7 research outputs found
Management of Malignancy Associated Superior Vena Cava Syndrome in the Emergency Department
No full textAbstract: Objective: The objective of this article was to do a review of the available literature on Malignancy associated Superior Vena Cava Syndrome (SVCS), and provide a quick effective guide on the latest approaches on management of patients presenting in the Emergency Room with SVCS.Methods: Multiple documents were identified which were published with regards to SVCS, Emergency Management of SCVS and case reports. All the papers were studied and latest diagnostic methods and management protocols were identified and extrapolated from the literature.Results: Of approximately 30 papers shortlisted that were written on SVCS, newer ways of identifying and managing SVCS is the ER (specifically) were collected and presented. Newer therapies i.e. External Beam Radiation Therapy via Photons in the Emergency setting, Multidisciplinary approach to Malignancy associated SVCS were discussed along with traditional symptoms relief measures.Conclusion: Both adults and children who present with the signs and symptoms of SVCS in the emergency room require extra care and multidisciplinary management
The Role of the Psycho-Oncology Multidisciplinary Tumor Board in Enhancing the Caregivers’ Well-Being for Cancer Patients
No full textProviding care to family members with prolonged illness challenges caregivers' well-being. Cancer is not just a disease, it reshapes the life of the patient and the family of the patient. The caregivers carry a heavy and unseen burden in a low-middle-income country like Pakistan, where the cancer system is already overburdened. In a research study conducted in Karachi, Pakistan, it was observed that 64% of caregivers experienced a burden in the Mild to Moderate range [1].
Along with this, in another study, it was seen that fatigue was reported as the most challenging aspect by the caregivers providing support to patients receiving active radiotherapy and having an advanced cancer diagnosis [2], and about 40-70% of caregivers experienced symptoms of depression [3]. Despite the evidence highlighting the need to support caregivers' well-being, there remains a lack of resources. Therefore, integrating a psycho-oncology multi-disciplinary tumor board (MDT) in cancer care can play a pivotal role in the well-being of cancer patients and in reducing the burden on the caregivers [4]
Emergency Management of Metastatic Spinal Cord Compression
No full textMetastatic Spinal Cord Compression (MSCC) is one of the major forms of oncological emergencies. Other common emergency scenarios seen in cancer patients include Neutropenic Sepsis, Hypercalcemia and Superior Vena Cava Obstruction (SVCO). During this brief discussion of MSCC we will be going over the red flag symptoms a patient may present with common malignancies. We shall go through the points that are associated with and the multidisciplinary management of MSCC. A patient presenting to the emergency room with symptoms including recent onset back pain [1, 2], in the extremes of age (i.e. <20 or >55), with a history of weight loss, pyrexia, night sweats, sensory loss, leg weakness, constant pain at night and at rest and/or complains of urinary retention, fecal incontinence should have MSCC considered in differential diagnosis and appropriate work up should be considered
Perspective of Medical and Dental Undergraduates towards Complementary and Alternative Medicine
Get PDFABSTRACT
Background:
The prevalent use of complementary and alternative medicine (CAM) requires health professionals including doctors and dentists having the essential knowledge to have better recommend their patients. This has lead to an increased need for integration of CAM teaching at the undergraduate level. Thus, the purpose of the study was to assess the perspective of complementary and alternative medicine among Pakistani medical and dental undergraduates.
Methods:
A questionnaire based cross sectional survey was conducted among first to fifth year undergraduate medical and dental students at Sindh Medical College and Ziauddin University in Karachi, during April until May 2019, using a structured 13-item questionnaire. Descriptive statistics were calculated for baseline characteristics. Frequency and proportions were calculated for categorical variables using SPSS version 20.
Results:
The response rate was 100% (40.7% for males and 59.3% for females). The mean age of medical and dental students was 20.5±1.39 years. Almost three-fourth of students (75.1%) had the knowledgeof CAM. The most experienced CAM modality amongst all was Yoga (23.4%) and Homeopathy (20%). Nearly 69.4 % of students believed that CAM is beneficial for medical and dental healthcare and 44.1% students will recommend CAM to their patients in future. Almost 39% of students think that CAM should be included into undergraduate medical and dental curriculum.
