Indian Journal of Palliative Care
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   2010| September-December  | Volume 16 | Issue 3  
    Online since December 9, 2010

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Physical therapy in palliative care: From symptom control to quality of life: A critical review
Senthil P Kumar, Anand Jim
September-December 2010, 16(3):138-146
DOI:10.4103/0973-1075.73670  PMID:21218003
Physiotherapy is concerned with identifying and maximizing movement potential, within the spheres of promotion, prevention, treatment and rehabilitation. Physical therapists practice in a broad range of inpatient, outpatient, and community-based settings such as hospice and palliative care centers where as part of a multidisciplinary team of care, they address the physical and functional dimensions of the patients' suffering. Physiotherapy treatment methods like therapeutic exercise, electrical modalities, thermal modalities, actinotherapy, mechanical modalities, manual physical therapy and assistive devices are useful for a range of life-threatening and life-limiting conditions like cancer and cancer-associated conditions; HIV; neurodegenerative disorders like amyotrophic lateral sclerosis, multiple sclerosis; respiratory disorders like idiopathic pulmonary fibrosis; and altered mental states. The professional armamentarium is still expanding with inclusion of other miscellaneous techniques which were also proven to be effective in improving quality of life in these patients. Considering the scope of physiotherapy in India, and in palliative care, professionals in a multidisciplinary palliative care team need to understand and mutually involve toward policy changes to successfully implement physical therapeutic palliative care delivery.
  14,633 992 16
Palliative surgical approach to rehabilitate spinal injury patient in Indian rural setup
Pradeep K Singh, Harshal Sakale, Sandeep Shrivastva, Rajesh Dulani
September-December 2010, 16(3):160-163
DOI:10.4103/0973-1075.73646  PMID:21218006
Objective: To evaluate the usefulness of conventional spinal surgery as palliative procedure to rehabilitate dorsolumbar injuries in a rural setup. Materials and Methods: Twenty-three patients with dorsolumbar spine injury with complete paraplegia were assessed on the clinical and social rehabilitation parameters after surgical stabilization at Acharya Vinoba Bhave Rural Hospital Sawangi, Wardha, India. The study group comprised 21 male and 2 female patients. The dorsolumbar spine injury was fixed by conventional posterior instrumentation using short-segment pedicle screw system and Harrington rod system with or without fusion. Functional and neurologic outcome was recorded in the follow-up period by using Functional Independence Measure and Frankel grade, respectively. Correlation and analysis of results was established statistically. Results: Functional outcome showed statistically significant improvement. Social cognition was found intact in a significant number of patients. Conclusion: This study demonstrates the usefulness of conventional instrumentation as palliative surgical approach to stabilize and rehabilitate patients from deprived sector of rural India.
  9,066 96 -
Psychosocial issues in palliative care: A review of five cases
Tonia C Onyeka
September-December 2010, 16(3):123-128
DOI:10.4103/0973-1075.73642  PMID:21218001
Palliative care is not just vital in controlling symptoms of the patient's disease condition, but also aims to extend the patient's life, giving it a better quality. However, several times in the course of management, the psychosocial impact of cancer, HIV/AIDS, and other life-limiting disease conditions may not be noticed and dealt with during the admission period, thereby giving rise to a more complex situation than the disease condition itself. This article aims to review some psychosocial issues and measures that can be taken to address them. It highlights the various roles and the importance of the clinician, nurse, social worker, and other members of the multidisciplinary team in tackling these issues and will help healthcare professionals in this field achieve better practice in the future.
