Podcasts about palliation

Episode 195 Vom 9. bis 13. April 2025 veranstaltet die SHI Homöopathie Schule in Zug den Homöopathie Krebskongress 2025. Diese fünftägige Veranstaltung widmet sich umfassend dem Thema Krebs und den homöopathischen Behandlungsmöglichkeiten. Der Kongress richtet sich sowohl an Fachleute als auch an interessierte Laien und bietet ein vielfältiges Programm mit renommierten Referentinnen und Referenten. Programmübersicht: 9. April 2025: Fachkongress Tierhomöopathie Vormittag: "Tumorerkrankungen bei Kleintieren" mit Referentin Lotti Egli. Nachmittag: "The Challenges of Homeopathic Cancer Care in Clinical Veterinary Practice" mit Referentin Dr. Sue Armstrong (Vortrag in Englisch). 10. bis 12. April 2025: Fachkongress Homöopathie Vorträge zur Anwendung der Jus-Methode bei Krebsfällen mit Gabriela Keller, Dr. Martine Jus, Marwin Zander und Christoph Grabenhofer. Behandlung komplizierter Krebsfälle durch Dr. med. Jens Wurster. Homöopathische Ansätze in der Krebsbehandlung mit Henny Heudens-Mast. "Homeopathy as a true alternative to allopathy in advanced cancer cases" mit Dr. Pradeep Gupta (Vortrag in Englisch). 13. April 2025: Publikumstag Spannende Vorträge zu Prävention, Behandlung und Palliation in der Homöopathie. Verschiedene Stände mit Fachexperten für den Austausch und Beratung. Veranstaltungsort: SHI Haus der Homöopathie, Steinhauserstrasse 51, 6300 Zug. Anmeldung und weitere Informationen: Details zu Programm, Preisen und Anmeldung finden Sie auf der offiziellen Website des Kongresses: HOMOEOPATHIE-KREBS-KONGRESS.CH . Nutzen Sie diese einzigartige Gelegenheit, um Ihr Wissen zu erweitern und sich mit Experten auf dem Gebiet der homöopathischen Krebsbehandlung auszutauschen.

Palliation er lindrende og støttende behandling, som kan blive nødvendig ved alvorlig fremskreden livstruende hjertesygdom som fx hjertesvigt. Mange oplever fysiske, psykiske og åndelige udfordringer, som kræver en særlig indsats. Hør sygeplejerske Elin Fredsted Petersen og overlæge Vibeke Brogaard Hansen fortælle om palliativ behandling herunder hvordan man kan starte en palliations-samtale med sygeplejersken eller lægen i god tid før den sidste tid. Læge Annemie Stege Bojer er vært.

Hør hvordan sygeplejerske Elin Fredsted Petersen og overlæge Vibeke Brogaard Hansen fra hjerteafdelingen på Vejle Sygehus har sat fokus på palliation og samarbejdet med kommuner, almen praksis og andre faggrupper. De forklarer bl.a. om typiske symptomer, om afdækning af basale palliative behov, men også om hvordan man starter en samtale om palliation med patienter og pårørende. Læge Annemie Stege Bojer er vært.  Nyttige links:  Dansk Cardiologisk Selskabs holdningspapir og Vejledning fra Dansk Selskab for Almen Medicin (DSAM)

Editor-in-Chief, Robert Amdur, MD and Resident Physician, Daniela Martir, MD discuss Partially Ablative Body Radiotherapy for Locally Advanced Unresectable Tumor. The discussion is based on a paper in PRO titled “Partially Ablative Body Radiotherapy (PABR): A Widely Applicable Planning Technique for Palliation of Locally Advanced Unresectable Tumors” (PMID 39393770).

Editor-in-Chief, Robert Amdur, MD and Resident Physician, Daniela Martir, MD discuss Partially Ablative Body Radiotherapy for Locally Advanced Unresectable Tumor. The discussion is based on a paper in PRO titled “Partially Ablative Body Radiotherapy (PABR): A Widely Applicable Planning Technique for Palliation of Locally Advanced Unresectable Tumors” (PMID 39393770).

On this week's episode of Critical Care Time, Cyrus & Nick are honored to be joined by palliative care expert, Dr. Anand Iyer. Together they explore the intricacies of palliation in the ICU, exploring the challenge and nuances of addressing this critical element of care amongst the sickest patients in the hospital. How do you begin these discussions? How do you ensure your patients and families feel heard? How do you help them realize palliation is part of the care process and not that you are giving up on a loved one? What terms should we avoid using? We cover all of this and more with Dr. Iyer so make sure to give this episode a listen and leave us some feedback! Hosted on Acast. See acast.com/privacy for more information.

This week we listen in on a debate from the PICS 2024 Symposium that occurred two weeks ago in San Diego. Today's debate is between master surgeon, Professor of Surgery at UCLA, Dr. Glen S. Van Arsdell taking the position of superiority of primary TOF repair and going up against Dr. Van Arsdell is noted master interventional cardiology expert, Professor of Pediatrics at Baylor College of Medicine, Dr. Athar M. Qureshi. Prepare for a spirited 'debate' between these two experts in their field. Apologies in advance for some sound deficiencies but the orators can be heard clearly enough to allow for an engaging back and forth and learning experience. Has either speaker swayed you? Take a listen!

Managing oncologic cases often requires collaboration between the referring veterinarian and specialist, but what does a successful partnership look like? A supportive collaboration between the pet owner, primary care veterinarian and oncology specialist is essential to achieve the best outcomes for these patients, but along with the major benefits that come from this joint effort are some hesitations. In this VetFolio Voice podcast episode, Dr. Cassi and veterinary oncologist Dr. Haley Leeper cover the options typically discussed with clients whose pets are diagnosed with cancer, from palliative care to referral to quality of life assessments and everything in between. You'll learn what a collaborative care team looks like and how oncology can embrace providing a spectrum of care, plus explore a new conditionally approved medication that is used for the treatment of canine lymphoma — verdinexor (Laverdia).

Brigitte Brisson, DMV, DVSc, DACVS from the Ontario Veterinary College at the University of Guelph joined us on OsteoBites to introduce Magnetic Resonance guided High Intensity Focused Ultrasound as a treatment modality for osteosarcoma and describe preliminary results in canine patients.High Intensity focused ultrasound (HIFU) is a non-invasive percutaneous thermal ablation technique that allows deep tissue treatment with precise control over the shape and location of energy deposition. It causes minimal collateral damage and can be used to treat primary and metastatic tumours. In addition to its role in tumour ablation, HIFU has attracted attention for its potential to stimulate the immune system and possibly mount a response against metastasis. In humans, HIFU has been used for ablation of a variety of soft tissue tumours and most recently, it has been used in bone applications, specifically for the treatment of osteoid osteoma (OO) lesions in pediatric patients. Other reported bone applications include bone metastasis and osteosarcoma.Dr. Brigitte Brisson is a professor of soft tissue surgery in the Department of Clinical Studies at the Ontario Veterinary College (OVC). She graduated from the Faculté de Médecine Vétérinaire at the University of Montreal in 1996. She performed a small animal rotating internship at the OVC followed by a Surgery residency with concurrent Doctor of Veterinary Science (DVSc) in small animal surgery. She became board certified in small animal surgery (ACVS) in 2001 and has since been on faculty at the Ontario Veterinary College. She is an ACVS Founding Fellow in Minimally Invasive Surgery and a Founding Member of Veterinary Neurosurgical Society.

This recording features audio versions of September 2024 Journal of Vascular and Interventional Radiology (JVIR) abstracts:Multidisciplinary Delphi Consensus on Safety of Combining Transarterial Radioembolization with Yttrium-90 Microspheres with Systemic Anticancer Agents for the Treatment of Liver Malignancy ReadImage-Guided Energy Ablation for Palliation of Painful Bony Metastases—A Systematic Review ReadImpact of Percutaneous Cryoablation on Renal Function in Patients with Stage I Renal Cell Carcinoma: A Systematic Review and Meta-Analysis ReadPredictive Factors for Recurrent Hemoptysis after Bronchial Artery Embolization in Patients with Lung Cancer ReadRadiofrequency Ablation in Patients with Interstitial Lung Disease and Lung Neoplasm: A Retrospective Multicenter Study ReadEffectiveness of Genicular Artery Embolization for Reducing Synovitis as Assessed by Contrast-Enhanced MR Imaging in Knee Osteoarthritis: A Pilot Study ReadHepatobiliary Infection after Transjugular Intrahepatic Portosystemic Shunt Creation in Patients with Prior Biliary Intervention: A Multi-Institution Retrospective Study ReadJVIR and SIR thank all those who helped record this episode:Host:Manbir Singh Sandhu, University of California Riverside School of MedicineAudio editor:Sonya Choe, University of California Riverside School of MedicineAbstract readers:Maximillian Hayama, Duke University School of MedicineIsabelle Barbosa, Frank H. Netter MD School of MedicineDaniel Roh, Loma Linda University School of MedicineSiddak Dhaliwal, University of Missouri School of MedicineEric Chang, University of Illinois-Chicago College of MedicineJoy Achuonjei, MD, Northwell HealthMaximillian Denys, University of California Riverside School of MedicineSupport the Show.

