Impact of the Lockdown on Patients Receiving Maintenance Hemodialysis at a Tertiary Care Facility in Southern India - A Mixed-methods Approach.

Aims: The mass quarantine measures adopted to control the COVID-19 pandemic greatly impacted the lives of patients on haemodialysis in India. We used a mixed methods approach to study its effect on dialysis outcomes and the lived experience of haemodialysis patients during the lockdown.

Methods: Quantitative data was collected from 141 subjects using a structured proforma to determine the impact of the lockdown on dialysis outcomes and travel expenses.

Choosing wisely: protocols, priorities and a postcard.

Can a young doctor without training in communication skills use empathy as a compass for making ethical decisions? This narrative reflects on a young boy left alone with a paralyzed dying father after six months of 'free' but futile treatment. Protocols should be weighed against prognosis and priorities when the disease is incurable.

'Sufficient Pain relief ' as a Practical Benchmark in Cancer Pain Management: A Prospective Study of Serial Pain Scores, Patient-rated Pain Relief and Perceived Sufficiency of Analgesics.

Objectives: Serial pain scores are used to guide pain management but there can be variability in what constitutes 'adequate' pain relief for an individual patient. We aimed to evaluate how patient-rated sufficiency of pain relief corresponded to pain scores, pain relief scores, and the felt need for increasing analgesics.

Material And Methods: Baseline and follow-up scores on the 11-point numerical rating scale (11-NRS) and verbal rating scale were obtained for116 patients with cancer pain.

Practical aspects of palliative care & palliative radiotherapy in incurable cervical cancer.

Cervical cancer is the most common cause of cancer-related deaths among economically disadvantaged women. The symptoms of pain, discharge, constipation, foul smell, insomnia and depression can be controlled with inexpensive medicines such as oral morphine, maintenance oral metronidazole, antidepressants and laxatives. These medications should be prescribed according to the palliative care guidelines and titrated to the individual patient's clinical response, pathophysiology, and metabolic parameters.

Regular Low-Dose Oral Metronidazole Is Associated With Fewer Vesicovaginal and Rectovaginal Fistulae in Recurrent Cervical Cancer: Results From a 10-Year Retrospective Cohort.

Purpose: Anaerobic necrosis in cervical cancer can lead to malodor, fistulae, and treatment abandonment. In this retrospective cohort study, we examined the association between maintenance metronidazole and the incidence of malignant fistulae in recurrent cervical cancer.

Methods: We screened all cervical cancer records registered between 2007 and 2016 in the local palliative care database at Christian Medical College, Vellore, India.

Prognostic Factors of Malignant Pleural Effusion among Palliative Care Outpatients: A Retrospective Study.

Background: Malignant pleural effusion (MPE) has varied survival and indicates advanced disease. LENT prognostic score is the first validated score used for MPE. This study assessed the role of LENT among palliative care cancer patients and assessed different patient, tumor, and treatment related factors that may affect survival.

Beyond Competence: Perspectives From Two Centuries.

A sense of failure and guilt can often be associated with the death of a patient. Using the Serenity Prayer as a framework, we present autobiographical narratives describing encounters that happened in Vellore, India over a hundred years apart. Powerlessness in the face of death, we suggest, is not the same as ignorance or incompetence.

Improving malodour management in advanced cancer: a 10-year retrospective study of topical, oral and maintenance metronidazole.

Objectives: To explore the relative effectiveness of topical or oral metronidazole used for malodour in necrotic cancers and to propose a protocol for metronidazole usage in managing malodour.

Methods: A retrospective case note review of the management of malodour over 10 years comparing outcomes with topical, intermittent and maintenance oral metronidazole.

Results: Among 179 patients treated for malodour, the commonest primaries were cervical (45%), and head and neck cancers (40%).

The patient who 'must not be told': demographic factors associated with collusion in a retrospective study in South India.

