Spirituality in people with advanced chronic obstructive pulmonary disease – challenge for more effective interventions, support, and healthcare education: Mini-review

More recently there has been a growing interest in spirituality in medicine, especially in the field of palliative care, oncology, intensive care, and cardiology. However, according to literature, it seems to be a limited number of researches on how healthcare professionals should provide spiritual care (SC) for people with non-malignant lung diseases and what kind of education for them enables them to do it efficiently. This mini-review aims to provide an overview of current knowledge of an area of spirituality and SC for people with advanced chronic obstructive pulmonary disease, including spiritual well-being and religious/spiritual coping, their relations with the quality of life and symptom burden, exercise capacity and daily functioning, mental health, or medication adherence. It also analyses the use of interventions to meet patients’ spiritual needs and patients’ expectations regarding SC provided by professional careers. Based on the literature authors try to show the fields that should be improved and proposed future research directions

Estudo da bioacumulação e eliminação do ácido ocadáico, produzido pelo dinoflagelado Prorocentrum lima, em mexilhões da espécie Perna perna (Mollusca:Bivalvia)

Dissertação (mestrado) - Universidade Federal de Santa Catarina, Centro Tecnológico.Nos últimos anos, o fenômeno conhecido como "maré vermelha", caracterizado por uma massiva proliferação de organismos pertencentes ao fitoplâncton que podem ser tóxicos, tem gerado problemas ambientais, econômicos e de saúde pública. Embora eventos de florações de algas tóxicas sejam considerados fenômenos naturais, nas últimas décadas esses eventos têm se tornado cada vez mais freqüentes. Existem algumas hipóteses que tentam explicar o aumento aparente da freqüência desses eventos, porém não existe dúvida de que as atividades humanas têm influenciado na expansão desses fenômenos. Freqüentemente, os moluscos que se alimentam de organismos produtores de toxinas não são afetados, mas acumulam as toxinas no seu organismo. Essas toxinas podem, subseqüentemente, ser transmitidas ao homem através do consumo de frutos-do-mar contaminados, tornando-se, assim, uma ameaça à Saúde Pública. Uma das síndromes transmitidas pelo consumo de moluscos é conhecida como "Envenenamento Diarréico por Consumo de Mariscos", DSP, que se caracteriza por ser um grave distúrbio gastrointestinal. O ácido ocadaico (AO), a principal toxina de DSP produzida por dinofiagelados, ao acumular-se no hepatopâncrea de mexilhões e ostras, causa a síndrome diarréica em consumidores. Além disso, ele também é conhecido como sendo um potente promotor de tumores. O objetivo deste trabalho foi estudar, utilizando as técnicas de Cromatografia Líquida de Alta Eficiência (CLAE), a bioacumulação e a eliminação do ácido ocadaico, produzido pelo dinofiagelados da espécie Prorocentrum lima em mexilhões da espécie Perna perna, a fim de conhecer os mecanismos de acumulação e eliminação dessa toxina, visando a obter dados para diminuir os riscos de contaminação humana. Em ensaios de laboratório, foi comprovado que o ácido ocadaico convertia em tóxicos os mexilhões P. perna, alimentados com o dinofiagelado. Mediante as análises dos hepatopâncreas e das fezes dos mexilhões, objetos do estudo, foi investigado a acumulação e a eliminação do ácido ocadaico nos moluscos, verificando-se que a concentração da toxina no organismo dos mexilhões foi proporcional à quantidade de células de P. lima disponíveis. Esses ensaios também demonstraram a rápida eliminação de AO. Após 48 horas da substituição da alimentação dos moluscos com o P. lima por Chaetoceros sp, o AO deixou de ser detectado nas amostras analisadas

Estudo comparativo das estimativas de energia fotovoltaica gerada sobre superfícies tridimensionais em ambiente SIG e das informadas pela plataforma Sundata/ Comparative study of the estimates of photovoltaic energy on three-dimensional surfaces in GIS and those reported by Sundata