  7,396 277 1
Treatment of cachexia in oncology
EM Tazi, H Errihani
September-December 2010, 16(3):129-137
DOI:10.4103/0973-1075.73644  PMID:21218002
Background: Cachexia is a complex metabolic syndrome associated with many chronic or end-stage diseases, especially cancer, and is characterized by loss of muscle with or without loss of fat mass. The management of cachexia is a complex challenge that should address the different causes underlying this clinical event with an integrated or multimodal treatment approach targeting the different factors involved in its pathophysiology. Aims and Objectives : The purpose of this article was to review the current medical treatment of cancer-related cachexia, in particular focusing on combination therapy and ongoing research. Results : Among the treatments proposed in the literature for cancer-related cachexia, some proved to be ineffective, namely, cyproheptadine, hydrazine, metoclopramide, and pentoxifylline. Among effective treatments, progestagens are currently considered the best available treatment option for cancer-related cachexia, and they are the only drugs approved in Europe. Drugs with a strong rationale that have failed or have not shown univocal results in clinical trials so far include eicosapentaenoic acid, cannabinoids, bortezomib, and anti-TNF-alpha MoAb. Several emerging drugs have shown promising results but are still under clinical investigation (thalidomide, selective cox-2 inhibitors, ghrelin mimetics, insulin, oxandrolone, and olanzapine). Conclusions : To date, despite several years of coordinated efforts in basic and clinical research, practice guidelines for the prevention and treatment of cancer-related muscle wasting are lacking, mainly because of the multifactorial pathogenesis of the syndrome. From all the data presented, one can speculate that one single therapy may not be completely successful in the treatment of cachexia. From this point of view, treatments involving different combinations are more likely to be successful.
  7,276 320 9
Palliative cancer care ethics: Principles and challenges in the Indian setting
Tejaswi Mudigonda, Parvathi Mudigonda
September-December 2010, 16(3):107-110
DOI:10.4103/0973-1075.73639  PMID:21217998
Palliative cancer treatment is a system of care that seeks to relieve suffering in patients with progressive cancer. Given the intractable symptoms with which certain malignancies manifest, palliative care offers a practical approach towards improving the patient's quality of life. However, there are an array of ethical issues associated with this treatment strategy such as particular methods of pain relief, a reliable assessment of suffering, autonomy, and multi-specialist care. While these principles are important to increase and improve the network of palliative care, the resource-poor Indian environments present numerous barriers for these principles to be practically applied. As the infrastructure of comprehensive cancer centers develop, paralleled with an increase in training of palliative care professionals, significant improvements need to be made in order to elevate the status of palliative cancer care in India.
  5,998 320 3
Caring for dying people: Attitudes among Iranian and Swedish nursing students
Sedigheh Iranmanesh, Karin Axelsson, Terttu Häggström, Stefan Sävenstedt
September-December 2010, 16(3):147-153
DOI:10.4103/0973-1075.73643  PMID:21218004
Aim: To compare the attitudes of Iranian and Swedish nursing students toward caring for dying persons. Materials and Methods: Their attitudes were measured with the Frommelt's Attitude Toward Caring of the Dying and the Death Attitude Profile Revised. Results: The results indicated that the participating Iranian students were more afraid of death and less likely to give care to dying persons than the Swedish participants. Conclusion: It is suggested that theoretical education should be individualized and culturally sensitive in order to positively influence the students' attitudes, and promote professional development.
  4,952 174 4
Effectiveness of "palliative care information booklet" in enhancing nurses' knowledge
Anita David, Sonali Banerjee
September-December 2010, 16(3):164-167
DOI:10.4103/0973-1075.73647  PMID:21218007
Context: Patients diagnosed with a disease like cancer require not only physical control of disease but also they need psychological reassurance, social and spiritual support in coming to terms with their disease. Nurses working in the specialized cancer hospitals play a significant role in the care of terminally ill patients. They must be knowledgeable, skilled and sensitive to the needs of these patients and their families in order to provide active, holistic care. Aims: In this study, we attempted to assess the level of knowledge about palliative care among nurses working in the oncology department using a self administered structured questionnaire and also to assess the effectiveness of information booklet designed on various aspects of palliative care on their knowledge. Settings and Design: Indo American Cancer Hospital, Hyderabad, AP, India. The design adopted for this study was One Group pretest - posttest, pre - experimental design. Materials and Methods: Hundred nurses working in Indo American Cancer Hospital, Hyderabad, AP, India were selected by using the non probability purposive sampling technique. A structured self administered questionnaire was prepared and administered as a pretest. An information booklet was developed pertaining to the general concepts of palliative care, care components (physical, social, emotional and spiritual) and role of the nurse in palliative care and it was given to the participants. As a post test, the same questionnaire was re-administered after four days to the same study subjects. Pretest and post test knowledge scores were compared and the findings were analyzed statistically. Statistical analysis used : Microsoft Excel and Statistical Package for Social Science package. Results: The post test scores were significantly higher than the pretest knowledge scores, which indicate that the developed information booklet regarding palliative care was highly effective in enhancing the knowledge levels of the nurses. Conclusions: The information booklet was effective in enriching the knowledge of nurses on palliative care. Enhancing the nurse's knowledge about palliative care will promote their understanding of the needs of the advanced stage patients and will enable them to provide quality care.
