الظهور الإلهي

 جاورجيوس مطران جبيل والبترون وما يليهما (جبل لبنان)

 في البدء كان روحُ الله يُرفرف على وجه المياه، وانتظم الروح على المياه بكلمة الله وكانت الخليقة (تكوين: الإصحاح الأول). هذه الخليقة الأولى كما أرادها الله عذراء عفيفة بلا عيب. ثم كان السقوط وطرد الانسان من الجنة، ومعه أصبحت الأرض تُنبت شوكًا وحسكًا (تكوين ٣: ١٨). ومن بعد السقوط أصبحت الخليقة بحاجة الى تجديد، فجاء الآب ثانية بكلمته الخلاقة ليقول: “هذا هو ابني الحبيب”.

 في البدء قال الله: “ليكن نور فكان نور” (تكوين ١: ٣). وفي المسيح يسوع كلمة الله المتجسد، كانت الحياة من جديد مع الله في فردوس مستعاد. كان النور الحقيقي الذي ينير كل انسان والذي به أُعطي الانسان ثانية سلطانًا أن يصير ابنًا للعليّ (يوحنا ١: ١-١٨).

في معمودية يسوع جاء الروح القدس يُرفرف من جديد على وجه مياه الاردن ليصنع الكون الجديد بالمعمودية وبالإيمان بالإنجيل. كان مظهر الله الحق في هذا الحبيب الذي تجسد.

في الظهور يتجلّى الله لنا آبًا وابنًا وروحًا قدسًا بعد أن ظهر طفلا في بيت لحم. ان الذي وُلد من أحشاء البتول ظهر لنا مخلّصا، محورًا للكون، بل كان الكون فيه خليقة جديدة، مسكن الله مع الناس.

في الظهور الإلهي نحن نقول شيئًا أساسيًا وهو أن الله ظهر في الجسد وان أجساد المؤمنين الذين يقفون في الكنيسة ويقيمون القداس الإلهي ليست ككل الأجساد التي خارج الكنيسة. الجسد المعمّد ليس ككل الأجساد لأن الله قائم فيه. الإنسان المسيحيّ واعٍ بآن معًا أنه من تراب وأنه من ضياء، وأن التراب فيه يتحوّل الى ضياء. نحن لا نتغنّى بالله. نحن إلهنا قائم فينا، في عيوننا، في لحومنا، في عظامنا. نحن نأكل الله أكلاً، ونشرب دمه شربًا.

المعمودية التي لنا بالروح القدس تجعلنا نُقيم جسرًا بين كل شيء والمسيح. كل شيء جميل في هذا العالم، كل شيء طاهر وجليل، كل حقيقة في هذه الدنيا، كل خلجة حلوة في قلوب الناس، كل ومضة فرح في عيونهم، كل هذا مصدره المسيح يسوع. إن أحببنا كل حقيقة في الكون وكل بهاء فيه، فنحن بذلك نحيا في المسيح يسوع لأننا نُقرّ أنها منه تجيء، وأنها منه تتّخذ معناها. المسيحيون موحّدون لأنهم يربطون كل شيء بالإله الواحد الظاهر في الابن. كيف يكون هذا؟ هذا ممكن اذا عدنا لشهادة يوحنا المعمدان القائل: “هذا هو حَمَلُ اللهِ الرافع خطايا العالم”.

هذا الكلام يعني لنا اليوم اننا نؤمن أن الله ليس ذلك البطاش المستأثر بالسماء والأرض، ليس ذلك الذي يسود ليستعبد الناس. انه تنازل حتى الناس، حتى الموت، موت الصليب. في الصليب والقبر والقيامة، انسكب روح الله على الخليقة من جديد ينبوعا متدفقا يغمر هذا العالم. اي عندما سكن الله في الناس وانسكبت حياته من أجلهم على الصليب، تدفّق روح الله من جديد على المسكونة.

نحن نصطبغ بماء المعمودية لكي نتقبّل عطية الله هذه.

 في المسيح يسوع، بقوة الروح القدس، نكسر الجسم الترابي فينا لكي نُدخل كل شيء الى المسيح ولا يبقى من تمييز بين المسيح والدنيا لأن المسيح وحده هو الدنيا. في المعمودية يولد المسيح فينا طفلا وعلينا أن نسعى لكي ينمو فينا ويكبر الى ملء قامته. في المعمودية ينال الانسان بدء الحياة الروحية، ينال بذار الخلاص وعليه ان يُنمي هذا البذار، أن يسقيه، أن يتعهده، أن يبقى على معمودية مستمرة كأن الكنيسة تُعمّده كل يوم. أن نصطبغ بالروح القدس يعني أن نكون مثل ابن الله حِملانا لله، حملانا متواضعين، مقدّمين ذواتنا باللطف والوداعة من أجل الآخرين. اذا استطعنا أن نتنازل، أن نحب، أن نبذل النفس والحياة من أجل الإخوة، من أجل الناس جميعا، نكون قد أدّينا مثل يوحنا الصابغ شهادة للمسيح. نشير اليه بحياتنا قائلين: “هذا هو حَمَلُ الله” فيراه من هم حولنا ويُقبلون اليه تائبين.

