Integration of palliative care with other medical specialties - opinions of nephrologists

The palliative and hospice care in Poland is offered mostly to patients with cancer in its terminal stages. According to the modern definition of palliative care, it should include patients with other chronic and advanced diseases. The goal of the study was to evaluate the knowledge and awareness in Polish nephrology specialists, concerning the problems of palliative care in patients with chronic renal failure. Anonymous surveys were carried out among 59 nephrologists (30 men and 29 women, with an average age of 42). Sixty percent of the respondents claimed that the quality of life is the criteria for effective treatment, while only 25% put biochemical parameters in the first position. Almost 80% of the respondents believe that dialysis patients do not receive proper psychological care and almost 90% state the same in relation to social care. Similar answers are given in relation to satisfying the spiritual needs and family support. More than 66% of nephrologists believe that doctors and nephrology nurses should be involved in the palliative care. More than half of nephrologists were forced to make the decision to abandon the dialysis therapy in patients with chronic haemodialysis and most of them think that there should be clear rules of conduct for such situations. More than 96% of the respondents believe that palliative care can be applied in nephrology, albeit 40% of nephrologists objected to putting palliative care training in the nephrology specialisation programme. After a presentation aimed at introducing the aspects of palliative care in nephrology, the percentage of specialists with a critical attitude was reduced to 16%. Palliative hospice care is not offered to chronic renal failure patients, although they would most probably benefit from it. Nephrologists acknowledge the necessity of training in the aspects concerning such care, as well as defining the ethical and legal guidelines concerning the withdrawal of dialysis therapy.The palliative and hospice care in Poland is offered mostly to patients with cancer in its terminal stages. According to the modern definition of palliative care, it should include patients with other chronic and advanced diseases. The goal of the study was to evaluate the knowledge and awareness in Polish nephrology specialists, concerning the problems of palliative care in patients with chronic renal failure. Anonymous surveys were carried out among 59 nephrologists (30 men and 29 women, with an average age of 42). Sixty percent of the respondents claimed that the quality of life is the criteria for effective treatment, while only 25% put biochemical parameters in the first position. Almost 80% of the respondents believe that dialysis patients do not receive proper psychological care and almost 90% state the same in relation to social care. Similar answers are given in relation to satisfying the spiritual needs and family support. More than 66% of nephrologists believe that doctors and nephrology nurses should be involved in the palliative care. More than half of nephrologists were forced to make the decision to abandon the dialysis therapy in patients with chronic haemodialysis and most of them think that there should be clear rules of conduct for such situations. More than 96% of the respondents believe that palliative care can be applied in nephrology, albeit 40% of nephrologists objected to putting palliative care training in the nephrology specialisation programme. After a presentation aimed at introducing the aspects of palliative care in nephrology, the percentage of specialists with a critical attitude was reduced to 16%. Palliative hospice care is not offered to chronic renal failure patients, although they would most probably benefit from it. Nephrologists acknowledge the necessity of training in the aspects concerning such care, as well as defining the ethical and legal guidelines concerning the withdrawal of dialysis therapy

A Hierachical Evolutionary Algorithm for Multiobjective Optimization in IMRT

Purpose: Current inverse planning methods for IMRT are limited because they are not designed to explore the trade-offs between the competing objectives between the tumor and normal tissues. Our goal was to develop an efficient multiobjective optimization algorithm that was flexible enough to handle any form of objective function and that resulted in a set of Pareto optimal plans. Methods: We developed a hierarchical evolutionary multiobjective algorithm designed to quickly generate a diverse Pareto optimal set of IMRT plans that meet all clinical constraints and reflect the trade-offs in the plans. The top level of the hierarchical algorithm is a multiobjective evolutionary algorithm (MOEA). The genes of the individuals generated in the MOEA are the parameters that define the penalty function minimized during an accelerated deterministic IMRT optimization that represents the bottom level of the hierarchy. The MOEA incorporates clinical criteria to restrict the search space through protocol objectives and then uses Pareto optimality among the fitness objectives to select individuals. Results: Acceleration techniques implemented on both levels of the hierarchical algorithm resulted in short, practical runtimes for optimizations. The MOEA improvements were evaluated for example prostate cases with one target and two OARs. The modified MOEA dominated 11.3% of plans using a standard genetic algorithm package. By implementing domination advantage and protocol objectives, small diverse populations of clinically acceptable plans that were only dominated 0.2% by the Pareto front could be generated in a fraction of an hour. Conclusions: Our MOEA produces a diverse Pareto optimal set of plans that meet all dosimetric protocol criteria in a feasible amount of time. It optimizes not only beamlet intensities but also objective function parameters on a patient-specific basis

