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Patient-Controlled Therapy with Intravenous Oxycodone in Breathlessness due to Advanced Cancer: A Case Report 晚期癌症患者呼吸困难时的静脉注射羟考酮患者控制疗法:病例报告
IF 1.1 Q4 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-01-04 DOI: 10.25259/ijpc_84_2023
M. Menon, Shiv Pratap Singh Rana, Subashini Perumal, Khawla Fuad
Dyspnoea is a debilitating symptom in medicine, especially in palliative care. Opioids are the pharmacological agents of choice in the treatment of dyspnoea in palliative medicine. Morphine is the best-studied opioid, and recent literature on oxycodone is encouraging. In refractory cases, opioid infusion and palliative sedation may have to be used. We present a case that used oxycodone in a patient-controlled device specifically for dyspnoea and its effects in relieving dyspnoea in a fast and timely manner. This helped in meeting the demands of the patient and relieving suffering rapidly with less sedation. This case report is unique in the use of an oxycodone patient-controlled device specifically for dyspnoea.
在医学领域,尤其是在姑息治疗领域,呼吸困难是一种使人衰弱的症状。阿片类药物是姑息治疗中治疗呼吸困难的首选药物。吗啡是研究得最透彻的阿片类药物,最近关于羟考酮的文献也令人鼓舞。在难治性病例中,可能必须使用阿片类药物输注和姑息镇静。我们介绍了一个病例,该病例在患者自控设备中使用了专门针对呼吸困难的羟考酮,并介绍了其在快速、及时缓解呼吸困难方面的效果。这有助于满足患者的需求,并在减少镇静剂的情况下迅速缓解痛苦。本病例报告在使用专门用于呼吸困难的羟考酮患者控制装置方面是独一无二的。
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引用次数: 0
Concerns of Primary Caregivers of Children with Complex Chronic Conditions in Kerala: A Qualitative Analysis 喀拉拉邦患有复杂慢性病儿童的初级护理人员的担忧:定性分析
IF 1.1 Q4 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-01-04 DOI: 10.25259/ijpc_9_2023
Sajida Abdulla, Hariprasad Pallippurath Gopalakrishna Pillai, Reshmi Ramachandran
Exploring data on primary caregiver experiences of dealing with chronically ill children (CIC) strengthens the ability of paediatricians to improve the quality of care by detecting unmet needs in paediatric palliative care and understanding their original concerns instead of presumed needs. Hence, this study aims to identify and describe the primary concerns and challenges faced by caregivers of children with complex chronic conditions in a tertiary care hospital in Kerala.Primary caregivers of 25 children aged <13 years with non-malignant life-limiting illnesses, admitted to the paediatric department of a government medical college in Kerala between 1 July 2021 and 28 February 2022, underwent in-depth interviews to analyse their most worrisome issues. Thematic analysis was the method chosen for qualitative data analysis.The main themes identified were medical issues, unmet needs, caregiver health issues, and social and financial issues. Among the medical issues, poor seizure control and infected bedsores, sleep deprivation in both patient as well as caregivers, and difficulty in maintaining the personal hygiene of patients were the major issues. Parents of almost all the CICs reported that they required diapers more than any other material or device. Maternal depression was the major caregiver health issue. The unavailability of antiepileptic drugs in peripheral health centres resulted in missing doses and undue expenses for travel to tertiary centres to obtain the same. Caregivers reported their dismay when they finally realised that they were given false hopes of a cure by different systems of medicine.The challenges faced by caregivers of children with complex chronic conditions are multifaceted. Their most problematic issues related to medical issues are the occurrence of breakthrough seizures and development of infected bedsores. The most important material hardship reported was diaper needs. Caregiver issues such as sleep deprivation and maternal depression must be identified and addressed while providing comprehensive palliative care.
