Displaying publications 61 - 80 of 119 in total

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  1. Biswal BM, Zakaria A, Baba AA, Ja'afar R
    Med J Malaysia, 2004 Mar;59(1):78-83.
    PMID: 15535340
    We conducted a questionnaire survey among 261 year-4 and year-5 medical students containing 27 questions related to cancer, radiotherapy, general oncology and palliative care to assess their knowledge, understanding, and exposure to oncology and palliative care in our medical school. Out of 261 students, 139 students returned their questionnaire for analysis. Twenty nine percent (29%) of the students had rarely visited the Radiotherapy and Oncology unit. There were profound deficiencies in the basic knowledge of cancer (46%), principles of radiotherapy treatment (59%), palliative care (64%), and cancer prevention (48%). They reported no specific teaching about early detection of common malignancies and cancer prevention. The main input of instruction about cancer came from surgery (46%) and pathology (28%) teachings. This study revealed that there is deficiency in cancer education in the undergraduate teaching program in our institution.
    Matched MeSH terms: Palliative Care*
  2. Beng TS, Guan NC, Seang LK, Pathmawathi S, Ming MF, Jane LE, et al.
    Am J Hosp Palliat Care, 2013 Aug;30(5):473-89.
    PMID: 23341445 DOI: 10.1177/1049909112473633
    A qualitative study was conducted with semi-structured interviews to explore the experiences of suffering in 15 palliative care informal caregivers in University Malaya Medical Centre. The data were thematically analyzed. Seven basic themes were generated (1) empathic suffering, (2) anticipatory grief, (3) obsessive-compulsive suffering, (4) helpless-powerless suffering, (5) obligatory suffering, (6) impedimental suffering, and (7) repercussion suffering. A model of compassion suffering was conceptualized from the analysis. This model may serve as a guide in the assessment and management of suffering in palliative care informal caregivers.
    Matched MeSH terms: Palliative Care/psychology*
  3. Rai NP, Divakar DD, Al Kheraif AA, Ramakrishnaiah R, Mustafa SM, Durgesh BH, et al.
    Asian Pac J Cancer Prev, 2015;16(16):6919-22.
    PMID: 26514468
    BACKGROUND: The treatment selection for the oral squamous cell carcinoma remains controversial. Radiation therapy or surgical excision of the lesion can be applied as the sole treatment or it can be used in combination with other treatment modalities. Radiotherapy is considered to be the safest of all the treatment modalities and can be used in several situations for oral and oropharyngeal cancers. The aim of this study was to evaluate the survival outcome differences in patients treated with radical and palliative radiotherapy as the primary treatment modality.

    MATERIALS AND METHODS: The study included a total of 47 patients with oral cancer reporting to our hospital between years 2009 to 2010. The age group for the selected patients was more than 65 years, treated with radical and palliative radiotherapy with no prior surgical interventions. Patients were evaluated till Dec 2013 for overall survival time.

    RESULTS: Twenty nine patients were treated with radical radiotherapy as main stay of treatment, out of which 21 died during the follow up time with median survival of 352 ± 281.7 days with 8 patients alive. All the 16 patients were dead who received palliative radiotherapy with a median survival time of 112 ± 144.0 days.

    CONCLUSIONS: This retrospective study showed improved overall survival time, loco regional control rates and reduced morbidity in patients treated with radical radiotherapy when compared to patients treated with palliative radiotherapy.

