ABSTRACT
Objective:To explore the characteristics and therapeutic strategies of Pott's puffy tumor（PPT）. Methods:The clinical data of two patients with PPT were retrospectively analyzed and combined with the literature, focusing on the comprehensive analysis of perioperative diagnosis and treatment strategies. Both patients underwent muti-disciplinary treatment, including timely administration of sufficient antibiotics capable of penetrating the blood-brain barrier. Early removal of PPT lesions was performed using a combined internal and external approach under nasal endoscopic guidance. Results:After standardized perioperative management, the symptoms of the two patients were completely relieved, with no recurrence after one=year follow=up. Postoperative complications such as frontal pain, numbness, local depression, or scar hyperplasiawere not present. Conclusion:PPT, being relatively rare and severe, requires careful attention. Key strategies for standardized perioperative management include multi-disciplinary consultation, timely and adequate antibiotic administration, and surgical intervention using a combined intranasal and extranasal endoscopic approach for lesion removal.
Subject(s)
Humans , Pott Puffy Tumor/complications , Retrospective Studies , Tomography, X-Ray Computed , Endoscopy/adverse effects , Postoperative Complications , Anti-Bacterial Agents/therapeutic use , Frontal Sinusitis/complicationsABSTRACT
Introducción: Este artículo reporta los avances y desafíos observados por un equipo de profesores involucrados en la orientación de la lectura y escritura académica al iniciar la preparación profesional en el programa de Medicina de la Universidad Industrial de Santander, desde un enfoque de géneros discursivos. Objetivo: Analizar la reorientación del perfil curricular y las decisiones pedagógicas de los profesores de la asignatura Taller de Lenguaje, orientada en el primer semestre de los años 2020 y 2021. Metodología: El artículo se orienta por el modelo de "reflexión sobre la acción" para la investigación pedagógica, el diseño de la enseñanza y el aprendizaje de las profesiones. Análisis y resultados: Se introdujo a los estudiantes en su cultura disciplinar por la vía de su léxico especializado y del contacto inicial con la terminología médica en su discurso científico. A su vez, se abordó, desde la lectura, el género disciplinar artículo de investigación y su componente el resumen o abstract; y desde la escritura, los géneros de formación glosario y bibliografía anotada. Se estudiaron temas puntuales de escritura, como los discursos referidos y el uso de signos ortográficos, de manera articulada con la producción de dichos géneros. Conclusiones: El avance principal de la pedagogía implementada consiste en la pertinencia de los textos elegidos y de los saberes lingüísticos ofrecidos en la formación profesional de los estudiantes de recién ingreso. El currículo actualmente integra la enseñanza de competencias generales referidas a prácticas, géneros y aspectos normativos de la comunicación académica con la enseñanza de competencias específicas para leer y escribir textos propios de cada disciplina. Finalmente, surgen desafíos como el de articular enfoques entre los profesores de Taller de Lenguaje y los de Medicina, o el de pensar en formas de evaluar el impacto del Taller de Lenguaje con indicadores ajustados a las disciplinas.
Introduction: This article reports the progress and challenges observed by a team of professors involved in the teaching of academic reading and writing at the beginning of professional training in the Medicine undergraduate program at Universidad Industrial de Santander, using a genre-based approach. Objective: To analyze the reorientation of the curricular design as well as the educational decisions made by professors of the subject, Taller de Lenguaje, taught during the first semester of 2020 and 2021. Methodology: The present study is guided by the reflection-on-action model for pedagogical research, teaching design, and professional training. Analysis and results: Students were introduced to their disciplinary culture by means of specialized vocabulary and initial contact with medical terminology and its scientific discourse. Regarding the reading practice, the research article was addressed along with the abstract as one of its components. In turn, students wrote training genres such as glossaries and annotated bibliographies. Specific issues related to academic writing such as the use of reported speech and punctuation marks were studied in parallel to the production of such genres. Conclusions: The main progress with the implemented pedagogy lies in the relevance of the chosen texts and the linguistic knowledge made available for the professional training of first year students. The current curriculum integrates the teaching of general competences related to practices, genres, and normative aspects of academic communication, with the teaching of specific skills to read and write texts particular to each discipline. Finally, challenges arise as to the articulation of approaches among professors in charge of Taller de Lenguaje and professors from the Faculty of Medicine, or as to the assessment of the impact of Taller de Lenguaje by means of subject-oriented indicators.
