ABSTRACT
Tetanus in patients with malignant wounds can be fatal. We report a case of a patient with carcinoma of the breast, with a malignant wound. She had applied native medication and approached us for pain management. She developed typical features of tetanus which despite prompt detection and management by the palliative care team, turned fatal. We further discuss the need to keep the possibility of the diagnosis in mind, educate the caregivers to be aware of the possibility of a toxic infection like tetanus that can occur in patients with open wounds, ascertain the immunisation status if possible and conclude by reiterating the conclusions of other authors that prophylactic tetanus immunisation for those with malignant wounds could be effective in reducing the resultant morbidity-mortality.
ABSTRACT
OBJECTIVES: The bio-psycho-socio-spiritual model is a common management approach in palliative care (PC) and chronic pain medicine (CPM), adopted by PC Physicians and Pain Physicians (PPs), respectively. There is a dearth of services and personnel of PC in India. As PPs are familiar with pain management and the bio-psycho-socio-spiritual model, we hypothesised that they would be willing to incorporate PC in their practice and therefore, sought to understand their attitudes/aptitudes/barriers/knowledge towards it. MATERIALS AND METHODS: We did a cross-sectional cohort study through a national survey of Indian PPs. The ten- item validated, survey questionnaire was mailed to 1300 PPs having E mail and registered with Indian Society for Study of Pain. RESULTS: We received responses from 6.6% of the PPs. About 10.39% did not want to practice PC; the rest were either practicing or wanted to, or were unable to. 81.8% had <10 years CPM experience while the rest had 10-15 years. About 53.3% PPs had <10 years' experience in PC; 10.4% had > 10 years and the rest had not practiced. About 70% were motivated by human suffering or had "personal reasons." About 40.26% had no barriers; the rest cited stress or lack of infrastructure/knowledge/skills/time/financial compensation. The majority chose institutional courses for training and the popular choice of duration of the course was 3 months. The opinion on financial viability/non-viability of PC was equally divided among the respondents. About 62.3% had "knowledge" but half of them lacked "skills;" 27.6% lacked both; the rest had no inclination towards PC. About a third felt multi-disciplinary care was feasible while half felt that it was partially feasible. CONCLUSION: Policy-makers, at regional to global levels are strategizing options for popularizing PC since it supports the dualistic model of cure and care, most essential for both, chronic-debilitating or life-limiting illnesses. The poor response to our survey was a major limiting factor. However, among the respondents, the majority showed both aptitude and a favourable attitude for PC practice. The inability to identify major barriers for not choosing PC did not support our hypothesis. However, we feel that PPs are a cohort who can be motivated/ encouraged to take up some form of brief, comprehensive courses in PC so that they can be conversant with the specific knowledge and skills needed to practice the multi-dimensional aspects of PC in their own settings.