جاورجيوس مطران جبيل والبترون وما يليهما (جبل لبنان)

Update in geriatric medicine.

Cayea D, Eckstrom E, Christmas C.

J Gen Intern Med. 2012 Mar;27(3):371-5. 

Author information

Abstract

INTRODUCTION:

With an aging population, internists will provide care to a growing number of older adults, a population at risk of developing multiple chronic medical conditions and geriatric syndromes. For this update in geriatric medicine, we highlight recent key articles focused on preventive strategies and lifestyle changes that reduce the burden of disease and functional decline in older adults.

METHODS:

We identified English-language articles published between March 1, 2010 and March 31, 2011 by review of the contents of major geriatrics/general medicine journals and journal watch services including: New England Journal of Medicine, Annals of Internal Medicine, Journal of the American Medical Association, Lancet, Archives of Internal Medicine, British Medical Journal, Journal of the American Geriatrics Society, and the Journals of Gerontology. We also reviewed updates to the Cochrane database of systematic reviews and articles highlighted by the ACP Journal Club and Journal Watch. Inclusion criteria included 
(1) randomized controlled trials, 
(2) conditions exclusive or common to older adults, and 
(3) commonly seen in generalist practices. 

After abstract review, each author selected five articles, and these were reviewed again by all authors. Through multiple discussions, consensus was reached on the final articles selected for inclusion based on their quality and potential to improve the health of older patients cared for by generalists.

Free PMC Article

Update in palliative care--2011.

Harris PF, Arnold RM, Braun UK, Fromme E, Ghermay R, Harman S, Jayes RL, Walling AM.

J Gen Intern Med. 2012 May;27(5):582-7. 

 

 Author information

Abstract

INTRODUCTION:

The aim of this update is to summarize scientifically rigorous articles published in 2010 that serve to advance the field of palliative medicine and have an impact on clinical practice.

METHOD:

We conducted two separate literature searches for articles published between January 1, 2010 and December 31, 2010. We reviewed title pages from the Annals of Internal Medicine, British Medical Journal, Journal of the American Geriatrics Society, JAMA, Journal of Clinical Oncology, JGIM, Journal of Pain and Symptom Management, Journal of Palliative Medicine, Lancet, New England Journal of Medicine, PC-FACS (Fast Article Critical Summaries for Clinicians in Palliative Care). We also conducted a Medline search with the key words "palliative," "hospice," and "terminal" care. Each author presented approximately 20 abstracts to the group. All authors reviewed these abstracts, and when needed, full text publications. We focused on articles relevant to general internists. We rated the articles individually, eliminating by consensus those that were not deemed of highest priority, and discussed the final choices as a group.

RESULTS:

We first identified 126 articles with potential relevance. We presented 20 at the annual SGIM update session, and discuss 11 in this paper.

Free PMC Article

Research roundup: December 2013.

Nicholson C.

Int J Palliat Nurs. 2013 Dec 20;19(12):619-20.

 

 Author information

Abstract

These pages provide brief synopses of a selection of recently published research articles of relevance to palliative care.

Management of muscle-invasive bladder cancer              in the elderly.

Basso U, Bassi P, Sava T, Monfardini S.

Expert Rev Anticancer Ther. 2004 Dec;4(6):1017-35.

Abstract

Bladder cancer is rare in patients below the age of 50 years, and most patients are in their 60s and 70s. 

Radical cystectomy is the preferred approach for patients with localized disease in most European countries and the USA, and evidence is growing in favor of neoadjuvant, platinum-based chemotherapy for patients at high risk of local and systemic relapse. 

Transurethral resection (TUR) followed by radiotherapy with or without concomitant chemotherapy appears to be a reasonable alternative, particularly in the UK and Canada.

 However, the elderly pose several treatment dilemmas, including the increased risk of perioperative complications, the management of orthotopic neobladder or different types of urinary diversion, as well as the higher risk of adverse events caused by pelvic radiotherapy and systemic chemotherapy. 
Multidimensional parameters such as biologic prognostic factors, performance status, functional independence, comorbidities and cognitive function of the patient should be collected in order to tailor treatment to the patient's life expectancy and preferences. Optimized integration of TUR followed by bladder removal (or radiotherapy), with or without adjunctive chemotherapy, can be recommended for otherwise healthy patients. Palliative measures, such as TUR followed by external radiotherapy alone or monochemotherapy, should be reserved for partially impaired patients with moderate comorbidities, in order to maximize the balance of benefits and toxicities. 

This review summarizes recent data concerning surgery, radiotherapy and systemic chemotherapy for bladder cancer in the elderly, and discusses pros and cons of the currently available therapeutic options.

[Palliative therapy concepts for patients with urothelial cancer of the urinary bladder].

[Article in German]

Vom Dorp F, Börgermann C, Rübben H.

