6^th World congress on Hospice and Palliative care May 13-14, 2019 Holiday Inn Singapore Atrium | Singapore

Biography:

Nitosh Kumar Brahma a life Fellow of The Institution of Engineers, India. He is actively engaged as Convener of WBSC/IEI, Chemical Engineering Division and as Visiting Professor of Institute of Genetic Engineering (IGE) Badu, Madhamgram. He completed his double Graduation with Distinction; BSc ÇU, B Tech, M Tech, TUB and Doctoral work in Max-Planck Germany 1968-1986. He published more than 100 articles related to Genetic Engineering, Chemical and Bio-Chemical Process Technology. He is the author of three books entitled Introduction to Chemical Science and Engineering, Molecular and Engineering Concepts of Microbiology and Bacterial adherence.

Abstract:

Causing cancer and its remedy in presence of microbes has been reported. Human healthy body contains10 trillion good immunological active cells and 100 trillion gut microbes. They are managing the metabolic and defense mechanisms. Symbiotically and infectiously microbes of a human body are managing the immunological tolerances. A tumor cell is differentiated by benign and malignancies (metastases). The disorders if caused by genetic mutations caused due to hereditary and environmental effects, may initiate cancer growth. Environmental factors are characterized by sudden effects of radiations and chemical reactions. A galaxy is conceptualized by gathering of millions of milk ways with trillions of planetary systems, symbolized the unending concepts of galaxy by Stephan Hawkins Black Hole and Einstein’s Relativity and E=mc2 relations. Similarly, the 100 trillion bacterial cells in a healthy body increased trillion-time possibilities to generate a cancer cell and its settlement on a surface of epithelial cells and are not destroyed by macrophage. In a healthy body.106 x103 x103 x10/106 x106 x102 =1/10=0.1=10% possibilities may initiate a generation of a cancer cell, due to inactivity of good lymphocytes and the generation of pathogenic microbes, prone to adhere and proliferate on thin epithelial cell liberates exo- and endo- toxins to destroy immune resistance. A cancer cell is adherence prone toxin liberating multidirectional cellular proliferation. Chemo- and radiotherapy are approached for treatments and need target-oriented drug delivery. Due to chemo, the tolerance factor and the immunological responses are also reduced, subsequently the existing of 1014 bacterial cells Camouflaging them as good microbes may change rapidly by genetic transformation to pathogen, opportunistic infections, initiate cancer patients towards fatal death by multiorgan failures. We are all generating cancer cells, continuously and are being destroyed by our immune system. In case of immune deficiencies this process could be stopped and could generate metastases. Louise Pasture, unpredictable power of microbes is well established in case of AIDS, for T-cell damage and aberration of chromosome 17 in case of Leukemia symbolize the shifting of immunological tolerance towards immune deficiencies and suppressions. During antibiotic and chemotherapy, antibiotic resistant as caused by transposable elements may lead to resistant bacterial proliferation and the damage of salt Na+, K+ balance. Lung, colon and pancreas, are those sustainable organs. So bidirectional chemotherapy of BNT, genetically engineered hybrid Escherichia coli could be appropriate to activate cytokine and macrophages and are characterized by the binding power of [Ab]+[Ag]→[AbAg]→immune complex. Cancer causing bacterial involvements varied by groups A, B and C and their probabilistic influence on organ specific cancer

Biography:

Rajesh Ravindran Nair is working at Cedar Hospital, India.

Abstract:

