This document discusses palliative and supportive care in oncology. It defines palliative care as preventing and relieving suffering through early management of pain and other physical, psychosocial, and spiritual problems across the cancer experience. The goals of palliative care are to anticipate, prevent, and reduce suffering and support the best possible quality of life regardless of disease stage. Early palliative care involvement has benefits like improved quality of life and mood over traditional late palliative care. An interdisciplinary team approach to palliative care is recommended.
Through palliative care, we change the role of a patient into a whole human being.
Through palliative care, we transform the stages leading to death into times filled with life
Palliative care is an approach to care which improves the quality of life of patients and their families facing the problem associated with life-threatening illness.
Through palliative care, we change the role of a patient into a whole human being.
Through palliative care, we transform the stages leading to death into times filled with life
Palliative care is an approach to care which improves the quality of life of patients and their families facing the problem associated with life-threatening illness.
SHARE Presentation: Palliative Care for Womenbkling
Dr. Michael Pearl discusses supportive palliative care for women with cancer, how it differs from hospice care, and the New York Palliative Care Information Act. Dr. Michael Pearl is Professor and Director of the Division of Gynecologic Oncology in the Department of Obstetrics, Gynecology and Reproductive Medicine at Stony Brook University Hospital.
Children are given palliative care in tertiary hospitals and even at home also. This topic includes which are the pediatric conditions require palliative care and what are the common symptoms children are facing and how to manage these symptoms.
There are many types of cancer treatment. The types of treatment that patient receive will depend on the type of cancer, stage of cancer and how advanced it is.
Some people with cancer will have only one treatment. But most people have a combination of treatments, such as surgery with chemotherapy and/or radiation therapy.
SHARE Presentation: Palliative Care for Womenbkling
Dr. Michael Pearl discusses supportive palliative care for women with cancer, how it differs from hospice care, and the New York Palliative Care Information Act. Dr. Michael Pearl is Professor and Director of the Division of Gynecologic Oncology in the Department of Obstetrics, Gynecology and Reproductive Medicine at Stony Brook University Hospital.
Children are given palliative care in tertiary hospitals and even at home also. This topic includes which are the pediatric conditions require palliative care and what are the common symptoms children are facing and how to manage these symptoms.
There are many types of cancer treatment. The types of treatment that patient receive will depend on the type of cancer, stage of cancer and how advanced it is.
Some people with cancer will have only one treatment. But most people have a combination of treatments, such as surgery with chemotherapy and/or radiation therapy.
International Association for Hospice and Palliative Care (IAHPC) – Международная ассоциация хосписной и паллиативной Помощи – некоммерческая организация, которая занимается развитием паллиативной помощи по всему миру.
Одно из приоритетных направлений работы ассоциации - образование. Во многих странах учебники по паллиативной помощи дороги или труднодоступны, поэтому IAHPC бесплатно распространяет руководство по паллиативной помощи.
Пока мы выкладываем это руководство на английском языке, но надеемся вскоре перевести его на русский - с вашей помощью, с помощью жертвователей и наших друзей.
Вы тоже можете помочь фонду - достаточно отправить СМС на номер 3443 со словом Вера и суммой пожертвования. Например, Вера 100.
Также пожертвование можно сделать через Пейпал, Яндекс-деньги, или просто кредитной карточкой - все варианты есть у нас на сайте hospicefund.ru/help
45 minutes of suffering (or Anesthesia Grand Rounds on Palliative Care)Mike Aref
Presentation on what palliative care is, comparison with hospice, primary palliative care screening, goals-of-care, definitions of DNR, basics of acute pain management and WHO analgesic ladder.
Palliative Care Across the Continuum as presented to the The Palliative Care Summit for PeopleFirst Homecare and Hospice that was held in Snowbird Utah on September 15, 2012, following the Rocky Mountain Geriatric Conference.
