Day 1 :
- Mental Health Palliative Care
Manager of Counselling at Sparsh Hospice
Mrs. Padma Sesha Sarada Lingaraju, Telecounsellor, Indian Association of Clinical Psychology, Counselling for mental health during COVID crisis. She earned Certification from Stanford University, 2019 about Palliative Care Always. She also earned Certification in End of Life Care: Challenges and Innovation, University of Glasgow, 2020 and Alzheimer’s Disease and Dementia Care Certification, University System of Maryland, 2020.Member of International Association of Hospice and Palliative Care (IAHPC) and life member of Indian Association of Palliative Care (IAPC).
INTRODUCTION:: Mental well-being of a patient and his/her family determines the path of life for the patient , especially at the juncture of hospice admission.Mental health comprises well-being at all other levels. It affects our behaviour, thoughts and even the outcome.
OBJECTIVES: To ensure mental well-being of the patient and family at the end of life.
MATERIALS AND METHODS: In a country like India, definition of quality of life is so varied that it is quite shocking. People from different walks of life in terms of social stature, religion, culture and financial background ,have a quality of life concept very individualised. While planning for quality of life at hospice, we need to keep in mind their social structure. Sensitising the family beyond the scope of their understanding of mental well-being might disturb their life beyond the comprehension of the health care provider. Mental well-being is about self-esteem, confidence, respect, communication, family bonds,finances and dignity and normalisation of stress factors. Mental well-being can result in better coping with physical and emotional stress of the disease. Mental well-being can be ensured for the patient by keeping him physically comfortable,reducing family collusion,having a definite care plan,addressing his spiritual issues,arranging for family meetings,facilitating rituals, connecting them with support groups,
RESULTS:: Mental well-being results in dignity and quality of life in the last days of the patients. It relieves the family of guilt and sense of wrongdoing.
CONCLUSION:: In EOLC,we address the total pain of the patient like physical, emotional,social and spiritual. Mental well-being is the overall well-being of the patient at the above four levels. This might sound complex but when handled with empathy and open mindedness, it can be achieved both for the patient and the provider.
MSW, MS, CSW-G, ACHP-SW and CCM, USA
In 2016, The World Alzheimer’s report estimated that 47 million around the globe had Dementia. By 2050, an American will be diagnosing with Alzheimer’s every 33 seconds. Caregivers provide 18 billion hours of unpaid assistance. In 2017, Every 66 seconds, an American will develop Alzheimer’s Disease. . Leading cause of Dementias are: Alzheimer’s Disease Vascular Dementia, Parkinson’s Disease, Lewy Body Disease, Alcohol-related Dementia,(Korstkoff’s syndrome), HIV/AIDS Related Dementias, and Frontal-Temporal Dementias ( Pick’s Disease). Early signs of Alzheimer’s over 60 found those who consistently slept for more than 9 hours each might twice as likely to develop neurological conditions. Arterial stiffness in Older Adults predicts future Dementia (Chen Cui U of Pittsburgh 2018).
Stages of Dementias include Mild Cognitive impairment, Early Dementia, Moderate Dementia, and Severe Dementia.
Risk factors of Dementia and Alzheimer’s include age, sedentary lifestyle, genetics, head trauma, lower education, poor social support, obesity, depression, hypertension, smoking, heart disease, and miscarriage in pregnancy.
Caring for Patients with Alzheimer’s and other Dementias include home safety tips, memory Aids, Enhanced communications, Strategies to assist with patients with mood and behavioral problems, such as Reminiscence techniques, communications enhancement techniques and positive psychology.
Implications for practice, policy or research. There’s a positive connection between higher levels of education and lower risk of dementia, including that the higher educated exercise more and both weight
Researchers and Dr. Tanzi suggest that the therapeutic answer might ultimately be a cocktail of medications. “Drugs to hit amyloid early on, drugs to hit tangles early on, drugs to hit inflammation,” Dr. Tanzi said. “And you might want to add antivirals.” (NYTimes Nov.2018)
Delirium and Alzheimer’s disease share many underlying path physiologic contributions. Thus preventing delirium may in turn prevent Alzheimer’s disease
Legal Instruments and financial issues to be planned with, Social Workers, Geriatric Care Managers, Alzheimer’s Association and Elder Law Attorneys.
Finally, the presentation will encourage social workers to examine their own practice implications when working with Alzheimer’s Disease and related dementias in community, , hospital, long term care settings, palliative care and hospice settings. Personal and Professional challenges. Professional and Reading Resources will be provided.