ABSTRACT
Resumen En su proceso de definición y consolidación, las ciencias de la vida se enfrentaron con la dicotomía sobre si la mejor manera de aproximarse a su objeto de estudio era seguir el modelo de la física -considerado el modelo científico por excelencia- o desligarse de este. La manera en la que este debate se decantó en cada disciplina tuvo consecuencias en el desarrollo posterior y en los alcances epistemológicos de las nuevas ciencias en consolidación. La comparación de la manera en la que se dio este debate en la biología y la psicología resulta relevante para entender la trayectoria de estas ciencias y sus posibilidades de integración disciplinar: la biología consiguió la unificación disciplinar integrándose alrededor de la teoría evolutiva, mientras que la psicología no consiguió exitosamente esa integración. Esto fue en parte por el intento de conectarse con las ciencias naturales a través de la fisiología, lo que, además, supuso un obstáculo para la comprensión e integración del principio unificador de la biología.
Abstract During the XIX century, different sciences were structured or consolidated in their modern form. Until then, biology, earth sciences, social sciences, and even physics, chemistry, and mathematics did not exist as autonomous disciplines as we know them today. In that century, the notion of "science" was utterly separated from natural philosophy, theology, and other forms of traditional knowledge. The consolidation of scientific disciplines was characterized by deep debates on the possibilities and methods of knowing the natural and human worlds. In their process of consolidation, all life sciences faced a dichotomy related to the best way to approach their object of study: should they follow the model of physics -considered the scientific model par excellence- or not take that model into account? This dichotomy provoked intense debates in all disciplines. The way this debate was resolved had lasting consequences in the subsequent development and the epistemological scope of the new sciences in consolidation. Comparing how this debate took place in biology and psychology is relevant to understanding the disciplinary trajectory followed by each science and the possibilities of integration in each field of knowledge. There is a generalized assumption in the history of psychology that the experimental paradigm adopted extensively in psychology at the end of the XIX century would have placed the discipline under the scientific status of natural sciences. However, in biology and psychology, there was a tension between a physiological-experimental paradigm and a historical-evolutionary paradigm. Understanding those debates within biology, and the comprehension of how biology achieved its disciplinary integration, shows why the experimental connection of psychology with physiology did not mean an explicit connection with the whole of the natural sciences. Disciplinary integration in biology was possible because of adopting the evolutionary principle under a historic paradigm instead of a physical-chemical one. That is why the experimental connection of psychology with physiology eventually became an obstacle for psychology in adopting the unifying principle of biology, the Theory of Evolution, as their basis for disciplinary integration. The first part of this article describes how two branches emerged in the process of consolidation of biology: physiological-experimental and historical-evolutionary. Each one had a different approach to its object of study, but both were necessary to form what is now modern biology. The second part focuses on unifying biology as a field of scientific knowledge, bringing the two branches of this science together under the evolutionary paradigm. The third part outlines the central debates in the consolidation of psychology as a scientific discipline at the end of the XIX century and the beginning of the 20th century. It introduces implications of how these debates on knowledge in psychology developed, as opposed to how it happened in biology. Finally, the difficulties of psychology connecting with the theory of evolution are addressed, as are the impossibility of integrating the different branches of the discipline.
ABSTRACT
@#Objective To analyze the clinical intervention effect of multi-disciplinary team (MDT) nursing mode on patients after transcatheter aortic valve implantation (TAVI). Methods A total of 89 patients who were admitted to our hospital and underwent TAVI surgery from April to December 2021 were selected, including 64 males and 25 females, with an average age of 64.7±11.8 years. The subjects were divided into a MDT intervention group (n=42) and a control group (n=47) according to different postoperative nursing intervention methods. Clinical effectivenesses were compared between the two groups. Results The left ventricular ejection fraction in the two groups significantly increased on the 7th day after the operation, and the increase in the MDT intervention group was more obvious, with no statistical difference between the two groups (P=0.14). On the 7th day after surgery, forced vital capacity/predicated value and forced expiratory volume in one second/predicated value significantly decreased, and decreased more significantly in the control group than those in the MDT intervention group with statistical differences (P=0.01). The ICU stay time (P=0.01), hospital stay time (P<0.01) and total postoperative pulmonary complications rate (P=0.03) in the MDT intervention group were significantly shorter or lower than those in the control group The evaluation results of the anxiety and depression status of the patients before and after nursing intervention showed that the scores of anxiety and depression in the two groups were significantly lower than before, and the scores of each scale in the MDT intervention group were lower. The score of quality of life of the two groups significantly improved at the end of 6 months after surgery, and in the MDT intervention group it was significantly higher than that in the control group (P=0.02). Conclusion MDT intervention mode can promote the rapid recovery of patients after TAVI, effectively reduce the risk of postoperative pulmonary complications, and improve the postoperative quality of life.