Palliative care is a specialized approach to medical care that focuses on providing relief from the symptoms, pain, and stress associated with serious illnesses. Its primary goal is to improve the quality of life for patients and their families facing life-threatening or chronic conditions, regardless of the prognosis.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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
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Title: Sense of Taste
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 structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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
4. Definition of Supportive Care
Supportive care in cancer is the prevention and management of the
adverse effects of cancer and its treatment
This includes management of physical and psychological symptoms
and side effects across the continuum of the cancer experience from
diagnosis through treatment to post-treatment care
Supportive care aims to improve the quality of rehabilitation,
secondary cancer prevention, survivorship, and end-of-life care
MASCC = Multinational Association of Supportive Care in Cancer
5. Goals of Palliative Care
To anticipate, prevent and reduce suffering
To support the best possible quality of life to the patients, family &
care givers regardless of the stage of the disease or the need for other
therapies
6. Objectives
To give the concept of palliative care in oncology
To discuss the factors involved in palliative care
To give the idea of approach to a patient of palliative care
To discuss the Indian scenario of palliative care
To give the concept of multidisciplinary approach
7. Definition
WHO:
Services designed to prevent & relieve suffering for patients and families facing
life-threatening illness through early management of pain & other physical,
psychosocial & spiritual problems
NCCN:
It is an approach to patient / family / care giver-centred health care that focus on
optimal management of pain and other distressing symptoms, while
incorporating psychosocial & spiritual care according to patient /family needs,
values, beliefs & cultures
8. Palliative care is Palliative care is not
Evidence based medical treatment It is not “giving up” on a patient
Vigorous care of pain and symptoms
throughout illness
Not in place of curative or life prolonging
care
Care that patients want at the same time
as efforts to cure or prolong life
Not the same as Hospice
9. ASCO : Recommendations
• The time to start palliative care is as soon as a patient cancer becomes advanced.
• For newly diagnosed patients with advanced cancer, the panel suggests that early
palliative care involvement within 8 wks after diagnosis
• In-patients and out-patients with advanced cancer should receive dedicated
palliative care services early in the disease course concurrent with active treatment
10. Palliative care should facilitate
a) Patient autonomy
b) Access to information
c) Choice
Palliative care becomes the main focus of care when disease- directed, life
prolonging therapies are no longer
a) Effective
b) Appropriate
c) Desired
12. Who can practice Palliative Care?
Palliative care should be initiated by the primary oncology team & augmented by
collaboration with an inter disciplinary team of palliative care experts
13. When to a start Palliative Care?
Patients having one or more of the following
Uncontrolled symptoms
Moderate – severe distress related to cancer diagnosis and therapy
Serious co-morbid physical and psychosocial conditions
Complex psychosocial needs
Poor prognosis
Potentially life limiting disease
Metastatic solid tumors
Patient/ family/ care giver concerns about course of disease and decision
making
Patient family care giver requests for palliative care
Patient request for a hastened death
15. Criteria for consultation with palliative care specialist
Patient characteristics
Patient with life limiting cancer diagnosis
Limited anticancer treatment options
Need for clarifications of goals of care
Resistance to engage in advance care planning
High risk of poor pain management / resistant pain to conventional interventions
High non-pain symptom burden, especially those resistant to conventional
management
High distress
Need for invasive procedures [i.e. palliative stenting/ venting gastrostomy]
Frequent visits and hospital admissions
Need for ICU level care
Communication barriers [language /literacy /cognitive impairment]
Request for hastened death
16. Assessment
The oncology team assesses the following
Benefits /burdens of anti cancer therapy
Patients / family /caregivers goals /values /expectations /priorities
Symptom management
Psychosocial distress
Educational and informational needs / cultural factors affecting care
17.
18. Benefits/ burdens of anti cancer therapy
Natural history of specific tumor
Potential for response to further treatment
Potential for treatment related toxicities
Patients understanding of disease prognosis
Goals and meaning of anticancer therapy for patient, family, care givers
Impairment of vital organs
Performance status
Serious co-morbid conditions
19. Patients/ family/ care-givers goals/ values/
expectations/ priorities
Shared decision making with patients / family /care-givers
Advance care planning
Goals and meaning of anti cancer therapy
Quality of life
23. Educational and informational needs or
cultural factors affecting care
Patient/family/care-giver values and preferences about information &
communication
Their perceptions of disease status
24. Hospice
Definition : It is defined as the care that is designed to give supportive care to
people in the final phase of a terminal illness and focus on comfort and quality of
life, rather than cure.
Goal : The goal is to enable patients to be comfortable and free of pain so that they
live each day as fully as possible.
Hospice programmes : They are generally home based but they sometimes provide
services away from home [ i.e. In hospitals ].
Philosophy : Is to provide support for the pts emotional, social & spiritual needs as
well as medical symptoms as a part of treating the whole person.
25. Bereavement
It is the period of mourning after a loss / death.
