%0 Journal Article
%C Division of Pediatric Gastroenterology, Hopital Sainte-Justine, University of Montreal, Montreal, Canada
%A Castilloux, Julie
%A Laberge, Anne-Marie
%A Martin, Steven R
%A Lallier, Michel
%A Marchand, Valerie
%J J Pediatr Gastroenterol Nutr
%D 2007 Mar
%N 3
%P 375-7
%T "Silent" tyrosinemia presenting as hepatocellular carcinoma in a 10-year-old girl
%V 44
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17325560

%0 Journal Article
%C 2nd Department of Radiology, Athens University School of Medicine, Attikon University Hospital, 1 Rimini st, Haidari 12462, Athens, Greece. ebrountz@cc.uoa.gr
%A Brountzos, Elias N
%A Ptochis, Nikolaos
%A Panagiotou, Irene
%A Malagari, Katerina
%A Tzavara, Chara
%A Kelekis, Dimitrios
%J Cardiovasc Intervent Radiol
%D 2007 Jan-Feb
%N 1
%P 66-73
%T A survival analysis of patients with malignant biliary strictures treated by percutaneous metallic stenting
%V 30
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17031733
%X BACKGROUND: Percutaneous metal stenting is an accepted palliative treatment for malignant biliary obstruction. Nevertheless, factors predicting survival are not known. METHODS: Seventy-six patients with inoperable malignant biliary obstruction were treated with percutaneous placement of metallic stents. Twenty patients had non-hilar lesions. Fifty-six patients had hilar lesions classified as Bismuth type I (n = 15 patients), type II (n = 26), type III (n = 12), or type IV (n = 3 patients). Technical and clinical success rates, complications, and long-term outcome were recorded. Clinical success rates, patency, and survival rates were compared in patients treated with complete (n = 41) versus partial (n = 35) liver parenchyma drainage. Survival was calculated and analyzed for potential predictors such as the tumor type, the extent of the disease, the level of obstruction, and the post-intervention bilirubin levels. RESULTS: Stenting was technically successful in all patients (unilateral drainage in 70 patients, bilateral drainage in 6 patients) with an overall significant reduction of the post-intervention bilirubin levels (p < 0.001), resulting in a clinical success rate of 97.3%. Clinical success rates were similar in patients treated with whole-liver drainage versus partial liver drainage. Minor and major complications occurred in 8% and 15% of patients, respectively. Mean overall primary stent patency was 120 days, while the restenosis rate was 12%. Mean overall secondary stent patency was 242.2 days. Patency rates were similar in patients with complete versus partial liver drainage. Mean overall survival was 142.3 days. Survival was similar in the complete and partial drainage groups. The post-intervention serum bilirubin level was an independent predictor of survival (p < 0.001). A cut-off point in post-stenting bilirubin levels of 4 mg/dl dichotomized patients with good versus poor prognosis. Patient age and Bismuth IV lesions were also independent predictors of survival. CONCLUSIONS: Percutaneous metallic biliary stenting provides good palliation of malignant jaundice. Partial liver drainage achieved results as good as those after complete liver drainage. A serum bilirubin level of less than 4 mg/dl after stenting is the most important independent predictor of survival, while increasing age and Bismuth IV lesions represent dismal prognostic factors

%0 Journal Article
%C Department of Health Sciences, Lehman College, City University of New York, Bronx, New York craig.demmer@lehman.cuny.edu
%A Demmer, Craig
%J Am J Hosp Palliat Care
%D 2007 Jan-Feb
%N 1
%P 7-12
%T AIDS and palliative care in South Africa
%V 24
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17347499
%X As a result of limited access to antiretroviral treatment, many South Africans die yearly of AIDS. It is important that the end-of-life needs of these people be met. This article examines the major challenges involved in providing quality end-of-life care to people with AIDS in South Africa. Published reports are reviewed, as is the author's experience living and working in KwaZulu-Natal, South Africa. The issues discussed include the nature of the South African health care system, with emphasis on the scarcity of palliative care resources for AIDS patients, ineffective control of pain, models of care such as the integrated community-based home care model that relies heavily on community caregivers to meet the needs of people dying of AIDS, the living conditions of AIDS patients and their families, and AIDS-related stigma. Broad recommendations are presented for improving palliative care services for people with AIDS in the South African context

%0 Journal Article
%C The Harry R. Horvitz Center for Palliative Medicine, The Cleveland Clinic Taussig Cancer Center, Cleveland, Ohio
%A Lagman, Ruth
%A Rivera, Nilo
%A Walsh, Declan
%A Legrand, Susan
%A Davis, Mellar P
%J Am J Hosp Palliat Care
%D 2007 Jan-Feb
%N 1
%P 20-8
%T Acute inpatient palliative medicine in a cancer center: clinical problems and medical interventions--a prospective study
%V 24
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17347501
%X The clinical characteristics and medical interventions of the 100 consecutive cancer admissions to the acute care inpatient palliative medicine unit at the Cleveland Clinic for 2 months are described. Median age was 62 years (range, 31 to 92 years). The male-female ratio was 1:1. Most admissions were referred by hematology-oncology and had prior antineoplastic therapy. Reasons for admission were symptom control and cancer-related complications. Patients underwent invasive diagnostic and therapeutic procedures, hydration, transfusions, radiation, or chemotherapy, or a combination, during their admission. Most were discharged home with hospice care or had outpatient clinic follow-up. The mortality rate was 20%. Aggressive multidisciplinary management of symptoms, disease complications, comorbid conditions, and psychosocial problems were provided. Palliative medicine physicians provided continuity of care in the outpatient clinic and at home. An acute inpatient palliative medicine unit within a tertiary level medical center has a definable and important role in comprehensive cancer care

%0 Journal Article
%C AIG Consulting, Inc., Atlanta, USA
%A West, John C
%J J Healthc Risk Manag
%D 2002 Spring
%N 2
%P 34-5
%T Advance directives: clear and convincing evidence of wish to terminate treatment may be required. Conservatorship of Wendland, 26 Cal. 4th 519, 28 P. 3rd 151, 110 Cal. Rptr. 2nd 412 (Cal. 2001)
%V 22
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17342985

%0 Journal Article
%C Community Consortium, Positive Health Program, San Francisco General Hospital, San Francisco, CA 94110, USA. dabrams@php.ucsf.edu
%A Abrams, D I
%A Jay, C A
%A Shade, S B
%A Vizoso, H
%A Reda, H
%A Press, S
%A Kelly, M E
%A Rowbotham, M C
%A Petersen, K L
%J Neurology
%D 2007 Feb
%N 7
%P 515-21
%T Cannabis in painful HIV-associated sensory neuropathy: a randomized placebo-controlled trial
%V 68
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17296917
%X OBJECTIVE: To determine the effect of smoked cannabis on the neuropathic pain of HIV-associated sensory neuropathy and an experimental pain model. METHODS: Prospective randomized placebo-controlled trial conducted in the inpatient General Clinical Research Center between May 2003 and May 2005 involving adults with painful HIV-associated sensory neuropathy. Patients were randomly assigned to smoke either cannabis (3.56% tetrahydrocannabinol) or identical placebo cigarettes with the cannabinoids extracted three times daily for 5 days. Primary outcome measures included ratings of chronic pain and the percentage achieving >30% reduction in pain intensity. Acute analgesic and anti-hyperalgesic effects of smoked cannabis were assessed using a cutaneous heat stimulation procedure and the heat/capsaicin sensitization model. RESULTS: Fifty patients completed the entire trial. Smoked cannabis reduced daily pain by 34% (median reduction; IQR = -71, -16) vs 17% (IQR = -29, 8) with placebo (p = 0.03). Greater than 30% reduction in pain was reported by 52% in the cannabis group and by 24% in the placebo group (p = 0.04). The first cannabis cigarette reduced chronic pain by a median of 72% vs 15% with placebo (p < 0.001). Cannabis reduced experimentally induced hyperalgesia to both brush and von Frey hair stimuli (p < or = 0.05) but appeared to have little effect on the painfulness of noxious heat stimulation. No serious adverse events were reported. CONCLUSION: Smoked cannabis was well tolerated and effectively relieved chronic neuropathic pain from HIV-associated sensory neuropathy. The findings are comparable to oral drugs used for chronic neuropathic pain