Ronald Chen, MD, MPH, FASTRO, hosts a conversation on the background, methodology, primary recommendations, and implications of the updated External Beam Radiation Therapy for Palliation of Symptomatic Bone Metastases: An ASTRO Clinical Practice Guideline. Alongside Tracy Balboni, MD, MPH, and Sara Alcorn, MD, they discuss recent data and changes to practice patterns such as increased use of advanced treatment approaches (e.g., stereotactic radiation) and reirradiation. The guidelines address five key questions in this context, built upon a systematic review of the available literature and with assessment of evidence quality and recommendation strength.

Ronald Chen, MD, MPH, FASTRO, hosts a conversation on the background, methodology, primary recommendations, and implications of the updated External Beam Radiation Therapy for Palliation of Symptomatic Bone Metastases: An ASTRO Clinical Practice Guideline. Alongside Tracy Balboni, MD, MPH, and Sara Alcorn, MD, they discuss recent data and changes to practice patterns such as increased use of advanced treatment approaches (e.g., stereotactic radiation) and reirradiation. The guidelines address five key questions in this context, built upon a systematic review of the available literature and with assessment of evidence quality and recommendation strength.

Commentary by Dr. Candice Silversides

2024 SCCM Congress: Saturday The episode starts out with a preview of the 2024 SCCM Congress schedule as the conference starts Sunday, January 21 in Phoenix, AZ 11:25: Then I highlight 3 presentations with Pharmacist speakers from the SCCM Digital Congress Fill the Tank or Squeeze the Pipes? Fluid Administration Over Early Vasopressor Therapy for the Management of Shock with Olivia Marchionda, PharmD, BCCCP Anticoagulation Considerations in Critically Ill Oncology Patients with Heather May, PharmD, MSc, BCCCP, FCCM Pharmacologic Agents Used in the ICU for Palliation of Symptoms: What's New? With Nicole Palm, PharmD, BCCCP, FCCM 2024 SCCM Congress website: https://congress2024.sccm.org PharmacyToDose.Com  @PharmacyToDose  PharmacyToDose@Gmail.com Learn more about your ad choices. Visit megaphone.fm/adchoices

Nytt år innebär nytt avsnitt av Akutläkarpodden där Arin bjudit in Emma och Katrin för att diskutera avancerad akutsjukvård för äldre, vad kan vi som akutläkare bidra med för att ge äldre patienter en värdig vård vid akut sjukdom? Innebär det alltid att utesluta alla livshotande tillstånd, operera, behandla, lägga in? Eller innebär det begränsning av vård? Palliation? Att pröva peroral behandling i hemmet? Vad vill patienten själv och vad säger de anhöriga? Vågar man lämna hemma? Arin tror att läkare är rädda för IVO, Emma har en annan teori. Katrin menar att man måste känna till åldersrelaterad risk för att kunna använda sina behandlingshjälpmedel men det hjälper lite om patienten ändå inte vill följa med in till sjukhus. Katrin menar att det är just den utmaningen att ge meningsfull vård till individen som gör det extra givande att jobba prehospitalt som akutläkare.

In unserer neuen Folge sprechen wir über die Rolle der palliativen Metallstenteinlage bei malignen rektalen Obstruktionen. Prof. Hünerbein hat dazu mit Kollegen der Robert-Rössle Klinik im Jahre 2005 eine retrospektive Analyse durchgeführt. Außerdem thematisieren wir die HIPEC und das Tumordebulking. Wie startet man, wenn man Peritonealkarzinosezentrum werden möchte? Hünerbein M, Krause M, Moesta KT, Rau B, Schlag PM. Palliation of malignant rectal obstruction with self-expanding metal stents. Surgery. 2005 Jan;137(1):42-7. doi: 10.1016/j.surg.2004.05.043. PMID: 15614280.

This podcast explains the pathophysiology of single ventricle cardiac lesions, and reviews the three-step surgical procedure used for palliation. 0:00 Introduction 1:55 Anatomy & Pathophysiology 3:56 Typical Palliation 8:50 Long Term Complications After Repair LEARNING OBJECTIVES After listening to this podcast, the learner should be able to: • Explain the pathophysiology of single ventricle heart disease • Discuss the different stages of palliation for single ventricle heart disease • Describe the physiological consequences of the Fontan circulation • Recognize long term problems associated with the Fontan circulation AUTHORS Madeleine Alvin, MD Pediatric Anesthesiology Fellow Boston Children's Hospital Annette Schure, MD Senior Associate in Cardiac Anesthesia Boston Children's Hospital DATES Initial publication: October 19, 2023 CITATION Alvin ML, Marcley S, Soohey R, McFee AM, Wolbrink TA, Schure AY. Surgical Palliation for Single Ventricle Lesions. 10/2023. OPENPediatrics. Online Course: https://learn.openpediatrics.org/learn/course/internal/view/elearning/5439/Surgical-Palliation-for-Single-Ventricle-Lesions. Video: https://youtu.be/zptfxT1pjxg. Podcast: https://soundcloud.com/openpediatrics/surgical-palliation-for-single-ventricle-lesions-by-madeleine-alvin-for-openpediatrics/s-j1wNCnQ9ZIX. Please visit: http://www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu

Det är dags för avsnitt 9 av Klinikern, där vi diskuterar det svåra området palliation, vård i livets slutskede. Hur duktiga är vi på att hantera de olika faserna, och hantera de svåra så kallade brytpunktssamtalen? Hur kan vi balansera på den tunna linjen mellan att överbehandla och förlänga lidandet, och att förkorta patientens liv genom att göra för lite? Vi diskuterar också betydelsen av att kunna ändra på beslut och planering, och vara medveten om att patientens situation kan variera även vid en obotlig terminal sjukdom.

This week we delve into cardiovascular surgery when we review a recent report from the Congenital Surgeons' Society on the outcomes of the hybrid approach of pulmonary artery bands for treatment of infants with critical left heart obstructive disease. What risk factors are associated with worse outcomes? Does this approach confer an advantage in comparison to the traditional 'stage I/Norwood' approach to this problem? Does the presence of multiple risk factors worsen outcomes and if so, to what degree? How does the heterogeneity of indications for this approach to obstructive left heart lesions stymie efforts to study this intervention? DOI: 10.1016/j.jacc.2023.07.020Editorial Comment :DOI: 10.1016/j.jacc.2023.08.023

Commentary by Dr. Valentin Fuster

Chronisch-obstruktive Lungenkrankheit: Husten, Auswurf, Durchblick

Commentary by Dr. Candice Silversides

In this episode, host Dr. Jacob Fleming interviews Dr. Jack Jennings about cryoablation, multidisciplinary care, and practice building for the treatment of desmoid tumors. --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/aNJOCP --- SHOW NOTES First, Dr. Jennings describes the typical presentation of desmoid tumors, also known as “aggressive fibromatosis.” These are neoplasms of fibrous connective tissue, but unlike sarcomas, they do not metastasize to other parts of the body. We quickly review characteristic imaging findings such as hypointense T1 and T2 signals. In the last decade, sorafenib (tyrosine kinase inhibitor) was established as a therapy for desmoid tumors. However, since sorafenib has failed to show significant efficacy, there has been exploration into other treatments such as surgical resection and cryoablation. Dr. Jennings encourages IRs to attend sarcoma tumor boards to learn about desmoid cases and opportunities to perform cryoablations when desmoids cannot be surgically resected. In extra-abdominal desmoids, cryoablation is ideal, since the interventionist can see the low attenuation ice ball forming and sculpt ablation zones to match irregular desmoid shapes. Dr. Jennings recommends forming a 10mm ablation margin around the tumor. Additionally, he discusses both active and passive thermal protection techniques for surrounding tissues. He utilizes carbon dioxide, hydropneumodissection, and motor/somatosensory evoked potentials to keep non-target tissues out of the ablation zone. The bowel and nerves (especially in the extremities) are critically important to avoid. For post-procedural care, Dr. Jennings emphasizes that pain is very common, due to large inflammatory responses. He usually admits patients overnight to monitor pain levels and give IV Decadron. Patients are then sent home with Medrol Dosepak. We also talk about the importance of informed consent about pain and potential nerve injuries. Finally, we discuss how IRs can be advocates for patients with desmoids. Dr. Jennings believes that preemptive measures can go a long way when talking to third party payers. He will usually include current National Comprehensive Cancer Network (NCCN) guidelines and current cryoablation papers in his clinic notes to support his recommendations. He also encourages IRs to collaborate with oncologists, surgeons, and radiation oncologists to craft the best treatment plan for their patients. --- RESOURCES Washington University MSK Interventions: https://www.mir.wustl.edu/education/subspecialty-programs/musculoskeletal-imaging-and-interventions/ Neuroanatomic Considerations in Percutaneous Tumor Ablation: https://pubs.rsna.org/doi/10.1148/rg.334125141 Anatomically Based Guidelines for Core Needle Biopsy of Bone Tumors: Implications for Limb-sparing Surgery: https://pubs.rsna.org/doi/10.1148/rg.271065092 National Comprehensive Cancer Network (NCCN) Guidelines for Soft Tissue Sarcomas (including Desmoid Tumors): https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1464 Society for Interventional Oncology (SIO): http://www.sio-central.org/ Cryoablation for Palliation of Painful Bone Metastases: The MOTION Multicenter Study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8011449/