Artificial intelligence (AI) is a term for simulated intelligence in machines. These machines are programmed to "think" like a human and mimic the way a person act. The goals of artificial intelligence include learning, reasoning and perception and machines are wired using a cross-disciplinary approach based in mathematics, computer science, linguistics, psychology and more. Since its beginning, artificial intelligence has come under scrutiny from scientists and the public alike. One common theme is the idea that machines will become so highly developed that humans will not be able to keep up and they will take off on their own, redesigning themselves at an exponential rate. Another is that machines can hack into people's privacy and even be weaponized. Other arguments debate the ethics of artificial intelligence and whether or not intelligent systems such as robots should be treated with the same rights as humans. Artificial intelligence (AI) has been springing up in hospitals and clinics around the world in both research and direct patient care settings, with machine learning being used to predict patient outcomes, diagnose diseases, and suggest treatments. In the field of oncology, emerging AI technologies can detect tumors, diagnose cancers, and even generate chemotherapy treatment recommendations that adjust in real time based on patient responses. Google's AI algorithm can detect cancer metastases with 92% accuracy. Google's AI software encompasses a variety of healthcare functions, from predicting the amount of time a patient will spend in the hospital to their probability of being readmitted, and even assessing their risk for death. In addition to rapidly sifting through extensive medical records to assess these metrics, Google's AI has a variety of pathologic functions. Detecting diabetic eye disease, expanding genomic research, and using digital pathology for cancer detection are among the most prominent applications. Google's AI cancer detection capabilities were published in a paper titled "Detecting Cancer Metastases on Gigapixel Pathology Images.” A convolutional neural network, a method that involves computers making predictions based on recognizing visual patterns, was used to detect tumors as small as 100 × 100 pixels, with an accuracy of 92.4%. This is compared with the previous most accurate AI method, which had a tumor detection accuracy of 82.7%, whereas pathologists conducting their own manual search had an accuracy of 73.2%. Models are trained through generating heat maps that display the probability of tumor locations, with the maximum value representing the most probable tumor location. This method reduces the false-negative rate of tumor detection by 25% compared with pathologists and by 50% compared with the previous best AI method. Most errors made by Google's AI in tumor detection were related to the method of tissue preparation, primarily out-of-focus slides of tissues, which could be mitigated through more comprehensive labels for varying tissue types and improved scanning quality. Although Google's AI has the potential to improve the accuracy of cancer detection, further improvements in the technology are necessary in order to ensure that it is equipped for larger data sets.

Biography:

Guillaume Pollet is a Specialized Breast Cancer Surgeon with Expertise in Oncoplasty and Global Care (Oncofertility) and Former G&O. His professional activity disrupts the conventional treatment after being educated in the Institut Curie, Paris, one of the most prestigious, innovative and precursor Cancer Center in the world. He is currently an Executive MBA at INSEAD Business School, Singapore.

Abstract:

Surgical treatment is part of the gold standard for early breast cancer, but sequelae may be associated (30% of cases), with negative impact on social, physical, personal and sexual life. Supportive care and awareness of Quality of Life (QOL) have modified the conventional care. The emergence and generalization of new techniques and technologies go in that direction. Methodology includes day surgery under general anesthesia, percutaneous without incision, iterative procedures following the volume targeted association of liposuccion-fat treatment and reinjection (fat grafting). The direct benefit is a volume gain; the indirect benefits are tissue rejuvenation with new vascularization, innervation and a better trophicity. The indications are for cosmetic sequelae and breast reconstruction (exclusive or combined). Beyond the former description, the Pros go for a low invasive surgery (low risk) with the benefit of liposuccion and an increase in mammogram transparency. On the other side, a lack of consistency in the results, the side effect of liposuccion (waves), the fear about stem cells and growth factors and benign modification in mammograms (calcifications, fat cysts). Results are mostly sustainable, and the main effect is the change in mentalities: cancer patients transform into aesthetic patients, without sickness. The impact is highly positive. It is concluded that the controlled and risk-free technique, the consistency of the results depends on the patient (comorbidities, past tarts, compliance, the experiment of the surgeon, learning curve, choice of the technic and devices used). Prediction of results using 3D is possible but not yet in reconstruction. The holistic allows strong relationship, confidence, trust and early adoption of the protocols proposed to the patient. Tailor-made treatment is a motto that should not be ignored, so as not to forget the main objective to treat a patient and not just a disease.

Biography:

Hemish Kania is working as surgical Oncology Fellow at Dr. B. Borooah Cancer Institute, India. 

Abstract:

Introduction & Aim: Esophageal carcinoma is a multifaceted and complex disease of rapidly rising incidence that exerts an increasing social and financial burden on global healthcare systems. Esophagogastrectomy is the standard treatment for esophageal carcinoma and end-stage benign esophageal disease; however, the techniques of esophagogastric anastomosis after esophagectomy are complex and associated with postoperative complications, such as anastomotic leakage and stricture.

Methods: All patients who underwent esophagectomy with cervical esophagogastric anastomosis at a single academic center from 2013 to 2018 were included in the study. Both early and late complications were analyzed.

