This document discusses psychological issues at the end of life from a holistic perspective. It addresses the physical, emotional, social, psychological, and spiritual needs and concerns of dying individuals. Regarding physical needs, it discusses pain management, body image, and finding meaning in illness. Emotionally, it explores common fears, loss/grief, and positive emotions. Socially, it addresses concerns for loved ones and communication patterns. Psychologically, it focuses on maintaining control and contributing to others. Spiritually, it examines religion/spirituality, meaning of life/death, and hope. The document also introduces palliative care and its role in improving quality of life compared to hospice care. Finally, it provides an overview
Dr. Elizabeth Paulk gives an excellent review of palliative care topics including end of life discussions, hospice, pain management, and family counseling.
Review of the latest research in the field on grief therapy and practice tips for practitioners. Topics include:
• The difference between normal grief and complicated or prolonged grief
• Research and issues involved in the inclusion of “Prolonged Grief Disorder” in DSM-V
• Cognitive behavioral techniques to treat prolonged grief
• The importance of self-awareness and the necessity of self-care when providing grief counseling
• Different cultural views of death
Presented by Susan Stuber, Ph.D. at the Philadelphia Society of Clinical Psychologists continuing education conference at the Philadelphia College of Osteopathic Medicine, March 22, 2013. A copy of the full presentation notes accompanying these slides may be obtained by contacting Dr. Stuber at sstuber@susanstuberphd.com.
Dr. Elizabeth Paulk gives an excellent review of palliative care topics including end of life discussions, hospice, pain management, and family counseling.
Review of the latest research in the field on grief therapy and practice tips for practitioners. Topics include:
• The difference between normal grief and complicated or prolonged grief
• Research and issues involved in the inclusion of “Prolonged Grief Disorder” in DSM-V
• Cognitive behavioral techniques to treat prolonged grief
• The importance of self-awareness and the necessity of self-care when providing grief counseling
• Different cultural views of death
Presented by Susan Stuber, Ph.D. at the Philadelphia Society of Clinical Psychologists continuing education conference at the Philadelphia College of Osteopathic Medicine, March 22, 2013. A copy of the full presentation notes accompanying these slides may be obtained by contacting Dr. Stuber at sstuber@susanstuberphd.com.
Presented at Kansas City University of Osteopathic Medicine 10/27/15 in Lecture Series in Bioethics. See live presentation here: https://www.youtube.com/watch?v=Dr3g3PeVKeo
'Loss, Grief and Bereavement Coping with Loss and Grief'Dr Wango Geoffrey
A new dawn has come in our lives in which we must be willing to face the reality of our lives. Part of that reality is the imminence of death. Death can be confusing especially with the advancement of medicine, science and technology and various attempts to make meaning and sense of our world. Ultimately, when death occurs, persons may oscillate between feelings of sadness and anticipation, especially when there is a lot of pain and suffering and hence our love and commitment to our loves ones is juxtaposed with relieve from pain. The interrelationships in our lives affect us all. The fact that death takes away our loved ones can be a panacea for disaster. The purpose of this presentation is to assist persons cope with loss and grief.
PSYCHO-SOCIAL AND MENTAL HEALTH IN END OF LIFE , PALLIATIVE CARE , HOSPICE CARE selvaraj227
PSYCHOSOCIAL AND MENTAL HEALTH IN END OF LIFE, LOSS, ANTICIPATORY GRIEF, MOURNING , BEREAVEMENT, GRIEF THEORY, END OF LIFE CAREGIVING IN THE FINAL STAGES OF LIFE, PALLIATIVE CARE HOSPICE CARE
Basics of palliative care including symptom management: pain, dyspnea, nausea and constipation; family meetings, goals-of-care, end-of-life care, and artificial nutrition.
Presented at Kansas City University of Osteopathic Medicine 10/27/15 in Lecture Series in Bioethics. See live presentation here: https://www.youtube.com/watch?v=Dr3g3PeVKeo
'Loss, Grief and Bereavement Coping with Loss and Grief'Dr Wango Geoffrey
A new dawn has come in our lives in which we must be willing to face the reality of our lives. Part of that reality is the imminence of death. Death can be confusing especially with the advancement of medicine, science and technology and various attempts to make meaning and sense of our world. Ultimately, when death occurs, persons may oscillate between feelings of sadness and anticipation, especially when there is a lot of pain and suffering and hence our love and commitment to our loves ones is juxtaposed with relieve from pain. The interrelationships in our lives affect us all. The fact that death takes away our loved ones can be a panacea for disaster. The purpose of this presentation is to assist persons cope with loss and grief.
PSYCHO-SOCIAL AND MENTAL HEALTH IN END OF LIFE , PALLIATIVE CARE , HOSPICE CARE selvaraj227
PSYCHOSOCIAL AND MENTAL HEALTH IN END OF LIFE, LOSS, ANTICIPATORY GRIEF, MOURNING , BEREAVEMENT, GRIEF THEORY, END OF LIFE CAREGIVING IN THE FINAL STAGES OF LIFE, PALLIATIVE CARE HOSPICE CARE
Basics of palliative care including symptom management: pain, dyspnea, nausea and constipation; family meetings, goals-of-care, end-of-life care, and artificial nutrition.