ABSTRACT
In recent years, the rapid increase in cancer treatment costs in China had brought a huge economic burden to society, and it was urgent to standardize the rational application of anti-tumor drugs. In the context of the reform of group payment related to disease diagnosis, a tertiary first-class hospital focused on the needs of patients and guided by value-based healthcare, established a professional and normalized refined anti-tumor drug management system, setted up a multidisciplinary diagnosis and treatment team, and promoted " Internet plus pharmaceutical services" in December 2018.From 2019 to 2021, the proportion of hospital drugs were 30.8%, 30.1%, and 27.3%, respectively. The amount of money spent on anti-tumor drugs were 83.25 million yuan, 76.41 million yuan, and 62.48 million yuan, respectively, showing a decreasing trend year by year. The practice of refined management of anti-tumor drugs fully reflected the core concept of value based healthcare, achieving closed-loop management of the entire process of drugs, improving the level of rational drug use, reducing the economic burden on patients, and providing reference for improving the level of rational use of anti-tumor drugs in public hospitals.
ABSTRACT
In recent years, some large public hospitals in China had successively opened scientific research outpatients to provide consulting services for clinical research, but there were generally problems such as insufficient audience and single role of expert teams. In July 2021, Shanghai Clinical Research Center established a multidisciplinary scientific research outpatient for the entire clinical research cycle, providing medical staffs with such services as clinical research design and project application, paper revision and achievement transformation. It also provided clerkship for medical students on campus to cultivate their standardized clinical research thinking. As of July 2022, the outpatient had provided research consulting services 16 times, teaching 8 class hours to medical students, and collaborated to solve multi-dimensional clinical research practical problems throughout the entire cycle, such as clinical trial design, project application, and paper publication. Good results had been achieved by this outpatient to provide reference for promoting the development of scientific research outpatients in China and improving the clinical research level of hospitals.
ABSTRACT
Objective:To study the characteristics and patterns of medical research integrity cases reported by the Ministry of Science and Technology, and to explore the countermeasures to strengthen the management of medical research integrity.Methods:20 batches of 555 cases of scientific research integrity cases publicly reported by the Ministry of Science and Technology of the People's Republic of China from June 2021 to May 2022 were taken as the research objects, and the papers involved, regional distribution, scientific research dishonesty and disciplinary measures were classified and analyzed.Results:Data falsification was the most common problem of scientific research dishonesty, accounting for 47.39%. Shandong Province was the province with the most reported cases, accounting for 50.81%. 27.67% of the corresponding authors received 5 disciplinary measures, and 26.28% of the first authors received 6 disciplinary measures. Among the disciplinary measures, the proportion of suspension of applications for various scientific research projects was the highest, with 87.60% of corresponding authors and 91.42% of first authors receiving this punishment. The corresponing authors with 5 years suspension accounted for 49.24% of all years, and the first authors accounted for 57.48%.Conclusions:To promote the integrity governance of medical research, we should strengthen the supervision of medical journals, promote regional exchanges, encourage active error correction, and improve the construction of scientific research integrity database.
ABSTRACT
Palliative care is the final link in the whole lifecycle health management and is an important part of promoting a healthy China. In order to further improve service efficiency and the quality of end-of-life care, Shanghai Jiading Yingyuan Hospital has constructed a new interdisciplinary team collaboration model for palliative care from the perspective of integrated medical theory, and applied this model to clinical practice. By elaborating on the theory of team integration, member composition and division of labor, implementation process and preliminary effects, this study aims to provide a theoretical basis and reference for other regions to carry out the integration path and collaborative model of interdisciplinary services in palliative care.