%0 Journal Article
%C King's College London, Florence Nightingale School of Nursing and Midwifery. patricia.grocott@kcl.ac.uk
%A Grocott, Patricia
%J Nurs Stand
%D 2007 Feb
%N 24
%P 57-8, 60, 62 passim
%T Care of patients with fungating malignant wounds
%V 21
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17345910
%X Any nurse who has cared for a patient with a fungating malignant wound will know that this is a challenging aspect of the care provided to patients with advanced cancer. This article examines the aetiology of fungating wounds and three core principles of fungating wound management and patient care. This is an under-researched area of clinical care and the literature that guides malignant wound care is drawn from disciplines such as oncology, chronic wound care and palliative care

%0 Journal Article
%C Bioethics Program, University of California, Davis Medical Center, Sacramento, USA
%A Rich, Ben A
%J Camb Q Healthc Ethics
%D 2007 Winter
%N 1
%P 63-73
%T Causation and intent: persistent conundrums in end-of-life care
%V 16
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17345968

%0 Journal Article
%C 1. Doctoral Student, NFORCE Research Group, University of Western Sydney, Penrith South NSW, Australia
%A George, Ajesh
%A Vickers, Margaret H
%A Wilkes, Lesley
%A Barton, Belinda
%J Contemp Nurse
%D 2006 Dec
%N 2
%P 228-42
%T Chronic grief: experiences of working parents of children with chronic illness
%V 23
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17343526
%X Parents of children with chronic illness experience multiple stressors associated with their numerous roles. For parents who are working full time and caring for a child with chronic illness, the stressors related to managing work and caring responsibilities are magnified. Although the impact of caring for a child with chronic illness has been widely investigated, the literature reveals a paucity of research on the experiences of parents who are also in full time employment. This paper shares qualitative findings of a study involving interviews of twelve parents who were working full time while caring for a child with chronic illness. Data was collected through in-depth semi structured interviews and thematic analysis was then used to develop and categorise themes. Two intertwined themes are reported: (1) grief and (2) dealing with professionals. In this study, parents revealed the chronic grief they experienced in relation to their child's condition, which often recurred at various stages of the child's illness. The child's initial diagnosis was found to be the most stressful part of the grieving process, with most feeling their voices as parents were not being heard or valued by health professionals at this time. This affected parents' confidence in the health care system and triggered the re-emergence of grief, aggravating an already stressful situation. The findings illustrate that the grief experienced by these parents can be exacerbated by their dealings with health professionals. Implications for various health professionals are drawn from the findings in order to highlight avenues where guidance and support can be provided to these parents

%0 Journal Article
%C Palliative Care Research Group, University Hospital of Freiburg, Freiburg i. Br., Germany
%A Becker, G
%A Momm, F
%A Gigl, A
%A Wagner, B
%A Baumgartner, J
%J Wien Klin Wochenschr
%D 2007 Mar
%N 3-4
%P 112-116
%T Competency and educational needs in palliative care
%V 119
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17347860
%X PURPOSE: To explore general practitioners' (GPs') and nurses' self assessment of professional education, competency and educational needs in palliative care. METHODS: All 897 registered GPs and all 933 registered home care nurses in the Province of Styria/Austria were sent postal questionnaires to evaluate their professional training in (i) pain control and symptom management, (ii) handling psychosocial needs and (iii) ability to cope with work-related distress. RESULTS: 61.8% of 546 evaluable respondents felt not at all or not sufficiently prepared for palliative care by their professional education (GPs: 70%, nurses: 50.4%). GPs rated the competency of their professional guild significantly higher and their educational needs significantly lower than nurses (p < 0.01). Both, GPs and nurses emphasised a great need for education in the area of neuropsychiatric symptom management. CONCLUSION: Our results provide a detailed analysis of needs and may help to target goals for training seminars in palliative care

%0 Journal Article
%C Harvard Medical School, Boston, Massachusetts, USA. jtemel@partners.org
%A Temel, Jennifer
%J J Support Oncol
%D 2007 Jan
%N 1
%P 30-1
%T Complexities of quality of life analysis in non-small cell lung cancer
%V 5
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17265784

%0 Journal Article
%C Albert Einstein College of Medicine, Bronx, New York; Geriatric Medicine, Long Island Jewish Medical Center, 270-05 76th Ave, New Hyde Park, NY 11040; gwolf@nshs.edu
%A Wolf-Klein, Gisele
%A Pekmezaris, Renee
%A Chin, Lisa
%A Weiner, Joseph
%J Am J Hosp Palliat Care
%D 2007 Jan-Feb
%N 1
%P 77-82
%T Conceptualizing Alzheimer's disease as a terminal medical illness
%V 24
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17347512
%X Alzheimer's disease is a common illness of the elderly population, with an estimated prevalence of 4.5 million people in the United States and 24.3 million worldwide. Despite current pharmaceutic advances in delaying disease progression, there is no cure. This article reviews the evidence for conceptualizing Alzheimer's disease as a terminal medical illness. Discussed are principles of palliative care as applied to the patient with Alzheimer's disease and the patient's family

%0 Journal Article
%C *Medical School Duluth double daggerSchool of Nursing, University of Minnesota daggerSMDC Health System, Duluth, MN
%A Elliott, BA
%A Gessert, CE
%A Peden-McAlpine, C
%J Alzheimer Dis Assoc Disord
%D 2007 January/March
%N 1
%P 49-54
%T Decision Making on Behalf of Elders With Advanced Cognitive Impairment: Family Transitions
%V 21
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17334272
%X Changes in family decision making responsibilities occur with progression of cognitive impairment. Focus groups with family members of nursing home residents with advanced cognitive impairment investigated values and beliefs used in making decisions for the elder. Family members described difficult decisions they had made to date, noting a significant transition in their decision making role when the elders' decisions needed to be superseded (especially with changes in living arrangements). In most families, one person or couple assumed the principal decision making responsibility. When decisions were made in the context of family conflict, managing the conflict became the focus, rather than the elder's care. In such cases, the elder's previously stated wishes regarding end of life care were not as likely to be honored