Urologe A. 2007 Jan;46(1):54-5.

Author information

Abstract

Urothelial carcinoma usually occurs in older patients. 
At initial diagnosis, about 30% of all patients show muscle invasive tumor growth or metastases. 
Due to their advanced clinical stage, palliative therapy concepts become more and more interesting. 
Gross and intractable hematuria can be treated with special bladder irrigation or selective arterial embolization. Hydronephrosis can be treated in the long-term with self-expanding memotherm stents. 
Palliative pelvic radiation is still controversial.

Palliative radiation therapy of symptomatic recurrent bladder cancer.

Yi SK, Yoder M, Zaner K, Hirsch AE.

Pain Physician. 2007 Mar;10(2):285-90.

Abstract

BACKGROUND:

Palliative radiation therapy (RT) is an established tool in the management of symptoms caused by malignancies. RT is effective at palliating both locally advanced and metastatic cancer, including related symptoms of pain, bleeding, or obstruction. Most data on palliative RT is in regard to its use in the treatment of painful bone metastases. There are also data that support RT palliation for locally advanced or recurrent rectal, prostate, and gynecological cancers. With regard to bladder cancer there is some evidence of the benefit of palliative RT for the control of urinary symptoms and hematuria; however, there is little evidence for the use of palliative RT for pain associated with locally recurrent bladder cancer. We report a case of locally advanced recurrent bladder cancer which was refractory to medical pain management, and was found to be highly responsive to palliative RT.

CASE REPORT:

An 80-year-old woman with recurrent bladder cancer and intractable pelvic pain refractory to oral and transdermal pain medications, received palliative pelvic RT to a dose of 50 Gy (5000 cGy) in 25 fractions with complete resolution of pain. The patient was originally found to have dysuria, frequency, and hematuria, secondary to an invasive high grade transitional cell carcinoma of the bladder with an adenocarcinoma component, AJCC pT2b N1 M0 Stage IV, for which she underwent a radical cystectomy, total abdominal hysterectomy, bilateral salpingo-oophorectomy, partial vaginectomy, and ileal conduit reconstruction. After undergoing 4 cycles of adjuvant chemotherapy, the patient did well for 5 months with no evidence of symptomatic, clinical, or radiographic recurrence of disease. Repeat staging CT of the abdomen and pelvis confirmed tumor recurrence in the left pelvis. The patient was treated with another course of chemotherapy and pain was managed with relatively low doses of opioid medication (25mcg transdermal fentanyl patch, and oxycodone 5mg bid). However at the fourth month, there was rapid escalation of severe pain with the patient becoming bed bound due to pain with an associated decrease in ambulation and anorexia. Ultimately a pain medication regimen of 200mcg transdermal fentanyl patch q2 days, oxycontin 20mg bid, oxycodone 5 - 10mg q 4 hours, ibuprofen 400mg q 8 hours, and gabapentin 600mg TID was not effective in controlling pain. The patient was then referred to Radiation Oncology 6 months after the pain initially began for evaluation. She received a total of 5000cGy over 25 fractions to a small pelvis field over 5 weeks and reported complete pain resolution. She was able to decrease pain medications, increase overall activity, and gain significant improvement in sleep quality and appetite even early on in the course of her radiation therapy.

CONCLUSIONS:

Palliative radiation therapy has been well studied in the setting of bone metastases and treatment of hematuria for locally advanced bladder cancer. There is little data that we are aware of on the use of RT for pain control with patients that have recurrent, locally advanced bladder cancer. We have presented a case in which an excellent outcome in pain control was seen for a patient with medically unmanageable pain. RT is an excellent option for pain management in recurrent bladder cancer and should be offered to patients whose pain is not otherwise optimally controlled.  
Palliative RT is an important component in the multimodality approach to cancer pain management and optimization of quality of life.

Free full text

[Chemotherapy for urothelial cancer of the bladder--update 2012].

[Article in German]

Niegisch G, Lorch A, Albers P.

Aktuelle Urol. 2012 Dec;43(6):412-9. 

Author information

Abstract

Despite adequate surgical treatment by radical cystectomy and pelvic lymphadenectomy, about half of patients suffering from muscle-invasive urothelial bladder cancer will die. 

Both overall and cancer-specific survival has been improved by neoadjuvant chemotherapy. 

However, it is still not possible to predict who is likely to benefit from neoadjuvant treatment and who will not. 

In contrast to neoadjuvant chemotherapy, the efficacy of adjuvant chemotherapy has not definitely been proven. 

In metastatic urothelial cancer chemotherapy is usually a palliative treatment option. However, in a significant proportion of patients, disease stabilisation and even long-term response can be achieved. Important advances to tailor first- and second-line chemotherapy have recently been reported for clinical prognostic parameters. This review discusses the current standards and developments in the chemotherapeutic treatment of urothelial bladder cancer. Furthermore, it should provide a framework for reasonable treatment choices in daily clinical practice.

© Georg Thieme Verlag KG Stuttgart · New York.

