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Mani RK, Bhatnagar S, Butola S, Gursahani R, Mehta D, Simha S, Divatia JV, Kumar A, Iyer SK, Deodhar J, Bhat RS, Salins N, Thota RS, Mathur R, Iyer RK, Gupta S, Kulkarni P, Murugan S, Nasa P, Myatra SN. Indian Society of Critical Care Medicine and Indian Association of Palliative Care Expert Consensus and Position Statements for End-of-life and Palliative Care in the Intensive Care Unit. Indian J Crit Care Med 2024; 28:200-250. [PMID: 38477011 PMCID: PMC10926026 DOI: 10.5005/jp-journals-10071-24661] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 02/28/2024] [Indexed: 03/14/2024] Open
Abstract
End-of-life care (EOLC) exemplifies the joint mission of intensive and palliative care (PC) in their human-centeredness. The explosion of technological advances in medicine must be balanced with the culture of holistic care. Inevitably, it brings together the science and the art of medicine in their full expression. High-quality EOLC in the ICU is grounded in evidence, ethical principles, and professionalism within the framework of the Law. Expert professional statements over the last two decades in India were developed while the law was evolving. Recent landmark Supreme Court judgments have necessitated a review of the clinical pathway for EOLC outlined in the previous statements. Much empirical and interventional evidence has accumulated since the position statement in 2014. This iteration of the joint Indian Society of Critical Care Medicine-Indian Association of Palliative Care (ISCCM-IAPC) Position Statement for EOLC combines contemporary evidence, ethics, and law for decision support by the bedside in Indian ICUs. How to cite this article Mani RK, Bhatnagar S, Butola S, Gursahani R, Mehta D, Simha S, et al. Indian Society of Critical Care Medicine and Indian Association of Palliative Care Expert Consensus and Position Statements for End-of-life and Palliative Care in the Intensive Care Unit. Indian J Crit Care Med 2024;28(3):200-250.
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Affiliation(s)
- Raj K Mani
- Department of Critical Care and Pulmonology, Yashoda Super Specialty Hospital, Ghaziabad, Kaushambi, Uttar Pradesh, India
| | - Sushma Bhatnagar
- Department of Onco-Anaesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Savita Butola
- Department of Palliative Care, Border Security Force Sector Hospital, Panisagar, Tripura, India
| | - Roop Gursahani
- Department of Neurology, P. D. Hinduja National Hospital & Medical Research Centre, Mumbai, Maharashtra, India
| | - Dhvani Mehta
- Division of Health, Vidhi Centre for Legal Policy, New Delhi, India
| | - Srinagesh Simha
- Department of Palliative Care, Karunashraya, Bengaluru, Karnataka, India
| | - Jigeeshu V Divatia
- Department of Anaesthesia, Critical Care, and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Arun Kumar
- Department of Intensive Care, Medical Intensive Care Unit, Fortis Healthcare Ltd, Mohali, Punjab, India
| | - Shiva K Iyer
- Department of Critical Care, Bharati Vidyapeeth (Deemed to be University) Medical College, Pune, Maharashtra, India
| | - Jayita Deodhar
- Department Palliative Care, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Rajani S Bhat
- Department of Interventional Pulmonology and Palliative Medicine, SPARSH Hospitals, Bengaluru, Karnataka, India
| | - Naveen Salins
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Raghu S Thota
- Department Palliative Care, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Roli Mathur
- Department of Bioethics, Indian Council of Medical Research, Bengaluru, Karnataka, India
| | - Rajam K Iyer
- Department of Palliative Care, Bhatia Hospital; P. D. Hinduja National Hospital & Medical Research Centre, Mumbai, Maharashtra, India
| | - Sudeep Gupta
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | | | - Sangeetha Murugan
- Department of Education and Research, Karunashraya, Bengaluru, Karnataka, India
| | - Prashant Nasa
- Department of Critical Care Medicine, NMC Specialty Hospital, Dubai, United Arab Emirates
| | - Sheila N Myatra
- Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
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Butola S, Butola D. Issues Related to Children-Faced by Armed Forces Families When Caring for Patients in Palliative Care - A Qualitative Study. Indian J Palliat Care 2023; 29:437-446. [PMID: 38058477 PMCID: PMC10696357 DOI: 10.25259/ijpc_58_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 09/26/2023] [Indexed: 12/08/2023] Open
Abstract
