Psychosocial aspects of sickle cell disease

The study described in this article deals with sickle cell patients in Jamaica whose illness is accompanied by leg ulceration, a common complication of sickle cell disease. After exploring the disease's psychological, social, and economic effects, the authors suggest various ways for social workers to help sickle cell patients.     

Evaluating palliative care education

This paper illustrates the evaluation of some of the effects of a 3-day workshop for principals and trainees in general practice on a number of aspects of palliative care, using pre-, immediate and late post-tests. Further qualitative evaluation is attempted by including a questionnaire with the late post-test. The evaluation is to demonstrate significant shifts, or differences, in confidence in dealing with physical and psychosocial symptoms, and in participants' perceived ability to cope, and to support these findings with qualitative data where appropriate.     

Psychosocial aspects of hand injuries and diseases

More than 50% of patients with a diagnosable psychiatric disorder initially present with somatic symptoms, which often effectively distract the physician from the true illness. Moreover, the occupational setting is ripe for the emergence of psychosocial issues.     

The pitfalls of palliative care

An eight-year-old Highland pony which had previously shown normal laryngeal function, underwent general anaesthesia for surgical treatment of a mandibular sinus. During its recovery from the anaesthesia, the pony suffered great respiratory distress and stridor, due to total bilateral laryngeal paralysis and pulmonary oedema. The animal was immediately given a temporary tracheostomy. Some hours later, postoperative myositis developed; it resolved within two days and the pony's laryngeal function returned to normal during the following year.     

Psychosocial aspects of genital herpes virus infection.

Reviews studies of psychosocial aspects of genital herpes virus infection. The fact that no cure is yet available has contributed to the heightened emotions caused by this sexually transmitted disease. Significant moral overtones exist for many people, and powerful social stigma are associated for many. Depression, anger, hostility, and reduced self-esteem have been reported among herpes sufferers. Alterations in sexual activity are common. The relationship between stress and recurrence has been examined. Results, although not fully conclusive, support the role of stress and emotional factors in the disease process. In terms of areas of future research, the interactive role of behavioral, emotional, and social variables and the immune system must be examined. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Controlling breakthrough pain in palliative care

This article challenges the common practice of boosting the syringe driver as a means of controlling breakthrough pain. The authors offer some guidelines for good practice for managing the MS26 syringe driver when used for pain control.     

Phenomenological approaches to palliative care research

A cDNA (mTOP3) encoding mouse DNA topoisomerase III (topo III) was cloned using the human TOP3 cDNA as a probe. The deduced amino acid sequence of mouse topo III showed 86.8% identity with that of human topo III. Mouse TOP3 mRNA was highly expressed in the testis in comparison with other tissues. The TOP3 mRNA level in the testis increased slightly 14 days after birth and showed a marked increase in 17 days, times when the cells in pachytene phase begin to appear and increase in number.     

Promoting symptom control in palliative care

This review deals with tobacco-associated cardiovascular effects and diseases. The importance of tabaccoism in primary care, its effects on cardiovascular, and immunology system and hemostasia, as well as, the role of smoking in atherosclerosis, coronary heart disease, acute myocardial infarct, diabetes, and other alterations are discussed. Finally we summarize the general tobacco control policies and the methods to achieve smoking cessation. Although it is well established the causal relationship between smoking and disease, and the general public is aware of this, the cardiologist's involvement and commitment is of utmost importance.     

The role of shiatsu in palliative care

Modern studies of the genetic control of development have increased the need for an accurate and comprehensive storage and display of gene expression data. This can be achieved in the form of an electronic graphic database of development. Here, we introduce the first steps towards a database of Drosophila embryogenesis. For each morphologically defined stage, a complete series of histological and/or optical sections are generated (optical sections are generated by laser confocal microscopy). Digitized sections are imported into a drawing program where they serve as templates to define the contours of organs and the position of individual cells. From these data, surface and point cloud models of all developmental stages are generated. Gene expression data can be entered by translating the expression domain of a given gene into the three-dimensional coordinate system of the database.     

Issues for palliative care in rural Australia

A project funded by the Commonwealth Government's National Palliative Care Program examined rural (non remote) palliative care services in eight rural regions of Australia with the aim of identifying sound service delivery models. The research methodology included, development of a palliative care service baseline, postal survey of all services in the selected regions followed by field examinations, and section of four regions for in depth analysis using interviews and group sessions with medical practitioners, clinicians, former carers and service managers. The research established that patients and carers want palliative care services to first address symptom management and pain control. The service should then place experienced care as the next highest priority, in conjunction with the provision of family supports. Service models should aim to deliver services in the home or in environments which are home-like and located close to families. Research has demonstrated that even the smallest hospitals can incorporate a palliative care unit. Palliative care service planning in rural areas needs to make a distinction between the main provincial city in the region and the rural hinterland as different planning approaches will often apply. Palliative care teams should vary according to the nature of the service catchment. Particular attention should be given to the method of providing palliative care nursing expertise in a region. This project concluded that when active treatment is no longer beneficial, palliative services in rural regions are commonly of a high quality, although access to tertiary services remains as a limitation during the pre-palliative treatment phase.     

Nutritional and digestive disorders in palliative care

The anorexia-cachexia syndrome is a particularly frequent complication of advanced cancer. Parenteral nutrition must remain the exception in palliative medicine but enteral nutrition through feeding tubes or by a gastrostomy is an efficient method to provide an adequate long term nutritional support at home which can improve the quality of life of the palliative care patient. One must never forget all simple means to improve nutritional status. Since the cost benefit ratio of the medications stimulating the appetite, such as the corticosteroids and the progestatives, must still be demonstrated in palliative medicine. Hiccups therapy is essentially based on several non pharmacological means and on the administration of metoclopramide, antacids, haloperidol or chlorpromazine. Chronic nausea is an extremely frequent problem in palliative care, treated most often by metoclopramide, haloperidol and corticosteroids. Constipation is another extremely frequent problem which can lead to serious complication if left untreated. Besides general means, therapeutic means essentially comprise drugs such as lactulose and macrogol, bisacodyl, docusan and prokinetic agents like cipraside.     

Developing a research culture for palliative care

The aim of study was to evaluate, during 2-year follow-up, bone mineral density in sites with different cortical/cancellous bone ratios (lumbar spine, total body, distal site of radius) and selected markers of bone turnover (total alkaline phoshatase, osteocalcin, pyridinoline and deoxypirydinoline) in patients with long-standing insulin-dependent diabetes mellitus in comparison with healthy controls. Additionally, the influence of age, sex, smoking, duration of diabetes, the degree of metabolic control, or coexisting chronic complications of diabetes (retinopathy, incipient nephropathy, polyneuropathy) on the studied indices of bone metabolism in patients with insulin-dependent diabetes mellitus were evaluated. It was found that patients with long-standing diabetes mellitus had significantly lower bone mineral density than healthy controls (p < 0.003 in lumbar spine and p < 0.001 in total body). The incidence rate of osteopenia and osteoporosis was significantly higher in this group of patients in comparison with the controls (p < 0.005 for lumbar spine and total body and p < 0.001 for radius). In comparison with healthy subjects, diabetic patients and significantly higher, but within normal reference range, serum alkaline phosphate (p < 0.005) and osteocalcin (p < 0.05), accompanied by similar pyridinoline and not significantly increased deoxypyridinoline. Duration and metabolic control of diabetes, or the coexistence of its chronic complications, did not correlate with bone mineral density or the studied indices of bone turnover. In conclusion, diabetic osteopenia seems to be a normal bone turnover state, not influenced by the duration or degree of metabolic control of diabetes.