Conclusion:
This study showed an encouraging interpretation of both medical and dental students regarding CAM knowledge and benefits. Majority of the students have optimistic attitude towards CAM practice in future and for the integration of CAM studies at undergraduate level
Some Pertinent Solutions to the Challenges Faced by the Pakistani Healthcare Systems
No full textHealth systems worldwide face various challenges. Disparities are evident among different geographic locations. There are several hurdles in providing high-quality professional education, especially in low- and Lower-Middle-Income Countries (LMICs), including insufficient basic infrastructure and a shortage of professionally trained staff. This issue presents a particular risk in LMICs that are ill-equipped to deal with complex and expensive treatments [1, 2]. Although developing and enhancing educational programs to yield more healthcare professionals is constructive, these efforts need to be accompanied by educational structuring that will provide postgraduates with the necessary competencies [3]. It is not uncommon for the patients in LMICs with a potentially curable disease to receive sub-optimal treatment because of a lack of competencies and a caring attitude. This prompts some interesting challenges around the speciality training of postgraduates. In particular, what we are trying to achieve in modern oncology training programmes? Are current examination systems an effective test of knowledge, skills, and safety to practice? And, if so, are they sufficient to prepare for independent practice? Or should training programmes incorporate non-clinical skills related to issues? Interestingly, according to World Health Organization (W.H.O.), there are six elements or system building blocks of the health system that includes (i) service delivery, (ii) health workforce, (iii) health information systems, (iv) access to essential medicines, (v) financing, and (vi) leadership/governance [4]. We believe that these elements overlap with our proposal of inclusion of non-clinical leadership skills during their early years so that they are aware of the gaps and develop a mindset to improve the healthcare system by themselves.In this paper, we propose these five concepts to be inducted into our postgraduate training that will pave the way to improve our healthcare system
Tumor Board can save Sphincter, A Review of Contemporary Multidisciplinary Management of Rectal Cancer
No full textAbstract: Colorectal cancer ranks third amongst various malignancies worldwide out of which a major proportion is of rectal carcinoma. With increasing incidence of rectal cancer amongst younger population in past two decades various advancements towards organ preservation approach have been devised. Total Neo-adjuvant approach (TNT) is current standard of care in various clinical scenarios involving rectal malignancy. In this review article role of Radiation in neo adjuvant setting and various landmark trials leading to it are discussed in detail
Multi-Disciplinary Management of Hidradenocarcinoma
No full textHidradenocarcinoma makes up 6% of eccrine malignancies, and is an uncommon eccrine sweat gland tumour. The etiology is due to genetic alterations and transformation from an existing lesion or hidradenoma. It typically affects the face and scalp, although it can also cause nodal involvement and show up on the trunk, abdomen, or groin. Due to its similarities to other skin tumours, it is challenging to diagnose histopathologically. Therefore, immunohistochemical markers, such as p53, Ki-67, keratin AE1/AE3, and cytokeratin 5/6, are crucial for the diagnoses. There are no prospective randomized trials available to direct treatment of hidradenocarcinoma. A key component of therapy is early diagnoses and case discussion in multidisciplinary tumor board. Wide local excision with clear margins is the mainstay of treatment. Adjuvant treatment like chemo radiation therapy is incorporated if nodal disease or positive margins are present. Recurrences are treated by re-excision followed by adjuvant radiation therapy. Adjuvant hormonal therapy depends on the receptor status of the disease. These tumors have a 50% recurrence rate and up to 60% of the time they metastasize to the brain, bone, lung, liver, mediastinum, or peritoneum in a two-year period. The overall five year survival rate is around 30%. Keeping in view the aggressive course of this disease, research based clinically evident new treatment strategies are the need of time to optimize overall survival and local disease control
