Relieving chronic breathlessness is a human right

Copyright © Via Medica. Chronic breathlessness, defined as breathlessness that persists despite optimising the treatment of underlying causes, is recognised by recent international consensus as a distinct clinical syndrome. Across our communities, population-based studies of chronic breathlessness expose an enormous burden from this. Among the palliative care population, one in four people die with severe breathlessness despite treatment from a palliative care service. Recently, the relief of breathlessness was claimed to be a human right, particularly when there are treatments available to alleviate the unnecessary suffering caused by chronic breathlessness. The timely recognition of, and response to chronic breathlessness is a crucial clinical skill

A simple visual navigation system for an UAV

We present a simple and robust monocular camera-based navigation system for an autonomous quadcopter. The method does not require any additional infrastructure like radio beacons, artificial landmarks or GPS and can be easily combined with other navigation methods and algorithms. Its computational complexity is independent of the environment size and it works even when sensing only one landmark at a time, allowing its operation in landmark poor environments. We also describe an FPGA based embedded realization of the method’s most computationally demanding phase

Is Neuropathic Pain a Good Marker of Peripheral Neuropathy in Hospice Patients with Advanced Cancer? The Single Center Pilot Study

Neuropathic pain (NP) affects approximately 30% of patients with advanced cancer. The prevalence of neuropathic pain related to peripheral neuropathy (NP-RPN) in these patients is not known. The aim of the study was to evaluate NP-RPN prevalence in hospice patients and to find out whether the absence of this pain is sufficient to rule out peripheral neuropathy. The study included a total of 76 patients with advanced cancer who were cared for at inpatient hospices. All patients were asked about shooting or burning pain (of the feet and hands), were examined systematically for sensory deficits and had a nerve conduction study performed. NP-RPN was found in 29% of the patients. Electrophysiologically-diagnosed peripheral neuropathy was found in 79% of patients, and the diagnostic electrophysiological criteria for neuropathy were met by one half of the patients without NP-RPN. The severity of NP-RPN was correlated with the clinically assessed severity of sensory neuropathy and the Karnofsky score, but was not correlated with the intensity of the clinical signs of motor neuropathy. The presence of NP-RPN did not reflect greater prevalence of motor and sensory abnormalities in neurological and electrophysiological examinations. The absence of NP-RPN did not rule out polyneuropathy in hospice patients

End‑of‑life care for patients with advanced lung cancer and chronic obstructive pulmonary disease: Survey among Polish pulmonologists

Copyright by Medycyna Praktyczna, Kraków 2019 INTRODUCTION There is evidence that people with nonmalignant disease receive poorer end‑of‑life (EOL) care compared with people with cancer. OBJECTIVES The aim of the study was to assess the selected aspects of symptomatic treatment and communication between physicians and patients diagnosed with either advanced chronic obstructive pulmonary disease (COPD) or lung cancer. METHODS A questionnaire survey was conducted online among members of the Polish Respiratory Society. RESULTS Properly completed questionnaires were returned by 174 respondents (27.2% of those proved to be contacted by email). In COPD, 32% of respondents always or often used opioids in chronic breathlessness and 18.3% always or often referred patients to a palliative care (PC) specialist. Nearly 80% of the respondents claimed that bedside discussions on EOL issues with people with COPD are essential, although only 20% would always or often initiate them. In people with lung cancer, opioids were routinely used for relief of chronic breathlessness by 80% of physicians; 81.7% referred patients to a PC specialist. More than half of the respondents always or often discussed EOL issues only with the patient’s caregivers or relatives. Younger physicians, those at an earlier stage of their career, those caring for higher numbers of patients with lung cancer, and those who were better acquainted with Polish Respiratory Society recommendations for PC in chronic lung diseases seemed to provide better EOL care for COPD patients. CONCLUSIONS Patients with COPD, as compared with patients with lung cancer, were less frequently treated with opioids to relieve chronic breathlessness or referred for a PC consultation. Discussing the EOL issues with a patient was generally found challenging by physicians, and most often pursued with caregivers instead. The COPD recommendations on PC may prove helpful in providing better EOL care by pulmonologists

The role of microstructural characteristics of additively manufactured Alloy 718 on tool wear in machining

This study aims to provide a fundamental understanding of the role of microstructural characteristics influencing tool wear when machining Alloy 718 fabricated using Powder Bed Fusion (PBF). The effects of preferred crystallographic orientation (texture), shape and distribution of grains, local misorientation, type and amount of precipitates as well as the type, size and amount of abrasive carbides, nitrides and oxides on tool wear are investigated in as-built condition and after the standard solutionising and double-aging treatment. The microstructures of workpiece materials and the surfaces of worn tools were examined using different material characterisation techniques, including Scanning Electron Microscopy (SEM), energy-dispersive X-ray spectroscopy (EDS) and electron backscatter diffraction (EBSD). A dislocation-based approach was used to reveal the cumulative effects of the microstructural characteristics on deformation behaviour and the thermo-mechanical loads on the tools during cutting. The analyses suggest that texture and the extent of material work-hardening prior to the onset of crack formation markedly influence the amount of plastic work and thus heat generation when machining Electron Beam Powder Bed Fusion (EB-PBF) material. The higher heat generation in the cutting zones provokes thermally-induced wear mechanisms like diffusion-dissolution and oxidation. In addition, the larger amount of hard oxide inclusions present in EB-PBF material leads to higher wear by abrasion. In contrast to the prevailing experimental approaches in this field, the present investigation is built on a physics-based framework to understand the fundamental aspects that govern material deformation and heat generation in cutting and, consequently, tool wear mechanisms. This framework can be used for machinability assessment of any alloy manufactured by different additive manufacturing (AM) technologies and for optimising the process-chain, including printing strategies and thermal post-treatments, to improve the machinability of AM alloys by tailoring their microstructure

