CME : Your SA Journal of CPD - Volume 29, Issue 7, 2011
Volume 29, Issue 7, 2011
Source: CME : Your SA Journal of CPD 29 (2011)More Less
Source: CME : Your SA Journal of CPD 29 (2011)More Less
All doctors encounter patients with advanced life-threatening illness and it is important that we develop competence in managing these patients throughout the progression of their illness and in caring for patients who are dying. General practitioners are at the front line of this care and although hospice care is becoming more accessible to patients in South Africa, patients rely on their GPs to provide continuity of care and support. This edition of CME provides an update of some key aspects of palliative care for the GP.
Source: CME : Your SA Journal of CPD 29, pp 270 –273 (2011)More Less
The recent PainSA conference held in conjunction with the International Association of the study of Pain, Africa Association for the study of Pain, NeuroPsig and the London Pain Consortium, presented current physiological evidence of the importance of neuronal and synaptic activities involved in generating pain. The physiological evidence supports the inclusion of medication previously considered as co-analgesics or adjuvant analgesics as primary analgesics. This article looks at the assessment and management of pain in the palliative care setting and the current recommendations for the management of neuropathic pain.
The strange case of Dr Jekyll and Mr Hyde : can we effectively manage sudden behaviour changes in the dying patient?Source: CME : Your SA Journal of CPD 29, pp 278 –281 (2011)More Less
The phone rings, it's 2 am, on the line is Sr Rebecca, the nurse on night duty at the Hospice, 'Sorry to wake you, but Mr Robertson has become very restless; he is refusing to take his medication and he is trying to get out of bed. He says we are trying to kill him.' In the background I can hear the commotion. 'Let me out of here! Stop, Stop, Stop!' This is followed by other loud noises and then a glass smashes on the floor.
By now I was wide awake. What was happening? Earlier, I had seen Ted Robertson on the ward round. He is a 68-year-old retired engineer with advanced non-small cell cancer of the lung. Apart from some dyspnoea, he was comfortable and lucid. The pain from the metastatic lesions in his ribs was well controlled on 1 g paracetamol 6 hourly, a stable oral dose of 90 mg long-acting morphine and ibuprofen 600 mg every 12 hours. Apart from the usual laxatives to prevent constipation, he was only taking oxazepam 15 mg to help him sleep. I had added no new medication in the past 72 hours. I had even thought of suggesting that he could be discharged. What had brought about this unexpected change? It was no use speculating. So many things could be responsible for Ted's sudden confusion. I needed to go and help to sort the out the problem before he injures himself or one of the nursing staff.
Source: CME : Your SA Journal of CPD 29, pp 282 –284 (2011)More Less
Palliative care is a field that is rich with opportunity and the need for clear, unambiguous and direct communication. The nature of the illness that brings a palliative care team into the management of a patient and family - the 'unit of care' - makes it all the more likely that difficult conversations will already have taken place. The breaking of bad news, such as the diagnosis of metastatic cancer or WHO stage 4 HIV/AIDS, has often taken place in suboptimal circumstances and the palliative care team sometimes has to revisit the conversation to assist the patient to come to terms with the diagnosis and the way the diagnosis was given.
Author Michelle A. MeiringSource: CME : Your SA Journal of CPD 29, pp 286 –290 (2011)More Less
Death in childhood is not regarded as normal, but despite all our efforts at 'saving children', death in childhood still happens. There is also a subset of children for whom death in childhood is anticipated and can be regarded as a normal outcome of the child's condition (e.g. trisomies, inoperable heart conditions). The death of a child is regarded by the Diagnostic and Statistical Manual of Mental Disorders (DSM) as a 'catastrophic stressor' for a parent - on par with experiencing a 'natural disaster'. Yet, why do we learn so little as health professionals about how to deal with it?
Source: CME : Your SA Journal of CPD 29, pp 291 –292 (2011)More Less
Author Charmaine BlanchardSource: CME : Your SA Journal of CPD 29 (2011)More Less
There is a growing recognition of the importance of spiritual care in providing quality care to patients with life-threatening illnesses. Subsequently, attention to spiritual issues is increasingly being expected of the health professional. The WHO definition of palliative care includes spiritual care as an aspect of improving the quality of life of patients facing death. Medical doctors are skilled in and comfortable with providing physical care. Psychosocial issues are recognised with appropriate referral to a social worker. However, spiritual care is not easily addressed.
'Doctor, my pain is getting worse. Please help me.' Some thoughts on opioid-induced neurotoxicity : more about... palliative careSource: CME : Your SA Journal of CPD 29, pp 292 –293 (2011)More Less
Author Chris BatemanSource: CME : Your SA Journal of CPD 29, pp 296 –298 (2011)More Less
International - New ARV info 'a cause of anxiety in patients'
Africa: Chad - vaccination flaws increase polio spread
E. coli outbreak linked to Egyptian seed
South Africa - Mediclinic rejects claims by health minister
Limpopo health department dismisses 'fake' paramedics
Gauteng health faces R235m in claims
Ban on killer fats imminent
Invention aims to bring relief to respiratory sufferers
Confirmatory viral load reduces HIV treatment switches fourfold in 6-country African study : Aids briefAuthor Carole Leach-LemensSource: CME : Your SA Journal of CPD 29, pp 299 –300 (2011)More Less
Targeted viral load testing to confirm treatment failure reduced unnecessary treatment regimen switches four-fold compared with clinical-immunological criteria alone (viral load <1 000 copies/ml 12.4% and 46.9%, p<0.001, respectively) among 250 patients in six African countries according to Kim CE Sigaloff and colleagues in a cross-sectional analysis of a multicentre prospective observational study published in the advance online edition of the Journal of Acquired Immune Deficiency Syndromes.