Undesirable drug interaction in palliative medicine

The importance of drug interactions in palliative care is acquiring more and more practical importance. In the polytherapy used in palliative care, drugs can induce a number of interactions and increase the risk of unwanted drug reactions. This paper discusses the importance of drug-drug interactions in clinical practice.The importance of drug interactions in palliative care is acquiring more and more practical importance. In the polytherapy used in palliative care, drugs can induce a number of interactions and increase the risk of unwanted drug reactions. This paper discusses the importance of drug-drug interactions in clinical practice

Communication in palliative care

Communication consists in an intentional exchange of verbal and non-verbal signs (symbols) undertaken in order to improve cooperation or share meanings among partners. The communication occurs on many levels, from the intrapersonal through interpersonal (involving a group), to the public level. In the context of palliative care, special importance is gained by the basic social behaviours, such as the ability to conduct a conversation. Communicativeness is a skill that is not only acquired through experience, but also through professional training. The interest of the interdisciplinary team requires improvement of the qualifications of its members in this respect. Only through full cooperation with the patient and the family, which will take into account the emotions and needs, can one negotiate common goals concerning care. Interdisciplinary team members should ensure proper communication in order to ensure the provision of optimal support to the patient and the family.Communication consists in an intentional exchange of verbal and non-verbal signs (symbols) undertaken in order to improve cooperation or share meanings among partners. The communication occurs on many levels, from the intrapersonal through interpersonal (involving a group), to the public level. In the context of palliative care, special importance is gained by the basic social behaviours, such as the ability to conduct a conversation. Communicativeness is a skill that is not only acquired through experience, but also through professional training. The interest of the interdisciplinary team requires improvement of the qualifications of its members in this respect. Only through full cooperation with the patient and the family, which will take into account the emotions and needs, can one negotiate common goals concerning care. Interdisciplinary team members should ensure proper communication in order to ensure the provision of optimal support to the patient and the family

What do we know about influence of opioids on immune system?

Działanie opioidów na układ immunologiczny jest zjawiskiem złożonym i zależy od następujących zmiennych: typu leku opioidowego, charakteru odpowiedzi (humoralna czy komórkowa) oraz typu komórek zaangażowanych w ich przebieg. Makrofagi wydają się pełnić znaczącą rolę w modulowaniu sygnału opioidowego. Potwierdzają to wyniki badań prowadzonych przez grupę krakowską, która oceniała wpływ terapii z użyciem różnych opioidów na parametry odporności humoralnej i komórkowej. Badania z zastosowaniem morfiny, fentanylu, metadonu zostały zakończone, a nadal prowadzone są badania z użyciem oksykodonu i buprenorfiny. W pracy został przedstawiony obecny stan wiedzy z poszerzeniem o wyniki badań własnych dotyczących oddziaływania opioidów na układ immunologiczny.Opioid effects on the immune system is a complex phenomenon which depends on the following variables: type of the opioid drug, the nature of the response (humoral or cellular), and the type of cells involved in its course. Macrophages appear to play an important role in modulating the signal of the opioid. This is confirmed by the results of research conducted by a group of researchers from Krakow, which evaluated the effect of treatment with different opioids on the parameters of humoral and cellular immunity. While studies with morphine, fentanyl, and methadone has been completed, research on oxycodone and buprenorphine are still conducted. The work will be covered by the so far obtained results of experimental usage of these opioids

Komunikacja w opiece paliatywnej

Komunikacja opiera się na intencjonalnej wymianie znaków (symboli) podejmowanej w celu poprawienia współpracy lub dzielenia się znaczeniami pomiędzy partnerami. Odbywa się ona na wielu poziomach - od intrapersonalnego, poprzez interpersonalny (angażujący grupę osób), aż do publicznego. W kontekście opieki paliatywnej specjalnego znaczenia nabierają podstawowe zachowania społeczne, takie jak zdolność do prowadzenia rozmowy. Komunikatywność to umiejętność, którą nabywa się nie tylko poprzez doświadczenie, ale także poprzez profesjonalny trening. W interesie zespołu interdyscyplinarnego leży podnoszenie kwalifikacji poszczególnych osób właśnie w zakresie komunikacji. Tylko poprzez pełną współpracę z pacjentem i jego rodziną, przy uwzględnieniu emocji i potrzeb, można uzgodnić wspólne cele związane z opieką nad chorym. Członkowie zespołów interdyscyplinarnych powinni zagwarantować właściwą komunikację w celu zapewnienia optymalnego wsparcia dla pacjenta i jego rodziny. Medycyna Paliatywna w Praktyce 2010; 4, 2: 81-8

Age influence on opioid consumption in terminally ill digestive cancer patients

The aim of this work was to estimate the influence of the age and gender on the opioids usage in terminally ill digestive cancer patients. A retrospective files analysis of the 344 patients who had died in two palliative units, divided into three groups (< 60, 60–70, > 70 years old) was performed. Morphine Equivalent Daily Dose (MEDD) on admission, within the last 3 days, last 5 days and in the last day of life were compared. The number of patients receiving coanalgesics and the number of coanalgesics used per patient were also analyzed. The amount of opioids remained stable through the last 5 days. The mean daily MEDD values in every time intervals were significantly higher in the youngest group than in older ones. The number of coanalgesics used was the highest in the youngest group. Smaller number of patients received coanalgesics in the oldest group. Women < 60 years old required a significantly higher MEDD than men in each time interval, except of the admission. Study confirms the lower amount of opioids used in the elderly digestive terminal cancer patients and also within younger males

Data supporting the understanding of modulatory function of opioid analgesics in mouse macrophage activity

The data presented herein expand the current understanding of the modulatory function of opioid drugs in mouse macrophage activity described in our relevant research article (Filipczak-Bryniarska et al., 2017) [1], in which we characterize the influence of morphine, buprenorphine and oxycodone on humoral and cell-mediated immune response in mice. Among other things, we have shown the effects of treatment with assayed analgesics on macrophage ability to induce antigen-specific B-cell response to sheep red blood cells as well as to generate reactive oxygen intermediates and nitric oxide. The current data demonstrate the effects of morphine, buprenorphine or oxycodone administration on phagocytosis of sheep red blood cells and zymosan by mouse macrophages, supplementing the data on immune modulatory capacities of assayed drugs, recently reported by us (Filipczak-Bryniarska et al., 2017; Kozlowski et al., 2017) [1,2]. Keywords: Immune modulation, Macrophages, Opioids, Phagocytosi