In this episode Kelly chats to Palliative Care Clinical Nurse Consultant, colleague and friend, Sarah.  Sarah talks about her journey into nursing, what inspired her interest in palliative care as a young nurse and the ups and downs of the job.  Sarah is super passionate about palliative care and bet you will be too after listening to this chat! Instagram: @twohumerusnursespodcast Email: hello@twohumerusnurses.com Linktree: https://linktr.ee/2hn   Safestyle workwear safety glasses take you from the worksite to the weekend! Safe, stylish, durable and meet AU/NZ standards! CLICK HERE and use our code HUMERUS10 for 10% discount! Music: Switch Me On by Shane Ivers www.silvermansound.com 

Episode 131: Gastepisode von Uta Stricker, Homöopathin an der SHI-Praxis zum Thema Palliation in der Homöopathie

Efter et par dages forsinkelse er Venner med Kræft tilbage med årets sidste afsnit! Vi runder året af med at snakke om vigtigheden af kræftfællesskaber med Maria og Benedicte. To kvinder omkring de 40 år, som begge for nylig har været ramt af kræft. De har mødt hinanden igennem REPHA, Videncenter for Rehabilitering og Palliation. Et uundværligt initiativ, som de gerne vil sprede kendskabet til. Og det kan vi kun bakke op om!Vi vender tilbage efter nytår - god jul!Værter: Stinne Leth & Christian HolmsbergKomponist: Christian Schødts-SørensenPodcasten er produceret og tilrettelagt af Mads G. Ladekarl og R*******k Productions

Alvorlig sygdom og død er blevet professionaliseret og institutionaliseret i dagens velfærdsstat. Vi har udviklet et effektivt, teknologisk og behandlingsfokuseret sundhedsvæsen. En udvikling, som har haft mange positive effekter, men som også har medført tab af omsorgens betydning for lindring og trøst, skriver Etisk Råd. Netop lindring og trøst er væsentlige elementer af behandling af uafvendeligt døende. I dag skal vi tale om, hvordan frivillige udgør en vigtig – men overset – ressource i den lindrende indsats for døende på danske plejehjem. Dagens gæster er sygeplejerske og ph.d. Karen Marie Sangild Stølen fra Københavns Professionshøjskole og sygeplejerske og faglig koordinator Ida Hornshøj Kristiansen fra plejecentret Sølund.

In this episode, social worker and hospice executive director, Nadine Persaud discusses,in detail, the differences between palliative care, comfort care and hospice care and the philosophies behind palliative care. The accessibility and barriers to accessing palliative care are additionally explored in this eye-opening episode.About Nadine:Nadine Persaud (MSW, PhD (c)) is currently the Executive Director of the Kensington Hospice and the Senior Director of Client Services at Kensington Health. Nadine has been working in the hospice palliative care field for the past 16 years. She sits on the Accreditation review panel for Hospice Palliative Care Ontario and is on the Board of Directors for the Hazel Burns Hospice. Nadine is a trainer for the Core Concepts Hospice Palliative Training for three of the hospices in Toronto and is a facilitator through Palcare for the hospices in York Region. Nadine was instrumental in redeveloping the Palliative Care Certificate Program through Durham College. This year, Nadine is the co-chair of the provincial conference for Hospice Palliative Care Ontario. Nadine received her Bachelor of Social Work and minor in Psychology at Ryerson University, a Master of Social Work at York University and recently successfully defended her PhD in Palliative Care through Lancaster University in England. Her research interests include the importance of making palliative care equitable and accessible to individuals who are structurally vulnerable, maximizing supports that are available to healthcare providers working in the field, and the supports that are available to adolescents and young adults living with advanced cancer at the end of life.Find Nadine on Instagram: @_nadinepersaud_Find Nadine on Twitter: @NPersaud5Visit us on our website:www.compassionincaregiving.comJoin our FREE Facebook community! https://www.facebook.com/groups/compassioncaregiverconnectionFor more visit our Instagram! @compassionincaregiving

In this thrilling episode, Lexman welcomes Dr. Rosalind Picard to discuss badges and pterosaurs! Rosalind shares some insights on these fascinating creatures, and the two discuss the way they can be used as a form of palliation. Be sure to tune in for an exciting discussion!

The episode is a real mixture of joy and sadness, as we traverse the globe for this month’s stories. Starting close to home, there’s news of the appointment of a Bishop of Christchurch, but in Africa, the news of another ... The post Station XV: Episode 175 – Persecution, Pelosi, Palliation, Prayer appeared first on The 15th Station.

To help prepare you for your PM&R Board Exams, we're bringing you a podcast series dedicated to current practices and core knowledge. Main Learning objectives: • Discuss recognition of “red flags” in back pain • Review goals of cancer rehabilitation • Discuss WHO stepwise approach to cancer pain • Note epidemiology of spinal malignancy Credits: Episode was written and hosted by: Benjamin Gill, DO, MBA; Adam Rupp, DO This episode was reviewed for accuracy by: Megan Clark, MD; Naomi Kaplan, MBBS This podcast series is directed by: Benjamin Gill, DO, MBA; Rosie Conic, MD, PhD; Sre Gorukanti, MD Please send feedback to aapdigitaloutreach@gmail.com so we can best suit your learning needs! Content for this series is based off of current PM&R learning materials and is created by residents for residents. It is not an official board review study guide.

Velkommen til en miniserie i to om palliation i almen praksis.I første afsnit fokuserer vi på de generelle aspekter af palliation såvel som identifikation af patienter med palliative behov, organsvigtssygdommene, terminalerklæring og terminaltilskud.Vores gæst er Anna Weibull. Hun er speciallæge i almen medicin og har den nordiske specialistuddannelse i palliation. Christian Vøhtz er redaktør og vært. Bilaget som omtales til at identificere palliative behov hedder SPICT og kan findes her: https://www.spict.org.uk/the-spict/spict-dk/

Dyspnø, kvalme, fatigue og eksistentiel lidelse er symptomer som hos palliative patienter ofte er udiagnosticerede og underbehandlede. I denne samtale gennemgår vi symptomerne og taler om ”Livssamtalen”.   Vores gæst Anna Weibull er speciallæge i almen medicin og har den nordiske specialistuddannelse i palliation. Christian Vøhtz er redaktør og vært. Bilag til symptomoverblik EORTC: https://vejledninger.dsam.dk/media/files/11/palliation_2014-bilag1.pdfBilag til den eksistentielle samtale EMAP: https://vejledninger.dsam.dk/media/files/18/bilag-5_-emap.pdf 

CardioNerds (Amit Goyal and Daniel Ambinder), ACHD series co-chair Dr. Daniel Clark (Vanderbilt University), and ACHD FIT lead Dr. Danielle Massarella (Toronto University Health Network) join ACHD expert Dr. Yuli Kim (Associated Professor of Medicine & Pediatrics at the University of Pennsylvania), to discuss single ventricular heart disease and Fontan palliation. They cover the varied anatomical conditions that can require 3-step surgical palliation culminating in the Fontan circulation, which is characterized by passive pulmonary blood flow, high venous pressures, and low cardiac output. Audio editing by Dr. Gurleen Kaur (Director of the CardioNerds Internship and CardioNerds Academy Fellow).  The CardioNerds Adult Congenital Heart Disease (ACHD) series provides a comprehensive curriculum to dive deep into the labyrinthine world of congenital heart disease with the aim of empowering every CardioNerd to help improve the lives of people living with congenital heart disease. This series is multi-institutional collaborative project made possible by contributions of stellar fellow leads and expert faculty from several programs, led by series co-chairs, Dr. Josh Saef, Dr. Agnes Koczo, and Dr. Dan Clark. The CardioNerds Adult Congenital Heart Disease Series is developed in collaboration with the Adult Congenital Heart Association, The CHiP Network, and Heart University. See more Claim free CME for enjoying this episode! Disclosures: None Pearls • Notes • References • Guest Profiles • Production Team CardioNerds Adult Congenital Heart Disease PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls There are various forms of unpalliated ‘single ventricle' congenital heart disease. The three main hemodynamic issues that need to be addressed in any form are unbalanced flow, pulmonary over-circulation, and blood mixing.  The Fontan palliation is a series of operations for congenital heart disease patients in whom biventricular repair is not feasible.  In the completed Fontan circulation, systemic venous blood is surgically routed directly to the lungs, effectively bypassing the heart, and creating passive pulmonary blood flow.  The hallmarks of the Fontan circulation (and Fontan failure) are elevated central venous pressure and low cardiac output.  Patients with Fontan circulation may experience significant morbidity in the long term from both cardiac and non-cardiac sequelae, and require lifelong specialist care.  Show notes 1. Why do some patients require Fontan palliation?  Many different types of anatomies may ultimately require single ventricular palliation via the Fontan procedure due to inadequate biventricular function to support both pulmonary and systemic circulations. Some examples include Tricuspid Atresia (hypoplastic RV), Double Inlet Left Ventricle (DILV; hypoplastic RV), Hypoplastic Left Heart Syndrome (HLHS; hypoplastic LV), and atrioventricular septal defects (AVSD; either RV or LV may be inadequate based on “commitment” of the common AV valve). The Fontan procedure was first described in 1971; at this time, mortality of single ventricular patients exceeded 90% in the first year of life.  2. What are the stages of Fontan palliation?  Effective pulmonary blood flow/balancing flow to the pulmonary and systemic circulations: for many conditions, this involves retrograde pulmonary blood flow from a systemic -> PA shunt (i.e. Blalock-Taussig-Thomas “BTT” shunt in which the subclavian artery is turned down and anastomosed to the pulmonary artery). In infants, the pulmonary vascular resistance (PVR) is high perinatally and gradually lowers over the first 3 months of life to adult levels with exposure to the atmosphere's natural pulmonary vasodilator: oxygen. Thus, in the first 3 months of life babies have an intri...