Results: 60 patients underwent resection for carcinoma of the esophagus and gastroesophageal junction. Of these 45 patients had esophagectomy with cervical esophagogastric anastomosis. Hand sewn and 15 patients underwent a linear stapled anastomosis Both groups were comparable with respect to preoperative characteristics. There was no difference in T and N stage of the disease. There was statistically significant difference in the mean anastomotic time(34.3 min in hand sewn group v/s 15.4 min in linear stapled group, p< 0.001), anastomotic leak (6 major leak and two minor leak in hand sewn group v/s 0 leaks in linear stapled), anastomotic stricture (8 in hand sewn group v/s 1 in linear stapled group). Similarly there was significant difference in the mean operative time, mean ICU stay ,mean hospital stay, ICD removal time, time of ambulation of oral feeds and time of ambulation of patients in linear stapled anastomosis compared to hand sewn anastomosis.

Conclusion: LS anastomotic technique for esophagogastric anastomoses in esophagectomy for cancer indicates that the new technique lowers anastomotic leakage and stricture rates compared to traditionally used HS techniques. Furthermore, the application of the LS technique is usually easy and standardized such that the incidence of technical errors is minimized. Use of staplers decreased the mean anastomotic time. The incidence of anastomotic leakage and stricture decreased which indirectly reduced the mean ICU stay, hospital stay and early supplementation of feeding to the patient which decreased the overall morbidity to the patient. The use of stapler however has shown no decrease or increase blood loss and surgical time, but decreased the anastomotic, pulmonary complications and mortality. The linear-stapled esophagogastric anastomosis is a safe and effective anastomotic technique, which can decrease the rate of leak, postoperative dysphagia. In contrast, the HS method requires surgical expertise and might not be practical everywhere; therefore, we should preferentially use LS over the HS method.

Biography:

Hemish Kania is working as surgical Oncology Fellow at Dr. B. Borooah Cancer Institute, India. 

Abstract:

Introduction & Aim: Esophageal carcinoma is a multifaceted and complex disease of rapidly rising incidence that exerts an increasing social and financial burden on global healthcare systems. Esophagogastrectomy is the standard treatment for esophageal carcinoma and end-stage benign esophageal disease; however, the techniques of esophagogastric anastomosis after esophagectomy are complex and associated with postoperative complications, such as anastomotic leakage and stricture.

Methods: All patients who underwent esophagectomy with cervical esophagogastric anastomosis at a single academic center from 2013 to 2018 were included in the study. Both early and late complications were analyzed.

Results: 60 patients underwent resection for carcinoma of the esophagus and gastroesophageal junction. Of these 45 patients had esophagectomy with cervical esophagogastric anastomosis. Hand sewn and 15 patients underwent a linear stapled anastomosis Both groups were comparable with respect to preoperative characteristics. There was no difference in T and N stage of the disease. There was statistically significant difference in the mean anastomotic time(34.3 min in hand sewn group v/s 15.4 min in linear stapled group, p< 0.001), anastomotic leak (6 major leak and two minor leak in hand sewn group v/s 0 leaks in linear stapled), anastomotic stricture (8 in hand sewn group v/s 1 in linear stapled group). Similarly there was significant difference in the mean operative time, mean ICU stay ,mean hospital stay, ICD removal time, time of ambulation of oral feeds and time of ambulation of patients in linear stapled anastomosis compared to hand sewn anastomosis.

Conclusion: LS anastomotic technique for esophagogastric anastomoses in esophagectomy for cancer indicates that the new technique lowers anastomotic leakage and stricture rates compared to traditionally used HS techniques. Furthermore, the application of the LS technique is usually easy and standardized such that the incidence of technical errors is minimized. Use of staplers decreased the mean anastomotic time. The incidence of anastomotic leakage and stricture decreased which indirectly reduced the mean ICU stay, hospital stay and early supplementation of feeding to the patient which decreased the overall morbidity to the patient. The use of stapler however has shown no decrease or increase blood loss and surgical time, but decreased the anastomotic, pulmonary complications and mortality. The linear-stapled esophagogastric anastomosis is a safe and effective anastomotic technique, which can decrease the rate of leak, postoperative dysphagia. In contrast, the HS method requires surgical expertise and might not be practical everywhere; therefore, we should preferentially use LS over the HS method.