ABSTRACT
The contents of general practice discipline construction comprise of orientation, team development, personnel training, scientific research, teaching base establishment and management of the discipline, etc. At present, the weakness in above aspects of general practice discipline construction is still the major challenges in most of the primary healthcare institutions. Our experiences in last 10 years shows that the application of Leicester Assessment Package can effectively promote the general practice discipline development for primary care institutions.
ABSTRACT
The problems that China's organ transplantation development facing are the disciplinary construction of Organ Procurement Organization (OPO), the cost of organ donation and financial management, and the construction of organ transplantation technology system under the "Chinese model". As long as we stick to the development path of specialization of organ donation, disciplinarization of OPO construction and systematization of organ transplantation, we will definitely be able to create Chinese technology, Chinese standards, Chinese team and Chinese system with Chinese characteristics and advancement.
ABSTRACT
Objective:To study the remote multi-disciplinary team (MDT) model in diagnosis and treatment of plague, in order to provide scientific basis for clinical treatment of plague.Methods:A retrospective analysis was made on the diagnosis and treatment process of a case of bubonic plague, a sudden imported Class A infectious disease, which was secondary to septicemic plague, involving a remote MDT team consisting of the Infectious Diseases Department, Intensive Care Unit, Respiratory and Critical Care Department, Cardiology Department, Pharmacy Department, and Nosocomial Infection Department of the General Hospital of Ningxia Medical University.Results:The patient was a middle-aged female who was engaged in herding work on the grassland. The first symptom was a sudden pain in the left lower abdomen for three days, accompanied by chest tightness and shortness of breath. After hospitalization, blood culture indicated Yersinia, abdominal CT indicated left lower abdominal lymph node enlargement, and lymph node puncture fluid was positive for Yersinia pestis nucleic acid. Combined with clinical symptoms and signs, the patient was diagnosed as bubonic plague secondary to septicemic plague, and was isolated for treatment. After remote MDT consultation, comprehensive treatment was given, including anti-infection treatment of streptomycin and ciprofloxacin, short-term application of hormones, nutritional support, and local application of chloramphenicol ointment, etc. Secondary acute pancreatitis occurred during the course of the disease, which improved after symptomatic treatment. Finally, after 20 days of treatment, MDT expert group assessed that it met the discharge criteria. No abnormalities were found in follow-up visits outside the hospital. Conclusion:The remote MDT is effective in the treatment of bubonic plague secondary to septicemic plague, which is worth popularizing.
ABSTRACT
Objective:To evaluate the teaching effect of multi-disciplinary integrated training program on the open comprehensive training room to improve the post competency of medical imaging students.Methods:A total of 122 residential students of five-year medical imaging from Batch 2014 of The First Affiliated Hospital of Chengdu Medical College were divided into experimental group and control group. The experimental group carried out the multi-disciplinary open comprehensive training program, and the control group carried out open-ended exercises. The comprehensive discipline theory examination, assessment of clinical thinking and comprehensive skill appraisal, and satisfaction questionnaire results were compared between the two groups. SPSS 23.0 was used for t test. Results:①Comprehensive discipline theory examination scores were higher in experimental group than the control group [(80.33±3.70) vs. (74.56±5.09)], with statistical differences ( P<0.05). ②Experimental group scored higher in clinical thinking and comprehensive skills than the control group did, and the difference was statistically significant [(87.58±3.15) vs. (74.52±3.66), P<0.05]. ③The questionnaire investigation showed that the experimental group students did better in improving autonomous learning ability, expression ability, the team cooperation ability, the ability to find and fix problems and the degree of self-esteem than control group, with statistically significant differences ( P<0.05). Conclusion:The multi-disciplinary open comprehensive training program has a good effect on optimizing the open-ended exercises. Students' knowledge of multi-disciplinary comprehensive theoretical knowledge and imaging skills have been improved, and the ability of teamwork, problem-solving ability, self-learning ability and innovation ability required by the core competence of the profession have been developed and improved, which meets the modern medical treatment of education "to create an educational platform of medical education collaboration and multi-disciplinary integration, and to cultivate students' innovative and autonomous learning."