Objectives Access to palliative care is limited, especially in rural India. Children needing care by palliative teams may themselves be patients, or siblings and children of patients. Armed forces families face characteristic lifestyle challenges - frequent transfers, living in difficult and remote areas, serving personnel staying apart from families for long periods - very different from issues faced by civilians. Military service increases the risk of psychosocial burden for serving personnel as well as families. Most depend on private and state medical services for palliative care so it is important for the palliative community to understand their issues. This study aimed to explore the issues related to children - faced by armed forces families when caring for patients in palliative care. Material and Methods Qualitative study based on thematic analysis of semi-structured interviews with caregivers - either serving personnel or their dependents, in three centres. Results Analysis of the 15 interviews showed that armed forces families face complex challenges related to children when caring for the palliative patient due to frequent movement, lack of paediatric palliative services in far-flung areas, disruption of the continuity of care, social isolation, language, and cultural barriers when living in non-native areas, inability to build and access family and community support and financial burden due to restrictive reimbursement policies. Conclusion Although medical and administrative support within the organisation provides a cushion, wives have to manage alone in the father's prolonged absence, and safety is a concern for children when living outside the campuses and serving personnel report guilt, anger, and helplessness at not being present when needed. Awareness of these issues can enable palliative workers to provide more meaningful support tailored to the needs of service families.
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Affiliation(s)
- Savita Butola
- Government of India, Border Security Force Hospital, Panisagar, Tripura, India
| | - Damini Butola
- Department of Clinical Psychology, Ranchi Institute of Neuro-Psychiatry and Allied Sciences, Ranchi, Jharkhand, India
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Gursahani R, Salins N, Bhatnagar S, Butola S, Mani RK, Mehta D, Simha S. Advance Care Planning in India: Current status and future directions. A short narrative review. Z Evid Fortbild Qual Gesundhwes 2023; 180:64-67. [PMID: 37353428 DOI: 10.1016/j.zefq.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 04/14/2023] [Accepted: 04/21/2023] [Indexed: 06/25/2023]
Abstract
India is undergoing economic, demographic and epidemiologic transitions. The healthcare industry is expanding rapidly as the burden of non-communicable diseases increases. The Indian Supreme Court [1] has recently enabled Advance Medical Directives (AMD). Implementation of Advance Care Planning (ACP) will depend on civil society and the palliative care sector until government support is available.
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Affiliation(s)
| | - Naveen Salins
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Sushma Bhatnagar
- National Cancer Institute and Institute Rotary Cancer Hospital; Department of Onco-Anaesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India; Indian Association of Palliative Care
| | - Savita Butola
- Sector Hospital, Border Security Force, Tripura, India; Indian Association of Palliative Care
| | - Raj K Mani
- Yashoda Hospital, Kaushambi, Ghaziabad, UP, India
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Ghoshal A, Joad AK, Spruijt O, Nair S, Rajagopal MR, Patel F, Damani A, Deodhar J, Goswami D, Joshi G, Butola S, Singh C, Rao SR, Bhatwadekar M, Muckaden MA, Bhatnagar S. Situational analysis of the quality of palliative care services across India: a cross-sectional survey. Ecancermedicalscience 2022; 16:1486. [PMID: 36819806 PMCID: PMC9934966 DOI: 10.3332/ecancer.2022.1486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Indexed: 12/13/2022] Open
Abstract
Objective Palliative care services in India were established in the 1980s but there is no detailed up-to-date knowledge about the quality-of-service provision nationally. We aim to describe the current quality of palliative care provision in India, as measured against nationally adopted standards. Method A digital survey adapted from the Indian Association of Palliative Care Standards Audit Tool was administered to 250 palliative care centres. Results Two hundred and twenty-three (89%) palliative care centres participated - 26.4% were government-run, while the rest include non-governmental organisations, private hospitals, community-led initiatives and hospices. About 200 centres 'often' or 'always' fulfilled 16/21 desirable criteria; however, only 2/15 essential criteria were 'often' or 'always' fulfilled. Only 5.8% provide uninterrupted access to oral morphine. Significance of the results Palliative care centres in India are falling short of meeting the essential quality standards, indicating the urgent need for new initiatives to drive national change.
