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1.
BMC Vet Res ; 17(1): 309, 2021 Sep 23.
Artigo em Inglês | MEDLINE | ID: mdl-34556100

RESUMO

BACKGROUND: This paper presents the first described case of laparoscopy-assisted prepubic urethrostomy and laparoscopic resection of a tumor of the distal part of the urethra in a female dog as a palliative treatment. CASE PRESENTATION: An intact, 11 -year-old, mixed breed female dog, weighing 15 kg, was admitted with signs of urinary obstruction and difficulty with catheterization. Vaginal, rectal, and endoscopic examinations revealed a firm mass in the pelvic cavity at the level of the pelvic urethra. Ultrasound and computed tomography examination showed enlargement of the urethral wall (5.5 cm width and 3 cm thick), which was significantly restricting the patency of the urethra. The lesion affected only the distal part of the urethra without the presence of local or distant metastatic changes. The affected portion of the urethra was laparoscopically removed while performing pre-pubic urethrostomy with laparoscopy. The patient regained full consciousness immediately after the end of anesthesia, without signs of urinary incontinence. Histopathological examination of the removed urethra revealed an oncological margin only from the side of the bladder. In the period of 2.5 months after the procedure, the owner did not notice any symptoms that could indicate a postoperative recurrence, which was diagnosed three months after the procedure. CONCLUSIONS: Pre-pubic urethrostomy can be successfully performed with the assistance of laparoscopy. The use of minimally invasive surgery will allow, in selected cases, removal of the urethral tumor, and in inoperable cases, to perform a minimally invasive palliative pre-pubic urethrostomy.


Assuntos
Doenças do Cão/cirurgia , Laparoscopia/veterinária , Medicina Paliativa , Uretra/cirurgia , Neoplasias Uretrais/veterinária , Obstrução Uretral/veterinária , Animais , Doenças do Cão/diagnóstico por imagem , Cães , Feminino , Resultado do Tratamento , Neoplasias Uretrais/complicações , Neoplasias Uretrais/diagnóstico por imagem , Neoplasias Uretrais/cirurgia , Obstrução Uretral/diagnóstico por imagem , Obstrução Uretral/etiologia , Obstrução Uretral/cirurgia
2.
BMJ Support Palliat Care ; 11(4): 411-417, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34535499

RESUMO

BACKGROUND: Educational board games facilitate active learning to conceptualise knowledge, and, promote collaborative learning and team work. Despite increasing interest in them, use in palliative and end of life care has been very limited to date. METHOD: In 'Bed race, The End of Life Game', participants are divided into four teams who move a model hospital bed around a board to collect items (syringe driver; Do Not Attempt Resuscitation form; oral hydration gel; a 'heart'; Just In Case medicines). To obtain items at themed 'checkpoints', each team needs to answer quiz questions, which require application of clinical knowledge and/or communication skills. Pregame and postgame quiz scores and feedback were collected from 12 game sessions involving 251 year 5 medical students. RESULTS: 169 (67%) of students completed pregame and postgame anonymous quiz questions and free-text feedback. Postgame quiz scores were higher for each topic, and the difference in the paired pregame and postgame questionnaires was statistically significant (p<0.05). Themes from the free-text feedback included 'engaging and fun'; 'relevant learning'; 'peer learning and team work'. CONCLUSIONS: Educational board games are not a new panacea for education, but the concept can be successfully applied in palliative care.


Assuntos
Medicina Paliativa , Estudantes de Medicina , Morte , Avaliação Educacional , Humanos , Aprendizagem Baseada em Problemas
5.
J Pain Symptom Manage ; 62(5): 960-967, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33933625