%0 Journal Article
%C Hebrew SeniorLife, Institute for Aging Research and Beth Israel Deaconess Medical Center, Boston, Massachusetts
%A Mitchell, Susan L
%A Teno, Joan M
%A Intrator, Orna
%A Feng, Zhanlian
%A Mor, Vincent
%J J Am Geriatr Soc
%D 2007 Mar
%N 3
%P 432-8
%T Decisions to forgo hospitalization in advanced dementia: a nationwide study
%V 55
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17341248
%X OBJECTIVES: To examine the prevalence and factors associated with decisions to forgo hospitalization in nursing home (NH) residents with advanced dementia. DESIGN: Cross-sectional study. SETTING: All Medicare- and Medicaid-certified NHs within the 48 contiguous U.S. states. PARTICIPANTS: NH residents with advanced dementia were identified using Minimum Data Set (MDS) assessments completed close to April 1, 2000 (N=91,521). MEASUREMENTS: Multilevel, multivariate logistic regression identified factors independently associated with having a do-not-hospitalize (DNH) directive. Independent variables included subject characteristics (MDS), facility factors (On-line Survey of Certification of Automated Records), and hospital referral region (HRR) features (Dartmouth Atlas). RESULTS: Nationwide, 7.1% (n=6,518) residents with advanced dementia had DNH orders (range 0.7% in Oklahoma to 25.9% in Rhode Island). Resident characteristics associated with having a DNH order were older age, white, living will, durable power of attorney for health care, and total functional dependence. Controlling for these factors, DNH orders were more likely in residents of facilities with the following features: not part of a chain, urban location, special care dementia unit, fewer black residents, nurse practitioner or physician assistant on staff, higher staffing ratios, and location in HRRs with fewer intensive care unit admissions during terminal hospitalizations. CONCLUSION: Directives to forgo hospitalization for U.S. NH residents with advanced dementia are uncommon and are associated with the organizational features of the facilities caring for them and the intensity of end-of-life care practiced in the region, as well as individual resident characteristics

%0 Journal Article
%C Department of Palliative Care, Policy and Rehabilitation, King's College London School of Medicine, London. jonathan.koffman@kcl.ac.uk
%A Koffman, J
%A Burke, G
%A Dias, A
%A Raval, B
%A Byrne, J
%A Gonzales, J
%A Daniels, C
%J Palliat Med
%D 2007 Mar
%N 2
%P 145-153
%T Demographic factors and awareness of palliative care and related services
%V 21
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17344263
%X BACKGROUND: Palliative care is not accessed by all those who can benefit from it.Survey aim: To explore awareness of palliative care and related services among UK oncology out-patients, and to analyse the relationship between demographic characteristics and knowledge. DESIGN: Cross-sectional interview-based survey. Analysis comprised univariate and multiple logistic regression.Participants and settings: Oncology out-patients receiving curative treatments at two district general hospitals in north-west London between December 2004 and April 2005. RESULTS: A total of 252 (94%) eligible clinic patients were interviewed. Only 47 (18.7%) patients recognised the term 'palliative care', but 135 (67.8%) understood the role of the hospice, and 164 (66.7%) understood the role of Macmillan nurses. Age-adjusted multiple logistic regression showed that recognizing the term 'palliative care' was more likely among the most socially and materially affluent patients than those who were the poorest (OR: 8.4, CI: 2.17-31.01, p =0.002). Understanding the role of Macmillan nurses was also more likely among the most socially and materially affluent patients compared with the poorest patients (OR: 7.0, CI: 2.41-18.52, p <0.0001), and was independently less likely among patients from black and minority ethnic groups than those who were classified as being white British (OR=0.5, CI:0.25-0.96, p =0.04). CONCLUSIONS: Awareness of palliative care and related services was low among black and minority ethnic groups, and the least affluent

%0 Journal Article
%C Department of Neurology, Room 4M62, San Francisco General Hospital, 1001 Potrero Avenue, San Francisco, CA 94110, USA. chemphill@sfgh.ucsf.edu
%A Hemphill, JC 3rd
%J Crit Care
%D 2007 Mar
%N 2
%P 121
%T Do-not-resuscitate orders, unintended consequences, and the ripple effect
%V 11
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17338835
%X ABSTRACT: Do-not-resuscitate (DNR) orders are commonly implemented in the critical care setting as a prelude to end-of-life care. This is often based on presumed prognosis for favorable outcome and interpretation of patient, family, and even physician wishes. While DNR orders explicitly apply only to an individual patient, the hospital culture and milieu in which DNR orders are implemented could potentially have an overall impact on aggressiveness of care across patients. As illustrated by the example of intracerebral hemorrhage, this may unexpectedly influence outcome even in patients without DNR orders in place

%0 Journal Article
%C Heart and Vascular Institute, Milton S. Hershey Medical Center, Pennsylvania State University College of Medicine, Hershey, Pennsylvania 17033-0850, USA. wpae@psu.edu
%A Pae, Walter E
%A Connell, John M
%A Adelowo, Amos
%A Boehmer, John P
%A Korfer, Reiner
%A El-Banayosy, Aly
%A Hetzer, Roland
%A Vigano, Mario
%A Pavie, Alain
%J J Heart Lung Transplant
%D 2007 Mar
%N 3
%P 219-29
%T Does total implantability reduce infection with the use of a left ventricular assist device? The LionHeart experience in Europe
%V 26
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17346623
%X BACKGROUND: Infection is the leading cause of death for left ventricular assist device (LVAD) patients with end-stage heart failure. Decreased infection may be possible with fully implantable LVADs such as the LionHeart, which lacks percutaneous conduits (PCs), a common source of device-related infection (DRI). This sub-study reports infections with the LionHeart and compares these results with historic data from the REMATCH trial, bridge to recovery (BTR) and bridge-to-transplantation (BTT) studies. METHODS: Twenty-three patients were implanted with the LionHeart LVAD and followed until death or heart transplant during a non-randomized, multicenter, European trial from October 1999 to April 2004. The nature and incidence of infection were analyzed and adjudicated to definitions similar to, or the same as, the REMATCH definitions. RESULTS: The combined number of implant days was 7,980, with a mean of 347 days (median 112, range 17 to 1,259 days). Survival at 1 year was 39%, with 2-year survival at 22%. Seventy-four percent of patients developed one or more infections, with 30% developing sepsis, and 35% developing pump-pocket infections (PSIs). No patients developed pump-housing or inflow- or outflow-tract infections (PI). For comparison, the prevalence rates of sepsis, PSI and PI in REMATCH were 51%, 35% and 19%, respectively. CONCLUSIONS: The patients in the European LionHeart Clinical Utility Baseline Study (CUBS) trial had less sepsis and less overall DRI compared with the REMATCH LVAD group. Therefore, the fully implanted device may cause less infection than PC devices during destination therapy (DT). Although lower for DT, these rates are still higher than for some BTT experiences. Areas for future improvement include miniaturization of controller/battery components to reduce wound complications related to pocket size, and installation of more modern lithium-ion batteries to decrease the need for re-operations due to battery end-of-life