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Affiliation(s)
- Arunangshu Ghoshal
- Department of Palliative Medicine, Tata Memorial Center, Homi Bhabha National Institute, Mumbai 400012, India
| | - Anjum Khan Joad
- Department of Anaesthesia and Palliative Care Medicine, Bhagwan Mahaveer Cancer Hospital and Research Center, Jaipur 302017, India
| | - Odette Spruijt
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria 3010, Australia
| | - Shobha Nair
- Department of Palliative Medicine, Amrita Hospital, Kochi 682041, India
| | - MR Rajagopal
- Trivandrum Institute of Palliative Sciences and Pallium India, Aisha Memorial Hospital Building, Paruthikuzhy, Thiruvananthapuram 695009, India
| | - Firuza Patel
- Department of Radiotherapy, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Anuja Damani
- Department of Palliative Medicine, Tata Memorial Center, Homi Bhabha National Institute, Mumbai 400012, India
| | - Jayita Deodhar
- Department of Palliative Medicine, Tata Memorial Center, Homi Bhabha National Institute, Mumbai 400012, India
| | - Dinesh Goswami
- Guwahati Pain and Palliative Care Society, Uzan Bazar, Guwahati, Assam 781001, India
| | - Geeta Joshi
- Community Oncology Center, Gujarat Cancer Society, Ahmedabad 380007, India
| | - Savita Butola
- Border Security Force Sector Hospital, Panisagar, Tripura 799260, India
| | - Charu Singh
- Department of Palliative Medicine, Amrita Hospital, Kochi 682041, India
| | | | | | - Mary Ann Muckaden
- Department of Palliative Medicine, Tata Memorial Center, Homi Bhabha National Institute, Mumbai 400012, India
| | - Sushma Bhatnagar
- Department of Onco-Anaesthesia and Palliative Medicine, Dr. B.R.A Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi 110029, India
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Krishnan SRG, Butola S. Wellbeing of Palliative Care Workers During Covid-19 Pandemic: Implications for Social Work Practice. J Soc Work End Life Palliat Care 2022; 18:345-359. [PMID: 35989591 DOI: 10.1080/15524256.2022.2112808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The present study is aimed at examining the wellbeing of palliative care workers in India (n = 114) with special reference to work related variables. The World Health Organization's five item wellbeing index was used to measure the wellbeing of the respondents. In general, the wellbeing of the respondents was found to be good. Furthermore, the age of the respondent (p < 0.001), gender (p < 0.05), work setting (hospital vs. non-hospital) (p < 0.05), work environment (p < 0.01), recent unemployment (job loss) (p < 0.01), years of experience in palliative care (p < 0.05), number of hours of work per week (p < 0.05), and the number of clients who died in the previous month (p < 0.01), were all found to be associated with the wellbeing of the respondents. Specifically, young and female respondents, those engaged in hospital based palliative care, having a poor work environment, facing recent unemployment, having less experience, working for more number of hours, and having more number of patients dying in the previous month, all had a lower level of wellbeing. The implications for social work practice have also been discussed in detail.
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Affiliation(s)
| | - Savita Butola
- Chief Medical Officer (SG), Border Security Force, Panisagar, India
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Butola S, Bhatnagar S, Rawlinson F. Caring and Conflict-Palliative Care in the Armed Forces: The Challenges for Caregivers. Indian J Palliat Care 2021; 27:405-418. [PMID: 34898934 PMCID: PMC8655645 DOI: 10.25259/ijpc_393_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 09/07/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES In India, Palliative care remains inaccessible, especially in remote areas. This study aimed at exploring the experience of caregivers related to arranging palliative care at home, for personnel and family members of an armed force. MATERIALS AND METHODS Qualitative study based on thematic analysis of semi-structured interviews with adult caregivers - either serving personnel or their dependent family members. RESULTS Lack of palliative care in rural areas makes arranging home care challenging for Indian caregivers, especially in armed forces. The families stay alone and personnel cannot be there to look after loved ones. Constraints of leave, financial and legal problems, frequent movement and social isolation disrupt care as well as family and community support systems, leading to psycho-social problems and stress for the serving personnel as well as families. Educating staff, integrating palliative care into existing medical services, coordinating with other agencies to increase awareness and provide care at home, access to opioids, timely leave, reimbursement of expenses, increased family accommodation, guidance about benefits, and considerate implementation of transfer policy can help mitigate some of their problems. CONCLUSION These caregivers face physical exhaustion, psycho-social, financial, legal, and spiritual issues- some common to all rural Indians and others unique to the armed forces. Understanding their experiences will help the providers find solutions, especially in relation to the unique needs of the men in uniform.