352 BUMC PROCEEDINGS 2001;14:352–357
The technological advances of the past century tended tochange the focus of medicine from a caring, service-oriented model to a technological, cure-oriented model.
Technology has led to phenomenal advances in medicine and
has given us the ability to prolong life. However, in the past few
decades physicians have attempted to balance their care by re-
claiming medicine’s more spiritual roots, recognizing that until
modern times spirituality was often linked with health care.
Spiritual or compassionate care involves serving the whole per-
son—the physical, emotional, social, and spiritual. Such service
is inherently a spiritual activity. Rachel Naomi Remen, MD, who
has developed Commonweal retreats for people with cancer, de-
scribed it well:
Helping, fixing, and serving represent three different ways of see-
ing life. When you help, you see life as weak. When you fix, you
see life as broken. When you serve, you see life as whole. Fixing
and helping may be the work of the ego, and service the work of
the soul (1).
Serving patients may involve spending time with them, hold-
ing their hands, and talking about what is important to them.
Patients value these experiences with their physicians. In this
article, I discuss elements of compassionate care, review some
research on the role of spirituality in health care, highlight ad-
vantages of understanding patients’ spirituality, explain ways to
practice spiritual care, and summarize some national efforts to
incorporate spirituality into medicine.
COMPASSIONATE CARE: HELPING PATIENTS FIND MEANING IN
THEIR SUFFERING AND ADDRESSING THEIR SPIRITUALITY
The word compassion means “to suffer with.” Compassionate
care calls physicians to walk with people in the midst of their
pain, to be partners with patients rather than experts dictating
information to them.
Victor Frankl, a psychiatrist who wrote of his experiences in
a Nazi concentration camp, wrote: “Man is not destroyed by suf-
fering; he is destroyed by suffering without meaning” (2). One
of the challenges physicians face is to help people find meaning
and acceptance in the midst of suffering and chronic illness.
Medical ethicists have reminded us that religion and spiritual-
ity form the basis of meaning and purpose for many people (3).
At the same time, while patients struggle with the physical as-
pects of their disease, they have other pain as well: pain related
to mental and spiritual suffering, to an inability to engage the
deepest questions of life. Patients may be asking questions such
The role of spirituality in health care
CHRISTINA M. PUCHALSKI, MD, MS
From The George Washington Institute for Spirituality and Health (GWish), The
George Washington University Medical Center Departments of Medicine and
Health Care Sciences, and The George Washington University, Washington, DC.
Presented at Baylor University Medical Center on February 28, 2001, as the Baylor-
Charles A. Sammons Cancer Center Charlotte ...
directly affects cancer outcomes, some data do suggest
that patients can develop a sense of helplessness
or hopelessness when stress becomes overwhelming.
This response is associated with higher rates of death,
although the mechanism for this outcome is unclear.
It may be that people who feel helpless or hopeless
do not seek treatment when they become ill, give up
prematurely on or fail to adhere to potentially helpful
therapy, engage in risky behaviors such as drug use, or
do not maintain a healthy lifestyle, resulting in premature
death.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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
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!
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
3. Holistic Perspective of the Dying Process
Physical
Spiritual
Emotional
Dying
Individual
Psychological Social
4. Physical Needs
The meaning of the illness
People try to find a reason for why bad
things happen.
Patients might blame themselves for their
illness.
They may feel abandoned by others.
5. Pain
is the most commonly experienced symptom
of terminally ill patients.
cause of pain must be known before
appropriate therapeutic methods can be
implemented.
most common treatment is drug therapy.
alternative treatments: biofeedback,
hypnosis, relaxation and imagery techniques,
acupuncture…etc.
pain management must be individualized.
6. Body Image
is the internal representation of one’s
feelings and attitudes toward one’s body.
a terminal illness may affect a previous
sense of body image.
body integrity: the body’s ability to
function normally.
Dying individuals may face gradual loss
of bodily functions. Caregivers should
deal with the emotions that may result.
8. Fears
fearof pain or suffering
fearof isolation or abandonment
fearof extinction
fearof rejection
fearof the unknown
fearof indignity
fearof an inability to fulfill one’s
responsibilities
uncertainty and fear about the future
9. Loss and grief
Grief is a natural response to loss.
Dying individuals grieve over the many
losses that are part of the dying process.
(Loss of: bodily functions, energy,
independence, self-esteem, future dreams).
They grieve over the impending death and
the end of life.
Kubler-Ross’s five stages of grief also
apply to the dying person.
10. Positive Emotions
Emotional growth in the face of
adversity.
Strengthen emotional bonds with
others.
Develop insights about the world.
Give new meaning to life.
11. Social Needs
Concerns about loved ones
Patients worry about the physical and
emotional toll of their illness on spouses or
other family members.
Emotional toll on family members can lead to
depression and stress-related symptoms.
Caregivers may neglect their own healthcare.
12. The dying person needs to know that others
still care about them.