%0 Journal Article
%C Sheffield Institute for Studies on Ageing, University of Sheffield, Sheffield
%A Gott, Merryn
%A Barnes, Sarah
%A Parker, Chris
%A Payne, Sheila
%A Seamark, David
%A Gariballa, Salah
%A Small, Neil
%J Palliat Med
%D 2007 Mar
%N 2
%P 95-9
%T Dying trajectories in heart failure
%V 21
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17344257
%X OBJECTIVES: To explore dying trajectories in heart failure. DESIGN: Prospective, longitudinal study. SETTING: Sixteen GP surgeries in four demographically contrasting areas of the UK. PARTICIPANTS: A total of 27 heart failure patients, >60 years of age, who completed questionnaires for at least five time-points before death. MAIN OUTCOME MEASURES: Kansas City Cardiomyopathy Questionnaire Physical Limitation Scale. RESULTS: No 'typical' dying trajectory could be identified, and only a minority of patients conformed to the theoretical trajectory of dying in heart failure. CONCLUSIONS: This study provides the first prospective data regarding physical decline prior to death in heart failure. Findings challenge current efforts to plan and deliver palliative care services on the basis of the theoretical heart failure dying trajectory

%0 Journal Article
%C Wessex Cardiothoracic Centre, Southampton University Hospital, Southampton, United Kingdom
%A Ooi, Adrian
%A Saad, Rasheed A
%A Moorjani, Narain
%A Amer, Khalid M
%J Ann Thorac Surg
%D 2007 Feb
%N 2
%P 684-5
%T Effective symptomatic relief of hypertrophic pulmonary osteoarthropathy by video-assisted thoracic surgery truncal vagotomy
%V 83
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17258017
%X Various modalities for the treatment of hypertrophic pulmonary osteoarthropathy (HPOA) associated with lung cancer have been suggested since 1958. Although the etiology remains speculative, unilateral vagotomy on the side of the lung cancer achieves symptomatic relief. We report a case of a 50-year-old woman with disabling HPOA and inoperable lung cancer who experienced effective pain relief and regained full mobility after video-assisted thoracoscopic surgery was used to perform truncal vagotomy. This relatively safe and simple procedure should be considered for terminal lung cancer patients with intractable HPOA

%0 Journal Article
%A Davies, Gareth
%J Vet Rec
%D 2007 Jan
%N 3
%P 99
%T FMD control measures
%V 160
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17237465

%0 Journal Article
%C Elisabeth Bruye`re Research Institute, Ottawa. cmcphers@uottawa.ca
%A McPherson, CJ
%A Wilson, KG
%A Murray, MA
%J Palliat Med
%D 2007 Mar
%N 2
%P 115-128
%T Feeling like a burden to others: a systematic review focusing on the end of life
%V 21
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17344260
%X Research into the burden of illness has focused predominantly on family caregivers, with little consideration of the other side of the caregiving relationship-care recipients' perspectives on having become a 'burden to others'. However, there is now a small but growing body of evidence to suggest that worry about creating burden to others is a common and troubling concern for people who are nearing the end of their lives. This concern is referred to as 'self-perceived burden'. The present study provides a systematic review of the literature, addressing self-perceived burden at the end of life. Using standard methods, literature was searched for relevant studies in palliative care and related fields. The review revealed that self-perceived burden is reported as a significant problem by 19- 65% of terminally ill patients. It is correlated with loss of dignity, suffering, and a 'bad death'. Self-perceived burden has also been identified as a relevant factor in death-hastening acts among patients with life-threatening illness, as well as in clinical decisions, such as the choice of place of care at the end of life, advance directives, and acceptance of treatment. Given the unique challenges faced by patients with advanced disease and their families, there is a need for further investigation into this under-researched area

%0 Journal Article
%C Department of Internal Medicine, Cantonal Hospital, St. Gallen. florian.strasser@kssg.ch
%A Strasser, F
%A Binswanger, J
%A Cerny, T
%A Kesselring, A
%J Palliat Med
%D 2007 Mar
%N 2
%P 129-37
%T Fighting a losing battle: eating-related distress of men with advanced cancer and their female partners. A mixed-methods study
%V 21
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17344261
%X BACKGROUND: Anorexia/cachexia is a frequent complication of advanced cancer with poorly understood psychosocial impact or eating-related distress (ERD) on both patients and family members. To assist palliative care practitioners manage this important psychosocial aspect of care, we aimed to discover and describe elements of ERD, focusing on male patients with advanced cancer and their female partners. METHODS: Nineteen male patients and their partners were systematically investigated by (1) focus group interviews and data analysis inspired by Grounded Theory, and (2) a comparative survey with categorical questions. RESULTS: For patients, eating-related distress was characterised by obstruction to eating, poor and capricious appetite, a disconnection of oral intake and ability to gain weight, and continuous efforts to eat. Partners expressed feelings of deep concern, frustration, and insufficiency in their loving and innovative efforts to prepare appealing food. Partners were more concerned about patients' weight loss than patients themselves (P =0.002). Patients felt more pressure to eat from partners than they estimated (P =0.007). CONCLUSION: Anorexia/cachexia of male cancer patients affects the cooking at home, a couple's daily eating routines, and their spousal relationship. Identification of ERD may trigger targeted psychosocial interventions

%0 Journal Article
%J Healthcare Benchmarks Qual Improv
%D 2007 Mar
%N 3
%P 25-9
%T Growth of hospital-based palliative care programs surges
%V 14
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17343026
%X Palliative care programs can improve quality of care for seriously ill patients in hospitals. Facility notes shortened lengths of stay, improved patient satisfaction. Multidisciplinary teams have greatest success; coordination of care critical

%0 Journal Article
%C School of Public Health, La Trobe University, Melbourne, Australia. f.mcinerney@latrobe.edu.au
%A McInerney, Fran
%J Soc Sci Med
%D 2006 Feb
%N 3
%P 654-67
%T Heroic frames: discursive constructions around the requested death movement in Australia in the late-1990s
%V 62
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=16046040
%X This paper focuses on a critical development in the life of the requested death movement [McInerney, F. (2000). "Requested Death": A new social movement. Social Science & Medicine, 50(1), 137-54.], that being the passage of the Northern Territory of Australia's Rights of the Terminally Ill (ROTI) Act 1995. This legislation, for the first time anywhere in the world, allowed for lawful euthanasia and physician-assisted suicide, thereby fulfilling key requirements of the movement. Taking a constructionist perspective, I analyzed discursive representations of dying, death and medicine in selected Australian print media during this time period (1995-1997). The media's predilection for reporting dramatic and unusual death coincided with the movement's construction of contemporary dying as horrific, intractable, and intolerable. Across all analyzed publications and genres, an heroic discourse was found to be a dominant influence, couched within a dramatic framing that served to reinforce many of the claims of the requested death movement. The framing of requested death activists as heroes, and of requested death itself as a redeeming and transforming act for those seeking it, were preeminent in press portrayals. The dominance of this heroic discourse suggests that such media and movement frames worked in tandem to both resonate with and reinforce popular Australian notions of terminal illness and dying in the late 20th century