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Affiliation(s)
- Savita Butola
- Border Security Force, Gwalior, Madhya Pradesh, India
| | - Sushma Bhatnagar
- Department of Oncoanaesthesia and Palliative Medicine, Dr. B.R.A IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Fiona Rawlinson
- Centre for Medical Education, Cardiff university, Wales, United kingdom
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Abstract
Palliative care, which is more than just terminal care, is still unknown in most parts of India. This narrative highlights how early integration of palliative medicine can help the patient and their family to make the most of their time together. Besides, excellent clinical acumen is required while looking after the sickest and the most critical patients, proper communication skills, and an ethical and holistic approach enables a good doctor-patient relationship. Good pain relief, symptom control, attention to nursing issues, providing information sensitively to empower patients and families for joint decision making, and advance care planning can help bring about a decent death and bereavement. Healing is brought about not only for the caregivers but also for the healthcare professionals.
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Affiliation(s)
- Savita Butola
- Central Armed Police Composite Hospital, Border Security Force Academy, Tekanpur, Gwalior, Madhya Pradesh, India
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Damani A, Ghoshal A, Rao K, Singhai P, Rayala S, Rao S, Ganpathy KV, Krishnadasan N, Verginiaz LAS, Vallath N, Palat G, Venkateshwaran C, Jenifer JS, Matthews L, Macaden S, Muckaden MA, Simha S, Salins N, Johnson J, Butola S, Bhatnagar S. Palliative Care in Coronavirus Disease 2019 Pandemic: Position Statement of the Indian Association of Palliative Care. Indian J Palliat Care 2020; 26:S3-S7. [PMID: 33088078 PMCID: PMC7535015 DOI: 10.4103/ijpc.ijpc_207_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 06/02/2020] [Indexed: 12/16/2022] Open
Abstract
The global pandemic involving severe acute respiratory syndrome–coronavirus-2 has brought new challenges to clinical practice and care in the provision of palliative care. This position statement of the Indian Association of Palliative Care (IAPC) represents the collective opinion of the experts chosen by the society and reports on the current situation based on recent scientific evidence. It purports to guide all health-care professionals caring for coronavirus disease 2019 (COVID-19) patients and recommends palliative care principles into government decisions and policies. The statement provides recommendations for palliative care for both adults and children with severe COVID-19 illness, cancer, and chronic end-stage organ impairment in the hospital, hospice, and home setting. Holistic care incorporating physical, psychological, social, and spiritual support for patients and their families together with recommendations on the rational use of personal protective equipment has been discussed in brief. Detailed information can be accessed freely from the website of the IAPC http://www.palliativecare.in/. We hope that this position statement will serve as a guiding light in these uncertain times.
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Affiliation(s)
- Anuja Damani
- Department of Palliative Medicine, Tata Memorial Centre, Homi Bhaba National Institute, Mumbai, Maharashtra, India
| | - Arunangshu Ghoshal
- Department of Palliative Medicine, Tata Memorial Centre, Homi Bhaba National Institute, Mumbai, Maharashtra, India
| | - Krithika Rao
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Bengaluru, Karnataka, India
| | - Pankaj Singhai
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Bengaluru, Karnataka, India
| | - Spandana Rayala
- Pediatric Palliative Care Consultant, Two Worlds Cancer Collaboration, MNJ Institute of Oncology and Regional Cancer Centre, Hyderabad, Telangana, India
| | - Seema Rao
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Bengaluru, Karnataka, India.,Honorary Tutor, School of Medicine, Cardiff, UK.,Palliative Care Consultant, Lien Collaborative for Palliative Care, Asia Pacific Hospice Palliative Care Network (APHN), Singapore
| | - K V Ganpathy
- Department of Palliative Medicine, Tata Memorial Centre, Homi Bhaba National Institute, Mumbai, Maharashtra, India.,Volunteer Counselor, Clinical Psychologist and CEO JASCAP, Mumbai, Maharashtra, India
| | - Nisha Krishnadasan
- National Information Officer, Indian Association of Palliative Care (IAPC), Guwahati, Assam, India
| | | | - Nandini Vallath
- Palliative Care Consultant-BARC Hospital, Chennai, Tamil Nadu, India.,Palliative care Consultant and Director-Quality Improvement Hub-India, National Cancer Grid, Tata Memorial Centre, Homi Bhaba National Institute, Mumbai, Maharashtra, India
| | - Gayatri Palat
