lack of resources or awareness. We conducted an interventional, questionnaire-based prospective study in a rural tertiary care oncological centre to look for the impact of establishing a pain clinic based on the knowledge and experience of cancer patients regarding their cancer pain. Material and Methods: The patient pain questionnaire was filled by 380 random non-surgical patients complaining of pain who visited our centre for the treatment of cancer. The information generated was used for setting up a pain clinic covering all aspects of cancer pain. After 3 months of starting the pain clinic services, all these patients who visited the pain clinic at least once were again surveyed similarly. Out of 380 patients, we could only follow up with 348 patients and other patients were lost to follow-up. Results: After visiting the pain clinic the mean value of the response for most of the questions decreased suggesting that the responses became more favourable as the knowledge improved and the experience of the pain became less distressing for the patients. The mean value of the responses to all the questions related to the overall knowledge of cancer pain before visiting a pain clinic was 4.22 ± 1.58 and after visiting a pain clinic was 3.83 ± 0.95 which was statistically significant ( P = 0.000). The mean value of the responses to the questions related to the overall experience of the pain before visiting the pain clinic was 3.81 ± 1.42 and after visiting the pain clinic was 2.14 ± 1.05 which was highly significant ( P = 0.000). We found out that the patients who had a higher mean value of the responses (8–10) suggesting the most unfavourable responses benefitted the most and the number of patients having the most unfavourable responses decreased after visiting the pain clinic. Conclusion: In a rural tertiary healthcare cancer centre, the establishment of a pain clinic increased the general understanding and experience of cancer patients regarding their pain and pain management.
{"title":"Impact of Establishing a Pain Clinic in a Rural Cancer Centre Based on the Knowledge and Experience of the Pain of Cancer Patients – A Prospective, Questionnaire-Based Study","authors":"Harsimran Singh Walia, Jagdeep Sharma, Mansi Chatterjee Walia, Lalita Gouri Mitra, Atin Goyal, Sofia Jaswal","doi":"10.25259/ijpc_54_2023","DOIUrl":"https://doi.org/10.25259/ijpc_54_2023","url":null,"abstract":"Objectives: Unrelieved pain significantly affects the quality of life of cancer patients. In rural settings, cancer patients do not have information or knowledge about how to control their pain because of a lack of resources or awareness. We conducted an interventional, questionnaire-based prospective study in a rural tertiary care oncological centre to look for the impact of establishing a pain clinic based on the knowledge and experience of cancer patients regarding their cancer pain. Material and Methods: The patient pain questionnaire was filled by 380 random non-surgical patients complaining of pain who visited our centre for the treatment of cancer. The information generated was used for setting up a pain clinic covering all aspects of cancer pain. After 3 months of starting the pain clinic services, all these patients who visited the pain clinic at least once were again surveyed similarly. Out of 380 patients, we could only follow up with 348 patients and other patients were lost to follow-up. Results: After visiting the pain clinic the mean value of the response for most of the questions decreased suggesting that the responses became more favourable as the knowledge improved and the experience of the pain became less distressing for the patients. The mean value of the responses to all the questions related to the overall knowledge of cancer pain before visiting a pain clinic was 4.22 ± 1.58 and after visiting a pain clinic was 3.83 ± 0.95 which was statistically significant ( P = 0.000). The mean value of the responses to the questions related to the overall experience of the pain before visiting the pain clinic was 3.81 ± 1.42 and after visiting the pain clinic was 2.14 ± 1.05 which was highly significant ( P = 0.000). We found out that the patients who had a higher mean value of the responses (8–10) suggesting the most unfavourable responses benefitted the most and the number of patients having the most unfavourable responses decreased after visiting the pain clinic. Conclusion: In a rural tertiary healthcare cancer centre, the establishment of a pain clinic increased the general understanding and experience of cancer patients regarding their pain and pain management.","PeriodicalId":13319,"journal":{"name":"Indian Journal of Palliative Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135512521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives: This article reviews the developments in artificial intelligence (AI) technologies and their current and prospective applications in endof-life communications. It uses Open AI’s generative pre-trained transformer 3 (GPT-3) as a case study to understand the possibilities of AI-aided communication in Palliative Care. Material and Methods: Open AI’s GPT-3 was taken as a case study where responses were generated through the GPT-3 beta playground (Davinci engine) and were scrutinised by six mental health professionals (MHPs) working in a palliative care setting in India. They were tasked to evaluate the responses generated by the AI (the identity was not revealed until a part of the study was completed) in a simulated palliative care conversation with another MHP posing as a patient. The aim was to undermine whether the professionals were able to detect that the responses were indeed generated by a machine and did they approve or disapprove of the responses. Results: The GPT-3 playground with the right prompts produced remarkable, often surprising texts and responses that imitated human interaction. However, glitches such as redundancy were noticed along with strongly held opinions in certain questions related to faith, death, and life after death. Conclusion: AI-assisted communication in palliative care could be used to train professionals in the palliative care field using it as a simulation in training. It could also be used as a therapeutic intervention for the purpose of engagement and philosophical dialogue after certain modifications. However, it would have its own limitations such as it cannot replace a human agent just yet.
{"title":"Can Artificial Intelligence aid communication? Considering the possibilities of GPT-3 in Palliative care","authors":"Rajashree Srivastava, Shikha Srivastava","doi":"10.25259/ijpc_155_2023","DOIUrl":"https://doi.org/10.25259/ijpc_155_2023","url":null,"abstract":"Objectives: This article reviews the developments in artificial intelligence (AI) technologies and their current and prospective applications in endof-life communications. It uses Open AI’s generative pre-trained transformer 3 (GPT-3) as a case study to understand the possibilities of AI-aided communication in Palliative Care. Material and Methods: Open AI’s GPT-3 was taken as a case study where responses were generated through the GPT-3 beta playground (Davinci engine) and were scrutinised by six mental health professionals (MHPs) working in a palliative care setting in India. They were tasked to evaluate the responses generated by the AI (the identity was not revealed until a part of the study was completed) in a simulated palliative care conversation with another MHP posing as a patient. The aim was to undermine whether the professionals were able to detect that the responses were indeed generated by a machine and did they approve or disapprove of the responses. Results: The GPT-3 playground with the right prompts produced remarkable, often surprising texts and responses that imitated human interaction. However, glitches such as redundancy were noticed along with strongly held opinions in certain questions related to faith, death, and life after death. Conclusion: AI-assisted communication in palliative care could be used to train professionals in the palliative care field using it as a simulation in training. It could also be used as a therapeutic intervention for the purpose of engagement and philosophical dialogue after certain modifications. However, it would have its own limitations such as it cannot replace a human agent just yet.","PeriodicalId":13319,"journal":{"name":"Indian Journal of Palliative Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135888328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Medication Considerations in a Cancer Patient with a Jejunostomy Tube (J-tube)","authors":"Meenakshi V. Venketeswaran","doi":"10.25259/ijpc_145_2022","DOIUrl":"https://doi.org/10.25259/ijpc_145_2022","url":null,"abstract":"","PeriodicalId":13319,"journal":{"name":"Indian Journal of Palliative Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135854331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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