%0 Journal Article
%C Westside Anesthesiology Associates of Rochester, Rochester, New York, USA
%A Szalados, James E
%J Crit Care Med
%D 2007 Feb
%N 2 Suppl
%P S44-58
%T Legal issues in the practice of critical care medicine: a practical approach
%V 35
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17242606
%X The intensive care unit is characterized by severely ill patients who frequently succumb to their disease, despite complex modern therapies and the best efforts of dedicated care teams. Although critical care is not historically characterized as a high-risk medical specialty with respect to litigation, the urgency, complexity, and invasive nature of intensive care unit care clearly increases legal risk exposure. Physicians do not practice in a vacuum. Instead, the practice of medicine is increasingly affected by government regulation, societal pressures, and pubic expectations. Law governs the interactions among the government, institutions, and individuals. Therefore, at a time when the practice of medicine itself is becoming increasingly more complex, physicians and other healthcare providers also face increasing administrative and legal challenges. Therefore, it is imperative that physicians develop an understanding of basic substantive and procedural law; first, so that their practices can be more focused and rewarding and less a fear of the unknown; second, that we can work proactively to minimize our legal risk; third, so that we can better communicate with risk managers, attorneys, and insurers; and finally, so that we can better understand and participate in future legal, legislative, regulatory, and public policy development. Accordingly, this general overview briefly addresses the substantive law of medical malpractice, informed consent, the law relating to research in critical care, Emergency Medical Treatment and Active Labor Act, the False Claims Act, peer review, state board disciplinary issues, and the Health Insurance Portability and Accountability Act; in addition, relevant procedural considerations will be briefly summarized

%0 Journal Article
%C Department of Palliative Care and Policy, King's College London, London. polly.edmonds@kcl.ac.uk
%A Edmonds, P
%A Vivat, B
%A Burman, R
%A Silber, E
%A Higginson, IJ
%J Palliat Med
%D 2007 Mar
%N 2
%P 101-107
%T Loss and change: experiences of people severely affected by multiple sclerosis
%V 21
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17344258
%X This study aimed to explore important issues for people severely affected by multiple sclerosis (MS). Individual interviews were conducted with 23 people with MS (PwMS) and 17 informal carers, the data relating to 32 PwMS. Information was obtained about 19 females and 13 males, with a mean age of 55, median time from diagnosis was 14.5 years, and physical disabilities ranged from mild to severe, although fifteen patients had severe disabilities. Twenty-six of the 32 individuals were unable to walk, 24 were catheterised, and 18 had considerably impaired or no upper limb function. Personal issues in relation to loss and change, particularly in terms of losses of or changes in physical abilities, including maintaining mobility, independence, relationships and social role were raised commonly in response to an open-ended question about what issues were important in living with MS. Coping with MS requires individuals to deal with the losses and changes brought about by their illness. Our study suggests that even patients who have had MS for many years and are now severely affected continue to experience loss and change. We recommend that attention be given to emotional support which specifically addresses three main areas of dealing with loss and change for people that are severely affected - physical issues, independence and relationships. Palliative care providers may have expertise in managing loss that could be useful for these patients in partnership with neurological services

%0 Journal Article
%C Department of Internal Medicine, Virginia Commonwealth Univerity, Richmond, USA
%A Weaver, Michael
%J J Opioid Manag
%D 2006 Sep-Oct
%N 5
%P 259-61
%T Malignant pain or malignant patients?
%V 2
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17319256

%0 Journal Article
%C Catherine of Siena Fellow in Ethics, Visiting Assistant Professor of Philosophy, Department of Philosophy, Villanova University, Villanova, Pennsylvania
%A Kirk, Timothy W
%J Pain Manag Nurs
%D 2007 Mar
%N 1
%P 25-34
%T Managing pain, managing ethics
%V 8
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17336867
%X Noncompliance of family caregivers can present home hospice nurses with difficult ethical choices and powerful feelings about those choices. This is particularly so when family members do not adequately palliate their loved ones, resulting in treatable symptom distress during the dying process. This article presents a case study, moral analysis, and an evidence-based, practical plan of action for engaging family members of palliative care patients on a home hospice service

%0 Journal Article
%C School of Social Work, University of Missouri, Columbia, Columbia, Missouri; Department of Communications, University of Texas at San Antonio, San Antonio, Texas oliverdr@missouri.edu
%A Oliver, Debra Parker
%A Wittenberg-Lyles, Elaine M
%A Day, Michele
%J Am J Hosp Palliat Care
%D 2007 Jan-Feb
%N 1
%P 49-53
%T Measuring interdisciplinary perceptions of collaboration on hospice teams
%V 24
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17347505
%X This project modified the Index for Interdisciplinary Collaboration to create a tool that could measure perceptions of collaboration by all members of the hospice team. Questions on the 42-item instrument were reworded to be more inclusive. This new Modified Index for Interdisciplinary Collaboration (MIIC) showed strong reliability for the total instrument and the original instrument subscales. Further use and testing of this instrument is recommended

%0 Journal Article
%C Intensive Care Unit, Liverpool Hospital, Australia. mmacpartlin@ausdoctors.net
%A MacPartlin, Matthew
%A Hillman, Kenneth M
%J Jt Comm J Qual Patient Saf
%D 2007 Jan
%N 1
%P 54-6, 1
%T Medical emergency team calls: the need to communicate a resuscitation plan
%V 33
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17283942
%X As illustrated in the case report of a 79-year-old woman, actions can be taken to ensure that the rapid response system is not used as the surrogate "do not actively resuscitate" team

%0 Journal Article
%C Palliative Care Unit and Department of Medicine, Hospital Melaka, Jalan Mufti Haji Khalil, 75499, Melaka
%A Taye, G A W C
%J Med J Malaysia
%D 2006 Oct
%N 4
%P 405-9
%T Pain issues from the palliative perspective: a survey among doctors in Hospital Melaka
%V 61
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17243516
%X This survey was intended to gauge the management of pain in palliative cancer patients by the doctors in Melaka Hospital. It also sought to identify possible barriers to adequate pain management among doctors and gauge their response to the adequacy of medical school teaching on cancer pain issues. A 39 item survey was used to cover the issues involved. Overall, the doctors displayed a lack of systematic approach to cancer pain management with inadequate knowledge of analgesia handling. Medical school exposure to cancer pain issues was lacking. Formulation of accepted clinical practice guidelines and new education strategies can improve cancer pain management

%0 Journal Article
%A Ziino, A J A
%J Arch Dis Child Fetal Neonatal Ed
%D 2006 Nov
%N 6
%P F464-5; author reply F465
%T Palliation bias is being overlooked in neonatal hypothermia trials
%V 91
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17056848

%0 Journal Article
%C Department of Radiology, University of Sassari, Sassari, Italy
%A Profili, Stefano
%A Manca, Antonio
%A Feo, Claudio F
%A Padua, Guglielmo
%A Ortu, Riccardo
%A Canalis, Giulio C
%A Meloni, Giovanni B
%J Cardiovasc Intervent Radiol
%D 2007 Jan-Feb
%N 1
%P 74-8
%T Palliative airway stenting performed under radiological guidance and local anesthesia
%V 30
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17031728
%X PURPOSE: To assess the effectiveness of airway stenting performed exclusively under radiological guidance for the palliation of malignant tracheobronchial strictures. METHODS: We report our experience in 16 patients with malignant tracheobronchial stricture treated by insertion of 20 Ultraflex self-expandable metal stents performed under fluoroscopic guidance only. Three patients presented dysphagia grade IV due to esophageal malignant infiltration; they therefore underwent combined airway and esophageal stenting. All the procedures were performed under conscious sedation in the radiological room; average procedure time was around 10 min, but the airway impediment never lasted more than 40 sec. RESULTS: We obtained an overall technical success in 16 cases (100%) and clinical success in 14 patients (88%). All prostheses were successfully placed without procedural complications. Rapid clinical improvement with symptom relief and normalization of respiratory function was obtained in 14 cases. Two patients died within 48 hr from causes unrelated to stent placement. Two cases (13%) of migration were observed; they were successfully treated with another stent. Tumor overgrowth developed in other 2 patients (13%); however, no further treatment was possible because of extensive laryngeal infiltration. CONCLUSIONS: Tracheobronchial recanalization with self-expandable metal stents is a safe and effective palliative treatment for malignant strictures. Airway stenting performed exclusively under fluoroscopic view was rapid and well tolerated