  4,876 137 1
Hospice: Rehabilitation in reverse
Senthilkumar Jeyaraman, Ganesan Kathiresan, Kavitha Gopalsamy
September-December 2010, 16(3):111-116
DOI:10.4103/0973-1075.73640  PMID:21217999
Hospice care is about quality of life at a time when a person has an illness for which curative measures are no longer possible, and for which a physician has determined the patient has a life expectancy of about six months or less, a hospice program can support the process of death and dying in a compassionate way. A growing trend is to utilize physical therapy more frequently in hospice. Physical therapy has several vital roles in hospice care as follows: maximizing functional ability and comfort to enhance quality of life; assuring patient and care giver safety; helping people redesign their lives and life goals; providing support around physical, emotional and spiritual issues at the end of life. The purpose of this review is to provide 1) a description of hospice care, 2) an explanation of the roles of physical therapists in hospice care.
  4,699 188 3
Palliative care awareness among Indian undergraduate health care students: A needs-assessment study to determine incorporation of palliative care education in undergraduate medical, nursing and allied health education
Sakshi Sadhu, Naveen Sulakshan Salins, Asha Kamath
September-December 2010, 16(3):154-159
DOI:10.4103/0973-1075.73645  PMID:21218005
Purpose: Quality assurance data worldwide suggests that the current healthcare system is providing inadequate care for the dying. Current health care education focuses entirely on cure and care is almost compromised or nonexistent in end-of-life settings. The purpose of this study was to determine palliative care awareness among Indian undergraduate health care students and assess the need for incorporating palliative medicine education into undergraduate health education. Methods: A non-randomized population based study was conducted using 39-point questionnaire. Undergraduate medical, nursing and allied health students of Manipal University were the target population. Results: 326 students participated in the study. 61.7% of students feel that resuscitation is appropriate in advanced metastatic cancer. 67.5% feel that all dying patients need palliative care and most of the students think that palliative care is equivalent to pain medicine, geriatric medicine and rehabilitation medicine. 89% of students think that Morphine causes addiction in palliative care setting. 60.7% of students feel that prognosis should only be communicated to the family. Conclusion: The outcomes of the study showed that the basic knowledge of palliative care among students was inadequate, and students are unprepared and uncertain in their approach of delivering end-of-life care.
  4,209 236 3
Artificial hydration at the end of life in an oncology ward in Singapore
Lalit Kumar Radha Krishna, Jissy Vijo Poulose, Cynthia Goh
September-December 2010, 16(3):168-173
DOI:10.4103/0973-1075.73668  PMID:21218008
Aim: The objective of this study has been to examine the frequency of use of artificial hydration in terminally ill cancer patients during the last 48 h of life and the occurrence of symptoms specific to hydration status. Other objectives were to find out if artificial hydration has any impact on survival or had any influence on the patterns of use of opioids and sedatives while under palliative care. Materials and Methods: Retrospective review of case notes of palliative care patients who died in a 95 bedded oncology ward was done. Information on demographic profile, duration of palliative care, medication use and on symptoms related to hydration status was collected. Patients on artificial hydration were compared to those who were not on artificial hydration for the above parameters. Survival curves were plotted for both groups using Kaplan-Meier method. Results : There were 238 patients of which 55.5% were females. The median age was 62 years and the median duration of palliative care was five days. Artificial hydration was given to 59.2% of patients. There was no significant difference in the incidence of symptoms related to hydration status or in the patterns of medication use between patients who received artificial hydration and those who did not. Kaplan-Meier survival curves did not show any significant survival difference (P value=0.9) between the two groups. Conclusion: Artificial hydration during the last 48 h of life did not have any significant impact on symptoms related to hydration status, medication use or on survival in terminally ill cancer patients under palliative care.