    Matched MeSH terms: Palliative Care*
  4. Choy YC, Puvenesvari S, Samad S
    Med J Malaysia, 1998 Sep;53(3):277-9.
    PMID: 10968166
    Coeliac plexus block has been described more than seventy years ago and is widely used for chronic pain management in upper visceral malignancies. The technique described here is a posterior approach using CT scan guidance with absolute ethyl alcohol. A case illustration of a patient with carcinoma of pancreas managed with coeliac plexus block for pain control is presented.
    Matched MeSH terms: Palliative Care/methods*
  5. Khoo SB
    Med J Malaysia, 2002 Dec;57(4):408-17.
    PMID: 12733165
    The concept of Palliative Care is still quite new in Malaysia and there is a need to promote the awareness of its importance for patients with incurable and advanced illnesses, not only to the public but also to the nursing and medical professionals. These patients especially the poor ones very often have no one to turn to; they cannot afford to seek treatment from the private hospitals, they are turned away from acute General Hospitals and are told that there is nothing more to be done because their illnesses are no longer curable, they cannot pay for GPs to come to their homes, and there is difficulty in purchasing opiate drugs for pain relief. This is a retrospective observational study of the palliative care services we try to provide to those few patients referred to us. This study showed that out of the total of 156 patients, majority were Chinese, peak age between 50-59 years, referrals were mainly from the community and the Obstetrics + Gynaecology department, patients were referred rather late, 60% of patients died at home, most common malignancies being those of the breast, colorectal and cervix, common sites of metastases being the lungs, liver, bones, peritoneum and local infiltration, 87% of patients experienced pain, about 40% of patients were not fully aware of both diagnosis and prognosis, common drugs used being opiate analgesics followed by dexamethasone, H2 antagonist, antiemetics and NSAID.
    Matched MeSH terms: Palliative Care/statistics & numerical data*
  6. Sharma S, Mohamad NA, Monga D, Achana S
    Med J Malaysia, 1996 Dec;51(4):453-6.
    PMID: 10968033
    Three hundred and five primigravid women were interviewed at term to assess the acceptability of epidural during labour, and reasons for the decisions. Data was collected on a prestructured proforma which consisted of background information, socio-economic status, knowledge about epidural analgesia, source of information and reasons for choice. Of the 305 patients only 17.3% were willing to receive epidural analgesia. This group consisted of 56.6% non-Malay women. Those employed in professional or skilled jobs (56.6%) also readily consented for epidural. Nearly half the women willing for epidural had received college (tertiary) education (43.3%) and more than a quarter (26.4%) were over 30 years of age. The majority of those who were unwilling had no prior knowledge about the procedure, and refused either out of fear, ignorance, resistance from husbands, on religious grounds or following poor feedback from friends. In order to advocate epidural analgesia, knowledge has to be targeted to the relatively less educated, unemployed women, mainly through the media or personally in the antenatal clinic by doctors and nurses. Services have to be improved as substandard analgesia may send out wrong messages and actually do more harm than good.
    Matched MeSH terms: Palliative Care/methods*
  7. Vijayan R, Delilkan AE
    Med J Malaysia, 1994 Dec;49(4):385-400.
    PMID: 7545779
    An Acute Pain Service (APS) was started in University Hospital, Kuala Lumpur by the Department of Anaesthesiology in October 1992 for more effective control of postoperative pain. The main modalities of treatment included patient controlled analgesia (PCA) using morphine or pethidine with PCA devises, epidural opiate analgesia (EOA) using tramadol or fentanyl/bupivacaine mixture and subcutaneous administration of morphine or pethidine. Five hundred and fifty-one patients were managed in the first year, with an overall patient satisfaction score of 83%. The majority (98.5%) of them were after abdominal or major orthopaedic surgery. Eighty per cent of patients scored < 3 on the verbal numeric pain scale, where 0 is no pain and 10 is the worst imaginable pain, on the first postoperative day. Nausea and vomiting was an unpleasant side effect in 20% of patients.
    Matched MeSH terms: Palliative Care*
  8. H'ng MWC, Leow KS
    Med J Malaysia, 2019 08;74(4):352-354.
    PMID: 31424051
    The PleurX catheter was developed to facilitate long-term intermittent drainage of malignant pleural effusion or ascites. For palliation, it is important that the process of insertion is safe and that this catheter remains complicationfree so as to improve end-of-life quality. We show that this catheter can be safely inserted and discuss methods to reduce infection, which was the most common complication. Our article hopes to enlighten clinicians, patients and their caregivers of this device as a treatment option in palliative patients. Proper case selection and caregiver training are essential in ensuring a successful outcome.
    Matched MeSH terms: Palliative Care/methods*
  9. Cheong WL, Mohan D, Warren N, Reidpath DD
    Mult Scler Relat Disord, 2019 Oct;35:86-91.
    PMID: 31357123 DOI: 10.1016/j.msard.2019.07.009
    BACKGROUND: Despite the global consensus on the importance of palliative care for patients with multiple sclerosis (MS), many patients in developing countries do not receive palliative care. Improving access to palliative care for MS requires a contextual understanding of how palliative care is perceived by patients and health professionals, the existing care pathways, and barriers to the provision of palliative care.