- Pain and Symptom Management
Dr. Duc Chung is the chief of hospice and palliative care at the VA Central California Health Care System in Fresno, CA and an assistant clinical professor at UCSF Fresno Hospice and Palliative Medicine Fellowship. He also served on the public policy and leadership committees with the American Academy of Hospice and Palliative Medicine (AAHPM) and currently the Chair-Elect of the Rehabilitation Interest Group of AAHPM. He enjoys resident and fellow teaching and mentorship. In his spare time, Dr. Chung enjoys singing and songwriting and often uses his compositions to heal and inspire patients during their difficult life journeys.
Nausea and vomiting are common symptoms that diminish patients’ overall quality of life in hospice and palliative settings. Approximately 62% of patients endure nausea and vomiting at the end-of-life. These difficult-to-control symptoms require not only a thorough history and physical examination but a broad understanding of the pathophysiology and mechanisms of action of different medications to effectively control nausea and vomiting. Key points in our history include obtaining details about positional vertigo, abdominal pain, early satiety, headaches with early morning nausea, increased CNS tumor burden, and ruling out other causes of nausea and vomiting, including polypharmacy, metabolic derangements, and psychological factors such as anxiety. It is also important to keep in mind that any particular patient can present with nausea and vomiting of multifactorial etiologies. The pathophysiology of nausea and vomiting involve the peripheral, cortical, chemoreceptor trigger zone (CTZ), and vestibular pathways. Within these pathways are mu, dopaminergic, muscarinic, and cannabinoid receptors that signal into the vomiting center, resulting in the nausea and vomiting reflex. For example, the peripheral pathway include mechano and chemoreceptors in the GI tract, serosa, viscera and provide afferents to the vomiting center via the vagas and splanchnic nervous systems, the glossopharyngeal nerve and sympathetics. The cortical pathway involve inputs from the sensory system as well as anxiety. The chemoreceptor trigger zone, located outside of the blood brain barrier, receives afferents from toxic triggers in the bloodstream and CSF which feed into the vomiting center. Blocking these various pathways will provide symptomatic relief. Various medications such as the commonly used Zofran, Compazine, Reglan, Haldol, Phenergan act through blocking various receptors that reduce signal pathways to the vomiting center. Recent evidence also demonstrated potential utility of NK-1 receptor antagonist such as aprepitant in the management of refractory nausea and vomiting. Furthermore, numerous studies have demonstrated potential utility of cannabinoid-containing medications such as dronabinol. The overall premise of nausea and vomiting management center around targeting multiple receptors simultaneously to block signal pathways to the vomiting center, thereby providing symptomatic relief. In summary, this presentation will highlight the pertinent questions that we should address during our history taking with emphasis on the pathophysiology of nausea and vomiting, the various receptors involved, medications employed to target these receptors, and explore novel medical and alternative interventions to target nausea and vomiting. A deep understanding of nausea and vomiting pathways will significantly alleviate much of these distressing symptoms.
- Palliative Care Research
MB.BS, DPM (UCT), DFM (US), M. Phil (UCT) St. Chads Community Health Clinic Main Road, Ezakheni Ladysmith 3381 South Africa
I was graduated and achieved MB.BS degree in 1989 from the University of Dhaka, Bangladesh. There after I have done three post graduations studies respectively Diploma in Palliative Medicine 2007 and MPhil degree in Palliative Medicine, 2016 From the University of cape town, South Africa. I have also did post graduate Diploma in Family Medicine, 2011 from the University of Stellenbosch, South Africa. I have worked in many countries in the world like Bangladesh, UK, Zambia, Zimbabwe, Botswana and South Africa. Since 2005 I have been working in South Africa under the Department of Health. I am a life member of Royal Medical Society, Edinburgh, UK and Fellow of Royal society of promotion of Health, UK. I am very much passionate about Palliative care Medicine and my thinking is without Palliative care Universal health care coverage cannot be delivered in health sector both public and private.
This research study explores the need for palliative care by the patients who are recovering from stroke after an acute event. Stroke survivors need comprehensive care for their physical, psychosocial, spiritual well-being and additional support. The comprehensive total care in all aspect of physical, social and spiritual well-being can only be offered by the holistic approach of palliative care focusing, as it does, on the rehabilitation for stroke survivors to improve their quality of life.
A literature review was conducted to investigate how palliative care can help to change the quality of life for stroke survivors. There has been little research on the topic of providing palliative care to stroke patients in South Africa. This research study explores the need and understanding of palliative care management for a stroke survival.
This research work is a cross sectional study using mixed methods-both quantitative and qualitative-interviewing patients, and family members of patients, who had suffered from a cerebrovascular accident.