%0 Journal Article
%C Institute of Clinical Neuroimmunology Klinikum Grosshadern, Ludwig-Maximilians-Universitat, Munich
%A Kumpfel, T
%A Hoffmann, LA
%A Pollmann, W
%A Rieckmann, P
%A Zettl, UK
%A Kuhnbach, R
%A Borasio, GD
%A Voltz, R
%J Palliat Med
%D 2007 Mar
%N 2
%P 109-114
%T Palliative care in patients with severe multiple sclerosis: two case reports and a survey among German MS neurologists
%V 21
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17344259
%X Due to its chronic and fluctuating time course, multiple sclerosis (MS), thus far, has not been regarded as a focus of palliative care. However, sometimes we are confronted with severely affected MS patients, who suffer from complex medical, physical and psychosocial problems, which are not fully covered by the current health care services.We present two cases of severely affected MS patients we saw in our outpatient MS clinic, and who, we believe, are candidates for palliative care. The first patient, with primary chronic progressive (pcP) MS for many years (Expanded Disability Status Scale (EDSS): 8.0) presented with complex painful dysaesthesias and a depressive syndrome. He refused any treatment, and finally committed suicide with the help of a euthanasia group in Switzerland. The second patient was also severely affected by a secondary chronic progressive (scP) MS (EDSS: 9.0) and was finally admitted to our palliative care unit due to a complex pain syndrome associated with panic attacks and anxiety. She spent three weeks on the palliative care unit and her symptoms improved gradually after changing and optimising her pain medication. The patient was discharged with home care and is seen regularly on the palliative care unit.Additionally, as a first step, a questionnaire was sent to 53 German MS specialists regarding their general view on the needs for palliative care in MS. Our two cases and the results of the questionnaire demonstrated that MS patients and their caregivers are confronted with a variety of symptoms which are difficult to treat, and are a cause of great suffering for the patients, including ataxia, depression and fatigue. The data of the questionnaire also showed that neurologists usually do not deal with end-of-life care issues in MS.More research is needed to define the role of palliative care in MS and establish appropriate interventions to improve the quality of life in advanced stage MS patients and their relatives

%0 Journal Article
%C Department of Surgery, Hamot Medical Center, Erie, Pennsylvania, USA
%A Dunn, Geoffrey P
%A Mosenthal, Anne C
%J Asian J Surg
%D 2007 Jan
%N 1
%P 1-5
%T Palliative care in the surgical intensive care unit: where least expected, where most needed
%V 30
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17337364
%X Despite dramatic improvements in survival from a broad range of afflictions seen in the surgical critical care unit, the problem of suffering in its many forms and its long-term consequences will remain as long as mortality characterizes the human condition. Palliative care in the surgical intensive care unit is an extension of time-honoured surgical principles and traditions that aims to relieve suffering and improve quality of life associated with serious illness as an end in it self or as part of treatment to save and prolong life

%0 Journal Article
%C Department of Internal Medicine, University of Michigan Comprehensive Cancer Center, Ann Arbor 48109-0848, USA. kalemker@umich.edu
%A Kalemkerian, Gregory P
%J J Support Oncol
%D 2007 Jan
%N 1
%P 27-8
%T Palliative chemotherapy for non-small cell lung cancer: a measured dose of reality
%V 5
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17265783

%0 Journal Article
%C Sahlgrenska Academy Institute of Health Care Sciences Gothenburg University/Sahlgrenska University Hospital Sweden, Goteborg, Sweden
%A Larsson, Annika
%A Wijk, Helle
%J Pain Manag Nurs
%D 2007 Mar
%N 1
%P 12-6
%T Patient experiences of pain and pain management at the end of life: a pilot study
%V 8
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17336865
%X Cancer pain is a difficult symptom for patients to handle, causing patients extreme discomfort and a decreased quality of life. To support independent pain control for patients with refractory pain while staying in their home, an intrathecal approach for continuous pain management with patient-controlled extra doses from an external pump was implemented. Pain management was supported by a structured guideline for the nursing interventions: To enhance the understanding of how the patients experienced their pain and the continuous pain management at the end of life, a pilot study was conducted. The study followed a qualitative design with unstructured tape-recorded interviews. Three themes emerged from the analysis: (1) The pain was dreadful, reminding the patient of the cancer and the uncertainty of the future; (2) the need to reveal and conceal pain coexisted; and (3) the pain management and structured guideline contributed positively to gain a new perspective on health in which pain did not play the central role. The conclusion is that patients need to communicate their experiences of the pain to manage the pain adequately, while at the same time they need to conceal it to manage their everyday environment. Forthcoming research will focus on the relation between the pain and the way patients experience cancer and on the experience and specific needs of their family

%0 Journal Article
%C Department of Radiology Korgialenio-Benakio Red-Cross Hospital, Athens, Greece
%A Thanos, Loukas
%A Mylona, Sofia
%A Pomoni, Maria
%A Athanassiadi, Kalliopi
%A Theakos, Nick
%A Zoganas, Leonidas
%A Batakis, Nikolaos
%J Eur J Cardiothorac Surg
%D 2006 Nov
%N 5
%P 797-800
%T Percutaneous radiofrequency thermal ablation of primary and metastatic lung tumors
%V 30
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17000115
%X OBJECTIVE: Primary lung cancer is the leading cause of death from cancer. For patients with inoperable lung cancer, percutaneous radiofrequency thermal ablation (RFA) under CT-guidance represents a minimally invasive treatment. It can also be applied in combination with radiation therapy and chemotherapy. MATERIALS AND METHODS: In a period of 18 months, RFA under CT-guidance 27 ablations were applied on 22 patients, 14 patients with primary lung cancer and 8 patients with metastatic lung tumor. There were 15 men and 7 women ranging in age between 48 and 79 years. All patients were not surgical candidates either due to the advanced stage or due to comorbid diseases, while five denied surgery. The lesions' size was no bigger than 6 cm (range 1-6 cm) with an average of 3.8 cm. The diagnosis of all treated lesions was obtained with percutaneous biopsy under CT guidance. The procedure was performed under local anesthesia. RESULTS: There were no major complications observed, but a small pneumothorax and a minor hemoptysis in four cases, all conservatively treated. All patients were hospitalized for 24h. Follow-up was initially done in 1, 3, 6 and 12 months after RFA and it was accomplished by personal interview or by telephone call up to December 2005. Median progression free intervals were 26.4 months for primary lung cancer and 29.2 months for metastatic tumor. CONCLUSION: RFA is a minimally invasive technique that can be used as a palliative treatment in nonsurgical candidates with primary or metastatic lung tumor with a low morbidity and mortality