- Consultant, Pain and Palliative Medicine, MNJ Institute of Oncology and RCC, Hyderabad, Telangana, India.,Executive Member, Pain Relief and Palliative Care Society, Hyderabad, Telangana, India.,Director, PAX India, Two Worlds Cancer Collaboration, Canada
| | - Chitra Venkateshwaran
- Department of Psychiatry and Palliative Care, Believers Church Medical College Hospital, Tiruvalla, Kozhikode, Kerala, India.,Clinical Director - Mehac Foundation, Kochi, Kerala, India
| | - Jeba S Jenifer
- Palliative Care Unit, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Lulu Matthews
- Medical Officer and Program Director Academics, IPM, Kozhikode, Kerala, India
| | - Stanley Macaden
- Honorary Palliative Care Consultant, Bangalore Baptist Hospital, Bengaluru, Karnataka, India.,National Coordinator, Palliative Care Programme of Christian Medical Association of India, New Delhi, India
| | - Mary Ann Muckaden
- Department of Palliative Medicine, Tata Memorial Centre, Homi Bhaba National Institute, Mumbai, Maharashtra, India.,International Children's Palliative Care Network, South Africa.,Past President, Indian Association of Palliative Care, Parel, Mumbai, Maharashtra, India
| | - Srinagesh Simha
- Karunashraya, Manipal, Manipal Academy of Higher Education, Bengaluru, Karnataka, India
| | - Naveen Salins
- Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Bengaluru, Karnataka, India
| | - Jeremy Johnson
- Emeritus Consultant in Palliative Medicine, Chief Mentor, Karunashraya, Bangalore Hospice Trust, Bengaluru, Karnataka, India
| | - Savita Butola
- Commandant (Medical)/CMO(SG), CAPF's Composite Hospital, Border Security Force, Tekanpur, Gwalior, Madhya Pradesh, India
| | - Sushma Bhatnagar
- Department of Onco- Anaesthesia and Palliative Medicine, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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Bhatnagar S, Damani A, Ghoshal A, Rao K, Singhai P, Rayala S, Rao S, Ganpathy KV, Krishnadasan N, Verginia (Retd. Army) LS, Vallath N, Palat G, Venkateshwaran C, Jeba SJ, Matthews L, Macaden S, Muckaden M, Simha S, Salins N, Johnson J, Butola S. Palliative care in coronavirus disease 2019 pandemic: Position statement of the Indian association of palliative care. Indian J Palliat Care 2020. [DOI: 10.4103/ijpc.ijpc_207_2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Butola S, Mohanti BK. Learning Palliative Care in India: Two Personal Perspectives. J Palliat Care 2018. [DOI: 10.1177/082585971302900207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Savita Butola
- BK Mohanti (corresponding author): Department of Radiation Oncology, Fortis Memorial Research Institute (FMRI), Sector 44, opposite HUDA City Centre Metro Station, Gurgaon 122002, Haryana, India
| | - Bidhu K. Mohanti
- Composite Hospital, Border Security Force, Jalandhar Cantt, Punjab, India
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Goyal P, Padhi TR, Das T, Pradhan L, Sutar S, Butola S, Behera UC, Jain L, Jalali S. Outcome of universal newborn eye screening with wide-field digital retinal image acquisition system: a pilot study. Eye (Lond) 2017; 32:67-73. [PMID: 28737759 DOI: 10.1038/eye.2017.129] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 04/27/2017] [Indexed: 12/25/2022] Open
Abstract
PurposeTo evaluate the outcome of universal newborn eye screening with wide-field digital retinal imaging (WFDRI) system.MethodsIn this pilot study, we examined 1152 apparently healthy newborn infants in the obstetrics and gynecology ward of a civil hospital in Eastern India over 1.5 years. The examination included external eye examination, red reflex test and fundus imaging by WFDRI (RetCam II, Clarity medical system, Pleasanton, CA, USA) by a trained optometrist. The pathologies detected, net monetary gain and skilled manpower saved were documented. The results were compared with three similar studies thus far published in the literature.ResultsOcular abnormality of any kind was seen in 172 (14.93%) babies. Retinal hemorrhage in 153 babies (88.9% of all abnormal findings) was the most common abnormality; it was bilateral in 118 (77.12%) babies and 4 babies had foveal hemorrhage. Other abnormalities included vitreous hemorrhage (n=1), congenital glaucoma (n=2), uveal coloboma (n=2), retinopathy mimicking retinopathy of prematurity (n=2), and cystic fovea (n=3). The retinal hemorrhages resolved spontaneously in all eyes. One baby with congenital glaucoma received surgery and the other was treated medically. The benefits included savings in skilled manpower, a net monetary gain of INR 4.195 million (US$ 62,612) and skilled manpower saving by 319.4 h.ConclusionsThe universal neonatal eye screening using WFDRI detected pathologies that needed immediate care or regular follow up; saved skilled manpower with a net monetary gain. But compared to a red reflex test the benefits were marginal in terms of detecting treatment warranting ocular pathologies.