Stroke patients admitted to medical wards, and who had attended the MOPD (Medical Outpatient Department) at Ladysmith Regional Hospital over 4-month period from the month of April to July 2013, and the members from family who were involved in their care at home.
The Islamic University - Gaza, Gaza, Palestine
Dr. Tayseer is a 5th year medical student at faculty of medicine at The Islamic University-Gaza. He is an eager, enthusiastic young researcher. He has authored many important research papers and presented them at national and international conferences. He completed one-year online course with WHO Collaboration Center for Sexual and Reproductive Health with University of North Carolina on Implementation Science. He serves on the Editorial board of many peer-reviewed medical journals. His research interest includes many fields; cardiac diseases especially CVD risk management in diabetic patients, neonatal care, palliative care, rehabilitation and physical medicine, pulmonology and respiratory medicine especially the management of chronic respiratory diseases and neurology. In his spare time, he participates in raising awareness campaigns and helps young students in starting their research projects. His personal interests are reading and playing football.
Background: Individual health is not only determined by the physical wellbeing of us but they are other as important dimension. The spiritual dimension of a patient's life is an important factor that may mediate detrimental impacts on mental health. Spiritual aspects of health-related quality of life among hemodialysis patients, either with chronic kidney disease or end-stage renal failure, have not been fully assessed.
Methods: This was a prospective, cohort, correlation design study of 440 adult patients on maintenance hemodialysis at four centers for hemodialysis in Gaza Strip. Participants were asked to complete a face-to-face interview. The interview contained questions on personal information and four scales. The scales were; FACIT-Sp-12, DASS-21, The Illness Perception Questionnaire (Brief Version) and the quality of life index SF-36.
Findings: Our study involved the interviewing of 440 patients. The hemodialysis patients had, on average, relatively good levels of spiritual well-being, moderate depression, severe anxiety, and mild to moderate stress. The results of the regression models indicated that aspects of spiritual well-being were negatively associated with depression, anxiety, and stress. However, we found that the more comorbidities the patients had, the better spiritually they are. On the other hand, all patients reported low scores regarding their quality of life. Interestingly, some patients believed that their emotional status greatly affected their disease progression. There were no significant differences between male and female patients.
Interpretation: Better spiritual and existential well-being of hemodialysis patients were significantly associated with less depression, anxiety, and stress. It appears that these patients use religious practices and spiritual beliefs as coping mechanisms to overcome their depression, anxiety, and stress. Furthermore, religion and spirituality cannot be separated from other physical complaints particularly in our culture as people in our region tend to be religious by nature.
- Palliative Care Nursing
RN BSN, KFSH&RC-J, KSA
Senior Manager, Case Management and Program Manager, Patient and Family Education Program at Cleveland Clinic, Abu Dhabi, UAE
Jacqueline Yammine, MN, RN, is the Senior Manager for the Case Management Department and the Program Manager for Patient and Family Education (PFE) Program at Cleveland Clinic Abu Dhabi (CCAD) in the United Arab Emirates (UAE). She has developed a comprehensive post discharge phone call program as part of a new service line in CCAD in collaboration with the PFE, Case Management, Clinical Nurse Coordinators, and the Nurse Triage teams.
Mrs. Yammine was the first case manager joining pre-operational CCAD in August 2014. Between 2005 and 2014, Mrs. Yammine was a Case Manager in a governmental community health services center in the city of Montreal, Quebec, Canada. Between the years 2000-2004, she worked in UAE in Jazzirah and Mafraq Hospital.
Mrs. Yammine is a candidate for the Doctor of Nursing Practice at Case Western Reserve University with an expected graduation date of December 2019. She earned her BSN in 2000 from the American University of Beirut (Beirut, Lebanon) and a MN in 2012 from Athabasca University (Alberta, Canada).
Worldwide, the need for palliative care is rapidly increasing due to an ageing population and increases in life limiting diseases. Palliative care is underdeveloped in most of the world, especially in developing countries in the Middle East and Asia. Although United Arab Emirates (UAE) is an oil-rich country that has the economic potential to provide the state of the art health care to its population, it has underdeveloped palliative care due to minimal provision and integration within the health care system. It is in its infantile phase, hampered by out-of-date laws on resuscitation, misplaced fears over opiate addiction, inadequate palliative care education and training to the medical professionals, lack of supporting policies, unstandardized care practices, and other factors.