A demanda da sociedade por fontes de energia limpa e de baixo custo tem impulsionado a utilização e propagação de ferramentas auxiliares no dimensionamento de sistemas elétricos. Fornecido gratuitamente pela Eletrobrás, o Sundata é uma plataforma hospedada na web composta por modelos climatológicos robustos, capazes de informar dados estimados de energia solar (Wh/m²) a partir de consultas por coordenadas geográficas. O presente artigo pretende conferir o desempenho do Sundata quando comparado a modelagens de irradiação solar computadas sobre terrenos tridimensionais no software especialista de geoprocessamento ArcGIS. O principal objetivo é propor uma metodologia analítica capaz de considerar os efeitos da existência de barreiras físicas na superfície topográfica que comprometem as métricas dimensionadas na plataforma Sundata

Biographical note of Professor Jacek Łuczak

–

Preliminary experience with the use of methadone in the treatment of cancer pain

Background. In an open clinical study analgesia and side effects of methadone were assessed and the calculation of equianalgesic doses of oral morphine and methadone used in our patients was appraised. Material and methods. Methadone was administered in 12 opioid - tolerant patients with severe cancer pain. Patients received methadone because of inadequate pain control (NRS > 5) (number of patients in brackets) during treatment with morphine (4), transdermal fentanyl (3), morphine, ketamine and transdermal fentanyl (1), tramadol (1), unsatisfactory analgesia with severe drowsiness during morphine with ketamine treatment (2) and very strong pain with nausea during morphine treatment (1). We used the following dose ratios while converting oral morphine equivalent to oral methadone: 4:1 (up to 100 mg morphine daily), 6:1 (100&#8211;300 mg morphine daily) and 12:1 (daily dose of morphine over 300 mg) although in this study because of daily doses of oral morphine over 100 mg we applied only the last two dose ratios. The starting daily dose of oral methadone in patient treated with tramadol was 9 mg. The single dose of oral methadone did not exceed 30 mg regardless the daily dose of oral morphine before the switch to methadone. After starting methadone we withdrew previous opioid treatment completely in 10 patients and 2 patients were treated concomitantly with methadone and other opioids. The mean equivalent daily dose of oral morphine before switching to methadone was 750.8 &plusmn; 464 mg. Methadone was administered usually 3 times a day and 11 patients were treated with oral methadone in water solution, 1 patient received the drug rectally in suppositories. Results. The mean time of the methadone treatment was 31.7 &plusmn; 21.2 (range 7&#8211;82) days and the starting doses were increased in 11 of 12 treated patients. The mean daily doses varied from 46 &plusmn; 19.9 mg at the beginning till maximal 135.3 &plusmn; 99.9 mg and 117.7 &plusmn; 97.5 mg at the end of methadone treatment. Good analgesia expressed by decrease in pain intensity to NRS < 3 was achieved in 6 patients, partial effect (NRS 3&#8211;5) was present in 5 patients, unsatisfactory analgesia was observed in 1 patient (NRS > 5) who ceased methadone after 7 days of the treatment. The most frequent side effects were drowsiness (5 patients), constipation (5 patients), nausea and vomiting (2 patients). We did not observe serious adverse reactions especially respiratory depression, which would cause cessation of the treatment. Conclusions. The results of this preliminary study confirmed high analgesic efficacy, good adverse event profile of methadone, safety and the effectiveness of the applied method of morphine to methadone dose calculation for the oral route.Wstęp. W otwartym badaniu klinicznym dokonano oceny analgezji i objawów ubocznych metadonu oraz zastosowanego sposobu przeliczania dawek równoważnych morfiny i metadonu, podawanych drogą