1. Cancer pain is prevalent, with up to 90% of patients with advanced cancer experiencing pain. However, 1 in 3 cancer patients do not receive adequate pain medication.
2. Cancer pain has multiple causes and can be somatic, visceral, neuropathic or sympathetically maintained. A thorough assessment including pain history and physical exam is important.
3. The WHO analgesic ladder provides guidelines for cancer pain management, starting with non-opioids and progressing to mild and strong opioids as needed. Adjunct treatments including antidepressants, corticosteroids, and interventional techniques can also help manage cancer pain.
CME presentation made on 10th Nov 2012. Discusses a Radiation Oncologist's perspectives of cancer pain management, shortcomings of WHO pain ladder, ASTRO guidelines for metastatic bone pain.
CME presentation made on 10th Nov 2012. Discusses a Radiation Oncologist's perspectives of cancer pain management, shortcomings of WHO pain ladder, ASTRO guidelines for metastatic bone pain.
a detailed description of pain and therpaeutic options available and clinical assessment of pain, approach to the patient with pain, assessment of intensity of pain, nsaids and opioids, tca. WHO pain ladder, chronic opioid therapy
a detailed description of pain and therpaeutic options available and clinical assessment of pain, approach to the patient with pain, assessment of intensity of pain, nsaids and opioids, tca. WHO pain ladder, chronic opioid therapy
Ems world expo pain management 11112014.handoutMichael Dailey
Acute pain management is one of the keys to quality patient care. Over the course of the last 10 years there has been a steady evolution of prehospital pain management protocols and use of different medications. Currently, we are on the verge of a national standard of care for treatment of pain in ambulances. What has changed over that time? What medications are currently being used across the country? How are these medications being given? Dr. Dailey will discuss a national dataset of pain management protocols and discuss the goals for optimal pain management for the acute pain of medical or traumatic pain in the prehospital arena.
Clossing
By 3 step ladder WHO cancer pain management, 90 % of cancer pain can be relief.
Since cancer patients cannot be cured, our main task is to let them die free of pain with Iman
To improving postoperative pain management, we need to;
- Always applies multi-modal analgesia. (get the advantages of multimodal analgesia)
- Implementation of the existing EB regarding the use of non-opioid + opioid on as needed basis.
- Use available specific evidence for optimizing multimodal pain management procedure (PROSPECT Web site).
HISTORY OF 3-STEP LADDER WHO
1980 – WHO establishes Cancer Control Programme
Cancer prevention
Early diagnosis with curative treatment
Pain relief and palliative care
1986 – ” Cancer Pain Relief “ published by WHO
Step Ladder WHO
Updated on 1996
Worldwide acceptance protocol
Today, worldwide consensus favouring its used for management of all pain associated with serious illness
Pharmacology of Chronic Pain Treatment Addiction and Risks Michael Changaris
Currently, we are in the middle of an epidemic. More people die from addiction to pain medications then die from car accidents.
This lecture explores the biopsychosocial model of chronic pain. It includes pharmacotherapy, psychotherapeutic and other treatment modalities.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
1. Dr. Md Mamun ur Rashid
DA , FCPS (ANAESTHESIA)
FIPM(Delhi)
2. CANCER PAIN : PREVALENCE &IMPACT
More than 14 million cases of cancer were diagnosed
worldwide
1 in 3 patients on average do not receive adequate
pain medication
50% of patients undergoing treatment for cancer and
up to 90% of patients with advanced cancer have pain
Cancer pain is multi focal, multi causal & dynamic.
Most patients have more than one type of pain
3. Barriers to effective pain
management
lack of knowledge regarding pain
assessment and management
• misconceptions about the analgesic use
• Increased survival among persons with
cancer due to introduction of new
treatments
• govt restrictions on sale of opioids
• opiophobia
4. CLASSIFICATION OF
CANCER PAIN
1. Somatic : bone metastasis
2. Visceral : pancreatic carcinoma
3. Neuropathic : plexopathy
4. Sympathetically maintained pain :
reflex sympathetic dystrophy
5. Pain is a cornerstone of
cancer treatment:
• promotes an enhanced quality of life
• Avoids psychological effects of cancer
pain
• improves functioning
• means for patients to focus on their
lives
• Increased survival
6. CAUSES OF PAIN IN CANCER
1. Tumor infilteration
2. Involvement of nerves/plexus
3. Bony mets
4. Massive ascites, pleural effusion
5. Visceral and peritoneal infilteration
6. Related to cancer treatment –
mucosites, polyneuropathy,
Postsurgical chronic pain syndromes
7. ASSESSMENT OF PAIN INTENSITY
Pain evaluation includes a detailed
oncologic, medical & psychosocial
assessment
Wisconsin Brief Pain Inventory (BPI)
Memorial Pain Assessment Card
Edmonton Staging System
Numerical Pain Rating Scale or VAS
WHO QOL scores
Eastern cooperative oncology group
performance scale & Karnofsky rating
8. Continue
Pediatric cancer pain assessment
includes use of the Beyer Oucher, Eland
Color Scale-Body Outline, Hester Poker
Chip Tool, and McGrath Faces Scale
The BPI is a 15-minute questionnaire
that can be self-administered.
It incorporates two valuable features of
the McGill Pain Questionnaire—a
graphic representation of the location of
pain and groups of qualitative descriptors
9.