探索主要照护者与慢性病儿童(CIC)打交道的经验数据,有助于儿科医生发现儿科姑息关怀中尚未满足的需求,了解他们最初的担忧而不是假定的需求,从而提高关怀质量。在 2021 年 7 月 1 日至 2022 年 2 月 28 日期间,喀拉拉邦一所政府医学院的儿科部门收治了 25 名年龄小于 13 岁、患有非恶性局限生命疾病的儿童,他们的主要护理人员接受了深入访谈,以分析他们最担心的问题。所确定的主要专题包括医疗问题、未满足的需求、护理人员的健康问题以及社会和经济问题。在医疗问题中,发作控制不佳和感染褥疮、患者和护理人员睡眠不足以及患者个人卫生难以保持是主要问题。几乎所有社区儿童的家长都表示,他们对尿布的需求超过了对其他材料或设备的需求。产妇抑郁是护理人员的主要健康问题。由于外围医疗中心没有抗癫痫药物,导致患者缺药,并为前往三级医疗中心购买药物花费过多。照顾者报告说,当他们最终意识到不同的医疗系统给了他们治愈疾病的虚假希望时,他们感到非常沮丧。与医疗问题相关的最棘手问题是突破性癫痫发作和褥疮感染。据报告,最重要的物质困难是尿布需求。在提供综合姑息关怀的同时,还必须识别和解决护理人员的问题,如睡眠不足和产妇抑郁。
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引用次数: 0
Symptoms, Electrolyte Disturbances and Serum Albumin Levels in Palliative Oncology Patients Admitted Through Emergency: Characteristics and Survival Outcomes 通过急诊入院的姑息治疗肿瘤患者的症状、电解质紊乱和血清白蛋白水平:特征和生存结果
IF 1.1 Q4 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-01-03 DOI: 10.25259/ijpc_235_2023
Mahesh Menon, Subhashini Perumal, Raza Ahmad, Priya Das, Shiv Pratap Singh Rana, Asif Sardar
Our research aimed to examine the characteristics of palliative oncology patients hospitalised through an emergency to look for the symptom profile, characteristics of dyselectrolytemia and blood investigations, and possible associations with mortality.After institutional review board approval, a retrospective, observational study of patients hospitalised in our tertiary care specialty oncology hospital was undertaken. Records of hospitalised cancer patients admitted from the emergency department under palliative care from January 2019 to October 2021 were examined. As all admissions during this period were through emergency due to institution COVID-19 protocols, all elective admissions were excluded from the study. Data collected included patient characteristics, blood investigations, and comorbid history of systemic diseases and factors that could be associated with electrolyte imbalance.There were 157 emergency admissions during the study period. A majority were patients with solid tumours (92.4%). Pain was the most frequent cardinal symptom, along with other symptoms (68/157) or in isolation (33/157), followed by reduced oral intake (32/157) and altered sensorium (24/157). sixty-six patients died within the hospitalisation period. On long-term follow-up, only 8 (5.1%) were surviving. Hyponatraemia (43%), Hypoalbuminaemia (66%), and altered renal function (33.1%) were prevalent. We observed a weak positive correlation between sodium levels and outcome (r = 0.199, P = 0.016) and a strong positive correlation between albumin levels and survival outcomes (r = 0.329, P = 0.000). Patients with normal albumin had a higher chance of survival (odds ratio: 33.1225, 95% confidence interval: 3.415–321.20, P = 0.003).Pain-reduced oral intake and altered sensorium are common emergency symptoms in oncology palliative care. Mortality is high in these patients. Hyponatraemia, hypoalbuminaemia, and deranged renal functions were commonly seen. Normal sodium and albumin levels were associated with higher chances of survival, and the association was strong for serum albumin levels. This may have prognostic utility.