RESUMO

BACKGROUND: Formal recognition of palliative medicine as a specialty has been one of the main drivers in the development of palliative care. AIM: To provide a comparative, comprehensive overview on the status of palliative medicine as medical specialty across Latin America. METHODS: We conducted a comparative study of 19 Latin American countries. Key informants and persons in charge of the specialization training programs were identified and interviewed. We collected data on general recognition as specialty (title, process of certification) and on training program characteristics (title, start year, requirements, training length, and type full time or part time). RESULTS: Eight of 19 countries (42%) Argentina, Brazil, Colombia, Costa Rica, Ecuador, Mexico, Paraguay and Venezuela reported palliative medicine as medical specialty. Thirty-five (sub)specialization training programs in palliative medicine were identified in the region (eight as a specialty and 27 as a subspecialty), the majority in Colombia (43.5%) and Brazil (33.7%). A total of 20% of the programs have yet to graduate their first cohort. Length of clinical training as specialty varied from two to four years, and from 520 hours to three years for a subspecialty. CONCLUSION: Despite long-standing efforts to improve quality of care, and significant achievements to date, most Latin American countries have yet to develop palliative medicine as medical specialty. Specialty and sub-specialty training programs remain scarce in relation to regional needs, and the programs that do exist vary widely in duration, structure, and content.


Assuntos
Medicina Paliativa , Brasil , Colômbia , Humanos , América Latina/epidemiologia , México , Especialização
6.
Surg Oncol Clin N Am ; 30(3): 591-608, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34053671

RESUMO

The importance of integrated palliative care in surgical oncology has been established by high-level evidence demonstrating improved patient-centered outcomes. There has been substantial improvement in efforts to incorporate palliative medicine training into medical and surgical education over the last decade. However, although trainees may feel confident in managing patients at the end of life, they may not have the insight or proficiency to provide optimal palliative care. Surgeons and palliative care physicians should collaborate on methods to optimize palliative care education for both trainees and practicing surgeons. A growing number of palliative care resources are available to this end.


Assuntos
Medicina Paliativa , Oncologia Cirúrgica , Competência Clínica , Humanos , Cuidados Paliativos , Medicina Paliativa/educação
8.
BMJ Support Palliat Care ; 11(3): 299-302, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33903260

RESUMO

Cannabinoids are chemicals derived naturally from the cannabis plant or are synthetically manufactured. They interact directly with cannabinoid receptors or share chemical similarity with endocannabinoids (or both). Within palliative medicine, cannabinoid receptors (CB1 and CB2) may modulate some cancer symptoms: appetite, chemotherapy-induced nausea and vomiting, and mood, pain and sleep disorders. Opioid and cannabinoid receptors have overlapping neuroanatomical receptor distribution, particularly at the dorsal horn, dorsal striatum and locus coeruleus. They have a favourable safety profile compared with opioids, and cannabis-based medicines help chronic pain. While cannabidiol (CBD) has anti-inflammatory properties, tetrahydrocannabinol (THC) is the psychoactive substance for issues such as mood and sleep. Nabiximols (Sativex), a CBD:THC combination, is Food and Drug Administration approved for some multiple sclerosis symptoms and epilepsy. There has been a swift societal evolution in attitudes about use of cannabis and cannabinoid medicines for chronic pain. In the USA, 33 states have now legalised prescription-based medical cannabis for several medical conditions; Canada has had legislation since 2001 authorising medical use. The European Union (EU) recently declared all EU citizens must have access to medical cannabis over the next 4 years. The integration into medicine and routine clinical use of cannabis is fraught with information gaps, regulatory issues and scarcity of research. Each patient should have a comprehensive assessment and risk-benefit discussion before any cannabis-based intervention to avoid possible complications such as hallucinations, psychosis and potential cardiac harm.


Assuntos
Canabinoides , Cannabis , Dor Crônica , Maconha Medicinal , Medicina Paliativa , Canabinoides/uso terapêutico , Dor Crônica/tratamento farmacológico , Humanos , Maconha Medicinal/uso terapêutico , Estados Unidos
9.
BMJ Support Palliat Care ; 11(3): 308-309, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33727341

RESUMO

Palliative medicine is always patient centred and promotes the principle that no unnecessary investigations are performed. The case is reported of a patient with suspected carbamazepine toxicity presenting as progression of symptoms of primary brain tumour. A comparison is made of the symptoms and signs of toxicity versus tumour, and an aid for deciding when to perform therapeutic drug level monitoring for some common drugs.


