Breaking Access and Distance Barriers: Using Innovative Modalities of Tele-Palliative Care (TH364)
Patients suffering from incurable and debilitating conditions are in crucial need of interprofessional palliative care services. Palliative care teams monitor, manage, and maintain such patients' performance status while improving symptoms and facilitating goals-of-care discussions. A growing workforce shortage in palliative care professionals as well as access issues in remote areas are significant barriers to patient-centered, serious illness care. Efforts to bring palliative care interprofessional expertise to patients in the community have proven successful in increasing early goals-of-care discussions, improving complex symptoms, and even delivering specialty palliative care to patients living with chronic conditions in rural areas.
Conclusions: Differences in symptom perception, diagnostic tests, and pharmacological procedures were found between patients with and without dementia. Specific diagnostic tools need to be developed for patients with dementia.
CONCLUSION: pain in palliative patients is mainly experienced by cancer patients and the elderly. Psychological factors affect the condition of pain, so the management that includes biopsychosocial aspect will be able to reduce pain significantly. PMID: 32041912 [PubMed - in process]
Despite significant advances in treatment, chronic obstructive pulmonary disease (COPD) remains a chronic and progressive disease that frequently leads to premature mortality. COPD is associated with a constellation of significant symptoms including dyspnea, cough, wheezing, pain, fatigue, anxiety, depression and insomnia, and is associated with increased morbidity. Palliative care is appropriate to support these patients. However, historically palliative care has focused on supporting patients with malignant disease, rather than progressive chronic diseases such as COPD.
We report the successful management of PHN with lumbar erector spinae plane block in a patient of CLL.
Prashant Sirohiya, Pratishtha Yadav, Sachidanand Jee Bharati, Bhatnagar SushmaIndian Journal of Palliative Care 2020 26(1):142-144 Pain adversely affects the quality of life in cancer patients. Although conventional oral analgesics and co-analgesics manage 80%–90% of pain, interventional pain management techniques may be useful in the management of cancer pain refractory to opioid analgesia or in patients unable to tolerate systemic opioids. Herein, we report three cases depicting the successful role of erector spinae plane block in our palliative care unit for the management of different chronic cancer pain.
Prashant Sirohiya, Tuhin Mistry, Sapna Singla, Sushma BhatnagarIndian Journal of Palliative Care 2020 26(1):145-146
Among seriously ill patients, those with advanced chronic kidney disease (CKD) and end-stage kidney disease (ESKD) arguably receive among the worst end-of-life care. These patients frequently die in the hospital, often after an intensive procedure like cardiopulmonary resuscitation, and with a low referral rate to hospice. There is now a concerted effort in the nephrology and palliative care communities to integrate palliative care into the treatment of these seriously ill patients. The Pathways Project is a national demonstration, funded by the Gordon and Betty Moore Foundation, to develop scalable innovations in kidney supportive care.
Increasing numbers of patients living with serious illness are requesting access to medical cannabis as well as guidance about its use for pain and symptom management, as a disease-modifying drug for cancer and other diseases, and as a strategy to avoid chronic opioid and benzodiazepine use. Select palliative care clinics have incorporated cannabis into their therapeutic toolkit, and “cannabis consultations” have become an entry point for accessing palliative care for some patients. In many states, physicians and advance practice providers are responsible for counseling and registering patients for medical cann...
Palliative care practitioners are increasingly treating patients with comorbid opioid use disorder (OUD), yet guidance is lacking for managing pain in this population. Historically, palliative care clinicians have liberally prescribed opioids to patients with limited prognosis. As medicine has evolved, patients with chronic illnesses, even metastatic cancer, are living longer thanks to immunotherapies and other novel treatments. Thus, palliative care patients are at greater risk of both developing OUD and/or chemical coping while receiving intensive treatments.
Bilateral renal agenesis has historically been described as “incompatible with life” as chronic anhydramnios results in pulmonary hypoplasia, leading to respiratory failure at birth. Recent reports have detailed the survival of infants with renal disease and severe oligo-/anhydramnios following prenatal serial amnioinfusions as a bridge to neonatal dialy sis with the goal of pediatric kidney transplant. Subsequently, clinical trials have proposed treating fetuses with bilateral renal agenesis with serial prenatal amnioinfusions to allow for pulmonary maturation and the potential for long-term survival.