我们的研究旨在检查通过急诊住院的姑息治疗肿瘤患者的特征,以了解其症状概况、解淀粉血症和血液检查的特征,以及与死亡率可能存在的关联。经机构审查委员会批准后,我们对本院三级肿瘤专科医院的住院患者进行了一项回顾性观察研究。研究对象为2019年1月至2021年10月期间在姑息治疗下从急诊科入院的癌症患者。由于在此期间所有入院患者都是根据医院COVID-19协议通过急诊入院的,因此研究排除了所有择期入院的患者。收集的数据包括患者特征、血液检查、合并全身性疾病史以及可能与电解质失衡有关的因素。研究期间共收治了 157 名急诊患者,其中大部分是实体瘤患者(92.4%)。疼痛是最常见的主要症状,同时伴有其他症状(68/157)或单独出现(33/157),其次是口服量减少(32/157)和感觉改变(24/157)。在长期随访中,仅有 8 人(5.1%)存活。低钠血症(43%)、低白蛋白血症(66%)和肾功能改变(33.1%)是普遍现象。我们观察到钠水平与预后呈弱正相关(r = 0.199,P = 0.016),白蛋白水平与生存预后呈强正相关(r = 0.329,P = 0.000)。白蛋白正常的患者生存几率更高(几率比:33.1225,95% 置信区间:3.415-321.20,P = 0.003)。这些患者的死亡率很高。低钠血症、低白蛋白血症和肾功能紊乱是常见症状。正常的钠和白蛋白水平与较高的存活几率相关,而血清白蛋白水平的相关性更强。这可能对预后有帮助。
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引用次数: 0
Choice of Place of the Death of Children with Cancer during End-of-Life Care – Parent’s Perspectives in a Developing Country 在临终关怀期间癌症儿童死亡地点的选择——发展中国家父母的观点
Q4 HEALTH CARE SCIENCES & SERVICES Pub Date : 2023-11-11 DOI: 10.25259/ijpc_28_2022
Latha Sneha, Swathi Narasimhan, Julius Xavier Scott, S. Shuba, P. S. Rajakumar, Anitha Rani
Objectives: The place of a child’s death is an indicator of the quality of paediatric palliative and end-of-life care. This study aimed to identify the choices of parents about the place of death of their children with cancer and to evaluate whether they had any regrets about their choices retrospectively. Material and Methods: All children who were treated in our centre for the past 9 years with palliative intent treatment to improve their quality of life were included in this study. For the children whose place of death was the hospital, data were collected from the case records. For the children who passed away at home, a telephone call was made to the families, informing them of the study, allowing time for there to be any clarifications. A verbal consent was requested for the study. Data were collected through the telephone conversation. Results: Out of the 59 children who died during the study period from 2012 to 2021, 31 children (52.5%) died in hospital settings. Eighteen (58.1%) families who had opted hospital as the place of death had regretted their choices. Families who chose home as a place of death were upset about inadequate pain management. The majority of the families had desired home care services for adequate symptom control and to keep the child comfortable in a familiar environment. Conclusion: Most children with life-limiting conditions continue to die in the hospital setting in developing countries due to a lack of dedicated palliative care services and home care. Most of the families retrospectively, regretted their choices of place of death. Most of the families, however, would prefer home as the place of death, if there was better end-of-life care support for symptom control at home. Specific policies institutional and nationwide need to be formulated to provide guidance to the professionals on the discussion of goals of care and place of care, with a supporting network to ensure its provision.
