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Incomplete Cross Tolerance and multiple mu opioid peptide receptors - Pasternak 2001

  • Incomplete cross tolerance is the idea that in developing tolerance to an opiate, you'll build up a tolerance to multiple opiates, but you won't get the same level of tolerance developed (incomplete!)

Hippocratic Facies

Paper

  • facies hippocratica

  • Illich describes this as having "moved into the atrium of death"

“You should observe thus in acute diseases; first the countenance of the patient, if it be like those of persons in health, and especially if it be like its usual self,for this is best of all. But the opposite are the worst, such as these: a sharp nose, hollow eyes, sunken temples; the ears cold, contracted and their lobes turned outwards; the skin about the forehead rough, stretched and parched; the color of the face greenish or livid. . . be it known for certain that the end is at hand.”

  • Sunken Eyes
  • Bitemporal Muscle Wasting
  • Livid Skin Colour (Bluish-Grey, Ashy Grey)

  • Decreased Level of Consciousiness

  • Prognostic sign described by hippocrates

  • Indicating when someone is likely to die

Other Scoring Systems

  • Palliative Prognostic Score (PaP Score)
  • Palliative Prognostic Index
  • Chuang Prognostic Score
  • Terminal Cancer Prognostic Score
  • Bruera Prognostic Indicator

PaP Score

  • Most validated score of them

  • Endoresed by Europeon Association for Palliative Care

  • Dyspnoea

  • Anorexia
  • Karnofsky Performance Status
  • Clinician Prediction of Survival in Weeks
  • Total Leukocyte Count

  • Percentage of Lymphocytes

  • Gives a score of:

  • A - 30 Day Survival more than 70%
  • B
  • C - 30 Day Survival less than 30%