Biography:

Aalapti Singh is currently pursuing Doctoral Research in the area of Psycho-Oncology in India. Her work persistently focuses on de-stigmatization and awareness creation about cancer and its treatment. She is interested in the areas of distress screening and management among oncology staff to help reduce burnout.

Abstract:

Cancer continues to be a majorly significant threat to our society despite advancements in its diagnosis and treatment. It is the second largest cause for mortality around the world after cardiovascular diseases. Cancer patients have to cope with a great deal of distress. Individuals facing a possible diagnosis of cancer are confronted with multiple physical, psychological and educational challenges. A diagnosis of cancer increases susceptibility to stress; indeed, cancer patients are at high risk for a variety of emotional disorders including anxiety, traumatic stress and depression. Patients’ stress can be amplified by long waiting room times, lack of information, poor communication between clinic staff and patients and inadequate psychosocial care. This calls for an immediate need to begin screening of distress in cancer patients. Examination of distress not only helps in capturing it’s prevalence but also guides in identifying the common areas of distress among patients, as well as relevant solutions to their problems. Most importantly, screening of distress alone is not solely useful in itself. After screening, patients must be given adequate interventions and be followed up regularly to monitor changes in their levels of distress over time. There are several tools available for screening of distress in cancer patients. Some are traditional and most commonly used, as well as, recently, experts through research have come up with cancer-tailored tools for examination of distress. The long established tools include- DASS (42), DASS (21), ESAS, HADS, Beck’s Depression Inventory (BDI) and many more. On the other hand, we now have tools more suited towards cancer patients’ interests such as the National Comprehensive Cancer Network Distress Thermometer (NCCN-DT), Emotional Thermometer (ET), Mental Adjustment to Cancer (MAC) scale and so on. This study encompasses the silent features of each of these tools, methodology of use and application in daily routine

Biography:

Aalapti Singh is currently pursuing Doctoral Research in the area of Psycho-Oncology in India. Her work persistently focuses on de-stigmatization and awareness creation about cancer and its treatment. She is interested in the areas of distress screening and management among oncology staff to help reduce burnout.

Abstract:

Cancer continues to be a majorly significant threat to our society despite advancements in its diagnosis and treatment. It is the second largest cause for mortality around the world after cardiovascular diseases. Cancer patients have to cope with a great deal of distress. Individuals facing a possible diagnosis of cancer are confronted with multiple physical, psychological and educational challenges. A diagnosis of cancer increases susceptibility to stress; indeed, cancer patients are at high risk for a variety of emotional disorders including anxiety, traumatic stress and depression. Patients’ stress can be amplified by long waiting room times, lack of information, poor communication between clinic staff and patients and inadequate psychosocial care. This calls for an immediate need to begin screening of distress in cancer patients. Examination of distress not only helps in capturing it’s prevalence but also guides in identifying the common areas of distress among patients, as well as relevant solutions to their problems. Most importantly, screening of distress alone is not solely useful in itself. After screening, patients must be given adequate interventions and be followed up regularly to monitor changes in their levels of distress over time. There are several tools available for screening of distress in cancer patients. Some are traditional and most commonly used, as well as, recently, experts through research have come up with cancer-tailored tools for examination of distress. The long established tools include- DASS (42), DASS (21), ESAS, HADS, Beck’s Depression Inventory (BDI) and many more. On the other hand, we now have tools more suited towards cancer patients’ interests such as the National Comprehensive Cancer Network Distress Thermometer (NCCN-DT), Emotional Thermometer (ET), Mental Adjustment to Cancer (MAC) scale and so on. This study encompasses the silent features of each of these tools, methodology of use and application in daily routine

Biography:

Amabelle Trina Gerona is working as Medical Oncology Fellow at St. Luke’s Medical Center, Philippines

Abstract:

Introduction & Aim: Sleep disturbances are highly prevalent in cancer patients and may be attributable to factors including pain, treatment side effects and psychological factors. However, the relationship between sleep and cancer is bidirectional. There is substantial evidence that sleep disturbance is associated with many aspects of cancer treatment, morbidity, mortality and quality of life. This study evaluated sleep quality in adult Filipinos with cancer and determined the association of demographic characteristics and clinical features to sleep quality.