目标:儿童死亡地点是儿科姑息治疗和临终关怀质量的一个指标。这项研究旨在确定父母对癌症患儿死亡地点的选择,并评估他们是否对自己的选择有任何后悔。材料和方法:本研究纳入了过去9年中在本中心接受缓和治疗以改善其生活质量的所有儿童。对于死亡地点在医院的儿童,从病例记录中收集数据。对于在家中去世的孩子,我们给他们的家人打了一个电话,通知他们这项研究,让他们有时间去澄清。这项研究要求得到口头同意。数据是通过电话交谈收集的。结果:在2012年至2021年研究期间死亡的59名儿童中,31名儿童(52.5%)死于医院环境。18个(58.1%)选择医院作为死亡地点的家庭后悔自己的选择。选择家中作为死亡地点的家庭对疼痛管理不足感到不安。大多数家庭希望获得家庭护理服务,以充分控制症状并使儿童在熟悉的环境中感到舒适。结论:在发展中国家,由于缺乏专门的姑息治疗服务和家庭护理,大多数患有生命限制疾病的儿童继续在医院环境中死亡。大多数家属事后都对他们选择的死亡地点表示遗憾。然而,如果在家中有更好的临终关怀支持来控制症状,大多数家庭更愿意将家中作为死亡地点。需要在机构和全国范围内制定具体政策,指导专业人员讨论护理目标和护理地点,并建立一个支持网络以确保提供这些目标。
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引用次数: 0
Effectivity of Palliative Care Bundle on Advanced Gallbladder Cancer: A Randomised Controlled Trial 姑息治疗一揽子治疗晚期胆囊癌的有效性:一项随机对照试验
Q4 HEALTH CARE SCIENCES & SERVICES Pub Date : 2023-11-11 DOI: 10.25259/ijpc_33_2023
Kusum K. Rohilla, C. Vasantha Kalyani, Amit Gupta, Manoj Gupta, Nirmal Matella
Objectives: The main aim of this study was to develop, test, and compare palliative care bundles to improve functional recovery, resilience, and quality of life among advanced gallbladder cancer patient with their routine palliative care. Material and Methods: This study was to test a palliative care bundle, a single-center, and two-arm randomised controlled trial done on a total of 116 participants (58 in each arm) from July 2019 to December 2021 at All India Institute of Medical Sciences, Rishikesh. Results: By the end of 4 th month, the recruitment rate was 96.7%, retention rate acceptance rate was 95%, and adherence rate was 85%. The palliative care bundle showed that a significant difference in trial outcome index score ( P = 0.014*) indicates the effectiveness of the palliative care bundle related to improvement in physical mobility, resilience, and quality of life of patients and reduced caregiver burden. Reported barriers faced by participants were physical exhaustion (65%), psychological factors (25%), social factors (15%) and unfamiliar surroundings (5%). Caregivers reported barriers that their job (40%), physical fatigue related to the care of their patient (40%), their education (10%), and lack of support for their other family members (10%) were some reasons forcing them not to practice palliative care bundle. Conclusion: The palliative care bundle did not interfere with the palliative treatment plan of any patients and significantly improved physical mobility, resilience, quality of life of patients, and reduced caregiver burden. Hence, a palliative care bundle can be considered in the palliative care of advanced cancer patients during their palliative treatment to provide holistic care.
目的:本研究的主要目的是开发、测试和比较姑息治疗方案,以改善晚期胆囊癌患者常规姑息治疗的功能恢复、恢复力和生活质量。材料和方法:本研究旨在测试2019年7月至2021年12月在瑞希凯什全印度医学科学研究所进行的一项缓和治疗捆绑试验,这是一项单中心、两组随机对照试验,共有116名参与者(每组58名)。结果:截至第4个月,招募率为96.7%,保留率为95%,接受率为85%。姑息治疗捆绑治疗显示,试验结果指数得分有显著差异(P = 0.014*),表明姑息治疗捆绑治疗的有效性与改善患者的身体活动能力、恢复能力和生活质量以及减轻照顾者负担有关。报告的参与者面临的障碍是身体疲惫(65%),心理因素(25%),社会因素(15%)和不熟悉的环境(5%)。护理人员报告说,他们的工作(40%)、与病人护理相关的身体疲劳(40%)、他们的教育(10%)以及缺乏对其他家庭成员的支持(10%)等障碍是迫使他们不实行姑息治疗捆绑治疗的一些原因。结论:姑息治疗包不会干扰任何患者的姑息治疗计划,并显著改善患者的身体活动能力、恢复能力、生活质量,减轻护理人员负担。因此,在晚期癌症患者的姑息治疗期间,可以考虑姑息治疗包,以提供整体护理。
{"title":"Effectivity of Palliative Care Bundle on Advanced Gallbladder Cancer: A Randomised Controlled Trial","authors":"Kusum K. Rohilla, C. Vasantha Kalyani, Amit Gupta, Manoj Gupta, Nirmal Matella","doi":"10.25259/ijpc_33_2023","DOIUrl":"https://doi.org/10.25259/ijpc_33_2023","url":null,"abstract":"Objectives: The main aim of this study was to develop, test, and compare palliative care bundles to improve functional recovery, resilience, and quality of life among advanced gallbladder cancer patient with their routine palliative care. Material and