Feasibility and safety of hospital discharge 24 hours after laparoscopic radical prostatectomy.

[Article in English, Spanish]

Diaz FJ, Hernandez V, de la Peña E, Blazquez C, Martin MD, Llorente C.

Arch Esp Urol. 2013 Dec;66(10):931-938.

Author information

Abstract

OBJECTIVES:

Minimally invasive techniques for the surgical treatment of prostate cancer have aimed to achieve the same functional and oncological outcomes of open surgery with a significant decrease in postoperative morbidity and a subsequent decreasing hospital stay. These improvements are important in the current economic context. Our aim was to evaluate the feasibility and safety of hospital discharge 24 h after laparoscopic radical prostatectomy (LRP).

METHODS:

A total of 266 consecutive patients with clinical diagnosis of localized prostate cancer consecutively treated with extraperitoneal LRP between May 2007 and December 2010 were analyzed. 
There were no exclusion criteria for the surgical procedure. Patients were discharged in less than 24 h only in the case of absence of medical complications, with drainage of less than 50 mL allowing its removal before discharge, normal oral feeding tolerance, no significant hematuria by bladder catheter and good functional recovery of the patient. 
All surgery-related complications that occurred within 90 days after surgery were recorded and were classified according to the modified Clavien scale.

RESULTS:

A total of 266 patients who underwent LRP were studied with a median follow-up of 34 months. 80 (30.1%) patients were discharged from the hospital in less than 24h. 89 (33.4%) patients were discharged within 48 h and 97 (36.5%) after 48h.The mean hospital stay of the entire case series was 2.9 days (SD 3.08). The mean hospital stay of patients who were discharged after 48h was 5,5 days (SD 3.94) Thirty-one patients (10.7%). experienced post-surgical complications. 25 (9.31%). of them were classified as Clavien I or II, and 6 (2.2%). Clavien III or IV. A total of 9 (3.3%) patients were readmitted. Of the group of patients who were discharged within 24h only one was readmitted due to hematuria.

CONCLUSIONS:

Extraperitoneal LRP is the standard treatment for localized prostate cancer in our institution. This treatment reliably and safely allows a hospital stay shorter than 24 h in a significant percentage of our patients.

Is it necessary to remove submandibular glands in squamous cell carcinomas of the oral cavity?

Basaran B, Ulusan M, Orhan KS, Gunes S, Suoglu Y.

Acta Otorhinolaryngol Ital. 2013 Apr;33(2):88-92.

Abstract

The aim of this study was to determine the frequency and the mechanism of submandibular gland (SMG) involvement in oral cavity squamous cell carcinomas (OCSCC), and to discuss the necessity of extirpation of the gland. 

The authors investigated and analyzed the retrospective charts of 236 patients who underwent surgery for OCSCC over a 10-year period and the pathology reports of 294 neck dissections with SMG removal. 

SMG involvement was evident in 13 cases (4%). 
Eight cases were due to direct invasion, which was the most common mechanism. 

Four cases had infiltration from a metastatic periglandular lymphadenopathy, and in 1 case, metastatic disease was confirmed. 

The tongue and floor of the mouth were the most frequent primary sites associated with SMG involvement. 
The study found no bilateral cases, and in 135 SMG specimens benign pathologies were detected. Involvement of the SMG in OCSCC is not frequent. It is appropriate to preserve the gland unless the primary tumour or metastatic regional lymphadenopathy is adherent to the gland.

KEYWORDS:

Neck dissection, Oral cavity, Squamous cell carcinoma, Submandibular gland, Xerostomia

The use of cannabinoids in chronic pain.

Reynolds TD, Osborn HL.

BMJ Case Rep. 2013 Jul 26;2013.

Abstract

We present the case of a 56-year-old man who developed chronic pain following the excision of a facial cancer that was poorly controlled despite multiple analgesic medications. 

Following the starting of nabilone (a synthetic cannabinoid) his pain control was greatly improved and this had a huge impact on his quality of life. 
We also managed to significantly reduce his doses of opioid analgesia and ketamine. 
We review the current literature regarding the medicinal use of cannabinoids, with an emphasis on chronic pain, in an attempt to clarify their role and how to select patients who may benefit from this treatment.

كيف عرفت الفصح

المطران جورج خضر

28 كانون الأول 2013

كل منا يهرب من حرج يدهمه ليسعى إلى فرح يتخيله في مكان ما في نفسه. كل يخاف الموت. ولكل منا موته ما عدا هذا الذي يخشاه في الأخير. لكن الأخير ينتظر أو نريده أن ينتظر. من يواجه؟ هذا فيه موت أو بعض من موت.