    OBJECTIVE: This study aims to examine and contrast the perceptions of MS patients, neurologists, and palliative care physicians towards providing palliative care for patients with MS in Malaysia.

    METHODS: 12 MS patients, 5 neurologists, and 5 palliative care physicians participated in this qualitative study. Each participant took part in a semi-structured interview. The interviews were transcribed verbatim, and analysed using an iterative thematic analysis approach.

    RESULTS: Patients and neurologists mostly associated palliative care with the end-of-life and struggled to understand the need for palliative care in MS. Another barrier was the lack of understanding about the palliative care needs of MS patients. Palliative care physicians also identified the scarcity of resources and their lack of experience with MS as barriers. The current referral-based care pathway itself was found to be a barrier to the provision of palliative care.

    CONCLUSIONS: MS patients in Malaysia face several barriers in accessing palliative care. Overcoming these barriers will require improving the shared understanding of palliative care and its role in MS. The existing care pathway also needs to be reformed to ensure that it improves access to palliative care for MS patients.

    Matched MeSH terms: Palliative Care*
  10. Mohd Arif Atarhim, Nurul Asyiqin Ibrahim, Chong Zhi Yin, Santhna Letchmi Panduragan, Hamidah Hassan
    MyJurnal
    Introduction: Early integration in palliative care for patients with advanced cancer has been correlated with an improvement quality of life, relieved depression while having survival benefits. Negative perceptions towards pal- liative care or misconception about the idea of palliative care were reported as one of the causes for late referral by physicians. The aim of this study was to determine the knowledge and perception of palliative care among can- cer patients in a tertiary hospital. Methods: A cross-sectional survey with populations of 139 cancer patients was conducted using convenience sampling. Quantitative data were collected by a structured questionnaire. A total of 92 responses were obtained. Results: Most of the participants were female (66.3%), Malay (71.7%) and attended secondary school (56.5%). The mean age of participants was 56.13 (±12.61) years while the mean income was RM 1944.20 (±2472.70). Majority of the participants had breast cancer (37.0%), followed by colorectal cancer (32.6%). Many of them were in stage IV (42.4%), followed by stage III (25.0%).Most of the cancer patients had a high level of knowledge and positive perception towards palliative care. They agreed that psychological, social and spiritual issues are a part of palliative care which helped to manage pain and other symptoms. Besides, responses portrayed positive perceptions of palliative care through the aspect of emotional reactions, cognitive reactions and palliative care needs. Conclusions: The current study has demonstrated that cancer patients in the tertiary hospital had better knowledge and perceptions in palliative care. High knowledge level and positive perception towards palliative care might increase the acceptance and palliative care practiced.
    Matched MeSH terms: Palliative Care; Hospice and Palliative Care Nursing
  11. Chaudhuri KR, Rukavina K, McConvey V, Antonini A, Lorenzl S, Bhidayasiri R, et al.
    Expert Rev Neurother, 2021 06;21(6):615-623.
    PMID: 33905283 DOI: 10.1080/14737175.2021.1923480