Assuntos
Neoplasias Encefálicas , Cuidados Paliativos na Terminalidade da Vida , Medicina Paliativa , Preparações Farmacêuticas , Neoplasias Encefálicas/tratamento farmacológico , Humanos , Cuidados Paliativos
10.
Am J Cardiol ; 148: 94-101, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-33684373

RESUMO

Prior studies have shown that the early inclusion of palliative care (PC) specialist is associated with better end-of-life experiences. The National Inpatient Sample Database was queried from 2012 to 2017 for relevant of ICD)-9 and -10 procedural and diagnostic codes to identify patients above 18 years with advanced heart failure (HF) admitted with cardiogenic shock (CS) requiring mechanical circulatory support (MCS). Baseline characteristics, utilization trends and invasive procedures and complications were compared among patients evaluated by PC and those who were not. There were 65,230 patients hospitalized for advanced HF complicated by CS requiring MCS, of these a PC consult was placed in in 9,200 patients (14.1%) and trended upward from 9.4 to 16.8%, between 2012 to 2017. The majority of patients, (37.3%) from the total population died in hospital. In reference to patients who were discharged alive, PC consultation was associated with a lower incidence of invasive procedures such as mechanical ventilation, pacemaker implantation, defibrillator implantation, insertion of percutaneous feeding tubes and tracheostomies performed (p <0.05 for all) whereas complications such as major bleeding, septic shock, transfusion of any blood product were comparable between both cohorts (nonsignificant p value for all). On the other hand, in those patients who died in hospital PC was associated with a lower incidence of pacemaker implantation, defibrillator implantation and insertion of percutaneous feeding tubes (p <0.05 for all). Despite the high morbidity and mortality associated with advanced HF patients with CS requiring MCS, the overall prevalence of PC consultation is exceedingly low. When utilized, the incidence of invasive procedures was lower. This study highlights the underutilization of PC services in this patient population, precluding any perceived benefit in end-of-life experiences.


Assuntos
Circulação Assistida , Oxigenação por Membrana Extracorpórea , Insuficiência Cardíaca/terapia , Medicina Paliativa , Encaminhamento e Consulta/estatística & dados numéricos , Choque Cardiogênico/terapia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Doença da Artéria Coronariana/epidemiologia , Desfibriladores Implantáveis , Nutrição Enteral , Feminino , Gastrostomia , Insuficiência Cardíaca/epidemiologia , Coração Auxiliar , Mortalidade Hospitalar , Humanos , Balão Intra-Aórtico , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Marca-Passo Artificial , Implantação de Prótese , Fatores Sexuais , Choque Cardiogênico/epidemiologia
12.
J Pain Symptom Manage ; 62(4): 720-729, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-33677071

RESUMO

CONTEXT: Hospice and palliative medicine (HPM) physicians frequently care for patients with substance use disorders (SUDs), but there is no consensus on which primary addiction medicine (AM) skills are essential. OBJECTIVES: Identify key primary AM skills that physicians should acquire during an ACGME-accredited HPM fellowship program. METHODS: A modified Delphi study consisting of 18 experts on SUD in HPM and medical education. A literature review and expert input identified initial AM skills. In three Delphi rounds, participants rated each skill on a nine-point scale from "not at all important to include" to "crucial to include." We calculated medians (IQRs), analyzed panelists' comments, and grouped skills using the RAND / UCLA appropriateness method. RESULTS: Among 62 proposed AM skills, 53 skills were rated as appropriate to include (38 of which achieved agreement), and nine skills were rated as uncertain. AM skills most relevant to HPM included 1) defining chemical coping, median 8.5 (IQR 2); 2) balancing life expectancy with risks of opioid use for patients with SUD, 9 (IQR 0); 3) explaining best practices to dispose unused opioids postmortem, 8 (IQR 2); 4) managing pain for hospice patients with SUD, 9 (IQR 0.75); and 5) partnering with hospice to manage patients on methadone and buprenorphine, 9 (IQR 2). Experts did not achieve consensus on whether HPM physicians should be encouraged to learn to prescribe buprenorphine for patients with opioid use disorder, 6 (IQR 3). CONCLUSION: HPM fellowships should consider incorporating the primary AM skills identified in this study in their curricula.