Fear of loneliness/abandonment may be
exacerbated if others:
Fail to disclose the truth about the diagnosis of
a terminal illness.
Refuse to deal openly and honestly with death-
related issues and feelings.
Physically and emotionally withdraw from dying
person.
13. Communication Patterns of dying
persons and those interacting with them (Glaser
&Strauss;1965).
They identifies 4 awareness contexts:
1. Closed awareness: patient does not know
he/she is dying even though medical personnel
and family members know it.
2. Suspected awareness: the patient does not
know but only suspects, with varying degrees
of certainty, that he/she is dying. The medical
staff and family do know the patient is
terminally ill.
14. 3. Mutual pretense. The patient, medical
personnel, and family know the patient is dying
but there is a tacit agreement to act as if this
were not the case.
4. Open awareness. The patient, medical
personnel, and family recognize and openly
acknowledge that the patient is dying.
15. Psychological Needs
Control and Independence.
Retaining a sense of control in their lives in crucial to
the dying person’s emotional well-being.
Dying individuals often prefer to perform tasks for
themselves rather than depend on others for
assistance. fear of increasing dependency on others
Contribution to others.
Doubts of value of life and whether they are a burden
to others.
Activities can enhance a sense of self-worth.
Review of one’s life.
Strive to find an answer to the question “Was my life
worthwhile?”
16. Spiritual Needs
Religion/spirituality becomes magnified as death
approaches (coping and adjusting to illness)
Most patients derive comfort from their religious
beliefs as they face the end of life.
Religious concerns can also be a source of pain
and spiritual distress (e.g., feeling punished or
abandoned by God).
Religion also influences patient's medical decisions,
both about active treatment and end of life care
17. Spiritual Uncertainty
Religious belief provides people with personal
strength.
Helps people accommodate to illness, adjust
to disability, feel less depressed, and cope.
Influence decisions about medical treatments.
18. Meaning of life and death
Victor Frankl, a psychiatrist, wrote of his
experiences in a Nazi concentration camp: “Man is
not destroyed by suffering; he is destroyed by
suffering without meaning”
Hope. Reflects a state of mind associated with
positive actions
Belief system. Caregivers should be aware of
the power of spiritual belief in helping individuals
cope with the process of dying.
The spiritual needs of the dying are rooted in
their family, religious, and cultural systems.
19. Spiritual or compassionate care = serving the
whole person—the physical, emotional, social, and
spiritual.
Rachel Naomi Remen, MD (developed week-long
retreats for people with cancer):
Helping, fixing, and serving represent three
different ways of seeing life. When you help, you
see life as weak. When you fix, you see life as
broken. When you serve, you see life as whole.
Fixing and helping may be the work of the ego,
and service the work of the soul.
21. Palliative Care
medical specialty focused on improving the
quality of life of patients facing serious illness
and their families.
The goal of palliative care is pain and
symptom management (e.g., fatigue, nausea,
shortness of breath, and loss of appetite,
depression…etc.).
All challenges are addressed (physical, emotional,
and spiritual problems).
22. Palliative care is provided for patients of any age.
It focuses on the patient and the family as well.
It is appropriate from the time of diagnosis and
can be provided along with curative treatment.
It can be provided at any stage of illness (in
conjunction with other therapies that are intended
to prolong life, such as chemotherapy or radiation
therapy).
23. Palliative care is carried out by a team of
professionals who provide the patient and their
family comprehensive care. This team may
include:
Palliative care physicians
Specialists or general practitioners
Nurses
Nutritionists
Nursing assistants or home health aides
Social workers
religious counselors
Physical, occupational, and speech therapists
24. Palliative Care vs. Hospice Care
Palliative care
can be offered as an early intervention in the
course of an illness along with curative
therapies meant to prolong life.
Hospice care
focuses primarily on comfort
intended to cease all curative treatments.
appropriate for patients with a terminal illness
and/or a life expectancy of six months or less
25. Lack of palliative care results in untreated
symptoms that hamper an individual’s
ability to continue his or her activities of
daily life.
At the community level, lack of palliative
care places an unnecessary burden on
hospital or clinic resources.
26. Palliative Care in Kuwait
Started in Kuwait in 2005.
Goal: pain and symptom management.
So far 80 children have received palliative care at
home and in the hospital.
Multidisciplinary team: Child life Specialist, nurse,
pain management specialist, psychologist, religious
counselor, physiotherapist, nutritionist.
27. Abdullah Children's Hospice
A comprehensive, pediatric palliative care facility
that embraces all the needs of children with life-
limiting and life-threatening conditions, their
families and their friends in an attractive, child-
friendly environment enabling them to live their
lives as fully as possible for as long as possible.
28. Bayt Abdullah will offer all families
registered with the hospice:
1) A specialized professional service, free of charge
for all children in Kuwait who meet the criteria for
admission to the hospice, regardless of nationality
or religion.
2) The choice of home, hospice or hospital based
care, or a combination of all three, depending on
their needs.
3) 24 hour support at the end of a telephone or in
the family home.
4) Respect for individual preferences of children and
families in relation to treatment and intervention.