Kontakt: ivajuntan@gmail.com       Musik: Blind Love Dub by Jeris (c) copyright 2017 Licensed under a Creative Commons Attribution (3.0) license. http://dig.ccmixter.org/files/VJ_Memes/55416 Ft: Kara Square (mindmapthat)    Dagens artikel:     Om du gillar du det vi gör - stöd Life Support Foundation! www.lifesupportfoundation.org     Bli månadsgivare eller använd Swish: 1234610804    Länk till Critical Care Reviews: https://criticalcarereviews.com See omnystudio.com/listener for privacy information.

Redaktør  Jon Eik Zwisler har udvalgt to artikler som er udgivet i 2021. Vi diskuterer indholdet og hører klip fra 3 podcasts som er udgivet i månedsskriftet. Redaktionen siger tak for 2021 og ønsker en glædelig jul og et godt nytårArtiklerne som omtales er: - Generalistens genkomst. Forfatter Flemming Bro. Udgivet Juni 2021- De menneskelige grundvilkår som øjenåbner for lægen. Forfatter Jan Helge Larsen et al. Udgivet Septemer 2021.Podcastsne der høres udklip fra er:- Ultralyd i almen praksis. Gæst Thomas Løkkegaard. Udgivet Februar 2021- Palliation i almen praksis. del 2. Gæst Anna Weibul. Udkommer Marts 2022- Supervisionslaboratoriet #1. Gæster J. Larsen & H. Kierkegaard. Udgivet April 2021

In August 2019, a hospital sought a court declaration that RR (a 20 year old man)lacked the capacity to make decisions about the palliative care that he was being offered, and to approve the proposed plan.

Wednesday Bible Study - July 29th, 2021 Bishop Danny St.Clair - The Palliation of Sin Proverbs 17

Dr. Susan and Dr. Jolle discuss new research in cats. We explain what a corregendum is and review an article about chemotherapy in cats after mastectomy. Dr. Susan commends authors that publish an update on their data. There may be some indication that chemotherapy may be useful in cats with stage 4 mammary tumors.

Campaign 1, Episode 54: The party begins to heal the wounds of Wood's End, knowing that the true cause of such wounds awaits them in the cathedral.   Music: “Village Ambiance”by Alexander Nakarada (www.serpentsoundstudios.com) Licensed under Creative Commons BY Attribution 4.0 License http://creativecommons.org/licenses/by/4.0/

Another conversation with Dr. Julie Pilitsis

Dr. Gosta Pettersson leads a discussion on Post Fontan Palliation Management Strategies.

Warum die Logopädie auch in die Versorgung palliativer Patientinnen und Patienten einbezogen werden muss - dieser Frage stellen sich Stefanie und Alex in Episode 44 von Iss Nix! Aber es geht auch um das Selbstbild, das wir in der Palliation haben und wie wir das verbessern können. Es gibt viel zu tun!

Single Ventricle Stage I Palliation Procedures by Dot Beke by OPENPediatrics

Was erwartet PatientInnen nach der Diagnose Krebs? Was bedeuten Wörter wie Adjuvanz, Metastasen und Palliation? Wie arbeiten OnkologInnen, ChirurgInnen, RadiologInnen und viele andere zusammen, um PatientInnen den bestmöglichen Weg durch ihre Erkrankung zu bieten? Diese und viele andere grundlegende Fragen und warum jeder anders von der Diagnose Krebs betroffen ist, beantwortet Prof. Dr. Thorsten Füreder in dieser Folge von Krebs [be]trifft. Prof. Füreder hat seine Ausbildung 2005 mit seiner Promotion an der medizinischen Universität Wien abgeschlossen. Nach seiner Facharztausbildung in Innerer Medizin mit dem Zusatzfach Hämato-Onkologie hat er sich im Jahr 2015 habilitiert. Prof. Füreder arbeitet am Wiener Allgemeinen Krankenhaus in der klinischen Abteilung für Onkologie und ist Programmdirektor für Tumore im Kopf-Hals Bereich. Für Fragen, Anregungen und Kritik zu unserem Podcast könnt ihr uns jederzeit über die österreichischen Webseiten der Firmen Pfizer und Merck, oder über die e-Mail Adresse krebsbetrifft@merckgroup.com kontaktieren! www.diagnose-krebs.at, www.merck.at, www.pfizer.at

This week we review the outcomes of Fontan palliation in the Down Syndrome patient. We speak with Assistant Professor of Pediatrics Dr. Lauren Sarno of East Carolina University about a recent work she co-authored on a complex statistical analysis she performed from the STS database. What accounts for worse outcomes in this patient population? Prepare to be surprised by the information provided this week! DOI: 10.1016/j.athoracsur.2019.07.085

This week we review the outcomes of Fontan palliation in the Down Syndrome patient. We speak with Assistant Professor of Pediatrics Dr. Lauren Sarno of East Carolina University about a recent work she co-authored on a complex statistical analysis she performed from the STS database. What accounts for worse outcomes in this patient population? Prepare to be surprised by the information provided this week! DOI: 10.1016/j.athoracsur.2019.07.085

Pancreatic Cancer Update, Issue 1, 2020 — Our interview with Dr Golan highlights the following topics as well as cases from her practice: Case: A man in his mid-40s with borderline-resectable adenocarcinoma of the pancreas (PAD) receives neoadjuvant FOLFIRINOX (0:00) Indications for adjuvant therapy in patients with borderline-resectable PAD (3:25) Management of borderline-resectable PAD (5:36) Selection of neoadjuvant therapy for patients with pancreatic cancer (8:06) Incidence of BRCA mutations in Israel and the United States (11:51) Case: A woman in her late 70s with node-positive, resectable PAD and multiple comorbidities receives adjuvant gemcitabine/capecitabine (14:03) Dosing and tolerability of gemcitabine/capecitabine as adjuvant therapy for elderly patients (17:36) Perspective on the role of surgical resection for older patients with pancreatic cancer (20:59) Results of the Phase III APACT trial of adjuvant gemcitabine/nab paclitaxel versus gemcitabine alone for surgically resected PAD (23:25) Choice of FOLFIRINOX versus gemcitabine/nab paclitaxel as first-line therapy for mPC (26:35) Reduction in the risk of recurrence with adjuvant therapy (28:38) Perspective on palliative and supportive care for patients with mPC (34:25) Importance of maintaining quality of life and managing depression for patients with pancreatic cancer (40:02) Role of medical marijuana in managing symptoms and treatment side effects in pancreatic cancer (42:56) Single-shot celiac plexus radiosurgery in pancreatic cancer: Palliation and functional outcomes (46:15) Molecular profiling for patients with pancreatic cancer; spectrum of mutations in DNA damage repair genes (48:43) Design, eligibility and endpoints of the Phase III POLO trial evaluating olaparib as maintenance therapy after first-line platinum-based chemotherapy for patients with mPC and a germline BRCA mutation (52:43) POLO trial results and clinical experience with olaparib as maintenance therapy (57:02) Selection and sequencing of therapy for patients with BRCA mutations (59:53) Side effects associated with PARP inhibitors in patients with pancreatic cancer (1:04:51) Response to first-line FOLFIRINOX followed by maintenance olaparib (1:06:44) Novel approaches in the management of pancreatic cancer (1:11:40) CME information and select publications

Allison Kaplan Sommer, Don Futterman and Noah Efron discuss three topics of incomparable importance and end with an anecdote about something in Israel that made them smile this week. --(Jewish) Might Makes Right?-- A once-mild religious Zionist party joins forces with a far-far-right religious party. What’s this say about the soul and politics of religious Zionism today? --The Reparation, Palliation and Adjuration Rumination-- For decades, once hapless immigrants to Israel from Yemen, Iraq and other Mid-eastern countries have said that, 70 years ago, their babies were taken and never returned. Some say that, until there is hard-and-fast evidence, these claims must be treated with suspicion. But shouldn’t we switch the default to trusting the victims? --The Decade Surveyed-- What were the most important people, events and trends of Israel’s momentous, trying, eventful past decade? --“They’re Not After Me, They’re After You!”-- For our most unreasonably generous Patreon supporters, in our extra-special, special extra segment, we discuss a meme pressed into service recently by PM Netanyahu, before that by US President Donald Trump and before that Indian PM Narendra Modi, saying, in each case, “They’re not after me, they’re after you! I’m just standing in the way.” What makes this sad bit of populism so easily transferable between three such different societies, in this sad epoch of populism? All this and the music of Noa Shapira! --Music-- Noa Shapira Seratim (סרטים), featuring Almot ha-Hen ‘Im (אם) Oy, He Yafah (אוי היא יפה) Ke-she-At Holekhet (כשאת הולכת)