Background: Patients with cancer need adequate information about diagnosis, treatment options, and possible outcomes and prognosis to make therapeutic decisions. In cultures where the family plays the dominant role in healthcare decisions, doctors are often requested to collude in withholding distressing information from the patient. This challenging situation has not been well studied and there is limited knowledge on the different factors that may contribute to collusion.

Interventions for the treatment of metastatic extradural spinal cord compression in adults.

Background: Metastatic extradural spinal cord compression (MESCC) is treated with radiotherapy, corticosteroids, and surgery, but there is uncertainty regarding their comparative effects. This is an updated version of the original Cochrane review published in theCochrane Database of Systematic Reviews (Issue 4, 2008).

Objectives: To determine the efficacy and safety of radiotherapy, surgery and corticosteroids in MESCC.

Creation of Minimum Standard Tool for Palliative Care in India and Self-evaluation of Palliative Care Programs Using It.

Background: It is important to ensure that minimum standards for palliative care based on available resources are clearly defined and achieved.

Aims: (1) Creation of minimum National Standards for Palliative Care for India. (2) Development of a tool for self-evaluation of palliative care organizations.

Nebulised furosemide in the palliation of dyspnoea in cancer: a systematic review.

Background: Dyspnoea is experienced by approximately two-thirds of cancer patients at the end-of-life. Despite the use and assessment of various interventions, palliation of dyspnoea poses a clinical challenge. The benefit of nebulised furosemide in the palliation of dyspnoea among cancer patients remains uncertain.

Can symptom relief be provided in the home to palliative care cancer patients by the primary caregivers? An Indian study.

Background: A large proportion of cancer deaths occur in the developing world, with limited resources for palliative care. Many patients dying at home experience difficult symptoms.

Objective: The objective of this study was to assess the feasibility of a structured training program on symptom management along with an acute symptom management kit for primary caregivers of cancer patients receiving home care.

Neuropathic Pain due to Fibromatosis: Does Anticancer Treatment Help?

Desmoid fibromatosis, although histologically benign, infiltrates local structures. The involvement of neural structures can lead to difficult neuropathic pain and the escalating use of analgesics. We report a patient with desmoid fibromatosis of the chest wall causing brachial plexus infiltration.

Should SPECT-CT replace SPECT for the evaluation of equivocal bone scan lesions in patients with underlying malignancies?

Introduction: Bone scintigraphy is used extensively in evaluating metastatic disease. There are currently no clear recommendations for the use of single photon emission computed tomography (SPECT)/CT in metastatic bone disease. Given its limited availability there is a need to identify the clinical indications for which SPECT/CT is clearly beneficial in influencing patient care and outcome.

Pain assessment and analgesic prescription for cancer patients in a medical ward: the influence of an educational intervention.

Background: Pain is present in more than 75% of patients with advanced cancer and is often under-treated. Adequate pain control is an essential component of patient care. By correctly following the WHO analgesic ladder, pain can be controlled in nearly 90% of patients with cancer.

Comparing three-dimensional volume-rendered CT images with fibreoptic tracheobronchoscopy in the evaluation of airway compression caused by tuberculous lymphadenopathy in children.

Background: Lymphobronchial tuberculosis (TB) causes airway compression in 38% of patients. The airway obstruction is conventionally assessed with fibreoptic tracheobronchoscopy (FTB). Multidetector-row spiral computed tomography (MDCT) with three-dimensional volume rendering (3-D VR) has significantly improved the imaging of the airways.

Non-infective pulmonary disease in HIV-positive children.

It is estimated that over 90% of children infected with human immunodeficiency virus (HIV) live in the developing world and particularly in sub-Saharan Africa. Pulmonary disease is the most common clinical feature of acquired immunodeficiency syndrome (AIDS) in infants and children causing the most morbidity and mortality, and is the primary cause of death in 50% of cases. Children with lung disease are surviving progressively longer because of earlier diagnosis and antiretroviral treatment and, therefore, thoracic manifestations have continued to change and unexpected complications are being encountered.