ABSTRACT
In order to give full play to the important role of multi-disciplinary treatment (MDT) in oncology teaching in talent training and discipline development, an oncology teaching and research section has been established, the textbook Clinical Oncology has been compiled, excellent teaching workers in affiliated hospitals have been selected to form an MDT teaching team, and a multi-tutorial system has been established for the discipline related to specific tumor types. The multi-tutorial system of disciplines combines lecture-based learning (LBL) with case-based learning (CBL) and problem-based learning (PBL). Students are arranged to observe and participate in clinical MDT consultation during the inter-class practice, and compared with the traditional assessment form, MDT case discussion questions, review writing, classroom simulation of the MDT process and real participation in clinical MDT discussions are added. The questionnaire for students who participated in MDT teaching showed that more than 93% of the students believed that the MDT teaching model was helpful for systematically mastering the knowledge of the chapters they had learned and understanding the cutting-edge progress, improving learning initiative, thinking and problem-solving ability, clinical comprehensive analysis ability and teamwork spirit. The majority of students' expression skills [89%(169/190)] and literature review skills [79%(150/190)] were improved; 94%(178/190) of students expressed their willingness to accept this teaching method. The teaching practice experience of the Department of Oncology of Jilin University based on the MDT model helps to improve the teaching level of oncology.
ABSTRACT
Discipline structure, as the core of discipline construction, plays an important role in promoting the prosperity of medical humanities. By sorting out the Chinese scholars’ division of the structure of medical humanities in China, this paper preliminarily discussed the existence of the subordinate discipline of medical humanities in China, and preliminarily verified the rationality and feasibility the viewpoint of "building a first-class discipline of medical humanities under the medical category, and forming a subordinate discipline of medical humanities based on horizontal association". At the same time, this paper put forward the view that the structure of medical humanities in China should be determined according to the needs of the current social development in China, and the concepts and criteria contained in the division of the Chinese discipline catalogue, so as to pave the way for the follow-up research.
ABSTRACT
Light chain amyloidosis (AL) is a kind of rare disease. The misfolding of the light chain of monoclonal immunoglobulin forms amyloid substances and deposit in different tissues and organs, resulting in organ dysfunction. The heart involvement is represented as light chain cardiac amyloidosis (AL-CA), leading to heart failure, arrhythmia, myocardial infarction, valvular and pericardial diseases. Cardiac involvement is crucial for the risk stratification and prognosis prediction of patients with AL. The median survival time of AL-CA patients is 24 months and only 6 months for the heart failure patients. In recent years, the prognosis of patients with AL-CA has been significantly improved, thanks to the advancement in diagnosis & treatment strategies of cardiac amyloidosis, the milestone in the breakthroughs in targeted therapy of AL, and the improvement of coordinated multidisciplinary treatment. This paper focuses on the cardiovascular involvement of AL and briefly illustrates the pathogenesis, clinical manifestations, and the diagnosis and treatment of AL-CA.
ABSTRACT
@#The Ehlers-Danlos syndromes (EDS) are a group of rare hereditary connective tissue disorders. EDS is clinically and genetically heterogeneous and usually involves multiple systems. EDS has 14 subtypes, the common features of which include joint hypermobility, skin hyperextensibility, tissue fragility, and etc. The clinical manifestations and their severity differ between the subtypes, involving recurrent joint dislocations, scoliosis, arterial aneurysm and dissection, organ rupture, and others. The complexity of the disease poses challenges to the diagnosis and management of EDS, together with the rareness of the disease. The development of clinical guidelines and implementation of coordinated multi-disciplinary team (MDT) approaches to the EDS is in priority in the world.Therefore, we formed the Multi-Disciplinary Working Group on the Ehlers-Danlos Syndromes in China. Based on GRADE methodology, the MDT group developed the Guidelines. The Group highly recommends a coordinated MDT approach to the diagnosis and management of EDS. The first drafted guidelines on EDS will facilitate the shortening of the diagnostic odyssey and meeting the unmet medical needs of the patients.