10. EVALUATION OF THE PATIENT WITH
CANCER PAIN
1. Oncologic history
• diagnosis and stage of disease
• History of implemented therapies -
chemotherapeutic agents used, types of
surgery, site of therapy
• radiotherapy
• outcome (including side effects)
• patient’s understanding of the disease
process and prognosis
11. Continue
2. Pain history
for each new pain site-
• Onset and evolution
• site and radiation areas
• Pattern (constant, intermittent, or
unpredictable)
• Intensity (best, worst, average, current;
rating on a 0 to 10 scale)
• quality, exacerbating and relieving factors
• pain interference with usual activities
• neurologic and motor abnormalities
(including bowel and bladder continence)
12. Continue
◦ vasomotor changes
• Current and past analgesics (use, efficacy, side
effects)
• Prior analgesic use, efficacy, and side effects
3.Psychosocial history
4. Medical history (independent of oncologic history)
• coexisting systemic disease
• Exercise intolerance
• allergies to medications
• current medications
• prior illness and surgery
5. Physical Examination
The physical examination must be thorough
13. MANAGEMENT OF CANCER-
RELATED PAIN
Basic principle :
• modifying its source (treatment of
cancer)
• interrupting its transmission
• modulating its influence at brain or
spinal cord sites (analgesics, anti
depressants, anxiolytics, neuraxial
analgesia)
14. GUIDELINES FOR CANCER PAIN
MANAGEMENT
1. WHO analgesic ladder
2. Pain treatment cantinuum
17. Continue
ADVANTAGE:
Effective pain relief
70-80% patients
Simple to use
assessment of cancer
pain
DISADVANTAGE:
less emphasis on
regional blocks
Extra emphasis on
opioids, not easily
available especially
oral morphine
18. Continue
The most effective form of treatment of any
cancer related pain is treatment of the cancer
itself
More than one treatment modality can be
employed at one time and one modality can
supersede another according to patients need
22. Pharmacologic Management
Oral analgesics are the mainstay of
therapy for patients with cancer pain
The noninvasive route should be
maintained as long as possible
1. Paracetamol & NSAIDS
blocks synthesis of prostaglandins,
which activates nociceptive fibres
Mild pain
Opioid sparing
Less side effects
24. Continue
3. Opioids
1st line for moderate to severe cancer pain
Effective pain control in 85% patients
Easily titrable
Good risk benefit ratio.
Dosage
1. Morphine 10mg; q 3-4h (max 400mg/d) GOLD
STANDARD FOR MOD-SEVERE PAIN
2. Codeine 120-360 mg; q 3-4h
25. Continue
3.Tapentadol 100-400mg/day NEW SYNTHETIC
OPIOID FOR SEVERE CANCER PAIN & LESSER
SIDE EFFECT
4.Tramadol 50-100mg; q8-12h(max 400mg/d)
5.Transdermal Fentanyl & transdermal
Buprenorphine.
Opioid responsiveness : it is the probability of
adequate analgesia(satisfactory without
intolerable & unmanageable side effects) that
can be attained during gradual dose titration
30. Continue
2. ANTI DEPRESSANTS
For neuropathic pain
Potentiate analgesic properties of opioids
31. Continue
3. CORTICOSTEROIDS
Mechanism:
• Reduction of inflammation
• Block C-fiber transmission
• Weak local anesth properties
• Reduce ectopic discharge from neuromas
• Action on dorsal horn cells
32. Continue
4. Neuron Revitalizer :
Methoxycobalamine: 500mcg TDS neuron
regeneration
5. Muscle Relaxants:
For muscle spasm
Tizanidine 2-6mg TDS
6. BISPHOSPHONATES
used in multiple myelomas, bone mets
7. OSTEOCLAST INHIBITORS
neuropathic & bone pain
33. Interventional Techniques for
Pain Management
When pharmacologic therapy fails to
provide adequate analgesia or leads to
unacceptable side effects.
A. Intravenous Infusion of Opioids with
Patient-Controlled Analgesia Devices
Indications
• severe pain
• need to titrate opioids rapidly
• oral route is not available because of
gastrointestinal (GI) obstruction,
malabsorption, uncontrolled nausea and
vomiting, dysphagia.
34. Continue
B. Intraspinal Analgesia
Used when :
1. Systemic opioids provides pain relief but
with unacceptable side effects
2. Unsuccessful treatment with strong
opioids
3. Life expectancy > 3-6mnths opioid alone
or in combination with other agents such as
bupivacaine, clonidine(30-120mcg/day),
midazolam(1.2mg/day
35. Continue
4.Intraspinal morphine is GOLD STANDARD
therapy (0.5 mg/day to 12.5mg/day)
5. pain relief is in a highly selective fashion
without motor, sensory, and sympathetic
effects
6. analgesia was potentially superior to that
achieved when opioids were administered
by other routes and, because the total
amount of drug administered is reduced,
side effects are minimal
36. Continue
C. NEUROLYTIC BLOCKS
SOMATIC & SENSORY BLOCKS:
• Paravertebral block: CA lung, Rib
secondaries
• Intercostal nerve block : CA breast, rib
seconadries
• Mandibular & Maxillary nerve block : CA
cheek, salivary gland tumor
• Deep & superficial cervical blocks: nerve
tumors, thyroid CA.
37. Continue
SYMPATHETIC PLEXUS BLOCK:
• Stellate ganglion block: upper limb tumors
• Coeliac plexus block: CA liver, pancrease,
stomach
• Lumbar plexus block: pelvic & lower limb CA
• Superior hypogastric plexus block: pelvic CA,
cervix, body of uterus
• Ganglion Impar block: CA rectum
38. Continue
Limitations :
• New pathways develop
• Pain relief upto 60-70%
• Duration 3-4mnths
• Deafferentation pain synd
Morbidity of procedure
D. INTRAVENOUS LIGNOCAINE INFUSION:
central analgesia, 5mg/kg over 60mins
upto 3weeks