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A LIVING WILL or “declaration of treatment ahead of time”. This is a documenti made by a person in full possession of their mental faculties, which covers specific directives as to the course of treatment that is to be taken by caregivers in case of serious conditions forbidding expression of the patient's free will. The person who signs it expresses her/his will about artificial treatments such as revival, saving-life therapies, artificial feeding in situations considered unacceptable to the patient herself/himself. This will let the patient think in advance about many difficult issues, her/his family and caregivers decide in advance about health care instructions and what the patient considers to be an appropriate/apt death, protecting him/her from aggressive treatment. On the other hand, some doubts about earlier decisions could arise up, creating conflicts between the patient's will and the values that lead her/his doctor. This act of will has no legal validity in Italy.
ADI Integrated Domiciliary Assistance
AGGRESSIVE TREATMENT DESPITE KNOWN OUTCOME Use of therapies and technologies to artificially extend the life of the terminally ill patient, causing often high costs in term of grief to the patient and the use of resources.
ANALGESIC A medication that reduces or eliminates pain without loss of consciousness
ANAMNESIS The complete medical history recalled with suitable information about the patient and her/his family, past and present clinical signs, the manifestation of the disease and the course of the illness.
ANEMIA A pathological deficiency in the oxygen-carrying component of the blood, measured in unit volume concentrations of haemoglobin, red blood cell volume, or red blood cell number.
ANESTHETIC An agent that causes loss of sensation and elimination of pain
ANOREXIA Loss or lack of appetite. Main causes are the presence of nausea and vomit, secondary effects of some drugs, modification of the metabolism, mouth disease, anxiety, depression. Some drugs, i.e. cortisone, work up appetite and are used in the early stage of the disease. In the terminal phase reduce food and drinks can be suitable.
ANTALGIC drug counteracting or avoiding pain, assumed so as to lessen pain or the perception of it.
ANTIEMETIC DRUG - a drug that prevents or alleviates nausea and vomiting
ANTIBLASTICO a drug that inhibits the proliferation of tumoral cells
APT /APPROPRIATE DEATH the concept of ‘apt/appropriate death' has to do with life style, personal beliefs and values. It is seen as ‘appropriate' if consistent to one's life.
ASTHENIA General loss or lack of bodily strength due to certain pathologies. It can go with drowsiness, weakness, debility, lethargy, and provoked by side effects or by growth of tumour through biochemical alteration. It is very common with progressive irreversible illnesses.
BURN-OUT SYNDROMEstress due to work very much common with helping professions, such as doctors, psychologists, nurses, teachers, social workers, etc. Characteristic features of this syndrome are emotional exhaustion, depersonalization and low personal accomplishment.
CACHEXIA progressive state of psychical and psychological decay. Characteristic features are asthenia, anorexia, loss of weight, weakness, various underlying disorders, autoimmune disorders, slowing down of mental capacity.
CAREGIVER (OR FAMILY LEADER) An individual, who attends to the needs of the patient. Not necessarily a family member, but also a friend, an acquaintance can do.
CLINICAL AUDIT An examined and verified account on the quality improvement process that seeks to improve patient care and outcomes through systematic review of care.
CLINICAL TRIAL evaluation of new drugs or other interventions on patients in strictly scientifically controlled settings to prove its efficacy and its safety
CONTRAST MEDIUM substance used during radiological examination to visualize natural or pathological organs or cavities.
CUP Central booking office, for physical examinations.
DH DAY HOSPITAL An institution that provides medical care and treatment during day-time so that the patient can be discharges for the night.
DEA emergency department, emergency ward
DEONTOLOGY Ethical theory concerned with duties and rights. In medicine it refers to a code of conduct that, through a series of rules, behavioural and ethical, settles duties and rights about the relationship between doctors, and doctor and patient.
DIAGNOSIS The act or process of identifying or determining the nature and cause of a disease or injury through evaluation of patient history, examination, and review of laboratory data.
DYSPHAGIA difficulty swallowing, difficulty in the passage of solids or liquids. It may be associated with a sense of obstruction or pain behind the sternum, possibly caused by some drugs of by the disease itself.
DYSPNEA is perceived difficulty breathing or pain on breathing. It may bring to “air hunger”
DRAINAGE Surgery removal of fluid or purulent material from a wound or body cavity.
DRUG TOLERANCE or addiction. The diminution in the response to a drug after prolonged use so that larger doses are required to achieve the same effect.
EDEMA An excessive accumulation of serious fluid in tissue spaces or a body cavity can brings the bulge of organs due to stasis.
EMFTOE presence of blood in the mucus spitted while coughing
EMOTTISI airborne emission of blood
EMPATHY Identification with and understanding of another's situation, feelings, and motives. In care giving empathy is one of the essential traits to set a helping relationship.
ENTERAL the inner part of the body. A feeding tube is a medical device used to provide nutrition to patients through a probe directly touching the intestine. The state of being fed by a feeding tube is called enteral feeding or tube feeding.
