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Course, academic year 2024/2025
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Paliative Medicine and Geriatrics - EAP0104401
Title: Paliative Medicine and Geriatrics
Guaranteed by: Onkologická a radioterapeutická klinika (14-401)
Faculty: Faculty of Medicine in Pilsen
Actual: from 2024
Semester: summer
Points: 2
E-Credits: 2
Examination process: summer s.:
Hours per week, examination: summer s.:1/1, C [HT]
Capacity: unlimited / unlimited (unknown)
Min. number of students: unlimited
4EU+: no
Virtual mobility / capacity: no
Key competences:  
State of the course: taught
Language: English
Teaching methods: full-time
Level:  
For type:  
Note: deregister from the credit exam date if a requisite was not fulfilled
Guarantor: prof. MUDr. Samuel Vokurka, Ph.D.
MUDr. Alexandra Židková, Ph.D.
Teacher(s): prof. MUDr. Samuel Vokurka, Ph.D.
MUDr. Alexandra Židková, Ph.D.
Attributes: Povinné předměty pro Všeobecné lékařství
Pre-requisite : EAP0103320, EAP0103390
Is co-requisite for: EAP0104310
Annotation -
The course Palliative Medicine and Geriatrics is designed to learn the principles and meaning of specific diagnostic,
treatment and nursing approach to geriatric patients and patients with otherwise incurable diseases
diseases, with the aim of contributing to the improvement of their health, or quality of life, and with the aim of eliminating the burden of these
patients with futile interventions regardless of their age, i.e. including children. Increased attention is paid
the importance of multidisciplinary and multiprofessional collaboration, ethical and legal issues, communication skills and
psychosocial issues, both in relation to the patient and his loved ones. They are discussed individually
options for solving significant symptoms of patients in palliative and geriatric care - e.g. pain, shortness of breath,
gastrointestinal problems, nutrition, cognitive disorders, mobility limitations, communication disorders, etc.).
Last update: Karlová Markéta, Ing. (13.01.2023)
Literature - Czech

* Povinná literatura:
Paliativní medicína pro praxi, 3. přepracované a rozšířené vydání, O. Sláma, L. Kabelka, J. Vorlíček, et al., Galén, 2022, ISBN 9788074926273
Geriatrie pro praxi. Topinková E. Galén, 2010.
Doporučená literatura:
Geriatrická paliativní péče a komunikace o nemoci. Kabelka L. Mladá fronta, 2018.
Geriatrie a gerontologie. Kalvach Z, Zadák Z, Jirák R, et al. Grada, 2004.
Vybrané klinické stavy u seniorů Úskalí diagnostiky a terapie. Matějovská Kubešová H, et al. Mladá fronta, 2015.
Kapačka, cévka, houkačka O tom, jak jsme zapomněli normálně stárnout a pokojně umírat. Hillman K. Cesta domů, 2018. 
Péče v závěru života. Kisvetrová H. Maxdorf, 2018.
Klinická etika, praktický přístup k etickým rozhodnutím v klinické medicíně, A. R. Jonsen, M. Siegler, W. J. Windslade, Triton, 2019, ISBN 9788075536532
Právo a péče v závěru života, Rozhodování na pomezí intenzivní medicíny a paliativní péče, B. Steinlauf, Wolters Kluwer, 2022, ISBN 9788075987143
Paliativní péče v onkologii, M. Sochor, I. Závadová, O. Sláma (eds.), Mladá fronta, 2019, ISBN 9788020442239
Geriatrická paliativní péče a komunikace o nemoci, druhé, přepracované a doplněné vydání, L. Kabelka, Mladá fronta, 2018, 9788020450494
Zdravotnické právo, P. Šustek, T. Holčapek a kolektiv, Wolters Kluwer, 2016, ISBN 9788075523211
Zákon č. 372/2011 Sb., o zdravotních službách a podmínkách jejich poskytování - účinnost od 1.1.2022
Dříve vyslovená přání pacientů, Výhody a rizika, J. Matějek, Galén, 2011, ISBN 9788072628506
Oxford handbook of palliative care, M. Watson, R. Campbell, N. Vallath, S. Ward, J. Wells, Thirt edition, Oxford university press, 2019, ISBN 9780198745655
Oxford textbook of palliative medicine, N. I. Cherny, M. T. Fallon, S. Kaasa, R. K. Portenoy, D. C. Currow, Sixth edition, Oxford university press, 2021, ISBN 9780198821328
časopis Paliativní medicína, Česká společnost paliativní medicíny ČLS JEP, ISSN 2695-1495, www.palmed.cz
web paliativnicentrum.cz
web paliativa.cz
web paliativnimedicina.cz




Last update: Vokurka Samuel, prof. MUDr., Ph.D. (10.01.2023)
Requirements to the exam -

Full attendance at the practical teaching and seminars.