Organizational Issues and Major Problems of Palliative Care Concerning Treatment of End-Stage Renal Disease in Polish Residential Hospices and Hospital-Based Palliative Medicine Wards

Background. Patients diagnosed with end-stage renal disease experience a significant level of symptom burden, including pain, nausea and vomiting, inability to urinate, fatigue etc. At this point in disease progression, it is important to establish what types and choices of therapy are most suitable for these patients, in particular, the value of continuing dialysis treatment. Material and methods. A self-administered questionnaire was distributed among Polish residential hos­pices and hospital based palliative medicine wards. All responses obtained underwent statistical analysis using Pearson’s Chi Square test. Results. Permanent palliative care facilities, from which 73 out of 166 registered in Poland, took part in the survey. ESRD patients were identified to be cared by 81% of the aforementioned institutions. The most common treatment approach for these patients was highlighted as conservative treatment (68%), followed by hemodialysis (47%), whereas merely 11% provided peritoneal dialysis. Differences between facilities were identified relating to therapeutic recommendations for terminal ESRD patients with residential hospices more likely to recommend dialysis in conjunction with palliative care, whereas palliative wards advocated a withdrawal from dialysis followed by the initiation of palliative care. Conclusion. All surveyed facilities considered ESRD patients eligible for guaranteed hospice and palliative care services. However, certain changes are needed to improve care for ESRD patients, including: the development of collaborative partnerships between hospices, dialysis centers and nephrologists, devel­opment of guidelines for withdrawing dialysis and applying conservative treatment, introducing better renal-based training for medical personnel as well as the introduction of transparency within rules relating to the financing of these services.Background:Patients diagnosed with end-stage renal disease (ESRD) experience a significant level of symptom burden, including pain, nausea and vomiting, inability to urinate, fatigue etc. At this point in disease progression, it is important to establish what types and choices of therapy are most suitable for these patients, in particular, the value of continuing dialysis treatment. Material and methods:A self-administered questionnaire was distributed among Polish residential hospices and hospital based palliative medicine wards. All responses obtained underwent statistical analysis using Pearson’s Chi Square test.Results:73 of 166 permanent palliative care facilities registered in Poland took part in the survey. 81% of the aforementioned institutions identified that they cared for ESRD patients. The most common treatment approach for these patients was highlighted as conservative treatment (68%), followed by hemodialysis (47%), whereas merely 11% provided peritoneal dialysis. Differences between facilities were identified relating to therapeutic recommendations for terminal ESRD patients with residential hospices more likely to recommend dialysis in conjunction with palliative care, whereas palliative wards advocated a withdrawal from dialysis followed by the initiation of palliative care.Conclusion:All surveyed facilities considered ESRD patients eligible for guaranteed hospice and palliative care services. However, certain changes are needed to improve care for ESRD patients, including: the development of collaborative partnerships between hospices, dialysis centers and nephrologists, development of guidelines for withdrawing dialysis and applying conservative treatment, introducing better renal-based training for medical personnel as well as the introduction of transparency within rules relating to the financing of these services

Organizational issues and major problems of palliative care concerning treatment of end-stage renal disease in Polish residential hospices and hospital- -based palliative medicine wards

Copyright © Via Medica. Background. Patients diagnosed with end-stage renal disease experience a significant level of symptom burden, including pain, nausea and vomiting, inability to urinate, fatigue etc. At this point in disease progression, it is important to establish what types and choices of therapy are most suitable for these patients, in particular, the value of continuing dialysis treatment. Material and methods. A self-administered questionnaire was distributed among Polish residential hospices and hospital based palliative medicine wards. All responses obtained underwent statistical analysis using Pearson's Chi Square test. Results. Permanent palliative care facilities, from which 73 out of 166 registered in Poland, took part in the survey. ESRD patients were identified to be cared by 81% of the aforementioned institutions. The most common treatment approach for these patients was highlighted as conservative treatment (68%), followed by hemodialysis (47%), whereas merely 11% provided peritoneal dialysis. Differences between facilities were identified relating to therapeutic recommendations for terminal ESRD patients with residential hospices more likely to recommend dialysis in conjunction with palliative care, whereas palliative wards advocated a withdrawal from dialysis followed by the initiation of palliative care. Conclusion. All surveyed facilities considered ESRD patients eligible for guaranteed hospice and palliative care services. However, certain changes are needed to improve care for ESRD patients, including: The development of collaborative partnerships between hospices, dialysis centers and nephrologists, development of guidelines for withdrawing dialysis and applying conservative treatment, introducing better renal-based training for medical personnel as well as the introduction of transparency within rules relating to the financing of these services