Nogen får lov til at leve til de er mætte af dage for dernæst at sove ind en stille søvn, men for andre er den sidste tid præget af sygdom og smerter. Heldigvis står der dygtige folk klar til at lindre, behandle og hjælpe til inden for det, vi kalder det palliative felt. I dette program af Stetoskopet ser vi nærmere på, hvordan arbejdet inden for palliation udformer sig, og hvordan læger, sygeplejersker og psykologer blandt mange andre professioner arbejder for at give terminale patienter den bedst mulige behandling under de omstændigheder, de skal leve resten af deres liv under. Lyt med når vi hører læge Søren Walter-Larsen og psykolog Julie Høgh fortælle om deres palliative arbejde med helt unge patienter under 18 år, der knap nok har taget hul på livet, og når sygeplejerske Mette Hal fortæller om sine erfaringer fra hospice og som del af et udekørende palliationsteam.Medvirkende: Julie Høgh, Søren Walter-Larsen, Mette Hal, Jaris Gerup, Stefanie Jolak, Agnes Schmidt Davidsen, Sofie Lindstrøm, Trine Toft SørensenIndslag: 2:26:00 Julie Høgh & Søren Walter-Larsen, 0:00 Mette Hal

Dr. Humera Ahmed discusses her best trainee abstract award winning project: Development of a risk score for interstage death or transplant after stage I palliation. Host: Mary Taylor, MD Editor: Courtney Celani, APRN, PNP-AC Producer: David Werho, MD

Dr. Humera Ahmed discusses her best trainee abstract award winning project: Development of a risk score for interstage death or transplant after stage I palliation. Host: Mary Taylor, MD Editor: Courtney Celani, APRN, PNP-AC Producer: David Werho, MD

Et nyt studie indenfor det der hedder palliativ behandling, viser at en ganske lille ændring i måden vi adresserer patienter på, kan ændre - ja endda forlænge livet. Tænk hvis det er en universel metode vi alle kan anvende.

Et nyt studie indenfor det der hedder palliativ behandling, viser at en ganske lille ændring i måden vi adresserer patienter på, kan ændre - ja endda forlænge livet. Tænk hvis det er en universel metode vi alle kan anvende.

Commentary by Dr. Valentin Fuster

Palliative care is not often thought of in relation to Parkinson’s disease, but as people understand its relevance and benefits, more people with Parkinson’s are adding it to their usual care. Palliation means to ease the burden of the symptoms of a disease, whether that burden is physical, emotional, or spiritual, and that burden can extend beyond the person with the disease to caregivers. Benzi Kluger, MD, MS, director of the University of Colorado’s Neurology and Supportive Care clinics, says that palliative care should begin at the time of diagnosis. He describes the results of a new study on palliative care in Parkinson’s and how it benefited the study participants who received it and viewed it as ‘supportive care’, as well as how palliative care can be incorporated in the day to day routine of people with Parkinson’s.  

This week we explore the world of cardiac transplantation with particular emphasis on the Fontan patient and transplantation. Outcomes are improving rapidly. Why is this? What about the liver and how are decisions made regarding cardiac versus cardiac+hepatic transplantation in this patient population? We review all of these questions with world authority on cardiac transplantation Dr. Daphne Hsu, Professor of Pediatrics, Chief of Pediatric Cardiology and Interim Chair of Pediatrics at Montefiore - Albert Einstein College of Medicine. Her insights into this complex patient group are valuable and novel. Article reviewed: DOI: 10.1016/j.athoracsur.2016.08.110

This week we explore the world of cardiac transplantation with particular emphasis on the Fontan patient and transplantation. Outcomes are improving rapidly. Why is this? What about the liver and how are decisions made regarding cardiac versus cardiac+hepatic transplantation in this patient population? We review all of these questions with world authority on cardiac transplantation Dr. Daphne Hsu, Professor of Pediatrics, Chief of Pediatric Cardiology and Interim Chair of Pediatrics at Montefiore - Albert Einstein College of Medicine. Her insights into this complex patient group are valuable and novel. Article reviewed: DOI: 10.1016/j.athoracsur.2016.08.110

This special episode is all about Palliative Care 101, featuring real life pall call experts! Tune in for a low-down on anti-emetics, aperients and alleviating symptoms as well as how to have some tough discussions. Thanks to all our guest stars for this very exciting and important episode! Email us questions at humerushacks@gmail.com Like our Facebook page 'Humerus Hacks' Follow us on Twitter @humerushacks  

This describes the diagnosis, workup and surgical interventions for single ventricle palliation.