ABSTRACT
Objective:This study aimed to evaluate the clinical features and treatment outcomes of the value of response-adapted treatment following radiotherapy and induction chemotherapy follwing subsequent comprehensive therapy in patients with resectable locally advanced hypopharyngeal carcinoma. Methods:This cohort study was conducted from September 2010 to September 2020 in our hospital, 231 patients pathologically confirmed stage Ⅲ and ⅣB resectable locally advanced hypopharyngeal carcinoma included. For the IC-directed ART strategy, IC is used to select good candidates to receive radical RT or CCRT, and others undergo surgery. He response-adapted strategy was determined based on the primary tumor response, which was evaluated at a dose of 50 Gy. If the response reached complete response or partial response（more than 80% tumor regression）, patients received radical RT or CCRT; otherwise, they received surgery, if possible, at 4 to 6 weeks after RT. The end points of the study were OS（overall survival）, progression free survival（PFS）, locoregional recurrence-free survival（LRRFS） and LDFS. Results:In IC-directed group, 75.0%（57/76） patients reached PR after 2 cycles of induction chemotherapy. While in RT-directed group, 70.3%（109/155） patients reached large PR at dose of 50 Gy. The median interquartile range follow-up period of the whole cohort was 63.8 months. The 5-year OS, PFS, LRRFS and SFL of the whole cohort were 47.9%、39.6%、44.3% and 36.2%, respectively. In evaluations based on the different treatment strategies, the 5-year OS and SFL were 51.3% versus 37.0%（HR 0.67; 95%CI 0.43-1.05; P=0.07） and 27.8% versus 39.8%（HR 0.68; 95%CI 0.46-0.99; P=0.04） between IC-directed and RT-directed groups. In additional, surgery complications did not significantly differ between these two groups. Conclusion:In this cohort study, the response-adapted strategy based on an early RT response facilitated better treatment tailoring, and higher laryngeal preservation compared with IC-directed strategies. This approach could provide a feasible laryngeal preservation strategy in patients with resectable locally advanced hypopharyngeal carcinoma.
Subject(s)
Male , Humans , Cohort Studies , Chemoradiotherapy , Carcinoma , Hypopharyngeal Neoplasms/therapy , Induction ChemotherapyABSTRACT
OBJECTIVE To evaluate the mode of pharmacists’ participation in multi-disciplinary diagnosis and treatment （MDT）， as well as the effects of pharmacists’ participation. METHODS Retrieved from Cochrane Library， PubMed， Embase， CNKI， CBM and Wanfang database， experimental studies and observational studies on the effects of MDT with pharmacists on clinical outcomes of patients were collected. After data extraction and quality evaluation， the results of included studies were analyzed descriptively. RESULTS A total of 10 studies were included， among which 3 were randomized controlled trials （RCT）， 2 were non-RCT， 4 were cohort and 1 was case-control study； there were 2 422 patients in total. In terms of effectiveness， tumor progression-free survival， glycosylated hemoglobin， re-admission rate and length of stay and other indexes were all improved significantly after pharmacists participated in MDT. In terms of safety， the incidence of major bleeding events was significantly decreased after pharmacists participated in MDT. In terms of economy， hospitalization costs and total outpatient expenses were improved significantly after pharmacists participated in MDT， but medical cost was not improved significantly. In terms of humanistic outcomes， there was controversy over the conclusion of patient compliance after pharmacists participated in MDT. CONCLUSIONS Pharmacists， based on their own pharmaceutical care skills and methods， actively participate in MDT throughout the process， improving the clinical outcomes of patients and enhancing the safety of medication. There are still controversies regarding economic and humanistic outcomes.
ABSTRACT
Immune checkpoint inhibitors (ICIs)-based immunotherapy combined with other treatment for hepatocellular carcinoma (HCC) has achieved significant efficacy in clinical research and practice, and has become the most commonly used and mainstay therapy for the treatment of unresectable HCC. In order to help clinicians administrating immunotherapy drugs and regimens rationally, effectively and safely, we organized a multidisciplinary expert team to adopt the "Delphi" consensus formation method, and finally revised and completed the "Multidisciplinary Expert Consensus on Combination Therapy Based on the Immunotherapy for Hepatocellular Carcinoma (2023 Edition)" on the basis of the 2021 version. This consensus mainly focuses on the principles and methods of clinical application of combination therapy based on the Immunotherapy, aiming to summarize the recommendations for clinical application based on the latest research and expert experience, and provide application guidance for clinicians.
Subject(s)
Humans , Carcinoma, Hepatocellular/therapy , Consensus , Immunotherapy , Liver Neoplasms/therapyABSTRACT
We provided the palliative care of a multiple disciplinary team care mode to a patient diagnosed with advanced head and neck cancer and her caregivers.People-centered integrated health services were provided according to the specific needs and preferences of individuals.The team-based palliative care relieved the suffering and improved the quality of life of the patient and that of her family who were facing challenges associated with life-threatening illness.