Assuntos
Medicina do Vício , Cuidados Paliativos na Terminalidade da Vida , Hospitais para Doentes Terminais , Medicina Paliativa , Médicos , Técnica Delfos , Educação de Pós-Graduação em Medicina , Humanos , Cuidados Paliativos , Medicina Paliativa/educação
13.
J Am Geriatr Soc ; 69(4): 1063-1070, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33580716

RESUMO

BACKGROUND: Geriatrics and palliative medicine specialists are uniquely trained to provide expert coordinated care for older adults and seriously ill and complex patients. Health system leadership geared towards this patient population is critically important as society ages. Currently, there is no standardized approach to teaching core leadership skills. To assess the leadership training needs of geriatrics and palliative medicine fellowship graduates, we conducted a needs assessment to identify (1) early career leadership trajectories and challenges and (2) knowledge and skills deemed essential for effective leadership. METHODS: Individuals identified as leaders in geriatrics and/or palliative medicine completed an electronic survey and a semi-structured qualitative interview. These leaders were divided into two categories: Icahn School of Medicine at Mount Sinai (ISMMS) trained leaders or non-ISMMS trained leaders. The semi-structured interviews were recorded, transcribed, and reviewed using thematic analysis. RESULTS: Within 1 year of fellowship graduation, 50% of ISMMS trained leaders had leadership positions; within 6 years, 100% had a leadership role. Based on qualitative interviews, both ISMMS trained leaders and non-ISMMS trained leaders perceived leadership training gaps in two domains: (1) knowledge and (2) skills. Knowledge and skill gap themes included communication and management, mentorship and negotiation, program development, knowledge, and apprenticeship. CONCLUSION: Geriatrics and palliative medicine physicians obtained leadership roles quickly after fellowship. Both ISMMS trained leaders and non-ISMMS trained leaders often felt unprepared, learned "on the job," and sought out additional leadership training. Early leadership training is needed to prepare fellowship graduates for the pressing demands of accelerated leadership.


Assuntos
Currículo/tendências , Geriatria/educação , Liderança , Medicina Paliativa/educação , Papel do Médico , Educação de Pós-Graduação em Medicina/métodos , Escolaridade , Bolsas de Estudo/métodos , Bolsas de Estudo/organização & administração , Humanos , Determinação de Necessidades de Cuidados de Saúde , Desenvolvimento de Programas , Pesquisa Qualitativa , Ensino , Estados Unidos
15.
Chirurg ; 92(2): 172, 2021 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-33566136
16.
Am J Phys Med Rehabil ; 100(10): e144-e146, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33496440

RESUMO

ABSTRACT: Hospice and palliative medicine is one of seven accredited fellowship subspecialties available to graduates of physical medicine and rehabilitation residency programs. Hospice and palliative medicine and physical medicine and rehabilitation share many of the same principles and practices, and physical medicine and rehabilitation residency training can be excellent preparation for hospice and palliative medicine fellowship. However, unlike the other six physical medicine and rehabilitation subspecialties, there is currently no requirement for hospice and palliative medicine training during physical medicine and rehabilitation residency. As a result, physical medicine and rehabilitation residents may encounter limited hospice and palliative medicine exposure or education, and lack explicit opportunities to develop the basic set of palliative care symptom management and communication tools that can be applied across the spectrum of physiatry care. Here, we provide five strategies that residents can use within their own programs to develop knowledge and experience in hospice and palliative medicine.