ننسج حياتنا كما يحلو لنا. قلما نرثها كما تنزل علينا. هذا مخيف. الخيال ليس يخيف. أن تواجه تعني أن ترث الله لأن الله الحقيقي هو في الآن. اخترعنا الأعياد لأننا نخشى الموت. حسن أن تستطيب الأعياد لأنك بها تضرب التفه الذي فيك، تنزل حلما إلى يومك، تحسب انك وارث الأبدية. هل الأبدية تعني لك خروجًا عن أيامك كما هي أم هي عمق أيامك إن كانت لك رؤية مؤمن؟
تستطيع أن تحول جرحك إلى مكان رجاء إذا كان لك في دمك فداء. كل دم مقبول على الرجاء فداء. خاليًا من الإحساس يكون من لا يقبل جرحه في الإيمان. من آمن هكذا يكون قد ارتضى نفسه في محبوبية الله. فإن لم تسعَ إلى ربك كل يوم تبقى في مصروعية العالم.
انت في عزلتك عن الوجود الحق لا تقدر على شيء. والعزلة هذه تعني عدم الحب. المحب في تطويق يعطيه ويأخذه. هو وحده ليس وحده. الناسك ليس معزولا إن كان قد تنزه. ونحن قائمون في جروحنا وجروح الآخرين. ليس من انسان منعزل حيا. الحي من قام من بين الأموات. لكنه قبل ذلك هو من هذه الأرض. لا يولد انسان قياميا. يصير كذلك من بعد موت.


مصيبتي مع بعض من المؤمنين أنهم يستطيبون الأعياد لأنها نازلة عليهم. لا يفهمون انها ليست بشيء ان لم يصنعوها، ان لم تنبت منهم. العيد لا يأتي اليك. يتدفق منك ان كنت يوما مع الله. ان لم تقبل الوجود كله لا تذوق الله. فتش عن الله في الوجود، في الألم، في انكسارك، في عزلتك. انه يشفي كل هذا. لا تكن فقط مع الطقوس فإن كنت لا تحب الإخوة لا يبقى لك شيء منها. ولكن لا تزدر الأعياد. هي قائمة في الفرح وفي الحزن بالقوة نفسها ان كنت تعرف ان تستطيبها. لا تحزن ان نزلت علينا الأعياد في أيام حزننا. لا شيء يغلب العيد فالعيد قيامة.


كل أهمية العيد انه يمكنك من الحب من ذاك الذي يضم الناس كلهم إلى الله واليك. معك وحدك ليس من ضم يكافئ النفس كلها. ليس من لقاء الا في انضمام الذات إلى الذات. الحياة الرتيبة قوقعة. الحياة الخارجة إلى كل حياة هي الوجود.


بالعيد تخترق التفه لكن الخوف أن تعيد لنفسك، ان تنغلق في حبها. العيد هو الآخرون الذين يقيمون معك الموسم والذين لا يقيمون. إذا ذهبت إلى الناس انوجدوا. الناس نيام. يخشون خطر الحب. أيقظهم في سبيل أنفسهم، لحياتهم. وقبل أن يفيقوا لا يستطيعون أن يحيوا. النوم يشبه الموت.

 «استيقظ أيها النائم وقم من بين الأموات فيضيء لك المسيح». هذه هي صلواتنا.

لقد جاء العيد حتى لا ننام. أظن أن المسيح قام حتى لا يبقى أحد راقدًا. أن تعطي المسيح يعني أولا أن تعطي اليقظة. المسيح أراد ميلاده يقظةً لنا دائمة. هو أراد أن يشاهد التلاميذ آلامه لما أفاقهم من نومهم في البستان. لذلك كان آباء البرية عندنا يكافحون النوم.
كان أبي يوقظني صباح الفصح عند الساعة الثالثة لنصل إلى الكنيسة قبيل الرابعة. ما كان يقول هذا طفل. فالصلاة كانت تبدأ عندنا قبل حلول السحر، تأخذ قسطًا من أواخر الليل والصغار والكبار واحد في اليقظة. في كنيستي الناس كلهم كبار. والمؤمنون عندنا يحفظون الصلاة باللغة الفصحى بلا خطأ في التشكيل. استقامة الرأي تتطلب استقامة اللغة. كانت عندنا شرطًا للصلاة وشبه الأميين ما كنا نسمح لهم بالقراءة. كنا نحسب في بساطتنا أن الرب يريد لغةً سليمة. لست أعلم إذا كان الملائكة يفرحون بلغةٍ مكسورة.
أهل كنيستي كانوا يذهبون إلى أن القراءة الفصيحة جزء من الإيمان. إحساسهم البسيط أن هذا جزء من استقامة الرأي. وكان عارفو اللغة بيننا يصححون قراءة الضعفاء في أداء الصلاة. وإحساسهم كان أن هذا شرط من استقامة الرأي. هل كانوا يظنون أن سلامة اللغة من سلامة الإيمان؟ كان عند البسطاء إصرار على أن الأسقف أستاذ في العربية. انت مستقيم الرأي ومستقيم اللسان. الأشياء واحدة.

 تعال لنأخذ وجودنا منك ونكون

المطران جورج خضر

21 كانون الأول 2013

"لما حان ملء الزمان أرسل الله ابنه مولوداً من امرأة، مولوداً تحت الناموس لننال التبني". ها قد بتنا أبناء يا سيدي بعد ان كنا مخلوقين من هذا الجسد.