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Affiliation(s)
- P Goyal
- Retina and Vitreous services, Shri Mithu Tulsi Chanrai Campus, LV Prasad Eye Institute, Bhubaneswar, India
| | - T R Padhi
- Retina and Vitreous services, Shri Mithu Tulsi Chanrai Campus, LV Prasad Eye Institute, Bhubaneswar, India
| | - T Das
- Smt. Kanuri Santhamma Center for Vitreoretinal Services, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India
| | - L Pradhan
- Infosys Pediatric Center, Capital Hospital, Bhubaneswar, India
| | - S Sutar
- Retina and Vitreous services, Shri Mithu Tulsi Chanrai Campus, LV Prasad Eye Institute, Bhubaneswar, India
| | - S Butola
- Retina and Vitreous services, Shri Mithu Tulsi Chanrai Campus, LV Prasad Eye Institute, Bhubaneswar, India
| | - U C Behera
- Retina and Vitreous services, Shri Mithu Tulsi Chanrai Campus, LV Prasad Eye Institute, Bhubaneswar, India
| | - L Jain
- Retina and Vitreous services, Shri Mithu Tulsi Chanrai Campus, LV Prasad Eye Institute, Bhubaneswar, India
| | - S Jalali
- Smt. Kanuri Santhamma Center for Vitreoretinal Services, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India
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Affiliation(s)
- Savita Butola
- Border Security Force, Composite Hospital, Border Security Force Campus, Jalandhar Cantonmentt, Punjab, India
| | - Mr Rajagopal
- WHO Collaborating Centre for Policy and Training on Access to Pain Relief, Chairman, Pallium India, Trivandrum, Kerala, India
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14
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Abstract
The Economist Intelligence Unit has ranked India's end-of-life care last out of 40 countries. The lack of orientation towards palliative care, poor communication skills, a disease-focused, curative approach and the unending battle against death-all lead to unrealistic hope in patients and their families. Inappropriate referrals at the end of life are common and result in a lot of avoidable suffering for both the patients and their families. Propagation of clear guidelines to limit inappropriate therapeutic interventions and referrals in patients with limited prognosis is the need of the hour. Awareness, sensitization, education and training in palliative care are urgently required to change attitudes. This would go a long way in mitigating the misery for both the dying and their carers.
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Affiliation(s)
- Savita Butola
- Composite Hospital, Border Security Force, GT Road, Jalandhar Cantt, Punjab, India,
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15
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Butola S, Mohanti BK. Learning palliative care in India: two personal perspectives. J Palliat Care 2013; 29:107-112. [PMID: 23923474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Savita Butola
- Department of Radiation Oncology, Fortis Memorial Research Institute (FMRI), Sector 44, opposite HUDA City Centre Metro Station, Gurgaon 122002, Haryana, India.
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Abstract
All India Institute of Medical Sciences, New Delhi, receives patients from all over India. This narrative describes the suffering of cancer patients who are unable to access pain relief and palliative care at their native places and have to repeatedly travel long distances to get morphine-all because of lack of awareness and availability of palliative care in North India, and the restrictions on availability of morphine due to stringent, outdated narcotic regulations.
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Affiliation(s)
- Savita Butola
- FHQ Border Security Force Hospital, New Delhi, India.
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