Methods: This was a cross-sectional surveillance study conducted among adult Filipinos with cancer seen at the Ambulatory Care Unit of a tertiary hospital. Questionnaires were answered to assess subjective sleep quality, pain score and quality of life. Frequency and percentages were determined. Determination of factors affecting sleep quality was analyzed using univariate and multivariate statistics.

Results: 406 cancer patients studied, 80% were women and the mean age was 53 years old. Majority (62%) had breast cancer. Seventy-nine percent (79%) of the patients had a PSQI score of 5 or greater, indicating poor sleep quality. Sleep among participants was characterized by prolonged time to fall asleep and shortened sleep duration. Majority reported some degree of daytime dysfunction due to poor sleep. Age, gender and marital status did not appear to affect the quality of sleep. Among disease-related factors, presence of more advanced disease, increasing pain severity and treatment with chemotherapy and/or radiotherapy were demonstrated to lead to poorer sleep quality. Surprisingly, even patients who were not receiving any active therapies (on-going surveillance) complained of sleep disturbance. Upon further investigation, poor sleep quality was shown to predict a worse quality of life among the study participants.

Conclusion: Overall, the quality of sleep among adult Filipinos with cancer is significantly impaired. In particular, presence of more advanced disease, treatment with chemotherapy and radiotherapy and moderate to severe pain significantly increase the risk of having poor sleep. In turn, disturbed sleep predicted a poorer quality of life. These findings support the need to include assessment of sleep quality for a more holistic approach to cancer care.

Biography:

Shelton Tacang is a graduate of BS Nursing and has completed his medical degree from the Davao Medical School Foundation, Philippines. He is currently a Senior Resident of the Department of Nuclear Medicine at Jose R. Reyes Memorial Medical Center.

Abstract:

Background: Hyperthyroidism does not safeguard individuals from developing thyroid cancer. Papillary thyroid microcarcinoma, not withstanding its torpid course and low risk, classification has a propensity to induce significant morbidity despite radioactive iodine treatment.

Clinical Case: We present the unusual case of a 37-year old, Filipino male who demonstrated typical signs and symptoms of toxic Multinodular Goiter (TMG) including anterior neck mass, tremors, weight loss, excessive sweating, palpitations, easy fatigability and bilateral proptosis. The patient upon follow up was found to have agranulocytosis attributed to being on anti-thyroid medication for two years. The patient was then subjected to total thyroidectomy with a histopathology report showing colloid goiter with concomitant papillary thyroid microcarcinoma (0.9 cm in widest diameter). Initial Radioactive Iodine (RAI) therapy was initiated following surgery and subsequent 131I Whole Body Survey (WBS 131I) a year after, showing a negative result; however, after two months of WBS 131I, there was locoregional recurrence detected by neck ultrasound and CT scan and eventually confirmed on lymph node biopsy after Modified Radical Neck Dissection (MRND). In an attempt to ablate the probable micrometastases, a second RAI therapy with a higher dose was administered and subsequent post-therapy scan revealed recurrence of cancer on the thyroid bed and distant metastasis on the right lower quadrant of the abdomen. Currently, the patient is on suppression therapy and constantly monitored for progression of the disease.

Conclusion: Even when aided with strict protocols, clinicians must recognize that guidelines are not surrogate to clinical judgment and that prompt institution of treatment is critical to circumvent potential pitfalls. This case further illustrates the avenue of championing the use of Radioactive Iodine (RAI) therapy just as in the low risk stratification.

Biography:

Michael Ian Rothenberg, Ph.D, LCSW is a Board Certified Clinical Sexologist, Certified Sex Therapist, Psychotherapist and the Founder and Clinical Director of the Center for Counseling and Sexual Health of Winter Park, Florida. As a sexuality educator, Dr. Rothenberg has held a long term faculty position, in Orlando, Florida, at the University of Central Florida (UCF), School of Social Work, where he developed the curriculum in Human Sexuality and taught courses on human sexuality and sexual behavior. Dr. Rothenberg, a former Hospice Social Worker, credited with developing the Sexological sub-field of Thanatological Clinical Sexology (the study of sexuality, death and dying), has published and been quoted in numerous articles relating to human sexuality and lectures, both nationally and internationally, at universities, hospitals and hospices, on topics related to human sexuality, sexual behavior and sexual health. 