Nurses play an integral part in the delivery of palliative care to their patients and families. There are multiple factors influencing the effectiveness of the nurse’s role in the successful delivery of palliative care. Given the context of the cultural background of both the international population of nurses working in the UAE; it is crucial to assess the factors associated with the delivery of palliative care in the population of nurses working in CCAD. Understanding the factors will facilitate planning for appropriate training programs and system changes in palliative care delivery.
Purpose: To perform a pre-implementation data collection to understand nursing knowledge, attitude, subjective norms, and perceived behaviors to help inform a successful implementation plan of palliative care services in a tertiary care hospital in the UAE.
Method: An online questionnaire which captured the nurses’ demographic information, knowledge of palliative care through the Palliative Care Quiz for Nurses (PCQN) survey, the nurses’ attitudes toward caring for terminally ill individuals using the Frommelt Attitude toward Care of the Dying (FATCOD) tool, and other questions to capture the beliefs and behaviours towards palliative care was completed by 214 multinational nurses working in a tertiary care hospital in the UAE.
Results: The vast majority of the studied sample had poor knowledge of palliative care, with the highest PCQN scores for nurses from South East Asia (58.36/100) All nurses (n=214) regardless of the continent of origin had a favourable attitude towards palliative care. Multiple regression tests to follow.
- Palliative Care Services at the End of Life
MSW, NIE, Sri Lanka
Thahir Noorul Isra qualified as a Social Worker in 2013. She has started to worked in Aroh India as coordinator of Community Base Comprehensive Palliative Care project. She started supervising Counselling students on placement when she became a Senior Practitioner in 2015 in Sri Lanka. Isra has initiated a CBCPC unit in the year of 2015 in Colombo-15 at Sri Lanka. In 2016 she has started a V4Us campaigned through the social media to familiarize the word “Palliative Care” among youngster. In 2017 National Cancer Control program invited her to share her experience on practicing palliative care in Muslim community in Sri Lanka. In 2015 Isra became a Rehabilitation Counselor in Rehabilitation of Person property and industry Authority (“REPPIA”). In 2019 Isra joined National Institute of Education as a Assistant Lecturer within the Skills and Inclusive Department. Along with she is carrying palliative care social work practice with her team.
Every patient gets fundamental right to receive good quality of care at the place where he/she lives. Home is a place of memories, familiarity and safety, a place where we remain comfortable, relaxed and confident and the best place for freedom of choice and autonomy. Unfortunately, it has become doubt due to Covid-19 pandemic situation. Unexpected lockdown increase level of stress among not only aged, but also general public (figure-1). Myths and media created anxiety among this vulnerable person. When lockdown period palliative care volunteer or front-line health care providers are not getting permission to express empathy and acknowledge emotions with patients and their families. They also surface level victims of Covid-19. The palliative care social worker is playing a vital role in Community Base Comprehensive Palliative Care setting. He is a driven energy to the unit. Most of the patient spending their quality of days with the support of CBCPC. Lockdown has closed all doors with all supportive mechanism in Sri Lanka. First week of lockdown palliative care social workers received many calls from the patient and caregivers. It was a huge challenge. No access to the house. Form a help desk for receiving a call to hear them and empower through the empathy. Develop healthy relationship with forces and front-line health care providers to deliver essential services in their door steps. Arrange a facilitator to support when they need to link with palliative care doctors and other health workers. A group of volunteers gets involved to create awareness and educate the patient, family and the general public through the social and other media platform. This strategy makes them to cope with the specific challengeable situation like Covid-19.
- Cancer Palliative Care
Dr Fan Lihong,M.D., 10th people's Hospital Affiliated to Tongji University,China
Prof. Fan, Chief Physician, Doctoral Supervisor. She has expertise in lung cancer, energy integration medicine research for a long time. She has accumulated rich clinical experience also formed a unique treatment system. She is currently the evaluation Expert of National Natural Science Foundation of China, Evaluation Expert of Shanghai Science and Technology Commission projects, Chairman of Shanghai CDC Committee on Cancer Prevention and Treatment, Director of Institute for the development of Integrative Medicine, Director of Energy Medicine and Health research Institute of Shanghai Jiao Tong University, Director of Energy Metabolism and Health research Institute of Tongji University, Vice Chairman of healthy lifestyle council of Sino-Russian friendship, peace and development committee under the Ministry of Foreign Affairs, and Director of healthy lifestyle research center. Won the "Chinese Medical Science and Technology Award", "China Hospital Science and Technology Innovation Award", China "Wuzhou Women's Science and Technology" Award, and Shanghai "Medical Technology" Award.