Assuntos
Competência Clínica , Educação de Pós-Graduação em Medicina/tendências , Cuidados Paliativos na Terminalidade da Vida , Internato e Residência/métodos , Medicina Paliativa/educação , Medicina Física e Reabilitação/educação , Humanos
17.
J Pain Symptom Manage ; 62(3): 593-598, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-33485936

RESUMO

BACKGROUND: The field of pediatric palliative care (PPC) continues to encounter challenges and opportunities to improving access to high-quality PPC services. In early 2019, a workshop identified 11 potential "next step" actions, and subsequently a national survey-based poll of members of the PPC community was conducted to prioritize these potential actions in terms of their "actionable importance." METHODS: Invitations to the survey were distributed in October 2019 to interdisciplinary PPC health care professionals via email to two major listservs, one hosted by the Section of Hospice and Palliative Medicine of the American Academy of Pediatrics, the other by the Center to Advance Palliative Care. Respondents rated the "actionable importance" of items relative to each other via a discrete choice experiment. Median importance scores are reported for each item. RESULTS: One hundred seventy-seven individuals responded to the survey. The majority (62.2%) were physicians, with nurses (16.4%), advanced practice nurses (7.9%), and social workers (7.3%) being the other most common responders. The top five potential actions, in descending rank order, were: Determine what parents value regarding PPC (median score of 17.8, out of a total score of all items of 100); Define and disseminate core primary PPC curriculum (median, 15.3); Develop PPC national representation strategy and tactics (median, 12.3); Create PPC-specific program development toolkit (median, 10.9); and, Analyze payment and financing ratios (median, 9.6). CONCLUSIONS: Those seeking to advance the field of PPC should take into account the findings from this study, which suggest that certain actions are more likely to have a beneficial impact on moving the field forward.


Assuntos
Cuidados Paliativos na Terminalidade da Vida , Enfermagem de Cuidados Paliativos na Terminalidade da Vida , Medicina Paliativa , Pediatria , Criança , Humanos , Cuidados Paliativos , Estados Unidos
18.
Schmerz ; 35(1): 61-73, 2021 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-33443680

RESUMO

Palliative care serves to improve the quality of life in patients suffering from incurable diseases. Pharmacotherapy of distressing symptoms plays an important role. Off-label use refers to the use of drugs outside the marketing authorization. In addition to the indications off-label use may also be due to duration of treatment, route of administration and the admixture of substances. Off-label use is common in palliative and hospice care and is probably unavoidable in many cases. For treatment planning and realization of off-label therapy in clinical practice, patient-related aspects, information, therapy monitoring and documentation of therapy effects should be considered in addition to drug-related information. Only in this way it is possible to offer a scientifically adequate, appropriate and economic therapy that is linked to an appropriate risk-benefit ratio for the individual patient. Due to the lack of authorization studies, reporting is of particular importance.


Assuntos
Cuidados Paliativos na Terminalidade da Vida , Uso Off-Label , Medicina Paliativa , Humanos , Cuidados Paliativos , Qualidade de Vida
19.
BMC Palliat Care ; 20(1): 14, 2021 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-33435961

RESUMO

BACKGROUND: China holds one fifth of the world's population and faces a rapidly aging society. In its ambition to reach a health care standard comparable to developed countries by 2030, the implementation of palliative care gains special importance. Until now, palliative care education in China is limited and disparate. This study aims to explore and determine factors that have impeded the development and implementation of palliative care education in China. METHODS: We conducted semi-structured interviews with n=28 medical teachers from seven Chinese universities. Interviews were transcribed, and thematic analysis applied. RESULTS: Three themes with two subthemes were constructed from data analysis. Theme 1 covers the still ambivalent perception of palliative care and palliative care education among participants. The second theme is about cultural attitudes around death and communication. The third theme reflects participants' pragmatic general understanding of teaching. All themes incorporate obstacles to further implementation of palliative care and palliative care education in China. CONCLUSIONS: According to the study participants, palliative care implementation through palliative care education in China is hindered by cultural views of medical teachers, their perception of palliative care and palliative care education, and their understanding of teaching. The study demonstrates that current attitudes may work as an obstacle to the implementation of palliative care within the health care system. Approaches to changing medical teachers' views on palliative care and palliative care education and their cultural attitudes towards death and dying are crucial to further promote the implementation of palliative care in China.


Assuntos
Atitude do Pessoal de Saúde/etnologia , Atitude Frente a Morte/etnologia , Atitude Frente a Saúde/etnologia , Cultura , Docentes de Medicina , Cuidados Paliativos , Medicina Paliativa/educação , China , Comunicação , Feminino , Humanos , Masculino , Pesquisa Qualitativa
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