%0 Journal Article
%C Practice and Day Clinic for Internal Medicine and Oncology, Neustadt/Sachsen, Germany
%A Papke, Jens
%A Koch, Rainer
%J Onkologie
%D 2007 Mar
%N 3
%P 105-8
%T Places of death from cancer in a rural location
%V 30
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17341896
%X Background: Most people would like to die at home, however, this wish still cannot be realized to any satisfactory extent. Provision of qualified palliative care can increase the death rate at home. Distribution of places of death of cancer patients in rural locations and possible factors influencing this distribution are still unknown. Patients and Methods: We retrospectively evaluated the data relating to death certificates of cancer patients issued between 1997 and 2003 by the administrative district Sachsische Schweiz'. Results: In small-town and rural locations, the places of death from cancer were equally distributed among hospital and home. Patients living in a rural location and diagnosed as having breast cancer were more likely to die at home. Since 2001, the number of breast cancer patients dying at home has been increasing. Conclusions: Rural locations provide favorable conditions for home deaths. High therapy costs and transfer of expensive therapies away from hospitals into the outpatient therapy sector appear to have an effect on the place where patients are finally cared for and where they eventually die. This circumstance meets the wishes of most patients and leads to a relevant cost saving for the healthcare system. An effective and rigorous health and economic policy is necessary in order to realize an extensive home care for terminally ill patients

%0 Journal Article
%C Department of Science and Technology Studies, Rensselaer Polytechnic Institute, Troy, New York 12180, USA. laynel@rpi.edu
%A Layne, Linda L
%J Soc Sci Med
%D 2006 Feb
%N 3
%P 602-13
%T Pregnancy and infant loss support: a new, feminist, American, patient movement?
%V 62
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=16194590
%X Using as examples three of the earliest pregnancy and infant loss organizations and multiple recent initiatives, I argue this is a unique patient movement, in part due to the particularities of pregnant patienthood. Although during the first 20 years of this distinctively US movement, pregnancy and infant loss support was hospital-based, there was remarkably little attention to the "medical" dimensions of these losses, e.g. etiology, diagnosis, prevention, and treatment. The thrust was instead on changing ideas and feelings. It is only since the turn of the century that bereaved parents have started to forge collaborations with physicians to work toward prevention. During the first phase (mid-1970s to mid-1990s), it was a women's movement, though it did not present itself as such, and although it was indebted to the feminist movement and included some feminist initiatives, the movement was dominated by a traditionally feminine ethos and included pro-life elements. During the second phase, as physicians and researchers have become more involved, leadership has become somewhat less female-centric while at the same time, more initiatives are explicitly feminist

%0 Journal Article
%C Department of Palliative Medicine, University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; iwases-rad@umin.ac.jp
%A Iwase, Satoru
%A Murakami, Tadashi
%A Saito, Yuichiro
%A Nakagawa, Keiichi
%J Am J Hosp Palliat Care
%D 2007 Jan-Feb
%N 1
%P 29-35
%T Preliminary statistical assessment of intervention by a palliative care team working in a Japanese general inpatient unit
%V 24
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17347502
%X The effectiveness of intervention by the palliative care team at the University of Tokyo Hospital was assessed using the Support Team Assessment Schedule. During the study, 316 consecutive patients with malignant tumor disease were referred to the palliative care team, which assessed 11 physical symptoms. Results were tested by paired t test to calculate 95% confidence intervals comparing the mean Support Team Assessment Schedule scores for each symptom from the first time to the last time after palliative care intervention. The study concluded that (1) intervention by a palliative care team in general inpatient units can effectively control pain, nausea, and vomiting in patients up until the terminal stage; (2) it is likely that cough is controllable in the terminal stage with intervention by a palliative care team; (3) mouth dryness, anorexia, constipation, diarrhea, fatigue, and ascites are difficult to alleviate in the long term even with palliative intervention

%0 Journal Article
%A Gotkine, Marc
%J Neurology
%D 2007 Feb
%N 7
%P 536; author reply 536
%T Probable medication-overuse headache: the effect of a 2-month drug-free period
%V 68
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17296926

%0 Journal Article
%C Guy's and St. Thomas' Foundation Hospital NHS Trust, London, UK. tarun.sabharwal@gstt.sthames.nhs.uk
%A Sabharwal, T
%A Irani, F G
%A Adam, A
%J Cardiovasc Intervent Radiol
%D 2007 Jan-Feb
%N 1
%P 1-5
%T Quality assurance guidelines for placement of gastroduodenal stents
%V 30
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17103108

%0 Journal Article
%C Lank Center for Genitourinary Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA. oliver_sartor@dfci.harvard.edu
%A Sartor, Oliver
%A Reid, Robert H
%A Bushnell, David L
%A Quick, Donald P
%A Ell, Peter J
%J Cancer
%D 2007 Feb
%N 3
%P 637-43
%T Safety and efficacy of repeat administration of samarium Sm-153 lexidronam to patients with metastatic bone pain
%V 109
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17167764
%X BACKGROUND: Samarium Sm 153 lexidronam (Sm-153) is an effective and well-tolerated treatment for painful bone metastases. The purpose of the analysis was to assess the safety and efficacy of repeated doses of Sm-153 in patients with metastatic bone pain. METHODS: Data were collected prospectively for 202 patients administered 1.0 mCi/kg of Sm-153. Particular emphasis was placed on analysis of data from 55 patients receiving > or = 2 doses. Pain scores, adverse events, and hematologic parameters were assessed after each dose. RESULTS: Mild, transient suppression of platelets and white blood cell counts was the most common adverse event after treatment. Nadirs were approximately half of baseline at 4 weeks after dosing with recovery by Week 8 in 90% of patients. Temporary grade 3 thrombocytopenia occurred in 11%, 12%, and 17% of patients after the first, second, and third drug administration, respectively. Grade 3 leukopenia occurred in less than 7% of patients independent of the number of administrations. Significant decreases in pain scores (P < .001) were observed at Week 4 after each of the first 3 doses and maintained at Week 8 after the first 2 doses (P < .003) but not the third. Decreases in pain scores were observed in 70%, 63%, and 80% of patients, respectively, at Week 4 after the first 3 administrations. CONCLUSIONS: Repeated dosing of 1.0 mCi/kg of Sm-153 was both safe and effective and is a reasonable treatment option in patients whose bone pain responds and then recurs after an initial dose provided that adequate hematologic function is present at the time of drug administration

%0 Journal Article
%C University of California at Davis, Department of Internal Medicine, Division of Hematology/Oncology, Department of Urology, 4501 X Street, Room 3016, Sacramento, CA 95817, USA. cxpan@ucdavis.edu
%A Pan, Chong-xian
%A Zhang, Hongyong
%A Lara, Primo N Jr
%A Cheng, Liang
%J Expert Rev Anticancer Ther
%D 2006 Dec
%N 12
%P 1707-13
%T Small-cell carcinoma of the urinary bladder: diagnosis and management
%V 6
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17181484
%X Small-cell carcinoma of the urinary bladder (SCCUB) accounts for less than 1% of all cancers arising in the urinary bladder. Current diagnosis and management of SCCUB are often patterned after small-cell lung cancer (SCLC). However, SCCUB therapy is different from that for SCLC. For example, many patients with SCCUB undergo local resection, which is rarely performed in SCLC. As in SCLC, platinum-etoposide combination chemotherapy is employed as the main systemic treatment option for SCCUB. Chemotherapy is usually combined with other therapeutic modalities, especially in patients whose disease is limited to the locoregional area. Owing to the rarity of this malignancy, no prospective study has been performed that establishes the efficacy and duration of chemotherapy or the relative efficacy of platinum-etoposide versus other chemotherapeutic regimens. This article provides a comprehensive review of the current status of SCCUB diagnosis and management, as well as some unique insights into this rare tumor

