ABSTRACT
BACKGROUND: Palliative care (PC) aims to improve quality of life in patients and its families against life threatening diseases, through suffering's prevention and relief. It is the duty of the dental surgeon to possess the knowledge needed to treat a patient with little life span, in order to establish an adequate treatment plan for each situation. AIM: To synthesize the published evidence on oral conditions, impact, management and challenges in managing oral conditions among palliative patients. METHODS: Articles were selected from PubMed and Scopus electronic platforms, using a research strategy with diverse descriptors related to "palliative care", "cancer" and "oral health". The article's selection was done in two phases. The first one was performed by the main researcher through the reading of the abstracts. In the second phase two researchers selected eligible articles after reading in full those previous selected. Data was tabulated and analyzed, obtaining information about what is found in literature related to this subject and what is necessary to be approached in future researches about PC. RESULTS: As results, the total of 15 articles were eligible, being one a qualitative analysis, 13 (92.8%) clinical trials and one observational study. Of the 15 articles, 8 (53.4%) involved questionnaires, while the rest involved: one systematic review about oral care in a hospital environment, 2 oral exams and oral sample collection, one investigation of terminal patient's (TP) oral assessment records, 2 collection of oral samples and their respective analysis and one treatment of the observed oral complications. CONCLUSION: It can be concluded that the oral manifestations in oncologic patients in terminal stage are, oral candidiasis, dry mouth, dysphagia, dysgeusia, oral mucositis and orofacial pain. Determining a protocol for the care of these and other complications of cancer - or cancer therapy - based on scientific evidence with the latest cutting-edge research results is of fundamental importance for the multidisciplinary team that works in the care of patients in PC. To prevent complications and its needed to initial the dentist as early as possible as a multidisciplinary member. It has been suggested palliative care protocol based on the up to date literature available for some frequent oral complications in TP with cancer. Other complications in terminal patients and their treatments still need to have further studying.
ABSTRACT
PURPOSE: Recent studies argue that the use of virtual reality tasks depicting activities daily living may be effective means for cognitive rehabilitation. The aim of this study was to test an ecologically oriented approach in virtual reality resembling the demands of everyday life activities for cognitive rehabilitation following stroke. MATERIALS AND METHODS: The sample comprised 30 sub-acute stroke patients recovering from stroke in a rehabilitation hospital. They were assessed in a single-arm pre-post intervention study on global cognition, executive functions, memory and attention abilities. The intervention consisted of virtual reality in a multidomain cognitive training approach depicting everyday life tasks (preparing food, choosing clothes, shopping, etc.). RESULTS: Improvements were found in the assessed cognitive domains at 6 to 10 post-treatment sessions. In-depth analysis through reliable change scores has suggested larger treatment effects on global cognition. CONCLUSIONS: Overall results suggest that the use of virtual reality-based exercises on everyday life activities may be a useful cognitive rehabilitation approach to provide short-term gains in cognition following stroke.Implications for rehabilitationVirtual reality-based cognitive rehabilitation resembling everyday life activities may provide short-term gains in cognition of stroke patients;Consistent improvements in executive functions may require higher treatment dosage than for improvements in global cognition.
