Symptom control is the essence of palliative care but is not without problems, especially in the difficult socio-economic conditions of a developing country. We present our experience with over 2000 hospice admissions over six years in India's first hospice, to highlight our problems and the measures we have taken to solve them. The prevalent habit of tobacco smoking and chewing in India gives rise to a high incidence of head and neck cancers which form 50% of our admissions. Another 24% is formed by breast and gynaecological cancers. The difficult symptoms in head and neck cancers are pain, dysphagia, fungation and trismus. Almost 25% of our head and neck cancers have feeding tubes, which we feel are justified and most useful for medication and basic nutrition. Difficult problems in gynaecological cancers are pain, chronic blood loss, ulcerations and fistulae. The inadequate or sporadic availability of oral and injectable morphine adds to our problems in pain control. Non-compliance of patients to take adequate medications and the resistance from relatives make it sometimes difficult to achieve optimum symptom control. India has many systems of alternate and unorthodox medicine. We find that these are best tried outside the hospice unless they are in fully-studied clinical trials. In the end there is always the difficult choice of either remaining in the hospice for optimal symptom control or going back to their homes, where this may not be available.
Breast Neoplasms ; physiopathology ; therapy ; Choice Behavior ; Complementary Therapies ; Family ; psychology ; Female ; Genital Neoplasms, Female ; physiopathology ; therapy ; Head and Neck Neoplasms ; physiopathology ; therapy ; Hospice Care ; methods ; Humans ; India ; Male ; Patient Acceptance of Health Care ; Pharmaceutical Preparations ; supply & distribution ; Practice Patterns, Physicians' ; Socioeconomic Factors ; Treatment Refusal

OBJECTIVE: The aim of this study was to review the literature about the relevance of the whole body vibration (WBV) in decreasing the number of fractures in osteoporotic women. METHODS: Searches were performed by three independent researchers through the PubMed and PEDro databases. RESULTS: Only 0.1% of the publications with “Fracture and osteoporosis” have a relation with WBVexercise. The achievements have revealed a positive effect of this exercise in patients with risk factors for fractures like osteoporosis. Protocols were performed two to three times a week, from 6 up to 18 months, and with 12.6 up to 40 Hz as frequencies. Different tools were used to evaluate the effects of the WBV exercise in conditions that could cause fractures in postmenopausal women. CONCLUSIONS: Although the paucity of research regarding direct effects of WBV in decreasing fractures, WBV could be a feasible and effective way to modify well-recognized risk factors for falls and fractures, improvements in some aspects of neuromuscular function and balance. More studies have to be performed establish protocols with well controlled parameters.
Accidental Falls ; Exercise* ; Female ; Humans ; Osteoporosis* ; Risk Factors* ; Vibration*