Dr. Carolyn Lam:               Welcome to Circulation on the Run, your weekly podcast summary and backstage pass to the journal and its editors. I'm Dr. Carolyn Lam, Associate Editor from the National Heart Center and Duke National University of Singapore.                                                 This week's journal is really special. It is the 2017 cardiovascular surgery-themed issue of "Circulation." To summarize this issue, I am so privileged to have the editors, Dr. Marc Ruel from University of Ottawa Heart Institute, as well as Dr. Timothy Gardner from Christiana Care Health System. Welcome gentleman. Dr. Timothy Gardner:     Hello. Dr. Marc Ruel:                   Hi, Carolyn. Glad to be here. Dr. Carolyn Lam:               Thank you for another beautiful themed issue, Marc. I see that there are four general themes within this theme, if I may. The first of which are a collection of papers on coronary disease and coronary surgery. Could you maybe start by giving us an overview of that? Dr. Marc Ruel:                   One of the main topics that have been looked at in the surgical-themed issue this year is coronary surgery. We all know well that 2016, 2017, the academic year was quite fertile in providing new information around coronary surgery, especially with the release of the ART trial had actually scientific sessions of the American Heart Association the last November with simultaneous publication.                                                 Interestingly, the cardiovascular surgical-themed issue has several coronary papers and one that deals with essentially with graft failure, if you will. There's an in-depth review written by Mario Gaudino, who is well known and does fantastic work at Cornell, who essentially put a team together looking at several aspects of coronary graft failure. I guess we can say that these are looked in quite great depth, and they deal with several aspects of what would lead to a coronary bypass graft to fail.                                                 First and foremost, Mario and the team look at the blood components. Then the artery and the native bed itself. Then they focus a lot on the conduit, not only the nature of the conduit being a venous versus arterial conduit, but also the way of storing the conduit prior to performing the bypass. Also, the technique that's used around the use of that conduit.                                                 Finally, I'd say that the review culminates with the patient bioreactor, for lack of a better term, aspect. Endothelial dysfunction in the patient with diabetes, age, gender, hypertension, dyslipidemia, etc., all these things that do act as a significant substrate for the fate of the conduit vessel.                                                 A very unique, I think, first-time, in-depth review that, certainly, the "Circulation" editorial team and reviewers were very excited about. I think this will be quite impactful and provide very, very detailed information for future research and future improvement and fate of the coronary graft conduits. Dr. Carolyn Lam:               And, Dude, I agree. It's the new look at perhaps a classic, old, central surgery, the cardiovascular surgery. Very nice, indeed. Dr. Marc Ruel:                   Precisely, thank you. We also have a couple of important, seminal original papers within the realm of coronary surgery. In fact, these also deal, to some extent, with the fate of conduits and certainly how they work in the patient population in long ago bypass surgery.                                                 One is a randomized control trial, a single center randomized control trial that was performed in South Manchester. It's called the VICO trial, a study comparing vein integrity and clinical outcomes. Essentially, the study looked at open vein harvesting versus two types of endoscopic vein harvesting for coronary artery bypass grafting.                                                 The study was performed at a single center in England with three sound methods, having three groups of 100 patients who were compared with regards to the vein harvest technique. The primary outcome was with regards to actual vein integrity, looking at muscular damage and endothelial function and integrity on microscopy.                                                 Surprisingly and actually quite reassuredly that there were very few differences between endoscopic vein harvest and open vein harvest. Certainly the investigators also looked, as one of their secondary outcomes, at quality of life. It was quality of life that was gained in patients who had endoscopic vein harvest versus those who had open vein harvest.                                                 Overall, there was no difference in major adverse cardiac events. Therefore, showing at least in an internally valid fashion that these investigators at their center could do endoscopic vein harvesting as well as open vein harvesting. Dr. Carolyn Lam:               I know that there are other original research papers, perhaps. Would you like to highlight any of them? Dr. Marc Ruel:                   Yes, for sure. Carolyn, there's also one more coronary surgery paper, which I wanted to highlight and that is the paper entitled, "Does Use of Bilateral Internal Mammary Artery Grafting Reduce Long-Term Risk of Repeat Coronary Revascularization?"                                                 This is a multi-center analysis with first author is Iribarne from Northern New England. Essentially, seven medical centers got together and took about 20 years of consecutive CABGs with a total number of 50,000 operations, or just shy of 50,000 operations.                                                 The median duration of follow-up was 13 years, and these patients were well matched together using a propensity matching scheme. I think this paper and this research is unique and of high impact. Even though it does have shortcomings of not being a randomized control trial, it is very welcome information, especially in light of the recent ART trial, which, as you know, did not show any difference at five years analysis between single and bilateral internal thoracic artery use.                                                 The particularity of the Iribarne paper is that it is a very large data set up with close to 50,000 patients. It is multi-centered, therefore, it is real life. It is a consecutive series. The patients are extremely well matched, and it is remarkable to hear that the patients, in fact, had no difference in mortality until about five years after the operation.                                                 As opposed to many previous series where single versus bilateral internal mammary grafting shows a mortality difference very early on, which always raises the suspicion of poor matching or confounding by indication, if you will, this paper did not have that.                                                 Finally, the follow-up was quite long and at about six years, there was really a mechanistic signal with regards to repeat revascularization events, which seemed to match the difference in late mortality. There was no difference in early and five-year mortality, but afterwards as repeat revascularization events started to occur more frequently in the single mammary group, this was matched by a difference in mortality, as well.                                                 I think a very useful, large, long follow-up mechanistically-based information that I think adds very significantly to the current information we have about bilateral versus single mammary use. Dr. Carolyn Lam:               Thank you, Marc. Two original papers, highlighted, dealing with really very important modern controversies in this area. Open vein versus endoscopic vein harvesting, single versus bilateral mammary artery bypass. Excellent.                                                 Let's move on now to the next sub-theme, if you will. And that is the collection of papers on "Adult Congenital Heart Conditions," really, really an increasingly important and growing population that we're seeing. Tim, would you like to summarize maybe some of the highlights of the papers there? Dr. Timothy Gardner:     The first paper, as you point out, is focused on adult patients with repaired tetralogy of Fallot. This series came from the UK and it examines the course of almost 60 patients, at a mean age of 35 years following a repair of tetralogy as infants or young children, developed right heart failure and required pulmonary valve replacement.                                                 This is a common scenario that we're seeing, successfully repaired children who appear to do well but as they get into their late 20s and 30s, their pulmonary valve function, which is often inadequate or not even present valve, require an intervention.                                                 The important learning here is that pulmonary valve replacement, either surgically or by catheter technique, was shown to be highly effective in salvaging right ventricular function. That is based on imaging studies as well as hemodynamic studies of right ventricular function. There was an almost, in this group of patients, almost an immediate reverse remodeling of the right ventricle after placement of the valve, that continued to improve over time.                                                 This was, I think, quite reassuring. There, historically, was a bit of a reluctance to operate on these patients as their right heart was failing, despite the fact that without some intervention to take the volume load off of the RV, the patients didn't do well. This is good news for an important group of patients who we are all seeing, who oftentimes present to the adult cardiologist because of this right ventricular failure problem. A nice, reassuring study.                                                 Actually, the other two congenital papers are, again, focused on the infant. They both deal with the infant with hypoplastic left heart syndrome or single ventricle pathology. The first paper seems sort of specialized in terms of its focus, "The Optimal Timing of Stage-2-Palliation for Hypoplastic Left Heart Syndrome." This was a report from the NIH Pediatric Heart Network. They had a single ventricle reconstruction trial.                                                 This network is comprised of about 10 North American centers, both in the U.S. and Canada and has provided excellent data about the management of pediatric heart disease but, in particular, the single ventricle trial has been excellent.                                                 In this particular paper, they look at the optimal timing for stage-2 repair. Just to remind ourselves, the first part of the three-stage treatment for hypoplastic left heart syndrome is the Norwood procedure, which has to be done shortly after birth, as the patent ductus arteriosus closes and converts, essentially, the single right ventricle into the systemic ventricle.                                                 The stage-2 comes along, usually done with a Glenn-type of shunt, increases pulmonary blood flow and stabilizes these infants until they can reach the age for, and the heart function for definitive repair. This has been a particularly difficult problem for the congenital heart surgeons. What is the optimal timing?                                                 This study, which involved over 400 patients, identified optimal timing for the second stage between three and six months after the Norwood. I think this was very reassuring, is reassuring or supportive for the congenital heart community in terms of both patients and also good evidence base that a delay of three to six months does, in fact, produce the best transplant-free survival.                                                 In fact, the other aspect of this observation was that infants who developed the need for another second stage operation sooner than that did not do well, and the reasons for the required earlier surgery could be failure of the initial operation or additional anatomic risk factors. But this, I think, was an important, large series, multi-center study that will prove to be very helpful in sorting out this complex timing of a three-stage repair.                                                 Just to comment, again, for readers who don't deal with infant congenital heart treatments very often, there's been a remarkable amount of success over the last two decades in salvaging and saving these very difficult infants with the hypoplastic left heart syndrome. In fact, an additional paper in this surgery-themed issue, comes from the UK and is, in fact, a report on the findings from the UK-wide audit of the treatment of infants with hypoplastic left heart syndrome.                                                 In fact, their findings, in this sort of real world, not in the Pediatric Heart Network trial group, is very similar. They found that infants who got to the second stage without additional refinement of the initial Norwood procedure and were able to be successfully treated with a Glenn shunt somewhere in the four-to-six-month age range, did well. They actually made the point that the anatomy was more of a determinant than anything else.                                                 I think that this particular review will reinforce what the congenital heart surgeons have learned about optimal timing for this three-stage treatment of what previously were unreconstructable children. Dr. Carolyn Lam:               Thank you so much, Tim. Isn't it wonderful the way papers come in and they're actually complementary and consistent with one another. We're just so lucky to be publishing all of these great, high-quality, impactful papers in "Circulation."                                                 Moving on, the next paper actually reminds us why this is a cardiovascular surgery-themed issue and not just a cardiac surgery-themed issue. Didn't we just say that earlier, Marc? This one is on abdominal aortic aneurysm treatment. A population-based landscape of this. Could you tell us a little bit more about that one? Dr. Marc Ruel:                   Absolutely. Carolyn, you're entirely right. We must remember that "Circulation" is also about peripheral vascular disease, saying this earlier, or cardiovascular surgery and anesthesia consult also when it encompasses vascular surgery. Precisely to that effect, one of the papers in our cardiovascular surgical-themed issue is a landscape population based analysis from Finland that looks at the incidence of abdominal aortic aneurysm between the years of 2000 and 2014.                                                 Finland has a population of about 5.5 million and remarkably has a very circumscribed healthcare system. They do not have an organized system of AAA care as some other countries have shown to have and potentially benefit from, but rather they have a treatment of this condition at several institutions, many of which may not be high volume.                                                 I think the paper is remarkable is that it is very well nested in terms of a population. It provides a comprehensive landscape of where this condition has evolved to over the last few years. Obviously, we see in the results from the authors that the mortality has decreased quite a bit, but also the incidence, probably as a result of better control of risk factors. And also the incidence of rupture outside the hospital.                                                 One thing that came out of this paper, as well, is a potential cohort of the benefits gained from developing an organized system of AAA care, from the reason that the mortality of AAA rupture in Finland was still quite high, despite this being a modern series. In fact, when you include ruptures, before arrival to hospital and at arrival to hospital, the overall mortality was almost 80% for ruptured AAA.                                                 Perhaps one message that comes out of this is that there may be a benefit in having specialized centers dealing with these conditions, especially as they are in the process of rupturing. One last observation was, obviously, the increasingly prevailing role of endoscopic vascular repair in the treatment of this condition, which, in fact, has now surpassed open repair as the dominant method of elective repair.                                                 I think, overall, a very comprehensive, well-nested, country-wide with good follow-up landscape of the AAA condition in a country that has essentially a similar socioeconomic status to much of the western world. Therefore, with external generalized ability to some extent. Dr. Carolyn Lam:               Exactly, and contemporary data. I really enjoyed that you paired those with an excellent editorial, as well. Finally, before we wrap this up, I have to ask Tim to comment on this next paper, and it's on ventricular assist device malfunctions, I love the title, "It's More Than Just The Pump." Of course, as a heart failure physician, this one's very close to my heart. Forgive the pun. But, Tim, could you tell us about that? Dr. Timothy Gardner:     This paper comes from the University of Pittsburgh and their artificial heart program. Robert Kormos is the first author and he's been one of the stalwart leaders in the use of LVADs and other pump devices. He reports on their experience with over 200 both HeartMate and HeartWare ventricular assist devices.                                                 It was interesting when we reviewed this paper by the editors, there was some thought that maybe this was a little too engineering focused and so on, but I think the point of the paper is that, as they say in the very first line in their report, reports of LVAD malfunction had focused on pump thrombosis.                                                 But they point out very appropriately that, in fact, controller failure, battery failure, cable failure and other causes of device failure, which can be critical and life threatening and so on, are engineering issues. It reminds us that when we're managing this difficult group of patients, and we're seeing many more patients today with getting LVADs than 10 or 20 years ago, we need to have the bioengineering abilities and resources available.                                                 Even the surgeon and the critical care physician who is dealing with these patients either has to acquire this kind of knowledge or capacity himself or herself, or needs to have a good bioengineer nearby.                                                 What's interesting, I think, that all of us define that these mechanical failures were more common in this pretty big experience than what we've more clinically worried about, which was thrombosis of the pump. Dr. Carolyn Lam:               Exactly. That's so wonderful. And you know it just leads me to really thank you both, Marc and Tim, for this extraordinarily excellent selection of original research, state-of-the-art and perspective articles and editorials on congenital, coronary, vascular and heart failure surgery. This really appeals not just to the cardiovascular surgeons but really to the vast readership of "Circulation."                                                 Thank you for a wonderful themed issue and thank you for this great podcast. Dr. Timothy Gardner:     Well, thank you. Dr. Marc Ruel:                   Thank you very much, Carolyn. Dr. Carolyn Lam:               Listeners, don't forget to tune in again next week.

