[Symptomatic treatments (pain management excluded) for adults in palliative care]. / Traitements symptomatiques (hors antalgiques) chez le patient adulte relevant de soins palliatifs.

Patients with evolutive and terminal desease often present 4 to 5 annoying symptoms, linked to the desease and implying a rigorous assessment as well as a treatment of the cause whenever possible. When all etiologic treatments have been used, the symptomatic treatments often allow to relieve the patient. This demands allying care and medication as well as mastering the available therapeutics so as to adapt the prescriptions at best. The present work essentially approaches the etiologies and symptomatic treatments of nausea and vomiting, hiccup, constipation, bowel obstruction, dyspnoea, congestion and death rattle and neuropsychic disfunctionning, in particular anxiety, depression and delirium. For the situations where the oral, transdermic and intravenous routes become difficult or impossible, medication to be administrated through subcutaneous routes are listed, with prudence, for not regulated.

Protocol for the treatment of malignant inoperable bowel obstruction: a prospective study of 80 cases at Grenoble University Hospital Center.

A prospective protocol for treatment of malignant inoperable bowel obstruction was implemented at Grenoble University Hospital Center for 4 years. All 80 episodes of obstruction resulted from peritoneal carcinomatosis and none could expect another treatment cure. The protocol comprised three successive stages. Stage I included treatment for 5 days with a corticosteroid, antiemetic, anticholinergic, and analgesic. Stage II provided a somatostatin analogue if vomiting persisted. After 3 days, Stage III provided a venting gastrostomy. Obstruction relief with symptom control was obtained by medical treatment in 29 cases and symptom control occurred alone in an additional 32 cases. Ten patients were relieved by venting gastrostomy. Symptom control without permanent nasogastric tube (NGT) placement occurred in 72 episodes (90%). Eight patients with refractory vomiting were obliged to continue the NGT until death. Fifty-eight obstruction episodes (73%) were controlled in 10 days or less. Median time before gastrostomy was 17 days. Median survival was 31 days. This series suggests that a staged protocol for the treatment of inoperable malignant bowel obstruction is highly effective in relieving symptoms. A subgroup experiences relief of obstruction using this approach.

[What is expected of psychologists in palliative care mobile teams? Their role and missions]. / Qu'attend-on d'un psychologue en équipe mobile de soins palliatifs? Son rôle et ses missions.

The present development of palliative care structures has led to the organisation, in institutes and also in the home, of multi-disciplinary teams destined that contribute to the care and accompanying of persons at the end of their life. The multiplication of these mobile teams invites us to gain further knowledge on the respective role of each professional and in particular that of the clinical psychologist in a function that is often ignored by the institutions. This study is aimed at providing a better definition of the role and missions of a psychologist working in a mobile team. The psychologists' clinical activity is specified with regard to interventions with the patients and their families and also their intervention among the medical and care professionals who look after these patients. The choice of working in a interdisciplinary group leads to a collaboration of quality and the dynamics of such collaboration guarantee the global approach of the patients in their physical, mental, social and spiritual suffering.