Abstract:

Introduction: Human beings are sexual beings from birth until death. This presentation explores sex and sexuality at the end of life and the importance of establishing a dialogue between patients and clinicians as an integral part of end of life care. 
Objectives: To identify and understand barriers and challenges in discussing sex and sexuality at the end of life and establish a methodology for better communication.
Methods: A qualitative methodological approach was utilized and the resultant data will be presented as case histories gathered in the context of clinical sexology consultations.
Results: As discomfort and physical pain, at the end of life, can be controlled through the proper use of medication, psychological and emotional distress, directly and indirectly, related to sex and sexuality, can be ameliorated through specific conversation and dialogue. 
Conclusion: This presentation hopes to raise important questions about the palliative care professional's responsibility regarding the understanding of sexuality for individuals in the end of life stage as well as illustrate how to begin to engage in needed discussions on sex and sexuality.

Biography:

SUPATTRA has completed her Bachelor of Nursing Science Program at the age of 24 years from Thai Red Cross College of Nursing affiliated Institutes Chulalongkorn University. She is the registered nurse in IPD ward, Division of Therapeutic Radiation and Oncology, Department of Radiology, King Chulalongkorn Memorial Hospital, Thailand

Abstract:

Cancer is the leading cause of mortality in Thailand. The estimated numbers of cancer deaths is 60,000 per year, since 2008 and trends  creasing in each year (Ministry of public Health, Thailand 2016)
The mortality of cancer patients with palliative care in IPD ward of Therapeutic Radiation Oncology unit King Chulalongkorn Memorial Hospital was 54 cases in 2016-2017. Therewere 59.26 percent  of all 32 cases prepared for good death process in the other hand 22 cases were incompleted process due to family understanding and co-operation, which translates to 40.74 percent  of all . The process of preparing for good death includes the palliative performance scale assessment, especially in patients with PPS ≤ 30% ,Nursing process , Symptoms management ,spiritual support ,family conference and nursing records. Therefore our performance Improvement group decided to develop the guide line for improvement the preparation of good death which consists of the process as following were created evaluation form for assessment of preparing for good death in end of life cancer patients with palliative performance scale ≤ 30%
 We implemented the guideline in 37 cases with the end of life cancer patients during march - June 2017
Tthe results revealed that 4 patients were incompleted the process, 33 case were completed preparation of good death, which person died on his own terms ,free from suffering in a supported of family and humanized care setting. which translates to 89.19 percent of all patients. 

Biography:

Dr. Hiromichi Matsuoka has expertise in evaluation and passion in improving the health and wellbeing. He has built his backgrounds as an anesthesiologist, physician of psychosomatic medicine, and palliative care doctors after years of experience in research, evaluation, and teaching both in hospitals and education institutions. Now he is in University of Technology Sydney and proceeding his research in patients with cancer pain

Abstract:

Background: Management of cancer patients suffering from neuropathic pain refractory to opioids and gabapentinoids remains an important challenge. Duloxetine is one of the choices after first-line treatment fails. The efficacy of duloxetine has been reported in non-cancer patients and in chemotherapy-induced polyneuropathy, but no randomized clinical trials have examined its effects on neuropathic cancer pain refractory to first-line treatment.
Methods: A multi-institutional, prospective, randomised, double-blind, placebo-controlled, two-parallel trial is planned. The inclusion criteria are adult cancer patients suffering from neuropathic pain refractory to opioids and gabapentinoids, patients with a numerical rating scale (NRS) pain score of 4 or higher, and patients with a total Hospital Anxiety and Depression Scale (HADS) score of less than 20. Patients with chemotherapy-induced peripheral neuropathy are excluded. The study will take place at 14 sites across Japan. Participants will be randomized (1:1 allocation ratio) to a duloxetine intervention group or a placebo control group. Evaluations will be made at baseline (T0 randomization), day 0 (T1), day 3 (T2), and day 10 (T3). The primary endpoint is defined as the difference in NRS score for pain intensity (average over the previous 24 hours) at T3 between the duloxetine and placebo groups. The enrolment started in July 2015. At the time of manuscript submission (November 2017), more than 95% of patients have participated. We thus expect to complete the recruitment by December 2017.
Discussion: Treatment of neuropathic pain in cancer patients represents an area of high unmet medical need. To our knowledge, there has been no randomised study of the analgesic efficacy of duloxetine in patients with neuropathic cancer pain refractory to opioids and gabapentinoids. This study of duloxetine in neuropathic pain refractory to opioids and gabapentinoids will be the first registered trial of therapy for this condition.