    Introduction: Although in some countries, palliative care (PC) still remains poorly implemented, its importance throughout the course of Parkinson's disease (PD) is increasingly being acknowledged. With an emergence of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) pandemic, growing emphasis has been placed on the palliative needs of people with Parkinson's (PwP), particularly elderly, frail, and with comorbidities.Areas covered: The ongoing COVID-19 pandemic poses an enormous challenge on aspects of daily living in PwP and might interact negatively with a range of motor and non-motor symptoms (NMS), both directly and indirectly - as a consequence of pandemic-related social and health care restrictions. Here, the authors outline some of the motor and NMS relevant to PC, and propose a pragmatic and rapidly deployable, consensus-based PC approach for PwP during the ongoing COVID-19 pandemic, potentially relevant also for future pandemics.Expert opinion: The ongoing COVID-19 pandemic poses a considerable impact on PwP and their caregivers, ranging from mental health issues to worsening of physical symptoms - both in the short- and long-term, (Long-COVID) and calls for specific, personalized PC strategies relevant in a lockdown setting globally. Validated assessment tools should be applied remotely to flag up particular motor or NMS that require special attention, both in short- and long-term.
    Matched MeSH terms: Palliative Care*
  12. Lim RB
    Ther Adv Respir Dis, 2016 10;10(5):455-67.
    PMID: 27585597 DOI: 10.1177/1753465816660925
    Despite advances in the detection, pathological diagnosis and therapeutics of lung cancer, many patients still develop advanced, incurable and progressively fatal disease. As physicians, the duties to cure sometimes, relieve often and comfort always should be a constant reminder to us of the needs that must be met when caring for a patient with lung cancer. Four key areas of end-of-life care in advanced lung cancer begin with first recognizing 'when a patient is approaching the end of life'. The clinician should be able to recognize when the focus of care needs to shift from an aggressive life-sustaining approach to an approach that helps prepare and support a patient and family members through a period of progressive, inevitable decline. Once the needs are recognized, the second key area is appropriate communication, where the clinician should assist patients and family members in understanding where they are in the disease trajectory and what to expect. This involves developing rapport, breaking bad news, managing expectations and navigating care plans. Subsequently, the third key area is symptom management that focuses on the goals to first and foremost provide comfort and dignity. Symptoms that are common towards the end of life in lung cancer include pain, dyspnoea, delirium and respiratory secretions. Such symptoms need to be anticipated and addressed promptly with appropriate medications and explanations to the patient and family. Lastly, in order for physicians to provide quality end-of-life care, it is necessary to understand the ethical principles applied to end-of-life-care interventions. Misconceptions about euthanasia versus withholding or withdrawing life-sustaining treatments may lead to physician distress and inappropriate decision making.
    Matched MeSH terms: Palliative Care/methods*
  13. Yip CH
    J Surg Oncol, 2017 Apr;115(5):538-543.
    PMID: 28097656 DOI: 10.1002/jso.24560
    Metastatic breast cancer is an incurable disease. With improvement in systemic therapy, survival has improved over the past few years. Removing the primary tumor has shown improved survival in retrospective studies, but this may be due to selection bias. The first reported randomized controlled trial (RCT) from India showed no difference in survival with surgery. However another RCT from Turkey showed that a select group of patient with bone-only metastases have a survival benefit.
    Matched MeSH terms: Palliative Care*
  14. Beng TS, Ann YH, Guan NC, Chin LE, Loong LC, Ying NT, et al.
    J Palliat Med, 2017 08;20(8):869-874.
    PMID: 28410449 DOI: 10.1089/jpm.2016.0448
    BACKGROUND: Measuring suffering objectively presents a challenge because suffering is a unique and subjective experience. However, objective tools are of profound importance in the detection and management of suffering in clinical practice for optimal patient care.

    OBJECTIVE: The objective of the study is to assess the psychometric properties of the Suffering Pictogram, a new suffering assessment instrument on a population of palliative care patients.