  4,235 97 1
The dangers of involving children as family caregivers of palliative home-based-care to advanced HIV/AIDS patients
SM Kang'ethe
September-December 2010, 16(3):117-122
DOI:10.4103/0973-1075.73641  PMID:21218000
The aim of this research paper is to explore the dangers of involving children as family caregivers of palliative care and home-based-care to advanced HIV/AIDS patients, while its objective is to discuss the dangers or perfidiousness that minors especially the girl children face as they handle care giving of advanced HIV/AIDS patients. The article has relied on eclectic data sources. The research has foundminors disadvantaged by the following: being engulfed by fear and denied rights through care giving; being emotionally and physiologically overwhelmed; being oppressed and suppressed by caring duties; being at risk of contracting HIV/AIDS; and having their education compromised by care giving. The paper recommends: (1) strengthening and emphasizing on children's rights; (2) maintaining gender balance in care giving; (3) implementation and domestication of the United Nations conventions on the rights of children; (4) community awareness on equal gender co participation in care giving; (5) and fostering realization that relying on child care giving is a negative score in fulfilling global Millennium Development Goals.
  3,396 107 3
Low cost continuous femoral nerve block for relief of acute severe cancer related pain due to pathological fracture femur
Rachel Cherian Koshy, G Padmakumar, O Rajasree
September-December 2010, 16(3):180-182
DOI:10.4103/0973-1075.73669  PMID:21218010
Pathological fractures in cancer patient cause severe pain that is difficult to control pharmacologically. Even with good pain relief at rest, breakthrough and incident pain can be unmanageable. Continuous regional nerve blocks have a definite role in controlling such intractable pain. We describe two such cases where severe pain was adequately relieved in the acute phase. Continuous femoral nerve block was used as an efficient, cheap and safe method of pain relief for two of our patients with pathological fracture femur. This method was proved to be quite efficient in decreasing the fracture-related pain and improving the level of well being.
  3,324 107 2
The perfidious experiences of men as palliative caregivers of people living with HIV/AIDS and other terminal illnesses in Botswana. Eclectic data sources
Simon Kangethe
September-December 2010, 16(3):174-179
DOI:10.4103/0973-1075.73648  PMID:21218009
The aim and objective of this scientific research article is to explore the literature with intent to raise attention to the perfidiousness of the experiences of men as palliative caregivers of people living with HIV/AIDS and other terminal illnesses. The article has utilized eclectic data sources in Botswana and elsewhere. The findings indicate that care giving position of men has been found beset by: retrogressive gender unfriendly cultures; patriarchy; weaker gender empowerment campaigns; and inadequate male involvement in care. The article recommends: (1) a paradigm shift of structural gender dynamics; (2) making AIDS care programmes both gender sensitive and gender neutral; (3) Strengthening gender mainstreaming; (4) diluting cultures and patriarchy; (5) and signing and domesticating SADC gender protocol and other gender friendly international agreements by Botswana government.
  3,263 96 1
Care of terminally ill cancer patients: An intensivist's dilemma
Sukhminder Jit Singh Bajwa, Sukhwinder Kaur Bajwa, Jasbir Kaur
September-December 2010, 16(3):183-183
DOI:10.4103/0973-1075.73671  PMID:21218011
  2,549 89 -
Care of terminally ill cancer patients: Resource allocation
Viroj Wiwanitkit
September-December 2010, 16(3):184-184
DOI:10.4103/0973-1075.73672  PMID:21218012
  1,922 63 -
Online since 1st October '05
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