Methods: This study was to test a palliative care bundle, a single-center, and two-arm randomised controlled trial done on a total of 116 participants (58 in each arm) from July 2019 to December 2021 at All India Institute of Medical Sciences, Rishikesh. Results: By the end of 4 th month, the recruitment rate was 96.7%, retention rate acceptance rate was 95%, and adherence rate was 85%. The palliative care bundle showed that a significant difference in trial outcome index score ( P = 0.014*) indicates the effectiveness of the palliative care bundle related to improvement in physical mobility, resilience, and quality of life of patients and reduced caregiver burden. Reported barriers faced by participants were physical exhaustion (65%), psychological factors (25%), social factors (15%) and unfamiliar surroundings (5%). Caregivers reported barriers that their job (40%), physical fatigue related to the care of their patient (40%), their education (10%), and lack of support for their other family members (10%) were some reasons forcing them not to practice palliative care bundle. Conclusion: The palliative care bundle did not interfere with the palliative treatment plan of any patients and significantly improved physical mobility, resilience, quality of life of patients, and reduced caregiver burden. Hence, a palliative care bundle can be considered in the palliative care of advanced cancer patients during their palliative treatment to provide holistic care.","PeriodicalId":13319,"journal":{"name":"Indian Journal of Palliative Care","volume":"36 9","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135042826","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}
引用次数: 0
Palliative Care Need in India: A Systematic Review and Meta-analysis 印度的姑息治疗需求:系统回顾和荟萃分析
Q4 HEALTH CARE SCIENCES & SERVICES Pub Date : 2023-11-11 DOI: 10.25259/ijpc_140_2023
Ankit Chandra, Aninda Debnath, Baridalyne Nongkynrih
Background: To achieve sustainable development goal 3.8, countries must prioritise the provision of palliative care. We aimed to estimate the prevalence of palliative care needs in India. Methods: A systematic literature search was conducted in databases of PubMed, Cochrane, Embase, Web of Science, and EBSCO Host. We included community-based studies published in English between inception and April 30, 2023. We excluded hospital-based studies that were conducted solely including diseased patients. Data were extracted independently, and a quality assessment was performed. To estimate the pooled prevalence and 95% confidence intervals (CI), we used the random-effects model. Heterogeneity was assessed using the Q statistic and I 2 test. Subgroup analyses were conducted based on the study site, urban–rural distribution, gender, and age groups. Publication bias was evaluated using a funnel plot and Egger test. STATA software was used for data analysis. Results: Out of the 2632 articles identified, 8 cross-sectional studies were included. Using the random-effects model, the pooled estimate of palliative care needs was found to be 6.21/1000 population (95% CI: 2.42–11.64). The southern region showed a prevalence of 10.83/1000 compared to 2.24/1000 in the northern region. Urban areas had a prevalence of 3.34/1000, while rural areas had a prevalence of 7.69/1000. Among females, the prevalence was 9.64/1000, compared to 6.77/1000 among males. Notably, individuals aged over 60 years had a higher prevalence of palliative care needs, with a rate of 37.86/1000 population. Conclusion: This systematic review and meta-analysis highlight a substantial need for palliative care in India, with a prevalence of 6.21 individuals/1000 population.