The craniofacial necrotizing fasciitis after a minor trauma in an elderly white woman

The term necrotizing fasciitis /NF/ was probably first described by Jones in 1871 as "hospital gangrene". NF, with its fast spreading from the local infection to massive necrosis of the underlying tissues, ie. superficial fascia and subcutaneous layers, is a potentially fatal disease, unless diagnosed early and properly treated. NF is more frequent in frail patients with chronic debilitating illnesses, immune deficiencies or from a poor social background. Sixty percent of NF cases occur in females. Here we present a case of necrotizing fasciitis of the head and neck region after a minor trauma (phenol blocks due to severe neuropathic pain) in an 82-year-old female with the history of trigeminal neuralgia

Ocena właściwości błony otrzewnowej - wskazania grupy European Renal Best Practice 2010. Wolny transport otrzewnowy - postępowanie i rokowanie

W marcu 2010 roku ukazały się kliniczne zalecenia grupy roboczej European Renal Best Practice dotyczące oceny właściwości błony otrzewnowej. Opisano własności transportowe błony otrzewnowej, upraszczając podział i zmieniając mianownictwo trzech rodzajów transportu otrzewnowego. Zwrócono uwagę na inne właściwości błony otrzewnowej: transport wolnej wody, osmotyczną konduktancję dla glukozy oraz transport dużych cząstek. Przedstawiono testy służące ocenie poszczególnych właściwości błony otrzewnowej, ich zalety i ograniczenia. Wskazano na konieczność wykonywania badań czynnościowych błony otrzewnowej i wykorzystywania ich wyników dla właściwego przepisu dializy. W drugiej części artykułu omówiono kliniczne problemy pacjentów z wolnym transportem otrzewnowym oraz przedstawiono możliwości skutecznej dializy otrzewnowej w przypadku takiego rodzaju transportu. Forum Nefrologiczne 2010, tom 3, nr 3, 154-16

Przestrzeganie zaleceń przez pacjentów dializowanych otrzewnowo

Nieprzestrzeganie zaleceń przez chorych dializowanych otrzewnowo w domu ma znaczenie dla wyników leczenia, jakości życia i przeżycia chorych. W opracowaniu omówiono aktualne ogólne nazewnictwo, częstość, przyczyny i metody oceny tego zjawiska wśród pacjentów dializowanych otrzewnowo. Zwrócono uwagę na konieczność stosowania tradycyjnych i nowoczesnych metod wspierania chorych w domu oaz prowadzenia dalszych badań nad interwencjami w tym zakresie, które pozwolą zmniejszyć odsetek chorych nieprzestrzegających schematu procedur dializy otrzewnowej, przyjmowania leków, diety i płynów

Recommendations for exit site care of peritoneal catheter in light of recent publications

Zakażenia ujścia cewnika otrzewnowego stanowią jedno z liczniejszych powikłań infekcyjnych dializoterapii otrzewnowej. Infekcje te mogą zwiększać ryzyko zapalenia otrzewnej i bywają powodem konieczności usunięcia cewnika i rezygnacji z tej metody leczenia nerkozastępczego. W opracowaniu zwrócono uwagę na najważniejsze elementy optymalnej opieki nad ujściem. Należą do niech: właściwa technika implantacji cewnika otrzewnowego, profilaktyczna antybiotykoterapia, optymalna technika zmiany opatrunku mająca na celu zapobieganie kontaminacji, stała ocena ujścia i tunelu cewnika z wczesnym wdrożeniem postępowania w razie infekcji, unieruchomienie cewnika oraz skuteczna edukacja i reedukacja. Omówiono zalety i wady miejscowo stosowanych antybiotyków oraz najnowsze badania wykorzystujące miód i inne środki antyseptyczne w opiece nad ujściem cewnika otrzewnowego.Exit site infections are one of the most frequent infective complications of peritoneal dialysis. These infections may increase risk of peritonitis and be the reason for catheter removal and technique failure. This paper reviews the most important elements of optimal exit site care. These are: appropriate implantation technique of peritoneal catheter, institution of antibiotic prophylaxis, optimal technique of change of dressing aiming at preventing contamination, ongoing assessment of the exit site and tunnel with early identification and treatment of exit-site problems, immobilization of the catheter to protect from trauma and effective education and reeducation. Benefits and drawbacks of topical antibiotics are reviewed as well as recent studies with use of honey and other antiseptics in care of peritoneal catheter exit site