Äntligen en podcast om palliativ vård på svenska. Nu behöver du inte sitta framför datorn för att lära dig om vård i livet slutskede. Lyssna på din telefon när du sitter på bussen eller är ute och går. I podcastavsnitten samtalar vi med kunniga personer om olika ämnen som rör palliativ vård och vi kommer också svara på lyssnarfrågor. Ställ dina frågor till oss på info@betaniastiftelsen.nu och märk meddelandet med "Palliationspodden".     Innehåll: 4.55 Allmänhetens tankar om vård i livets slutskede. 9.52 Greger Fransson, Svenska palliativregistret 29.23 Frågor om vård i livets slutskede till läkaren Johan Sundelöf (Vad kommer ordet palliativ ifrån, vad är viktigt för den som befinner sig i livets slutskede och vad händer med kroppen i livets slutskede?) 43.20 Vad vill personal veta mer om?

Associate Professor Neil Orford is an intensive care specialist and Director of Intensive Care at University Hospital Geelong. Neil is the clinical lead for the i-Validate program. In this podcast he discusses this collaboration between Barwon Health and Deakin University which aims to improve patient-centred end-of-life care through training in clinical communication.

Den videnskabelige podcast vil i denne uge dykke ned i en statusartikel om behandlingsmæssige udfordringer ved palliation og obstipation. Dette gøres sammen med en af artiklens forfattere, speciallæge i onkologi og klinisk farmakologi Lene Jarlbæk. Senere i programmet skal det handle om en ny metaanalyse i The Lancet omkring antidepressivas effekt på børn og unge. Chefredaktør Torben Kitaj taler med Ugeskriftets medicinske nyhedsredaktør, kardiolog Per Lav Madsen, om metaanalysen.

Radiation therapy can be very helpful in treating painful bone metastases or those at risk for causing a fracture due to compromise of bone strength. Dr. Vivek Mehta reviews the basics of this approach. 

Radiation therapy can be very helpful in treating painful bone metastases or those at risk for causing a fracture due to compromise of bone strength. Dr. Vivek Mehta reviews the basics of this approach. 

Radiation therapy can be very helpful in treating painful bone metastases or those at risk for causing a fracture due to compromise of bone strength. Dr. Vivek Mehta reviews the basics of this approach. 

Otis Webb Brawley (Chief Medical Officer, American Cancer Society) talks to ecancertv at the UICC World Cancer Congress 2014 about how the time has come to invest in cancer prevention and palliative care.

Interview with Emily Finlayson, MD, MS, author of Functional Outcomes After Lower Extremity Revascularization in Nursing Home Residents: A National Cohort Study, and William J. Hall, MD, MACP, author of Lower Extremity Revascularization in Nursing Home Residents: Surgery as Palliation

1.6 million people are on the Australian Organ Donation Registry. How do you approach organ donation with your patients? Steve Philpot speaks at the May VIN meeting about how we can better facilitate organ donation and about the usefulness of the donation registry.

Voluntary palliated starvation

Brazil leads an all-star cast through a thought provoking discussion on the prickly topic of end of life care in critical care.

What does plantar fasciitis feel like? Not one of my patients would be in my office if they weren’t experiencing pain. The pain is usually worse for the first couple of steps after getting out of bed or getting up from a seated position. The description attached to this is “The first step is the worst step!”. What is happening is that the muscles in the calf and arch are contracting during rest because of the foot is allowed to relax. The stretching that occurs on the first step increases the force within the plantar fascia and the sensitive plantar fascia becomes painful. This pain often radiates into the calf and forefoot. The location of the pain is very characteristic. It is usually found on the inside and front of the weight-bearing heel. Pain is found in other locations usually have other underlying problems besides plantar fasciitis. This often leads people to conclude that they do not have enough padding under their heel, that they strike heel too hard. This is not the case. When we look at the tissue of plantar fasciitis under a microscope, as we can do after surgery, what we find is both interesting and counterintuitive. First, we do not find inflammation in the tissue. We also don’t see that the tissue damage is located on the spur. What we find is that the damage consists of small tears within the ligament that do not completely heal, leading to blood vessel proliferation and deterioration of the tissue. Who gets it? Certainly, it is more common in people that are overweight. You would expect this because the more that you weigh, more pressure that you are putting on the plantar fascia. People that have restricted ankle range of motion either naturally or after an injury or surgery, also seem to develop it more frequently. So impaired flexibility seems to be an issue. I also see up frequently in athletes and in people with sedentary occupations. So where doesn’t all go wrong? Well, my belief is that plantar fasciitis is rooted in a poorly functioning and weak arch muscles. The weakened muscles fail to protect the plantar fascia, which gradually weakens and tears. The underlying problem is our shoe wear. Our feet were designed without shoes in mind. Our natural state is to walk, shoeless, on rocks, tree roots, and uneven surfaces on the forest floor. In this state, our feet are asked to do a different job than when they are in shoes. When we walk barefoot, our toes are flexing and grasping for purchase in the mud and dirt. This conditions our feet, especially the small arch muscles. In addition, our feet are constantly twisting to adjust to the uneven surfaces. This twisting and torquing of the arch is also a function of the small muscles. When we walk in shoes, the jobs that are feet are asked to do is much more crude. The toes really do nothing. The foot hits the floor as one unit, never allowing the muscles to work much. It would be really much like taking a small child and never allowing them to use her hands without any snug pair of mittens on. By the time that child was an adult, the muscles in their hands may be a capable of grasping and doing fine manipulation of objects. That child’s hand would most likely be permanently impaired from this development. Why would we expect our feet to develop differently? Finally, our sedentary lifestyle contributes by allowing us to be heavier and in worse condition. In many ways, plantar fasciitis can be a sign of overall poor body conditioning. Other contributing factors include the fact that we as a Society are getting older. In some cases, changes in activity and stress to these for structures can precipitate an episode of plantar fasciitis. This is a factor in many forms of tendinitis and stress injury. There was a great man, named Julius Wolff, who came up with a very simple principal that underlies this. Dr. Wolff was one of the first professors of orthopedics in Berlin. He was examining heel bones and noted that this small bony spicules within the bones lined up with the force within the bone. He correctly guessed that the loading of a bone causes it to become stronger over time. However, this remodeling requires time. If the stress overload to the bone, then it can go on to injury before it strengthens. Therefore, training errors during athletics in which a person “overdoes it”, can lead to injury. Other general medical problems can also contribute such as diabetes, atherosclerosis, and inflammatory conditions such as rheumatoid arthritis. So, how do we treat it? Whatever we do, this seems to work 85-90% of the time. Many of the treatments that have been suggested include heat, cold, wrapping with an Ace wrap, taping, therapeutic ultrasound, phonophoresis, deep tissue massage such as using the Graston technique, and soaking in Epsom salts. These methods have many things in common. The first is that they don’t do a darned thing to help cure plantar fasciitis, but they do make it feel better for a while. This may be of some benefit. They also all work the same way. The Gate Theory Of Pain was developed by Melzack and Casey in 1968. It suggests that pain is modified in several areas from the source of the pain, in this case in the foot, to where it is perceived in the brain. The pain nerves are stimulated and conduct their impulses to the spinal cord. If enough impulses stimulate the nerve or gate in the spinal cord, this impulse is relayed to the brain, where we would identify and understand that something painful was occurring. If other nerves such as the nerves that sense cold, heat, pressure, vibration, or light touch are stimulated at the same time, these impulses interfere with the gate in the spinal cord, making it less likely that the pain will be noticed by relaying it to the brain. Placing ice on an injury or rubbing it stimulates these nerves and makes it harder to proceed pain. Another way of treating plantar fasciitis is to reduce the stress on the plantar fascia. Wearing a rigid shoe reduces the motion in the front and middle portions of the foot, reducing stress and hopefully allowing the body to catch up with the injury. Similarly, arch supports can eliminate or reduce motion within the arch, reducing pressure and stress from the plantar fascia. But didn’t you that these were bad for feet? Well, I did say that they were bad for healthy feet. Let’s talk about the stages of healing. Nearly every injury occurs and resolves in a pattern. I use this pattern to help guide my treatment and the degree of activity that is appropriate. Stage I is the acute stage. In this stage, pain is present to the point that it interferes with daily function. During this stage, the injured area should be protected and arrested. Palliation or doing things to simply help with pain is really reasonable. Stretching may be helpful at this stage. Strengthening and conditioning however does not make sense when you can barely make it through the day. To some extent a period of time needs to be allowed to get out of this stage. Hopefully, it will be brief. Stage II is the subacute stage. In this stage, the pain is not functionally limiting. Usually, it is primarily morning pain or pain at the onset of activity. The pain can temporarily increases with activity, but the activity should not aggravate it for any prolonged period of time. It is likely that athletics of any significant intensity may be difficult during this stage. The protection that was begun during the first stage should be gradually removed during this stage. This includes such things as supportive shoes and arch supports. The rehabilitative goals are not only improving flexibility but also beginning strengthening on a gradual basis and conditioning. Stage III is the final stage. The pain has resolved. During this stage, the foot should be gradually exposed to increasing stress to allow it to strengthen. Hopefully, with weight loss, and conditioning, the foot can be strengthened above its preinjury level. At a minimum, rehabilitative exercises should focus on flexibility. As it has been documented scientifically, that tight Achilles tendons and muscles and tight hamstring muscles are associated with the development of plantar fasciitis, improving flexibility of these muscles is a key part of rehabilitation. The stretches focused on the Achilles/gastrocnemius complex, the hamstrings, and the plantar fascia. Strengthening and conditioning exercises focus on the intrinsic muscles. I encourage my patients to do these exercises without shoes. One good exercise is to place the front of the foot on a 2 x 4” and to slowly rotate the heel in a circle, shifting the weight on the forefoot from the inside to the outside during the rotation. Begin by doing this for 30 seconds, 3 repetitions, once a day. Gradually, increase the duration to 5 minutes or more, 3 times a day. Other exercises include balance exercises, such as one leg squats or yoga positioning maneuvers. The intrinsic exercises that I think due to most good involve weight bearing (no towel scrunching or picking up marbles with her toes). As resilience increases, hopping or leaping maneuvers are very helpful and may help you get back to sports. http://www.wholefoot.com/what-does-plantar-fasciitis-feel-like/feed/ 0