"الذين وُلدوا لا من دم ولا من رغبة جسد بل من الله". هكذا نعرف أنفسنا بك. أنت قلت: "لن أسميكم عبيداً بعد. أنتم أبناء". أنت أيها الناصري اخترعت ان الإنسان حبيب الله والحبيب ليس عبداً.
دعوتنا إلى الألوهة. هذه ندّية. انها ليست فقط نسابة أنت مخترع الحب. اذا سمى الله الإنسان حبيباً ألا يعني هذا انه ساواه بنفسه؟ هل العشق إلاّ بين متساوين؟
لما قال الرسول أرسل الله ابنه عند ملء الزمان أراد ان ليس يعرف بعد المسيح زمن غير زمنه أي وجود غير وجوده لأنك تعرف الأزمنة والناس.
ان تكون دعوتنا إلى ما دون الألوهة هذا ليس فيه شيء. أنت كريم ولا تدعو الا لذاتك. أنت ما اعطيتنا شيئاً من الأشياء. أنت تعطينا نفسك لعلمك ان الانسان تحقَّق فقط بربوبيتك.
يا أيها الحب الذي لا يدنى منه اجعلنا نفهم ان المحبة أساسك وأساس الإنسان وان المعرفة كلام فيها. كان زمانك ملء الزمان لكوننا لا ننتظر شيئاً بعدك يا أيها السيد المبارك. لا نسعى في الأشياء إلاّ إليك. لا يضاف شيء عليك اذ لا يقاس بك شيء.
المساواة بيننا وبين الله ليست في الجوهر. هي في الكرامة هو رآها فينا. اذ انعكست علينا بمحبته. حتى لا نكون أمواتًا نجيء منه في كل حين. ربِّ لا تقم هوة بيننا وبينك. نحن نريد ان نأتي منك كل حين. بهذا نتكون، أردم المسافات إن رأيتها.
سمر في عيونهم، ربِّ، انهم اذا رأونا رأوك. ولكن اجعل هذا ممكناً فيك أي روضنا على محبتك ليشهدوا اننا نحبك.
إذا كنا فيك لا نبقى نسأل عما لنا وعما لك. كل شيء لك. لا تدعنا ندهش بنفوسنا لئلا نستكبر ونموت. تعال أيها الرب يسوع لنفكر معك وبك ونحن فيك.

 تعال لنأخذ وجودنا منك ونكون.

Spirituality in palliative home care: a framework for the clinician.

Vermandere M, Lepeleire JD, Van Mechelen W, Warmenhoven F, Thoonsen B, Aertgeerts B.

Support Care Cancer. 2013 Apr;21(4):1061-9. 

Author information

Abstract

PURPOSE:

Spiritual care at the end of life remains poorly understood despite its promotion by the World Health Organisation. The purpose of this paper was to develop a consensus-based framework of the main elements of spiritual care in palliative home care.

METHODS:

Expert meeting using the nominal group technique, followed by a two-stage web-based Delphi process, was used. Experts from three stakeholder groups (physicians, professional spiritual care givers and researchers) representing two countries (Belgium and the Netherlands) participated in this study.

RESULTS:

Fourteen elements of spiritual care were retained: (1) being sensitive to patient's fear of the dying process; (2) listening to the patient's expectations and wishes about the end of life; (3) giving attention to patient's wishes about the design of the farewell; (4) offering rituals if the patient experiences them as meaningful; (5) listening to the stories, dreams and passions of the patient; (6) helping the patient find strength in inner resources; (7) connecting with the patient in truth, openness and honesty; (8) supporting communication and quality of relationships; (9) making sure the patient feels comfortable and safe; (10) seeing spirituality as an interwoven, though specific dimension; (11) caring for your own spirituality; (12) knowing and accepting your vulnerability; (13) being able to learn from your patient; and (14) having an interdisciplinary team that is there when needed.

CONCLUSIONS:

The experts agreed to the 14 main elements of spiritual care in palliative home care. There were no differences in this regard between the stakeholder groups. This study provides a first step towards the development of an interdisciplinary spiritual care model in palliative home care.

Attachment theory and spirituality: two threads converging in palliative care?

Loetz C, Müller J, Frick E, Petersen Y, Hvidt NC, Mauer C.

Evid Based Complement Alternat Med. 2013;2013

Abstract

The aim of this paper is to discuss and explore the interrelation between two concepts, attachment theory and the concept of spirituality, which are important to palliative care and to founding a multivariate understanding of the patient's needs and challenges. Both concepts have been treated by research in diverse and multiform ways, but little effort has yet been made to integrate them into one theoretical framework in reference to the palliative context. In this paper, we begin an attempt to close this scientific gap theoretically. Following the lines of thought in this paper, we assume that spirituality can be conceptualized as an adequate response of a person's attachment pattern to the peculiarity of the palliative situation. Spirituality can be seen both as a recourse to securely based relationships and as an attempt to explore the ultimate unknown, the mystery of one's own death. 