doustną. Materiał i metody. Metadon podawano 12 chorym z bólem nowotworowym o silnym natężeniu, wcześniej leczonych innymi opioidami. Wskazaniem do stosowania metadonu była niedostateczna kontrola bólu (NRS > 5) (w nawiasach podano liczbę chorych) podczas leczenia morfiną (4), przezskórnym fentanylem (TF) (3), morfiną, ketaminą i przezskórnym fentanylem (1), tramadolem (1), nasilone bóle i senność podczas terapii morfiną i ketaminą (2) oraz bardzo silne bóle i nudności podczas leczenia morfiną (1). Przyjęto następujący sposób przeliczania dawek równoważnych opioidów: przy ekwiwalentnej dawce dobowej doustnej morfiny do 100 mg dawkę dobową doustnego metadonu obliczano według przelicznika 4:1, przy dawce dobowej doustnej morfiny 100&#8211;300 mg według przelicznika 6:1, przy dawce dobowej doustnej morfiny powyżej 300 mg według przelicznika 12:1, przy czym z powodu ekwiwalentnych dawek dobowych doustnej morfiny powyżej 100 mg w badaniu zastosowano tylko ostatnie dwa przeliczniki. U chorej leczonej tramadolem początkowa dawka dobowa doustnego metadonu wynosiła 9 mg. Niezależnie od wielkości dawki dobowej doustnej morfiny początkowa jednorazowa dawka metadonu nie przekraczała 30 mg. Po rozpoczęciu leczenia metadonem u 10 chorych całkowicie odstawiano wcześniej przyjmowany opioid, 2 chorych otrzymywało równocześnie metadon i inne opioidy. Średnia ekwiwalentna dawka dobowa doustnej morfiny, przed zamianą na metadon, wynosiła 750,8 &plusmn; 464 mg. Metadon podawano najczęściej 3 razy dziennie - 11 chorych otrzymywało lek doustnie w roztworze wodnym, 1 chorego leczono metadonem podawanym drogą doodbytniczą w postaci czopków. Wyniki. Średni czas leczenia metadonem wynosił 31,7 &plusmn; 21,2 dni (zakres 7&#8211;82), średnie dawki dobowe leku zwiększyły się u 11 spośród 12 leczonych chorych i wynosiły na początku 46 &plusmn; 19,9 mg, maksymalnie 135,3 &plusmn; 99,9 mg, na końcu terapii 117,7 &plusmn; 97,5 mg. Korzystne efekty przeciwbólowe, wyrażające się zmniejszeniem natężenia bólu do NRS < 3, odnotowano u 6 leczonych chorych, efekt częściowy (NRS 3&#8211;5) stwierdzono u 5 chorych, u 1 pacjentki efekt analgetyczny oceniono jako niedostateczny (NRS > 5) i po 7 dniach zakończono leczenie. Spośród objawów ubocznych najczęściej występowały senność (5 chorych), zaparcie stolca (5 chorych) oraz nudności i wymioty (2 chorych). Nie obserwowano poważnych działań niepożądanych, zwłaszcza depresji oddechowej, które spowodowałyby konieczność przerwania leczenia. Wnioski. Wyniki wstępnego badania potwierdziły wysoką skuteczność analgetyczną i dobrą tolerancję metadonu oraz bezpieczeństwo i przydatność zastosowanego sposobu przeliczania dawek morfiny na dawki metadonu, podawanych drogą doustną

Prescribing non-opioid drugs in end-stage kidney disease

Palliative care services are increasingly involved in the care of patients with chronic kidney disease, either alone or as a comorbid condition. Because renal impairment often changes the pharmacokinetic and/or pharmacodynamic effects of a drug, this presents a challenge for prescribers. This article provides guidance for prescribing non-opioid drugs commonly used for palliative care symptom relief in patients with end-stage kidney disease (ESKD; i.e. Chronic Kidney Disease Stage 5, eGFR &lt;15mL/min/1.73m²) whether or not they are receiving dialysis. Opioids are not included, nor symptom relief in the last hours–days of life, because specific guidance is available elsewhere. Tables have been produced to highlight, when possible, the most, intermediate and least ‘renally safe’ drugs for chronic use. However, sometimes the cautious use of a familiar drug may be preferable to an unfamiliar (albeit ‘renally safer’) one. Similarly, we do not advocate the automatic switching of patients to a ‘renally safer’ drug when an alternative is proving satisfactory. Finally, this article aims to complement and not replace specialist renal unit guidance