背景:为实现可持续发展目标3.8,各国必须优先提供姑息治疗。我们的目的是估计缓和治疗需求在印度的流行程度。方法:系统检索PubMed、Cochrane、Embase、Web of Science、EBSCO Host等数据库的文献。我们纳入了从开始到2023年4月30日以英语发表的基于社区的研究。我们排除了仅包括患病患者的基于医院的研究。数据独立提取,并进行质量评估。为了估计总患病率和95%置信区间(CI),我们使用了随机效应模型。采用Q统计量和I 2检验评估异质性。根据研究地点、城乡分布、性别和年龄组进行亚组分析。采用漏斗图和Egger检验评价发表偏倚。采用STATA软件进行数据分析。结果:在确定的2632篇文章中,8篇横断面研究被纳入。使用随机效应模型,发现姑息治疗需求的汇总估计为6.21/1000人口(95% CI: 2.42-11.64)。南部地区患病率为10.83/1000,北部地区患病率为2.24/1000。城市地区患病率为3.34/1000,农村地区患病率为7.69/1000。女性患病率为9.64/1000,男性为6.77/1000。值得注意的是,60岁以上的人对姑息治疗需求的患病率更高,为37.86/1000。结论:本系统综述和荟萃分析强调了印度对姑息治疗的大量需求,患病率为6.21人/1000人。
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引用次数: 0
Assessment of the Impact of Yoga on the Quality of Life of Breast Cancer Patients: A Systematic Literature Review 瑜伽对乳腺癌患者生活质量影响的评估:系统文献综述
Q4 HEALTH CARE SCIENCES & SERVICES Pub Date : 2023-11-11 DOI: 10.25259/ijpc_306_2022
Jayajith Nair, Anju Mishra, Anjali Midha Sharan
Patients with breast cancer (BC) typically undergo multimodal treatment over an extended period and deal with a wide range of symptoms that severely impair their overall quality of life (QoL) and prognosis. Concern about the health-related QoL of persons diagnosed with cancer as well as the calibre of care they receive is increasing every day. This study aims to assess the impact of yoga on the QoL of patients with BC. PRISMA guidelines served as the foundation for the methodologies used to identify the studies. A total of 480 records were found using PubMed/Medline and Google Scholar databases. A final set of 22 studies was assessed for the work based on the exclusion and inclusion criteria and study eligibility. Yoga has a moderate effect on BC patients. Pranayama has been shown to have a positive effect on improving the QoL. The study observed that yoga was more useful during actual treatment for cancer than after completion. The various randomised controlled trials (RCT) and meta-analysis included in this study believe that yoga has a positive effect. However, the outcomes of various studies do not support this point completely. According to the safety information that is currently available, yoga is not associated with severe adverse outcomes. There is no concrete evidence that establishes the role of yoga as one of the alternative medicines in treating BC patients after chemotherapy. More clinical trials are needed to investigate the advantages of yoga in the overall improvement of QoL in BC patients.
乳腺癌(BC)患者通常在较长时间内接受多模式治疗,并处理严重影响其整体生活质量(QoL)和预后的各种症状。对被诊断患有癌症的人与健康有关的生活质量以及他们得到的护理质量的关注日益增加。本研究旨在评估瑜伽对BC患者生活质量的影响。PRISMA准则是用于确定研究的方法的基础。在PubMed/Medline和Google Scholar数据库中共发现了480条记录。根据排除标准和纳入标准以及研究资格对最后一组22项研究进行评估。瑜伽对BC患者有中等效果。调息已被证明对改善生活质量有积极作用。研究发现,瑜伽在癌症的实际治疗过程中比完成治疗后更有用。本研究中包括的各种随机对照试验(RCT)和荟萃分析都认为瑜伽有积极的作用。然而,各种研究的结果并不完全支持这一观点。根据目前可获得的安全信息,瑜伽与严重的不良后果无关。没有具体的证据表明瑜伽作为治疗化疗后BC患者的替代药物之一的作用。需要更多的临床试验来研究瑜伽在BC患者总体生活质量改善方面的优势。
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引用次数: 0
Palliative Care in Drug Resistance Tuberculosis: An Overlooked Component in Management 耐药结核病的姑息治疗:管理中被忽视的组成部分
Q4 HEALTH CARE SCIENCES & SERVICES Pub Date : 2023-11-11 DOI: 10.25259/ijpc_141_2022
Deependra Kumar Rai, Priya Sharma
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.