Biography:

Abstract:

Background: - In GUH(Gondar University Hospital) large number of surgery is done annually, among these most are done under general anesthesia. Post-operative delayed awakening is one problem of patients who have surgery under general anesthesia. Most commonly, delayed awakening is due to drugs effects persistence, duration and the type of anesthetic given, potentiating by other drugs, low immunity, prolonged NM blockade, metabolic and endocrinal disorders, electrolyte and acid-base disorders and hypothermia may cause delayed emergence from anesthesia.
Objective:-The objective of this research is to determine the prevalence and associated risk factors of delayed awakening in patients who will be operated under general anesthesia in GUH.
Method:-This research was conducted by a cross sectional method of study design by observing and interviewing after GA. Data was collected by self-administered structured questionnaire. The data was collected by the investigators to decrease the none response rate. The data was cleaned, edited, checked for completeness and entered in to SPSS version 20 for analysis. The result was presented with tables and graphs.
Result: A total of 151 patients were involved with completed data for the study. Out of these majority of them 93 (61.6 %) are males. Of these 14(9.3%) were 14 years and below, 68(45.0%) were between 25-44 years and 11(7.3%) were 65 years and above. Almost around (94.7 %) had normal BMI. From those the overall prevalence of delayed awakening from general anesthesia is 8(5.3 %). From those three fourth of them were in age between 25-64 years and only 25% were above 64 years. Seven of the study participants had 30 minutes to 1 hr. delay of awakening from anesthesia. But only one study subject had more than 1 hr. delay of awakening.
Conclusion: The overall prevalence of delayed awakening from general anesthesia in the current study is 5.3 %. Age, BMI, abdominal surgical procedure, surgical duration, taking opioid medication, anesthetic agents, hypothermia and coexisting diseases seems like a risk factors for delayed awakening from general anesthesia.

Biography:

Dr fatungase oluwabunmi motunrayo is a consultant Anesthetist of over 10 years experience as a fellow of the National Postgraduate Medical College(FMCA) , Nigeria. She is a fellow of the West African College of surgeons (FWACS) and a Fellow of the International College of Surgeons (FICS). She is a senior lecturer at the Obafemi Awolowo College of Health Sciences , Ogun State Nigeria. She is the current Head, department of Anaesthesia and intensive care and the coordinator of the palliative care unit. Her area of interest are regional anesthesia, pediatric anesthesia , pain management and palliative care.

Abstract:

Palliative care has become an area of special expertise within medicine, surgery, nursing, social work, pharmacy, chaplaincy and other disciplines. However, advances in palliative care have not yet been integrated effectively into standard clinical practice. There is an increasing acknowledgment of the inadequacies in the care of dying persons and their families. The goal of improving the quality of palliative care services is a challenge to the very integrity of health care professionals and the health care system.
In our health care facility however, Chronic Pain and Palliative Unit is a part of Anaesthesia and Intensive Care department established May 2016. The modality of management of palliative care patients in our health facility is a comprehensive approach where different specialist work together as a team in overall patient care.
The aim of this study is to provide a pragmatic solution to none or late referral (of patients that may benefit from palliative care) from other departments. Howbeit to establish the level of awareness, knowledge and attitude of the tertiary institution staff members as regards palliative care services  rendered in the health care facility. It is hoped that this survey will make a significant contribution to improving the plight of dying patients and their families in our health facility
Materials and Method:
This was a descriptive study based on the assessment of the level of awareness, knowledge and attitude of different cadre of staff of the state tertiary facility
The study was carried out for a period of six months February -July 2018 (both data collection and analysis).
Data was collected using self-administered questionnaires. Ethical considerations were ensured. .
Data analysis was done with Statistical Package for Social Sciences (SPSS) version 20 Chicago IL (U.S.A) and results obtained were presented in prose, tables and figures.
Results:
A total of four hundred questionnaires were administered during the period of study. Ninety-two were returned unfilled, while a total of three hundred and eight agreed to participate in the study. The study showed that majority of the participants have good knowledge about chronic pain and palliative care. Majority (213, 69.16 %) of the participants have heard about the term “Hospice and Palliative Care before. Majority (124, 58.21%) heard about the term at the inauguration ceremony of the Unit, meanwhile others came across the term through social media [Television / Radio / Internet (34, 15.96%)], information materials (20, 9.39%), Cancer screening facility (19,8.92%), and from family members (16, 7.52%).
Furthermore, majority (274 89.0%) of the participants were willing to support the successful running of Palliative Care services by giving physical (123, 39.94%), emotional (79 ,25.65%) or spiritual support (50, 16.23%).  Only few were willing to support financially (31, 10.06 %).
Many (283, 91.88%) of them would prefer to refer dying/terminally ill patients to the hospital for care till death comes.
Conclusion:
Despite the fact that larger proportions of the participants have appreciable level of knowledge and awareness about palliative care services and also willing to support the successful running of services, majority still prefer to refer mainly dying/terminally ill patients for the services. 