ERYTHEMA Redness of the skin caused by dilatation and congestion of the capillaries, often a sign of inflammation or infection. It disappears pressing the skin.
EUTHANASIA literally “good death” The act or practice of ending the life of an individual suffering from a terminal illness or an incurable condition, as by lethal injection or the suspension of extraordinary medical treatment. In Italy euthanasia is outlaw by law and by the medical code of conduct
EXTRA-HOSPITAL DISCHARGE FORM As the Hospital discharge form it sums up all the info from the health record and gives every detail about the patient discharged from an hospice.
FAMILY LEADER (OR CAREGIVER) An individual, who attends to the needs of the patient. Not necessarily a family member, but also a friend, an acquaintance can do.
GRADING measure of the progress of tumours rated by its histological and cytological grade of increasing malignity and how much a tumour differs from normal cells
GOOD DEATH It is ‘good' if a person feels complete and keeps being an important element of the surrounding environment, despite bodily decay; if the person is free from physical pain; nursed with love and ready to end her/his course with a sense of completeness, with peace.
HEMORRHAGE BLEEDING loss of blood (external or internal) from the body
Hospice an inpatient facility that provides a shelter to terminally ill patients. It' s a place whose standard is set by law: environmental comfort is a fundamental part of the patient's healing; relatives can join the patients and live with him/her. In hospice patients can spend all their last days with their families since there's not visiting time, eat food prepared by her/his family, having sometimes her/his pet with him/her and, like at home, he can listen to music or watching tv in her/his single room.
HOSPITAL DISCHARGE FORM an informative tool for data acquisition about the patient discharged from a recovery structure, with all the information from the health record.
HORMONE THERAPY The administration of natural or synthetic hormones in medical treatment.
IATROGENIC, DISORDERcomplication of treatment induced in a patient by a therapy.
INFUSION DEVICEthat, through venous, spinal or subcutaneous access, can dose drugs or other substances in given quantities and for many days. It can contain drugs even for a week, and can be usefully put in small containers like a marsupium or hanged at the neck under the clothes, according to the patient's needs.
INFORMED CONSENT consent by a the patient based upon an appreciation and understanding of the treatment and/or diagnosis explained by the doctor (in a understandable way) upon purpose, significant risks and possible alternatives. An informed consent requires a good dialogue, a trusty relationship between doctor and patient and it is based upon an appreciation and understanding of the facts about health.
IN-HOME ASSISTANCE Welfare system operating in or providing at the home of the patient the necessary professional expertise for appropriate treatment.
LYMPH GLANDsmall organ belonging to the lymphatic system.
METASTASIS Transmission of pathogenic microorganisms or cancerous cells from an original site to one or more sites elsewhere in the body, usually by way of the blood vessels or lymphatics. The presence of metastasis is a primary sign of a malignant tumour.
MORPHINE A crystalline alkaloid extracted from opium, the soluble salts of which are used in medicine as a powerful analgesic or a sedative
MOURNING is a multi-faceted response to a significant loss. It's the expression of a profound grief and great pain. It may start an hour or a day after the perceptions of the loss (mourning) and depression may follow. The ‘mourning work' upon oneself is the process of reassessment, understanding of the experience and the emotional response to loss, accepting the reality.
NEOPLASIA synonym of tumour. Formation of a neoplasm in the original site is primitive neoplasia; secondary neoplasm comes with the process of metastasis.
NODULE A small knotlike protuberance, a small mass of tissue or aggregation of cells that can be benign or malignant
ONCOLOGY The branch of medicine that deals with tumours, including study of their development, diagnosis, treatment, and prevention
OPIOID/OPIATE Any of various sedative narcotics containing opium or one or more of its natural or synthetic derivatives.
OPHIOPHOBIA prejudice, resistance, suspicion about using opiates as a therapeutic drug to control pain. It is cause of pain for millions of people whose pain is not properly treated.
PALLIATIVE TREATMENT Any form of medical care or treatment that concentrates on reducing the severity of the symptoms of a disease, or slow the disease's progress, rather than provide a cure. At the end of life, when recovery is no longer an option, palliative treatment accepts death as a natural process that can't be accelerated or slowed down, and takes care of the patient and her/his family, all participating in the process of the disease. Taking care means paying attention to physical symptoms as well as to the socio-economic situation of the patient, understanding family tensions, expectations for their future, the values that guide the family, in order to find the better plan assistance for them.
PARENTERAL The administration of a drug in a manner other than through the digestive tract, as by intravenous or intramuscular or subcutaneous, endoarterial, endocardiac injection.
PERCUTANEOUS administration of a drug through the skin
PERFORMANCE STATUS (PS): measure is used to determine the patients' general well-being.
PHLEBOCLYSIS glass container or bag with sterile liquid that can be injected to the patient as a drug is a subcutaneous or venous way
PHYSICAL DEPENDENCY The state of being determined, influenced, or controlled by some drugs (opiate, alcohol, nicotine, etc); a compulsive or chronic need that brings to withdrawal symptoms after discontinuing a drug. It must not be confused with psychological dependency or drug addiction.