姑息治疗应成为耐药结核病(DRTB)管理的重要组成部分;然而,它并没有得到重视。即使在目前的情况下,许多患者和他们的护理人员认为耐多药和广泛耐药结核病(TB)是一种绝症,并认为它几乎是死刑判决,这组患者也需要姑息治疗。有一种误解,认为姑息治疗作为治疗的一个组成部分,在疾病的终末期,治愈性治疗对提高病人的生存没有作用。然而,姑息治疗的真正意义是减轻疾病各个阶段的痛苦,而不仅仅局限于临终关怀。耐药结核病的姑息治疗旨在改善患者及其照护者的生活质量、缓解难治性症状和减轻身体、社会心理和精神痛苦。迫切需要对所有结核病卫生保健工作者进行基本姑息治疗方面的培训,并将姑息治疗纳入结核病卫生保健系统。
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引用次数: 0
Issues Related to Children-Faced by Armed Forces Families When Caring for Patients in Palliative Care – A Qualitative Study 军人家庭在姑息治疗中照顾患者时所面临的儿童相关问题-一项定性研究
Q4 HEALTH CARE SCIENCES & SERVICES Pub Date : 2023-11-03 DOI: 10.25259/ijpc_58_2023
Savita Butola, Damini Butola
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.
目标:获得姑息治疗的机会有限,特别是在印度农村。需要姑息治疗小组照顾的儿童本身可能就是病人,或者是病人的兄弟姐妹和子女。武装部队家庭面临着特有的生活方式挑战——频繁调动、生活在困难和偏远地区、服役人员长时间与家人分开——与平民面临的问题非常不同。服兵役增加了服役人员及其家庭的心理社会负担风险。大多数人依靠私人和国家医疗服务来进行姑息治疗,所以姑息治疗社区了解他们的问题很重要。本研究旨在探讨军人家属在照顾姑息治疗病人时所面对的儿童相关问题。材料和方法:定性研究基于对三个中心的护理人员(服务人员或其家属)的半结构化访谈的主题分析。结果:对15次访谈的分析表明,武装部队家属在照顾姑息病人时面临着与儿童有关的复杂挑战,原因包括:频繁调动、偏远地区缺乏儿科姑息治疗服务、护理连续性中断、生活在非土著地区时面临社会隔离、语言和文化障碍、无法建立和获得家庭和社区支持以及限制性报销政策造成的经济负担。结论:虽然组织内的医疗和行政支持提供了缓冲,但在父亲长时间不在的情况下,妻子必须独自管理,当孩子住在校外时,安全是一个问题,服务人员报告说,在需要的时候不在场,他们感到内疚、愤怒和无助。对这些问题的认识可以使姑息治疗工作者根据服务家庭的需要提供更有意义的支持。
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引用次数: 0
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 晚期转移性癌症患者从重症监护病房开始姑息治疗转诊:来自南印度三级转诊癌症研究所的质量改进过程
Q4 HEALTH CARE SCIENCES & SERVICES Pub Date : 2023-11-03 DOI: 10.25259/ijpc_267_2022
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.
目的:重症监护病房(ICU)的危重癌症患者没有任何姑息治疗(PC)干预,因为没有从ICU转介的姑息治疗。该项目旨在为至少50%的进展性姑息性癌症重症监护患者启动PC转诊,以加强与患者和护理人员的沟通。我们在这个项目的团队中包括了PC内科医生、肿瘤学家和心理学家。材料和方法:我们使用了质量改进(QI)的A3问题解决方法,同时也使用了计划、执行、检查和行动过程。收集了可能受益于PC转诊的ICU患者6个月以上死亡的第一次基线评估;这使我们意识到某些患者可能已经开始使用PC。构建患者入ICU及出院流程图。对妨碍转诊的根本原因进行了分析。在团队协商一致后,我们制作了一个PC触发工具,并开始使用它来启动PC转介。PC放电协议也被启动。与住院医生和护士进行了教育讨论,以确保继续使用触发工具。结果:重症监护PC转诊从0%缓慢上升到2019年11月的50%以上,到2020年3月达到70%以上;出院的病人有他们家附近PC中心的详细信息。结论:结构化的QI流程和引入PC触发工具可提高ICU危重患者50%的PC转诊成功率。
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Indian Journal of Palliative Care
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