Thus, spirituality in the palliative context corresponds to the task of attachment behavior: to transcend symbiosis while continuing bonds and thus to explore the unknown environment independently and without fear.
 Spiritual activity is interpreted as a human attachment behavior option that receives special quality and importance in the terminal stage of life. Implications for clinical practice and research are discussed in the final section of the paper.

[Guidelines on the management of implantable cardioverter defibrillators at the end of life.]

[Article in Spanish]

Datino T¹, Rexach L², Vidán MT³, Alonso A⁴, Gándara A⁵, Ruiz-García J⁶, Fontecha B⁷, Martínez-Sellés M⁸.

Rev Esp Geriatr Gerontol. 2013 Dec 9.

Abstract

This article is a joint document of the Spanish Society of Geriatrics and Gerontology, the Spanish Society of Palliative Care and the Section of Geriatric Cardiology of the Spanish Society of Cardiology. Its aim is to address the huge gap that exists in Spain with regard to the management of implantable cardioverter defibrillators (ICDs) in the final stages of life. It is increasingly common to find patients carrying these devices that are in the terminal stage of an advanced disease. This occurs in patients with advanced heart disease and subsequent heart failure refractory to treatment but also in a patient with an ICD who develops cancer disease, organ failure or other neurodegenerative diseases with poor short-term prognosis. 

The vast majority of these patients are over 65, so the paper focuses particularly on the elderly who are in this situation, but the decision-making process is similar in younger patients with ICDs who are in the final phase of their life.
Copyright © 2013 SEGG. Published by Elsevier Espana. All rights reserved.

KEYWORDS:

Cuidados paliativos, Decision-making, Desfibrilador automático implantable, Implantable cardioverter defibrillator, Palliative care, Retirada de tratamiento, Toma de decisiones, Treatment retrieval

Carol Levy

Classification of and risk factors for estrogen deprivation pain syndromes related to aromatase inhibitor treatments in women with breast cancer: a prospective multicenter cohort study

• Francoise Laroche
,
• Joël Coste
,
• Terkia Medkour
,
• Paul Henri Cottu
,
• Jean-Yves Pierga
,
• Jean-Pierre Lotz
,
• Karine Beerblock
,
• Christophe Tournigand
,
• Xavier Declèves
,
• Patricia de Cremoux
,
• Didier Bouhassira
,
• Serge Perrot

Received 30 September 2013; accepted 20 November 2013. published online 23 December 2013.

Abstract 

Aromatase inhibitors (AI) are the first-line treatment in women with breast cancer for total estrogen depletion. Half the treated women may develop pain and this condition may therefore be seen as a clinical model of pain related to estrogen deprivation. In this prospective multicenter study, we classified AI-related pain syndromes and identified their predictors.

A one-year, prospective, multicenter cohort study, with six visits, was carried out on 135 women with early-stage breast cancer and no pain at the start of AI treatment. 

At initial assessment, we investigated clinical (demographic and psychosocial, cancer characteristics and treatment, sleep, quality of life), biological (sex hormones, vitamin D, bone biomarkers, oxidative stress, immunological and inflammatory markers), environmental and genetic (polymorphism for pain mechanisms) risk factors for pain.

During one year of follow-up, 77 women (57%) developed pain, leading to AI discontinuation in 12 cases. 

Five pain syndromes were identified: joint pain (36%), diffuse pain (22%), tendinitis (22%), neuropathic pain (9%) and mixed pain (11%), mostly persistent (57%), with diffuse and joint pains the most intense.

Risk factors for the development of pain included higher levels of anxiety and impaired quality of life at the initial assessment, whereas cancer characteristics, genetic background, inflammation, immunological and hormonal status at baseline were not significant predictors.

Key words: Breast cancer, pain, estrogen deprivation, aromatase inhibitors, arthritis

Does the New Formulation of OxyContin® Deter Misuse? A Qualitative Analysis

Lesly-Marie Buer¹, Jennifer R. Havens² and Carl Leukefeld¹

¹Department of Behavioral Science, University of Kentucky,

Lexington, Kentucky,

USA

²Center on Drug and Alcohol Research, University of Kentucky,

Lexington, Kentucky,

USA

Address correspondence to Lesly-Marie Buer, Department of Behavioral Science, University of Kentucky,

122 Medical Behavioral Science Building, Lexington, KY 40536

, USA. E-mail: lesly-marie.clevenger@uky.edu

The purpose of this qualitative study is to understand changing illicit drug use patterns in rural Appalachia since a new formulation of OxyContin® was released with the goal of deterring diversion and misuse. Participants (n = 25) from a longitudinal study of rural drug users (N = 192) were approached to participate in semistructured qualitative interviews between April and June 2011. The primary finding is that the majority of participants switched from using the original formulation OxyContin to immediate-release oxycodone. We discuss the implications and limitations of these findings.

Read More: http://informahealthcare.com/doi/abs/10.3109/10826084.2013.866963

Meaning-in-life in nursing-home patients: 

a correlate with physical and emotional symptoms.