Overall survival (OS) of lung cancer varies greatly with individual patients in the global setting. Multiple factors may affect the prognosis. Different antibiotics have significant effects on the prognosis of lung cancer patients. The intestinal microbiome, nutritional status and inflammatory factors all have significant impact on OS of lung cancer patients.The main mechanisms are as follows.1.Immunomodulatory effects of intestinal lung axis microecology on NSCLC.2. Prognostic mechanisms of antibiotic therapy for advanced NSCLC.3.The value of biomarkers in predicting survival of advanced NSCLC patients4. Albumin-bound paclitaxel has a favorable effect on advanced NSCLC and improves the quality of life5.Advanced NSCLC patients with metabolic disease have a worse prognosis.
- Palliative Care
Family medicine Assistant Consultant, MNGHA, PHC, Alhassa, KSA
Dr. Maream Alhobel currently works as an assistant consultant in the primary health care clinics in ministry of national guard health affairs “NGHA”, Al-Hassa, Kingdom of Saudi Arabia. NGHA Primary Healthcare Centers are working on providing the best precautionary and therapeutic services to the national guards and their dependents It also serves as a training center for Saudi board family medicine residency program. She earned her medical degree from Imam Abdulrahman bin Faisal University (Formerly known as University of Dammam) school of medicine, Dammam, KSA, and completed a family medicine residency program in King Abdulaziz National Guard Hospital Al-Hassa, KSA. She also earned Arab Board of Family medicine. During her residency, she had an elective rotation in Palliative medicine at King Fahad Specialist Hospital in Dammam and she continues to pursue her interest in Palliative medicine and planning to choose palliative medicine as fellowship.
Saint Joseph University, Beirut, Lebanon
Mouhawej Marie Claire is working in Hôtel-Dieu de France Hospital. He has a research interest in palliative care. He gained his knowledge in the Saint Joseph University, Beirut, Lebanon & inspired many young researchers through her interests.
Palliative care (PC) has been defined by the World Health Organisation (WHO) as ‘an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial, and spiritual’.
Palliative care is a relatively new discipline in Lebanon although progress has been made in recent years. On 2004, The Ministry of Public Health introduced palliative care as a patient right in an article of the Law on “patients’ rights and informed consent” and established on 2011 a National Palliative Care Committee, with the mandate of elaborating national plans for research, education, practice and policy related to palliative care. This Committee launched on October 2012 the national strategies and plans to raise public awareness: introduction of a Primary Palliative Care curriculum into medical and nursing schools and primary care residency programs to ensure that all primary care physicians can provide a basic level of palliative care to the community; recognition of PC as a new specialty; incorporation the standards for Essential Palliative Care into the new hospital accreditation criteria to ensure that all hospitals in Lebanon are providing a minimum level of palliative care to their patients; introduction of new narcotic drugs to the market and facilitating the procedure to renew them.
Many hospitals have already special pain clinic and some of them introduced recently a consultant PC team (mobile team) but only 2 has PC unit. In our hospital, we launched PC services with an interdisciplinary team 3 years ago, then prepared for a PC unit with adequate local and equipments.
Attitudes and approaches to PC vary widely amongst religions and cultures. Decisions are influenced by the beliefs of the caregivers, patients and their families. Several studies stressed the importance of cultural issues when practicing PC. Concepts such as decision making, life support and advance directives, family involvement in the care, suffering and expression of pain, as well as religion and faith differ from one culture to another, and play important roles in how end-of-life care is perceived.
We describe cultural aspects of PC in our country and discuss, based on our clinical experience, the attitudes and practice of physicians and nurses in PC and challenges to implementing PC in emerging countries.
- Hospice Palliative Care
Dr Amberly Burger, MD, MMM Beacon Health System, Indiana, USA
For most clinicians in the United States, Palliative Care means hospice. As such, most procedure subspecialties have not referred to this service. A shift occurred when hospitals became financially responsible for readmissions. A common cause of readmissions to acute care settings is the diagnosis of heart failure which cost hospitals several thousand dollars each readmission. These patients suffer from systemic symptoms such as depression, anxiety, insomnia, and dyspnea, etc. Palliative care interventions have been shown to improve these symptoms and the quality of life for these patients while discussing with the patient their goals. Currently, Cardiology Guidelines encourage the use of a palliative care team to support patients’ and their families who suffer from severe heart failure and its effects. In some cases, this intervention decreases readmissions to the acute care. As hospitals have increased interest in readmission and mortality data, there will be a shift to increasing the need for Primary Palliative Care and Specialty Palliative Care. This presentation focuses on interventions for patients with CHF to improve their quality of life.