Biography:

Dr Michaela Bercovich is the director of the Oncological Hospice in Sheba hospital, Tel Hashomer, Israel and a lecturer at Tel Aviv University Sackler School of Medicine. Dr. Bercovitch was born in Romania, Bucharest, where she graduated from medical school as MD in Pediatrics. In 1987 she emigrated to Israel and after two years training in Internal Medicine and Geriatrics she continued her medical practice in the Oncological Hospice. In 1998 she initiated a 2 year comprehensive postgraduate course of Palliative Medicine for doctors. She is involved in the education of medical students, nurses and doctors across Israel.Her research fields include pain control, impact of high dose opioids on patients’ survival, development of clinical auditing tools and a hospice oriented clinical database. She is the author of the chapter discussing treatment of pain with TENS (Oxford Textbook of Palliative Medicine), and other chapters addressing euthanasia, non-pharmacological treatments for chronic pain, the role of the physician near death, and the effect of patient-setting on the work of the team.Dr. Bercovitch was a member of the Directory of European Association for Palliative Care (2007-2016); Served as the Chairperson of Israeli Palliative Medicine Society (2002-2016) focusing on the recognition of Palliative Medicine as a sub-specialty and its inclusion as a government-funded treatment. Along the years she has actively participated in the conception and promulgation of the first Israeli law regarding the dying patient.

Abstract:

Since ancient times, the obligation of the physician was to relieve suffering. Despite this fact, little attention was given to the problem of suffering and dying in medical education, research or practice. In the 21^st Century life expectancy is increasing, more people live with serious effects of chronic illnesses, and they must deal with many complex issues: relief of symptoms, effect of the illness on roles and relationships, restoring or maintaining quality of life. Each of these issues creates expectations, needs, hopes and fears, which must be addressed in order for the ill person to adapt and continue living, and presents a set of public health challenges requiring the attention of policy makers. Traditionally end of life care in the form of Palliative care has been offered mostly to cancer patients. For some years this kind of care has been offered for a wider range of serious illnesses, and was integrated more broadly across care services. Hospice was created as "a coordinated program providing palliative care to terminally ill patients and supportive services to patients, families, 24 hours a day seven days a week. Services are comprehensive, case managed based on physical ,social , spiritual and emotional needs during the dying process by medically directed interdisciplinary team consisting of patients, families, health care professionals and volunteers"(WHO). Hospice treatment is the most personalized way to care, by recognizing a patient not only like a body part, but as a unique being, with soul and psyche. Each patient means a new book to be read and understood by the team. Accordingly, Hospice care is flexible, and aggressive palliative interventions have to answer some questions: what is the goal of intervention?, does the intervention has a chance of high efficacy?, what is the impact on the patient (side effects, complications, discomfort)? what is the life expectancy?, and what does the patient want? Hospice program is limited for those patients diagnosed with terminal illness with a limited life spam and it is not a must in health care system. Hospice is a choice and any individual has the right, in conformity with the law, to decide how to be treated when facing a terminal illness. Those patients refusing to accept the imminence of death and want to continue to fight they are not eligible for hospice. Those prefer to concentrate on living as comfortably as they can until their last day prefer the hospice care.