Haugan G.

J Clin Nurs. 2013 Dec 18.

Abstract

AIMS AND OBJECTIVES:

To investigate the prevalence of physical and emotional symptoms and the associations between symptoms and meaning-in-life in a cognitively intact nursing-home population.

BACKGROUND:

Meaning has been found to be a strong individual predictor of successful ageing and life satisfaction as well as an important psychological variable that promotes well-being. Meaning serves as a mediating variable in both psychological and physical health.

DESIGN AND METHODS:

The study employed a cross-sectional design. Data were collected in 2008 and 2009 using the QLQ-C15-PAL quality-of-life questionnaire, the purpose-in-life test and the Hospital Anxiety and Depression Scale. A total of 250 cognitively intact nursing-home patients who met the inclusion criteria were approached and 202 attended.

RESULTS:

The prevalence of symptoms was fairly high, with fatigue (57%), pain (49%), constipation (43%) and dyspnoea (41%) as the most frequent physical symptoms, while 30% were depressed and 12% had anxiety. Significant correlations between meaning-in-life and symptom severity were displayed.

CONCLUSIONS:

The level of symptom severity among cognitively intact nursing-home patients is high, requiring highly competent staff nurses. Meaning-in-life might be an important resource in relation to a patient's physical and emotional health and global well-being.

RELEVANCE TO CLINICAL PRACTICE:

Facilitating patients' meaning-in-life might help reducing symptom severity and fostering quality of life in cognitively intact nursing-home patients. However, advancing staff nurses' competence in palliative care, symptom management and nurse-patient interaction is important for care quality and quality if life in nursing homes.
© 2013 John Wiley & Sons Ltd.

KEYWORDS:

meaning and purpose-in-life, nursing-home patients, quality of life, symptoms

Ethical issues in the geriatric patient with advanced cancer 'living to the end'.

Daher M.

Ann Oncol. 2013 Oct;24 Suppl 7:vii55-58.

Abstract

Cancer incidence will increase as the population ages; there will be a 50% increase in new cancer cases over the next 20 years, and the biggest rates of increase will occur in the developing world. Owing to technical advances in the care of critical illness, as it is the case in elderly people with advanced cancer, physicians, patients and families are often confronted with ambiguous circumstances in which medical advances may inadvertently prolong suffering and the dying process rather than bring healing and recovery.

 In this review of the ethical issues confronting physicians who care for patients with advanced life-limiting illnesses like cancer, a philosophical debate continues in the medical community regarding the rightness or wrongness of certain actions (e.g. physician-assisted death, euthanasia), while at the same time there is a strong desire to find a common ground for moral discourse that could guide medical decision-making in this difficult period in the lives of our patients. We will discuss how a good palliative care can be an alternative to these ethical dilemmas. Although some issues (e.g. the role of physician-assisted death in addressing suffering) remain very controversial, there is much common ground based on the application of the four major principles of medical ethics, no malfeasance, beneficence, autonomy and justice. Thus, the physician's primary commitment must always be the patient's welfare and best interests, whether the physician is treating illness or helping patients to cope with illness, disability and death. A key skill here is the communication of bad news and to negotiate a treatment plan that is acceptable to the patient, the family and the healthcare team. Attention to psychosocial issues demands involvement of the patients and their families as partners.
 Physicians should be sensitive to the range of psychosocial distress and social disruption common to dying patients and their families. 
Spiritual issues often come to the fore. 
An interdisciplinary healthcare team can help in these areas. 

The goals of this review are to raise the awareness of doctors, nurses and other members of the healthcare team to the important ethical issues that must be addressed in providing medical care to elderly patients with advanced cancer; and also to encourage members of the healthcare team to take the ethical issues seriously so that we can improve the circumstances of a vulnerable group of patients-the elderly patients with cancer.

Gaps in end-of-life care.

J Med Liban. 2011 Jan-Mar;59(1):37-9.

 Daher M.

Abstract

End-of-life care is an important aspect of medical practice. Individual physicians and the medical community must be committed to the compassionate and competent provision of care to dying patients and their families. Patients rightfully expect their physicians to care for them and provide them with medical assistance as they are dying. To care properly for patients near the end of life, the physician must understand that palliative care entails addressing physical, psychosocial, and spiritual needs and that patients may at times require palliative treatment in an acute care context.
 To provide palliative care, the physician must be up to date on the proper use of opioids and the legality and propriety of using high doses of opioids as necessary to relieve suffering. Good symptom control; ongoing involvement with the patient; and physical, psychological, and spiritual support are the hallmarks of quality end-of-life care. Care of patients near the end of life, however, has a moral, psychological, and interpersonal intensity that distinguishes it from most other clinical encounters. With appropriate education, physicians can play a key role to improve care for patients and families who are living with advanced life-threatening illness. Although some issues (e.g., the role of physician-assisted death in addressing suffering) remain very controversial, there is much common ground based on the application of the four major principles of medical ethics, nonmaleficence, beneficence, autonomy, and justice.