A Novel and More Efficient Way to Grind Punching Tools

ABSTRACT A simulation model of punch grinding has been developed which calculates the instantaneous material-removal rate, arc length of contact and temperature based on the kinematic relationships between wheel and workiece and determines the optimum machine parameters to reduce cycle time and achieve a constant-temperature no-burn situation. Two basic outputs of the simulation model include arc length of contact and specific material-removal rate. A thermal model is included in the simulation to calculate maximum grinding zone temperature rise. A novel method is developed to constrain this temperature rise in the simulation. The thermal model inputs a constant value of specific grinding energy and the energy partition, which represents the fraction of the grinding energy conducted as heat to the workpiece. The simulation-based optimization can lead to a drastic reduction of grinding cycle time. Moreover, the limitation of maximum grinding zone temperature rise below the transitional temperature can help to avoid generation of workpiece thermal damage, which includes thermal softening, residual tensile stress, and rehardening burn. The grindability of high speed steel (HSS) is also discussed in terms of power consumption, specific grinding energy and undeformed chip thickness

Funding models in palliative care: lessons from international experience

Background:Funding models influence provision and development of palliative care services. As palliative care integrates into mainstream health care provision, opportunities to develop funding mechanisms arise. However, little has been reported on what funding models exist or how we can learn from them.Aim:To assess national models and methods for financing and reimbursing palliative care.Design:Initial literature scoping yielded limited evidence on the subject as national policy documents are difficult to identify, access and interpret. We undertook expert consultations to appraise national models of palliative care financing in England, Germany, Hungary, Republic of Ireland, New Zealand, The Netherlands, Norway, Poland, Spain, Sweden, Switzerland, the United States and Wales. These represent different levels of service development and a variety of funding mechanisms.Results:Funding mechanisms reflect country-specific context and local variations in care provision. Patterns emerging include the following:Provider payment is rarely linked to population need and often perpetuates existing inequitable patterns in service provision.Funding is frequently characterised as a mixed system of charitable, public and private payers.The basis on which providers are paid for services rarely reflects individual care input or patient needs.Conclusion:Funding mechanisms need to be well understood and used with caution to ensure best practice and minimise perverse incentives. Before we can conduct cross-national comparisons of costs and impact of palliative care, we need to understand the funding and policy context for palliative care in each country of interest

Integrated care for patients with advanced chronic obstructive pulmonary disease

Przewlekła obturacyjna choroba płuc (POChP) jest trzecią przyczyną zgonów i trzecią przyczyną niesprawności (mierzonej za pomocą wskaźnika DALY) u osób powyżej 60. roku życia. Ciężką lub bardzo ciężką postać POChP (wskaźnik FEV1, odpowiednio, poniżej 50% i 30% należnej wartości) rozpoznaje się u mniej więcej jednej piątej ogółu chorych. Chorzy na zaawansowaną POChP z reguły cierpią z powodu fizycznej i umysłowej niepełnosprawności, w wielu przypadkach źle radzą sobie z problemami wynikającymi z choroby i współistniejących schorzeń. To z kolei stwarza duże ryzyko zaostrzeń POChP, które prowadzą do pogorszenia przebiegu choroby, istotnego zwiększenia kosztów medycznej opieki oraz zwiększenia ryzyka zgonu. Obecna organizacja medycznej opieki dla tej grupy chorych nie zapewnia odpowiednich warunków zdrowotnych i socjalnych. Wydaje się jednak, że zastosowanie modelu zintegrowanej opieki, zalecanego przez Światową Organizację Zdrowia stworzyłoby możliwość poprawy sytuacji chorych na zaawansowane POChP. W Polsce ta forma opieki jest realizowana od kilkunastu lat w zakładach medycyny paliatywnej i hospicjach w odniesieniu do chorych na zaawansowane nowotwory. Wykorzystanie tych doświadczeń powinno pomóc w integracji działań wokół lekarzy rodzinnych i wyspecjalizowanej pielęgniarki, z jednoczesnym zapewnieniem dostępu do specjalistów w zależności od indywidualnych potrzeb chorego. Powinno także umożliwić szersze wykorzystanie pracowników pomocniczych, jak: pracownicy socjalni, pomocnicy medyczni oraz wolontariusze, a także psycholodzy i duchowni (zwłaszcza w końcowej fazie choroby). Pneumonol. Alergol. Pol. 2010; 78, 2: 126-132Chronic obstructive pulmonary disease (COPD) is the third cause of mortality and disability (assed by DALY) among patients above 60 year old. Severe and very severe COPD (FEV1 = equal or less than 50% and 30% of expected value, respectively) is estimated at 20% of all COPD patients. Advanced COPD usually leads to physical and mental deterioration, the patients often manage with the problems caused by the disease and other comorbidities poorly. This leads to increased risk of COPD exacerbations and further deterioration of the patient’s status, increased costs of medical care and eventually increased risk of death. Current organization of medical care for those patients does not provide adequate health and social support for them. However, it seems that introducing an integrated approach proposed by World Health Organization, could improve the situation of advanced COPD patients. In Poland, this kind of care has been provided in advanced cancer patients throughout stationary palliative care units and hospices during the last several years. This experience should be helpful in integrating actions of general practitioners and specialized nurses, as well as providing access for the specialists’ consultations according to the individual needs of the patients. It should also allow for broad cooperation with auxiliary staff, such as social workers, medical assistants and volunteers, as well as psychologists and clergymen (especially in the terminal phase of the disease). Pneumonol. Alergol. Pol. 2010; 78, 2: 126-13