Redefining Palliative Care-A New Consensus-Based Definition.

CONTEXT: The International Association for Hospice and Palliative Care developed a consensus-based definition of palliative care (PC) that focuses on the relief of serious health-related suffering, a concept put forward by the Lancet Commission Global Access to Palliative Care and Pain Relief. OBJECTIVE: The main objective of this article is to present the research behind the new definition. METHODS: The three-phased consensus process involved health care workers from countries in all income levels. In Phase 1, 38 PC experts evaluated the components of the World Health Organization definition and suggested new/revised ones. In Phase 2, 412 International Association for Hospice and Palliative Care members in 88 countries expressed their level of agreement with the suggested components. In Phase 3, using results from Phase 2, the expert panel developed the definition. RESULTS: The consensus-based definition is as follows: Palliative care is the active holistic care of individuals across all ages with serious health-related suffering due to severe illness and especially of those near the end of life. It aims to improve the quality of life of patients, their families and their caregivers. The definition includes a number of bullet points with additional details as well as recommendations for governments to reduce barriers to PC. CONCLUSION: Participants had significantly different perceptions and interpretations of PC. The greatest challenge faced by the core group was trying to find a middle ground between those who think that PC is the relief of all suffering and those who believe that PC describes the care of those with a very limited remaining life span.

International Association for Hospice and Palliative Care Position Statement: Euthanasia and Physician-Assisted Suicide.

BACKGROUND: Reports about regulations and laws on Euthanasia and Physician Assisted Suicide (PAS) are becoming increasingly common in the media. Many groups have expressed opposition to euthanasia and PAS while those in favor argue that severely chronically ill and debilitated patients have a right to control the timing and manner of their death. Others argue that both PAS and euthanasia are ethically legitimate in rare and exceptional cases. Given that these discussions as well as the new and proposed laws and regulations may have a powerful impact on patients, caregivers, and health care providers, the International Association for Hospice and Palliative Care (IAHPC) has prepared this statement. PURPOSE: To describe the position of the IAHPC regarding Euthanasia and PAS. METHOD: The IAHPC formed a working group (WG) of seven board members and two staff officers who volunteered to participate in this process. An online search was performed using the terms "position statement", "euthanasia" "assisted suicide" "PAS" to identify existing position statements from health professional organizations. Only statements from national or pan-national associations were included. Statements from seven general medical and nursing associations and statements from seven palliative care organizations were identified. A working document including a summary of the different position statements was prepared and based on these, an initial draft was prepared. Online discussions among the members of the WG took place for a period of three months. The differences were reconciled by email discussions. The resulting draft was shared with the full board. Additional comments and suggestions were incorporated. This document represents the final version approved by the IAHPC Board of Directors. RESULT: IAHPC believes that no country or state should consider the legalization of euthanasia or PAS until it ensures universal access to palliative care services and to appropriate medications, including opioids for pain and dyspnea. CONCLUSION: In countries and states where euthanasia and/or PAS are legal, IAHPC agrees that palliative care units should not be responsible for overseeing or administering these practices. The law or policies should include provisions so that any health professional who objects must be allowed to deny participating.

Access to opioids: a global pain management crisis.

The lack of availability of opioids in many countries has created a pain management crisis. Because the Single Convention on Narcotic Drugs requires governments to report annual opioid statistics, there is a need for methods to calculate individual nations' opioid needs. Ways to address this need are discussed.

Opioid inaccessibility and its human consequences: reports from the field.

Strong opioids such as morphine are rarely accessible in low- and middle-income countries, even for patients with the most severe pain. The three cases reported here from three diverse countries provide examples of the terrible and unnecessary suffering that occurs everyday when this essential, inexpensive, and safe medication is not adequately accessible by patients in pain. The reasons for this lack of accessibility are explored, and ways to resolve the problem are proposed.

Empleo de medicamentos durante el embarazo / Drug use during pregnancy

El presente reporte expone consideraciones importantes que deben ser tomadas en cuenta siempre que se atienda a una mujer embarazada o en edad de concebir, además se detallan algunas drogas de teratogenecidad potencial y/o efectiva. En los casos posibles se sugieren alternativas menos peligrosas

Efecto de la fracción acuosa de Casearia arguta H.B.K. sobre el metabolismo de carbohidratos en ratones / Aqueous Fraction effect of Casearia arguta H.B.K. on Carbohydrate Metabolism in Mice

La "fracción acuosa" de Casearia arguta H.B.K., ("raspalengua"), produjo, en ratones, una disminución en los niveles plasmáticos de glucosa a dosis de 100, 300 y 500 mg/kg respectivamente, pero produjo un aumento marcado a una dosis de 1000 mg/kg. Además produjo simultáneamente un aumento de la tolerancia oral a la glucosa con la dosis de 500 mg/kg, efecto que se observó hasta 2 h después de la administración de una dosis de glucosa. Con la dosis de 1000 mg/kg, por el contrario, se produjo una disminución de la tolerancia a los 30 minutos y luego un aumento a las 2 h. Una dosis de 500 mg/kg, de la "fracción aciuosa" produjo un aumento en los niveles séricos de insulina a las 1, 2 y 4 horas con respecto a los controles y una disminución, con la dosis de 1000 mg/kg., en el mismo período de tiempo. No se observó, con ninguna de las dosis, cambio alguno a las 24 horas