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------=_NextPart_01C7747D.F7028520 Content-Location: file:///C:/E67B2C8D/PalliatveCare-DrSham_files/pres.xml Content-Transfer-Encoding: quoted-printable Content-Type: text/xml; charset="utf-8" ------=_NextPart_01C7747D.F7028520 Content-Location: file:///C:/E67B2C8D/PalliatveCare-DrSham_files/slide0002.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" The learning palliative care team
28 Jan 07
H= KPS
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The role of palliative care
Dr Michael Sham
28 January 2007
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A3FLS0Yo5ewCUUYoosAUYpaKfKAmKCKWihxVgG7c9aKdRS9muwXP/9n= ------=_NextPart_01C7747D.F7028520 Content-Location: file:///C:/E67B2C8D/PalliatveCare-DrSham_files/slide0003.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" The learning palliative care team
28 Jan 07
H= KPS
2
Palliative care
•Focuses on patients with active, progressive, and far-advanced illness= and a limited prognosis
<= span class=3DBB style=3D'position:absolute;left:-4.58%'>•Holistic care: physical, psychologica= l, social, spiritual
<= span class=3DBB style=3D'position:absolute;left:-4.69%'>•Adopts a multi-disciplinary approach<= /span>
------=_NextPart_01C7747D.F7028520 Content-Location: file:///C:/E67B2C8D/PalliatveCare-DrSham_files/slide0004.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" The learning palliative care team
28 Jan 07
H= KPS
3
Holistic care
•Physical problems: symptoms, possible causes, assessment of se= verity, impact on the patient
<= span class=3DBB style=3D'position:absolute;left:-4.39%'>•Psychosocial issues: coping, family a= nd significant others, grie= f
<= span class=3DBB style=3D'position:absolute;left:-4.13%'>•Spiritual issues: religion, dignity (identity, pride, meaning)
------=_NextPart_01C7747D.F7028520 Content-Location: file:///C:/E67B2C8D/PalliatveCare-DrSham_files/slide0005.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" The learning palliative care team
28 Jan 07
H= KPS
4
Teamwork
•Doctors= 3;
•Nurses = ;
•Physiother= apists / occupational therapists
•Dietitians=
•Clinical psychologists
•Social workers
•Pastoral c= are workers
•Volunteers=
------=_NextPart_01C7747D.F7028520 Content-Location: file:///C:/E67B2C8D/PalliatveCare-DrSham_files/slide0006.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" The learning palliative care team
28 Jan 07
H= KPS
5
Back to the patient …
------=_NextPart_01C7747D.F7028520 Content-Location: file:///C:/E67B2C8D/PalliatveCare-DrSham_files/slide0007.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" The learning palliative care team
28 Jan 07
H= KPS
6
Physical symptoms
•Mid-thoracic discomfort
•Constipation
•Poor appetite
•Dyspnoea
------=_NextPart_01C7747D.F7028520 Content-Location: file:///C:/E67B2C8D/PalliatveCare-DrSham_files/slide0008.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" The learning palliative care team
28 Jan 07
H= KPS
7
Mid-thoracic discomfort
•Pain
•Dysphagia
•Nausea
•Dyspnoea
------=_NextPart_01C7747D.F7028520 Content-Location: file:///C:/E67B2C8D/PalliatveCare-DrSham_files/slide0009.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" The learning palliative care team
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file:///C:/E67B2C8D/PalliatveCare-DrSham_files/slide0010.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" The learning palliative care team
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AUUUUAFFFFABRRRQAUUUUAFFFFABRRRQAUUUUAFFFFABRRRQAUUUUAFFFFABRRRQAUUUUAFFFFAB RRRQAUUUUAFFFFABRRRQAUUUUAFFFFABRRRQAUUUUAFFFFABRRRQAUUUUAFFFFABRRRQB+Vf/D87 /qif/l1//cVH/D87/qif/l1//cVFFAB/w/O/6on/AOXX/wDcVH/D87/qif8A5df/ANxUUUAfoB+z T8a5P2h/gl4d+IR0kaANXFwf7NFz9pMXlTyQ/wCt2JnPl5+6OuO1eqUUUAFFFFABRRRQAUUUUAFF FFABRRRQAUUUUAFFFFABRRRQAUUUUAFFFFABRRRQAUUUUAFFFFABRRRQAUUUUAFFFFABRRRQAUUU UAFFFFABRRRQAUUUUAFFFFABRRRQAUUUUAFFFFABRRRQAUUUUAFFFFABRRRQAUUUUAFFFFABRRRQ AUUUUAFFFFABRRRQB//Z ------=_NextPart_01C7747D.F7028520 Content-Location: file:///C:/E67B2C8D/PalliatveCare-DrSham_files/slide0011.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" The learning palliative care team
28 Jan 07
H= KPS
10= 3;
Total pain
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file:///C:/E67B2C8D/PalliatveCare-DrSham_files/slide0012.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" The learning palliative care team
28 Jan 07
H= KPS
11= 3;
Causes of constipation
•Pain
•Inactivity
•Diet and fluid intake
•Drugs
•Depression
•Hypercalcaemia?
------=_NextPart_01C7747D.F7028520 Content-Location: file:///C:/E67B2C8D/PalliatveCare-DrSham_files/slide0013.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" The learning palliative care team
28 Jan 07
H= KPS
12= 3;
Poor appetite
•Assessment of food intake
•Food: choices, presentation, consistency
•Environment
•Other symptoms: nausea, sore or dry mouth, dysphagia
•Depression
------=_NextPart_01C7747D.F7028520 Content-Location: file:///C:/E67B2C8D/PalliatveCare-DrSham_files/slide0014.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" The learning palliative care team
28 Jan 07
H= KPS
13= 3;
Impact of poor appetite
•Fear of starvation
•Fear of disease progression
•Fear of death
•Appearance
•Weakness
•Fatigue
•Meals as sources of pleasure, social activity
------=_NextPart_01C7747D.F7028520 Content-Location: file:///C:/E67B2C8D/PalliatveCare-DrSham_files/slide0015.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" The learning palliative care team
28 Jan 07
H= KPS
14= 3;
Assessment of dyspnoea
•Severity of dyspnoea
•Impact of dyspnoea: functional impairment, significance =
•Possible causes of dyspnoea: history,= physical examination
------=_NextPart_01C7747D.F7028520 Content-Location: file:///C:/E67B2C8D/PalliatveCare-DrSham_files/slide0016.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" The learning palliative care team
28 Jan 07
H= KPS
15= 3;
Investigations
•Chest radiograph
•Oximetry: satisfactory oxygen saturation does not exclude dyspnoe= a
<= span class=3DBB style=3D'position:absolute;left:-3.89%'>•Other investigations: e.g. haemoglobin level, ECG, echocardiography
------=_NextPart_01C7747D.F7028520 Content-Location: file:///C:/E67B2C8D/PalliatveCare-DrSham_files/slide0017.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" The learning palliative care team