Dr. Hy Muss, expert in breast cancer and geriatric oncology at the University of North Carolina at Chapel Hill, discusses considerations around prevention, screening, and treatment considerations for older women with breast cancer.

Dr. Hy Muss, expert in breast cancer and geriatric oncology at the University of North Carolina at Chapel Hill, discusses considerations around prevention, screening, and treatment considerations for older women with breast cancer.

Der Verlust eines Neugeborenen stellt für die betroffenen Eltern ein tief greifendes Ereignis dar. Vor allem im europäischen bzw. deutschsprachigen Raum wird die Problematik klinisch, wissenschaftlich und gesellschaftlich erst in Ansätzen wahrgenommen und untersucht, eine Übertragung der Ergebnisse von im anglo-amerikanischen Sprachraum durchgeführten Untersuchungen ist aufgrund unterschiedlicher Rahmenbedingungen nur eingeschränkt möglich. Im Rahmen eines infausten Krankheitsverlaufs kann eine Therapiezieländerung zu palliativer Therapie eine Rolle spielen. Dieser Aspekt wurde insbesondere aus Sicht der Eltern noch zu wenig wissenschaftlich beleuchtet und deren Auswirkung auf die Trauerreaktion der Eltern erst in wenigen älteren Studien untersucht. Die Betreuung der Familien sowohl in der Zeit der Erwägung und Besprechung einer palliativen Behandlung, zum Zeitpunkt des Versterbens des Kindes als auch in der Trauerphase stellt behandelnde Ärzte und das Pflegepersonal vor große Anforderungen. Eine Analyse der lokalen Bedingungen für Familien, die von einem neonatalen Verlust betroffen sind, erscheint von großem Interesse, um die zukünftige Betreuung den Bedürfnissen anpassen und verbessern zu können. Die dieser Dissertationsschrift zugrunde liegende Studie zeigt auf, wie Eltern den Tod ihres Neugeborenen erleben und welche Faktoren dieses Erleben und die Trauerreaktion beeinflussen. Im Rahmen einer deskriptiven Kohortenstudie wurden die Eltern aller Neugebo-renen, die im 5-Jahres-Zeitraum zwischen dem 1. Januar 1999 und dem 31. Dezember 2003 auf der neonatologischen Intensivstation verstarben, um schriftliche sowie persönliche Studienteilnahme gebeten. Der 21-seitige Fragebogen enthielt 242 Fragen einschließlich der Perinatal Grief Scale (PGS, validiertes Messinstrument). Die halbstrukturierten Interviews wurden aufgezeichnet und transkribiert. Die quantitativ erhobenen Daten wurden mittels explorativer statistischer Vergleiche analysiert, wobei ausschließlich nonparametrische Verfahren zur Anwendung kamen. 50 Eltern zu 31 von insgesamt 48 verstorbenen Kindern beteiligten sich, davon 41 per Fragebogen und Interview, 9 nur schriftlich. Die mediane Interviewdauer betrug 2,6 Stunden. Die Trauerintensität (PGS-Score) sowie die Dauer der Trauerphase bei Eltern mit Entscheidung zum Abbruch intensivmedizinischer Maßnahmen wichen nicht signifikant von denjenigen anderer Eltern ab. Unterschiede bzw. Korrelationen (p < 0,05) der PGS (medianer PGS-Score) bestanden bezüglich Geschlecht (Mütter: 63; Väter: 59), dem Vorhandensein vorher geborener Kinder (mit bzw. ohne vorher geborene Kinder 65 bzw. 51), dem Vorhandensein nachher geborener Kinder (mit bzw. ohne nachher geborene Kinder 59 bzw. 66) sowie dem Zeitraum zwischen Tod des Kindes und Interview. Mütter äußerten häufiger, dass die Trauer Auswirkungen auf das soziale Umfeld gehabt habe (p < 0,03). 95% der Eltern mit Entscheidung zur Beendigung intensivmedizinischer Maßnahmen meinten, dass sie angemessen in die Entscheidung miteinbezogen wurden und 92% gaben an, diese Miteinbeziehung nicht zu bedauern. 85% hatten diesbezüglich keine Schuldgefühle. 45% der Eltern fühlten sich jedoch in dieser Situation überfordert. 17% der Mütter und 6% der Väter fühlten sich generell schuldig für den Tod ihres Kindes. 60% der Eltern waren anwesend, als ihr Kind verstarb. Das Zugegensein wurde von allen als positiv empfunden. 75% der nicht anwesenden Eltern hätten sich dies im Nachhinein anders gewünscht. Eltern, die keinen Körperkontakt zu ihrem Kind gewünscht hatten (42%), hätten sich diesen in 79% im Nachhinein gewünscht. Die Mehrzahl der Eltern (79%) empfand das Vorhandensein von Erinnerungsgegenständen an das verstorbene Kind als hilfreich in der Trauerphase. Der Wunsch nach einem Gesprächspartner war in den ersten sechs Monaten nach dem Tod des Kindes geringer als im darauf folgenden Zeitraum (Väter 42%; 56% sowie Mütter 68%; 73%). 83% der Mütter und 71% der Väter meinten, dass sich die Beziehung zu ihrem Partner seit dem Tod des Kindes verändert habe, wobei 83% angaben, dass sie das Ereignis einander näher gebracht habe. Die vorliegende Studie zeigt, dass die Befragung trauernder Eltern möglich ist. Die Bereitschaft betroffener Familien, an einer Untersuchung ihrer Situation teilzunehmen, war überraschend groß. Die stattgefundenen Gespräche wurden von den Eltern trotz der immanenten Belastung ausschließlich positiv beurteilt. Nach den vorgelegten Daten scheint eine Einbeziehung der Familie in den Prozess der Entscheidungsfindung zur Umorientierung des Therapieziels von Heilung auf Palliation bei schwerstkranken Früh- und Reifgeborenen keine ungünstigen Auswirkungen auf den Trauerverlauf, auf Schweregrad und Dauer elterlicher Schuldgefühle im Zusammenhang mit dem Verlust des Kindes oder auf die Häufigkeit pathologischer Trauerreaktionen zu haben. Die individuellen Bedürfnisse der Eltern hinsichtlich der verschiedenen Möglichkeiten des Kontakts zu ihrem sterbenden Neugeborenen sind nicht einheitlich. Auf das Anfertigen, Aushändigen bzw. Bewahren von Erinnerungsgegenständen sollte geachtet werden. Der perinatale Tod eines Zwillingskindes kann eine ebenso schwerwiegende Belastung der Familie auslösen wie der Tod eines Einlingskindes. Der Verlust der inneren Stabilität der Familie bei Tod eines Neugeborenen beeinträchtigt Geschwisterkinder in unterschiedlichem Ausmaß und verursacht auch bei ihnen spezielle Betreuungsbedürfnisse. Wenige Wochen nach einem perinatalen Todesfall sollten den Eltern seitens des medizinischen Betreuungspersonals ein oder mehrere Nachgespräche angeboten werden. Dabei sollte auf zu erwartende Unterschiede zwischen der mütterlichen und väterlichen Trauerreaktion hingewiesen werden. Auf das Risiko pathologischer oder chronischer Trauerreaktionen sollte ebenfalls verwiesen werden, da sie einer professionellen Betreuung bedürfen. Abschließend kann festgehalten werden, dass keine Handlungsrichtlinien kreiert werden können, die die Bedürfnisse aller betroffenen Eltern erfassen. Die Betreuung der Eltern muss vielmehr anstreben, diese auf ihrem individuellen Weg emotional zu begleiten, Verständnis für die gezeigten Reaktionen aufzubringen und individuell geeignete Hilfsangebote zur Verfügung zu stellen.