    DESIGN AND SETTING: This is a validation study conducted at University of Malaya Medical Centre, Kuala Lumpur, Malaysia. Ninety one palliative care patients were recruited. Patients were interviewed with the Suffering Pictogram and FACIT-Sp.

    RESULTS: The median completion time for the Suffering Pictogram was five minutes. The Suffering Pictogram showed good internal consistency, with a Cronbach's alpha of 0.836. The total scores of the Suffering Pictogram correlated strongly and negatively with FACIT-Sp total score (Spearman's Rho = -0.625, p care. The instrument can be used as a screening tool to detect suffering directly.

    Matched MeSH terms: Palliative Care/methods*
  15. Chong LA, Chong PH, Chee J
    J Palliat Med, 2018 09;21(9):1242-1248.
    PMID: 29733235 DOI: 10.1089/jpm.2017.0626
    BACKGROUND: The provision of pediatric palliative care in Asia Pacific varies between countries and availability of essential medications for symptoms at the end of life in this region is unclear.

    OBJECTIVE: To determine medications available and used in the management of six symptoms at the end of life among pediatric palliative care practitioners in Asia Pacific. To identify alternative pharmacological strategies for these six symptoms if the oral route was no longer possible and injections are refused.

    DESIGN AND SETTING: An online survey of all Asia Pacific Hospice Palliative Care Network (APHN) members was carried out to identify medications used for six symptoms (pain, dyspnea, excessive respiratory secretions, nausea/vomiting, restlessness, seizures) in dying children. Two scenarios were of interest: (1) hours to days before death and (2) when injectables were declined or refused.

    RESULTS: There were 54 responses from 18 countries. Majority (63.0%) of respondents were hospital based. About half of all respondents were from specialist palliative care services and 55.6% were from high-income countries. All respondents had access to essential analgesics. Several perceived that there were no available drugs locally to treat the five other commonly encountered symptoms. There was a wide variation in preferred drugs for treating each symptom that went beyond differences in drug availability or formulations.

    CONCLUSION: Future studies are needed to explore barriers to medication access and possible knowledge gaps among service providers in the region, so that advocacy and education endeavors by the APHN may be optimized.

    Matched MeSH terms: Palliative Care/methods*
  16. Rehman R, Marhisham MC, Alwi M
    Future Cardiol, 2018 01;14(1):55-73.
    PMID: 29199861 DOI: 10.2217/fca-2017-0053
    Patent ductus arteriosus (PDA) stenting has gained acceptance for palliation in cyanotic congenital heart disease. The PDA in tetralogy of Fallot with pulmonary atresia (ToF-PA) arises, in the left aortic arch, from underneath the arch and connects to the proximal left pulmonary artery, often resulting in stenosis. The PDA is usually elongated and tortuous, making stent implantation challenging. Shorter duration of palliation, aggravation of branch pulmonary artery stenosis resulting in poor growth and difficulty at surgery makes ductal stenting controversial. Access via the carotid and axillary artery reduces complexity of the procedure and improves success, with recent data demonstrating good pulmonary artery growth. Advances in bioresorbable stents offer future promise and will likely resolve some controversies surrounding PDA stenting in ToF-PA.
    Matched MeSH terms: Palliative Care/methods*
  17. Distelhorst SR, Cleary JF, Ganz PA, Bese N, Camacho-Rodriguez R, Cardoso F, et al.
    Lancet Oncol, 2015 Mar;16(3):e137-47.
    PMID: 25752564 DOI: 10.1016/S1470-2045(14)70457-7
    Supportive care and palliative care are now recognised as critical components of global cancer control programmes. Many aspects of supportive and palliative care services are already available in some low-income and middle-income countries. Full integration of supportive and palliative care into breast cancer programmes requires a systematic, resource-stratified approach. The Breast Health Global Initiative convened three expert panels to develop resource allocation recommendations for supportive and palliative care programmes in low-income and middle-income countries. Each panel focused on a specific phase of breast cancer care: during treatment, after treatment with curative intent (survivorship), and after diagnosis with metastatic disease. The panel consensus statements were published in October, 2013. This Executive Summary combines the three panels' recommendations into a single comprehensive document covering breast cancer care from diagnosis through curative treatment into survivorship, and metastatic disease and end-of-life care. The recommendations cover physical symptom management, pain management, monitoring and documentation, psychosocial and spiritual aspects of care, health professional education, and patient, family, and caregiver education.
    Matched MeSH terms: Palliative Care/economics; Palliative Care/standards*
  18. Devi BC, Tang TS, Corbex M
    Ann Oncol, 2008 Dec;19(12):2061-6.
    PMID: 18641007 DOI: 10.1093/annonc/mdn422
    The provision of palliative care (PC) and opioids is difficult to ensure in remote areas in low- and middle-income countries. We describe here the set up of a home-care program in Sarawak (the Malaysian part of the Borneo Island), where half the population lives in villages that are difficult to access.
    Matched MeSH terms: Palliative Care/manpower; Palliative Care/organization & administration*
  19. Atieno OM, Opanga S, Martin A, Kurdi A, Godman B
    J Med Econ, 2018 Sep;21(9):878-887.
    PMID: 29860920 DOI: 10.1080/13696998.2018.1484372
    BACKGROUND: Currently the majority of cancer deaths occur in low- and middle-income countries, where there are appreciable funding concerns. In Kenya, most patients currently pay out of pocket for treatment, and those who are insured are generally not covered for the full costs of treatment. This places a considerable burden on households if family members develop cancer. However, the actual cost of cancer treatment in Kenya is unknown. Such an analysis is essential to better allocate resources as Kenya strives towards universal healthcare.