Last update: Šnebergerová Šárka (13.01.2023)
Syllabus -

1. Basics, definitions, organizational structure in the Czech Republic

a. Definition, history and evidence. General and specialized care, multidisciplinary approach.

b. Forms of provision of palliative care (depending on the place of provision: hospice, home specialized PP, hospital counseling team, outpatient PP, stationary, respite stays)

c. Children's palliative care

d. Options for providing care to geriatric patients (general, specialized, non-medical)

2. Interdisciplinary cooperation, coordination of care

a. Interdisciplinary assessment and communication with the doctor of the basic field

b. Indication of terminal palliative care, application to hospice

c. Hospital palliative care - early intervention, request for a consultation of a palliative physician and a geriatrician

3. The needs of patients with serious illness and in geriatrics

a. The most common symptoms of a serious illness

i. pain: acute, chronic, breakthrough

ii. GIT: damage and infection of the oral cavity, dysphagia, constipation, diarrhea, ileus, nausea, vomiting, intestinal obstruction

iii. pulmonary: shortness of breath, cough

iv. nutrition and fluids: nutritional support, anorexia, cachexia, thirst, sub/dehydration

v. skin: pruritus, intertrigo, decubitus and chronic wounds

vi. neuropsychiatric, neurodegenerative: cognitive disorders, delirium, confusion, insomnia, depression, anxiety, fear, communication and mobility disorders due to impaired sensory, motor or executive speech functions

vii. venous access: possibilities, limitations and advantages

viii. ostomies, catheters and drains: importance and risks

ix. other: hypercalcemia, spinal cord compression, intracranial hypertension syndrome, anemic syndrome, fevers, pathological fractures, etc.

b. Specifics of the geriatric patient

i. characteristics of organism aging, polymorbidity, chronicity, polypragmasia, fragility, renal and hepatic dysfunction, nutrition

ii. restriction of physical activity, osteoporosis (prevention and complications), arthrosis, degenerative diseases of the spine, joint replacements,

iii. cognitive and neuropsychiatric changes, problems of care for patients with cognitive disorders and differentiation of communication and movement disorders due to sensory, motor or executive speech function disorders

c. Psychological needs

i. hierarchy of patient needs (Maslow's pyramid)

ii. orientation in the trajectory of the disease

iii. adaptation to illness, emotions

iv. grief and mourning (child as survivor)

d. Social needs

i. orientation in the social support system (patients and caregivers/parents)

ii. social ties, social role of the patient, caregivers and loved ones

e. Spiritual needs

i. Hope, faith, meaning of life, religious belief

ii. Spiritual needs of a non-religious nature, traditions, rituals, a sense of wholeness, completion

f. Care of the dying - picture and management of terminal symptoms, including intensive care

4. Communication with a focus on emotions in the doctor - patient - closed people relationship

a. communication of unfavorable news incl. pediatric issues

b. interview about prognosis

c. communication about a reasonable and realistic goal of treatment

d. conflicts - prevention and resolution

e. family conference

5. Ethical and legal context of providing palliative care

a. legal norms in relation to palliative care

b. recommended procedures in pediatrics and adult patients

c. ethical aspects: palliative sedation, euthanasia, assisted suicide

6. Deciding on the Adequacy of Treatment

a. the patient's values and preferences, previously expressed wishes

b. a close person and a person with the right of proxy consent for patients who are not competent

c. treatment goal and therapeutic balance, procedure alternatives and their documentation

d. prognostic uncertainty Practical exercises, seminars: practical solutions for selected symptoms (e.g. pain, shortness of breath, malnutrition, disorientation, agitation), long-term intensive care unit, geriatric unit, hospice.

Last update: Šnebergerová Šárka (13.01.2023)
Learning resources

Moodle course - https://moodle.lfp.cuni.cz/course/view.php?id=610

Last update: Křikavová Lenka, Ing. (01.03.2024)
 
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