PSYCHOLOGICAL DEPENDENCY occurs when a drug has been used habitually and the mind has become emotionally reliant on its effects, either to elicit pleasure or relieve pain, and does not feel capable of functioning without it. Its absence produces intense cravings.
PYREXIA fever
POSOLOGY The study of the dosages of medicines and drugs in a certain period of time
POST-OPERATIVE period of time that follows the surgical operation, corresponding more or less to convalescence
PROGNOSIS A prediction of the probable course and outcome of a disease.
PROTOCOL pattern for the treatment of a pathology settled by studies on international reviews. Guidelines to a clinical trial
QUALITY OF LIFE perception of the patient's life. It is the most important thing to consider when a diagnosis, a treatment and assistance are to be given to terminally ill patients. To improve the quality of life means not only to cure symptoms but taking care of all the sufferance to give a better and global return to the patient.
RELAPSE Return of a disease after a period of improvement or suddenly after remission. It can be used as a synonym for falling back.
RECRUDESCENCE Aggravation of a disease or of its course after a period of quiescence.
REMISSION Abatement or subsiding of the symptoms of a disease, but not necessarily of the disease itself.
RSA welfare sanitary residence
RELIEF RECOVERY refers to the recovery of a patient for a short period of time in the hospice, as to let her/his family or her/his caregiver in temporary difficult circumstances (prostration, emotional break down), to relieve and recovering to get back to the patient's nursing at home.
SYMPTOM A sign or an indication of disorder or disease, especially when experienced by an individual as a change from normal function, sensation, or appearance.
SOCIAL WORKER assists in the identification of social needs, works on the necessary intervention to improve the quality of life of the patient. He coordinates the supporting team of domiciliary assistance. He contributes to the execution of the planning assistance and set the official procedures necessary to get the acknowledgements for disability, inability, etc.
SURGICAL RESECTION Surgical removal of all or part of an organ, tissue, or structure due to a pathological process otherwise incurable.
SUBCUTIS deep part of skin, under epidermis or superficial skin. Also called TELA SOTTOCUTANEA with PANNICOLI ADIPOSI IN PARTE ANCHE MUSCOLI CUTANEI . In palliative cures, the subcutis is often used to inject drugs continuously or by injection with a small needle+tube, that can be left for different days.
STAGING the whole diagnostic survey necessary to set the extension of a tumour in its primary location and in possible secondary sites (metastasis)
TERMINAL PHASE Causing, ending in, or approaching death. A phase where the treatment is ‘active', to answer physical, relational, and spiritual needs.
TERMINAL SEDATION Suppression of the awareness induced by a sedative drug when resistant and uncontrollable symptoms occur. It needs the informed consent.
TERMINAL SUFFERER a person enters the terminal phase of a disease when, due to an irreversible alteration to the vital bodily functions, the mechanism of self-regulation that rules a living body to starts to weaken. The process has death as a natural ending.
TISSUE a collection of interconnected cells that perform a similar function within an organism. Principal tissues are: epithelial, muscuclar, connective, nervous tissue.
TOTAL PAIN An unpleasant sensation occurring in varying degrees of severity as a consequence of injury, disease, or emotional disorder. Deep mental anguish, suffering or pain. Apart from the physical aspects, it goes with the sense of loss and longing for life before the disease: dismissal from work, missing social life, changing of the body (hair, face, loss of weight, etc); a feeling of distress about daily pain, re-thinking about the earlier/previous life, worries about the future, distress in missing the meaning of everyday life with suffering.
TNM international classification system in staging tumours. TNM is based on 3 parameters: dimension of the primary tumour (T), involvement of REGIONALI Lymph glands (N), presence of metastasis (M).
TROPHISM state of nutrition of an organ or a tissue
TUMORAL CLASSIFICATION definition of a tumour, on the cytological level and its organic organization. Standardization is made not only because of the microscopic observation, but also through the study of cell structure and genetics.
TUMOROUS MARKER A physiological substance (protein, hormone, etc.) that when present in abnormal amounts may indicate the presence of tumorous pathologies. The measurement of tumorous markers can works as a prognosis and as efficacy control of a drug.
UOCP: palliative cures operative unit.
URP: public relations office.
VICARIOUS JUDGEMENT decision made by relatives or by the medical team when the patient can't express her/his will anymore. It's making a choice according to the patient's will if he could decide, in that point.
VOLUNTEER A person who renders aid, performs a service, or assumes an obligation voluntarily. The volunteer, after adequate training, helps families in need, for example offering good company or providing medicine, leaving her/his family free to spend some time with the patient. The volunteer offers her/his willingness and availability in strict collaboration with the sanitary team he belongs to.
WITHDRAWAL SYMPTOMS characteristic symptoms that appear after discontinuing a drug that has caused physical dependence. It can go with nausea, vomit, diarrhoea, cramps, insomnia, delirium.
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