    OBJECTIVES: To evaluate the economic burden of treating cancer patients.

    METHOD: Descriptive cross-sectional cost of illness study in the leading teaching and referral hospital in Kenya, with data collected from the hospital files of sampled adult patients for treatment during 2016.

    RESULTS: In total, 412 patient files were reviewed, of which 63.4% (n = 261) were female and 36.6% (n = 151) male. The cost of cancer care is highly dependent on the modality. Most reviewed patients had surgery, chemotherapy and palliative care. The cost of cancer therapy varied with the type of cancer. Patients on chemotherapy alone cost an average of KES 138,207 (USD 1364.3); while those treated with surgery cost an average of KES 128,207 (1265.6), and those on radiotherapy KES 119,036 (1175.1). Some patients had a combination of all three, costing, on average, KES 333,462 (3291.8) per patient during the year.

    CONCLUSION: The cost of cancer treatment in Kenya depends on the type of cancer, the modality, cost of medicines and the type of inpatient admission. The greatest contributors are currently the cost of medicines and inpatient admissions. This pilot study can inform future initiatives among the government as well as private and public insurance companies to increase available resources, and better allocate available resources, to more effectively treat patients with cancer in Kenya. The authors will be monitoring developments and conducting further research.

    Matched MeSH terms: Palliative Care/economics; Palliative Care/methods
  20. Lim RBL
    J Pain Palliat Care Pharmacother, 2003;17(3-4):77-85; discussion 87-9.
    PMID: 15022953 DOI: 10.1080/j354v17n03_11
    Palliative care first began in Malaysia in 1991, and since then there has been a growing interest in the field and its development both from the government and nongovernmental organizations. It is important to recognize the potential advantages and disadvantages of palliative care provided by both government and private programs to maximize development for the greater benefit of patients. A close relationship between these two bodies must be created so that there is smooth continuity of service and no overlapping of roles. This article highlights some thoughts on how palliative care has developed over the years from the perspective of a clinician who is currently working in the government sector and cooperating with nongovernmental organizations to develop a palliative care network in the region.
    Matched MeSH terms: Palliative Care/organization & administration*; Palliative Care/standards
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