The team of palliative care also provides bereavement care
26. Hospice & palliative care development in India
Palliative care has been developing in India since mid 1980s
Now in India there are > 150 palliative and hospice centres in 16 states
Mostly concentrated in large cities [but in Kerala it is more wide spread]
Non governmental organizations, public and private hospitals
But in rest of the states of India it is totally absent
Barriers to the development of palliative care are:
Poverty
Population density
Opioid availability
Work force development &
Limited National palliative care policy
27. Developing palliative care in India
Based on the western models of palliative & hospice care for implementation in
Indian cultural context, successful models are being developed for
Affordable
Sustainable
Community based palliative care services
28. Role of counselling in palliative care
Most of the patients in palliative care suffer from depression therefore
counselling plays a very important role in palliative care
for the better cooperation of the patient and care takers
accepting the facts
to understand the treatment, its benefits and side effects
The counsellor provides emotional & psychological support to patients
Therefore it is a part of palliative care rather than considering it as separate
entity
29. Role of family physicians in palliative care
Attending to palliative care needs is a responsibility of primary care doctors
They are in a unique position to provide comprehensive care to the patient
To make it possible for terminally ill patients to remain at home for the
remaining period of life , they should have an access to a doctor who is
Easily approachable
Skilled in palliative care
Prepared to come for a home visit
Provide round the clock care
Therefore family physicians of palliative care patients should be trained for
the basic interventions and care to be offered
Improving the skills of doctors in palliative care principles have to be
initiated in the profession so that they could meet the needs of challenging
society
31. Alternative therapy
It is the term used to describe any medical treatment or intervention that has not
been sufficiently scientifically documented or identified as safe and effective for a
specific condition
All the following are alternative therapies :
Acupuncture
Guided imagery
Chiropractic treatment
Yoga & meditation
Hypnosis
Bio feedback therapy
Aromatherapy
Herbal remedies
Massage
32. Integrative medicine
Integrative medicine : Medical care + Evidence based CAM
Evidence based CAM should be added to medical care:
Patient dissatisfaction with conventional medical care alone
A need for personal control
Traditional and superstitious thoughts
33. Few benefits
Some of the CAM have evidence in acting as adjuvants along with
medical treatment, therefore can be used
Acupuncture and massage therapy may provide pain relief in cancer pain
/ in end stage patients
Relaxation by imagery can improve oral mucositis pain
Patients with severe COPD and dyspnoea may benefit from the use of
relaxation with breathing retraining
34. Metronomic chemotherapy
To avoid the problems caused by traditional chemotherapeutic regimens a
new modality called Metronomic chemotherapy has been proposed
It refers to the chronic equally spaced administration of low doses of
various chemotherapeutic drugs without extended rest periods
The novelty of this modality lies not only in its anti tumor efficacy with
very low toxicity but also in a cell target switch, now aiming at tumor
endothelial cells
This new concept includes the possibility of treating tumors that no longer
respond to traditional chemotherapy
35. Role of metronomic chemotherapy in palliative care
Studies show that use of metronomic chemotherapy in palliative care in
various sites like
Head & neck ca
Breast ca
Ovarian ca
Advanced GI ca
Refractory haematological malignancies
Showed cost effectiveness, well tolerated with minimal toxicity and
improved quality of life
37. Pain
• “Pain is whatever the experiencing person says it is, existing
whenever he/she says it does.”
- Margo McCaffery, 1968
• An unpleasant sensory and emotional experience associated
with actual or potential tissue damage, or described in terms of
such damage.
- International Association for the Study of Pain (IASP)
40. End stage of life – peaceful death
Peaceful death is one that is free from avoidable distress and suffering of patients,
families and caregivers; in general accord with patients and family's wishes and
consistent with clinical cultural and ethical standards i.e.
Freedom from pain
Being at spiritual peace
Being with family
41. Benefits of palliative care
Kavalieratos et al
Systematic review and meta analysis of 43 RCTs in palliative care vs usual care : both in
IP & OP settings
Improved QOL & symptom burden
No change in survival
Improvements in advance care planning, patient and care-giver satisfaction and
lower health care utilization
42. Benefits of palliative care
Davis et al
A review of 62 studies on palliative care in ambulatory and home care [ 28 RCTs ]
Improvements in depression, patient / cae-giver QOL,patient and family
satisfaction,care-giver burden
Reduced aggressiveness at EOL, increased advanced directives
Reduced hospital length of stay and hospitalizations,reduction in overall cost of
care
43. Benefits of palliative care
Temel et al
Patients with newly diagnosed stage IV NSCLC with standard monthly out patient
palliative care
Improved QOL
2.7 months medial benefit
Less aggressive curative care [ 4th line chemo ]
Hospice referral earlier and longer duration
Improved prognostic awareness – less chemo at EOL
44. Take home message
• Palliative care is a part cancer therapy
• It should be started as early as possible
• The treating physician along with caregivers, patient and his family
should work as a team in palliative care
• Palliative care in India is still developing – therefore palliative care
policy and specific guidelines according to the Indian conditions should
be developed
45. Take home message
• All patients of cancer should be given good QOL till the end of life
• Hospice & bereavement should be a part of your palliation
• Counselling the patient and his family about the disease, options of
treatment and prognosis should be done for better decision making
46. Take home message
• Patient autonomy, willingness and preferences should be respected
• Emotional, spiritual & psychological support to be provided to the
patient and his family
• Finally the patient should have a pain free life till the last breath and a
peaceful death.