Le Journal médical libanais. The Lebanese medical journal
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Within the framework of medical and nursing education, formal attention to training in palliative care (PC) continues to be overlooked by the majority of training programs. PC is defined by the World Health Organization (WHO) as an "approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness...". ⋯ The purpose of this article is to describe present endeavors in Lebanon, and to recommend a model for future outlook. In conclusion PC education needs to be developed in Lebanon warranting the need for a foundation course in palliative and end-of-life care.
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A considerable number of patients with cancer suffer considerable pain during their disease. Most of these patients achieve analgesia using opioids and adjuvant medication; however, 5-10% of them still experience inadequate pain control despite aggressive combined pharmacological therapy and their use is often associated with adverse events. ⋯ Commonly used interventional therapies for cancer pain include neuroaxial, neurolytic including sympathetic block and paravertebral block ; in addition, neurosurgical procedures are used as last rescue once other techniques failed in order to achieve the highest possible success while minimizing potential complications and side effects. The intent of alternative therapies is to provide adequate and effective pain management in the oncology and palliative care arena with improvement in patient quality of life.
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The goal of palliative care (PC) is to relieve suffering. PC is an urgent humanitarian need worldwide for people with cancer and other chronic fatal diseases. PC in Lebanon has made some important strides in the last decade but it is still in its infancy. ⋯ In order to respond to the cancer priority needs in a community and make the best use of scarce resources, PC services should be strategically linked to cancer prevention, early detection and treatment services. The time will come for Lebanon to form the National Council for Pain Relief and Palliative Care as an advocacy and coordination body for pain relief and PC in the near future. To that effect, we believe the future is near.
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Technical advances in the care of advanced illness have created ethical challenges for physicians, patients, and families at the end of life. In the effort to survive longer, they are often confronted with difficult choices regarding medical advances that may inadvertently prolong suffering and the dying process rather than bring healing and recovery. Four major principles of medical ethics assist patients, families, and their physicians in making meaningful and morally acceptable choices with respect to care at the end of life: the Hippocratic principles of nonmaleficence and beneficence, as well as the more recently developed principles of autonomy and justice. The nature of these principles and their application in decision making and communication during the care of patients with advanced illnesses are reviewed.
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Opioid analgesics are essential for the management of moderate to severe pain. In spite of their documented effectiveness, opioids are often underutilized, a factor which has contributed significantly to the undertreatment of pain. Many countries have developed true national policies on cancer pain and palliative care, and in others only guidelines for care have been developed. Ideally, national policies facilitate and legislate not only a patient's right to care, but also the necessary components of education and drug availability which are so critical for the appropriate achievement of public health programs.