%0 Journal Article
%C From the Harborview Medical Center, Division of Pulmonary and Critical Care, Department of Medicine, University of Washington, Seattle, WA
%A Wall, RJ
%A Engelberg, RA
%A Gries, CJ
%A Glavan, B
%A Curtis, JR
%J Crit Care Med
%D 2007 Feb
%T Spiritual care of families in the intensive care unit*
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17334245
%X OBJECTIVES:: There is growing recognition of the importance of spiritual care as a quality domain for critically ill patients and their families, but there is a paucity of research to guide quality improvement in this area. Our goals were to: 1) determine whether intensive care unit (ICU) family members who rate an item about their spiritual care are different from family members who skip the item or rate the item as "not applicable" and 2) identify potential determinants of higher family satisfaction with spiritual care in the ICU. DESIGN:: Cross-sectional study, using data from a cluster randomized trial aimed at improving end-of-life care in the ICU. SETTING:: ICUs in ten Seattle-area hospitals. SUBJECTS:: A total of 356 family members of patients dying during an ICU stay or within 24 hrs of ICU discharge. INTERVENTION:: None. MEASUREMENTS AND MAIN RESULTS:: Family members were surveyed about spiritual care in the ICU. Chart abstractors obtained clinical variables including end-of-life care processes and family conference data. The 259 of 356 family members (73%) who rated their spiritual care were slightly younger than family members who did not rate this aspect of care (p = .001). Multiple regression revealed family members were more satisfied with spiritual care if a pastor or spiritual advisor was involved in the last 24 hrs of the patient's life (p = .007). In addition, there was a strong association between satisfaction with spiritual care and satisfaction with the total ICU experience (p < .001). Ratings of spiritual care were not associated with any other demographic or clinical variables. CONCLUSIONS:: These findings suggest that for patients dying in the ICU, clinicians should assess each family's spiritual needs and consult a spiritual advisor if desired by the family. Further research is needed to develop a comprehensive approach to ICU care that meets not only physical and psychosocial but also spiritual needs of patients and their families

%0 Journal Article
%C Clinical Pastoral Education Program, James A. Haley Veterans Hospital, Tampa, Florida
%A Hampton, Diane M
%A Hollis, Dana E
%A Lloyd, Dudley A
%A Taylor, James
%A McMillan, Susan C
%J Am J Hosp Palliat Care
%D 2007 Jan-Feb
%N 1
%P 42-8
%T Spiritual needs of persons with advanced cancer
%V 24
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17347504
%X Spiritual needs, spiritual distress, and spiritual well-being of patients with terminal illnesses can affect their quality of life. The spiritual needs of patients with advanced cancer have not been widely studied. This study assessed the spiritual needs of 90 patients with advanced cancer who were newly admitted to hospice home care. They completed a demographic data form and the Spiritual Needs Inventory shortly after hospice admission. Scores could range from a low of 17 to a high of 85; study scores were 23 to 83. Results showed great variability in spiritual needs. Being with family was the most frequently cited need (80%), and 50% cited prayer as frequently or always a need. The most frequently cited unmet need was attending religious services. Results suggest the importance of a focus on the spiritual more than the religious in providing care to patients at the end of life

%0 Journal Article
%C Division of Gastroenterology, VA North Texas Health Care System and University of Texas Southwestern Medical School, Dallas, Texas 75216, USA. Ali.siddiqui@utsouthwestern.edu
%A Siddiqui, Ali
%A Spechler, Stuart J
%A Huerta, Sergio
%J Dig Dis Sci
%D 2007 Jan
%N 1
%P 276-81
%T Surgical bypass versus endoscopic stenting for malignant gastroduodenal obstruction: a decision analysis
%V 52
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17160470
%X The treatment options for palliating malignant gastroduodenal obstruction include open gastrojejunostomy (OGJ), laparoscopic gastrojejunostomy (LGJ), and endoscopic stenting (ES). The aim of this study was to compare the clinical outcomes and costs among ES, OGJ, and LGJ in patients who present with gastroduodenal obstruction from advanced upper gastrointestinal tract cancer. We designed a model for patients with malignant gastroduodenal obstruction. We analyzed success rates, complication rates and costs of the three treatment modalities: ES, OGJ, and LGJ. Baseline outcomes and costs were based on published reports. Success was defined as no major procedure-related and long-term complications over a 1-month period. Failure of therapy was defined as recurrent symptoms or death due to a procedural complication. Sensitivity analyses and cost-effectiveness analyses for the various strategies were performed. ES resulted in the lowest mortality rate and the lowest cost of the three treatment options analyzed. Mortality in the OGJ group was 2.1 times that in the ES cohort and 1.8 times that in the LGJ cohort. Sensitivity analyses confirmed ES as the dominant strategy. In conclusion, ES is the preferred treatment for palliation of duodenal obstruction due to advanced upper gastrointestinal tract cancer

%0 Journal Article
%C Bakoulev Scientific Center for Cardiovascular Surgery, Moscow, Russia
%A Bockeria, Leo A
%A Podzolkov, Vladimir P
%A Makhachev, Osman A
%A Zelenikin, Mikhail A
%A Alekian, Bagrat G
%A Ilyin, Vladimir N
%A Gadjiev, Ali A
%A Shatalov, Konstantin V
%A Kakuchaya, Teya T
%A Khiriev, Titalav Kh
%A Zaets, Sergey B
%J Ann Thorac Surg
%D 2007 Feb
%N 2
%P 613-8
%T Surgical correction of tetralogy of Fallot with unilateral absence of pulmonary artery
%V 83
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17257996
%X BACKGROUND: Tetralogy of Fallot with unilateral absence of the pulmonary artery is a rare congenital heart defect that still represents a surgical challenge. The purpose of this study is to summarize our experience of surgical treatment of this complex lesion. METHODS: From 1983 to 2003, 27 patients with tetralogy of Fallot and unilateral absence of the left (n = 25) or right (n = 2) pulmonary artery underwent different surgical interventions. The age of patients ranged from 40 days to 37 years (median, 5.3 years). Pulmonary arterial Nakata index and Nakata index Z-score were used for the quantitative assessment of the contralateral pulmonary artery. Twenty patients underwent various palliative procedures, namely Blalock-Taussig or Gore-Tex shunt, transluminal balloon pulmonary valvuloplasty, and reconstruction of right ventricular outflow tract without ventricular septal defect closure. At a median interval of 3.6 years after palliation, 13 patients underwent complete repair of tetralogy of Fallot. In the other 7 patients, complete repair was performed as a primary intervention. RESULTS: Hospital mortality after palliation and after a complete repair was the same and reached 5%. Sixteen patients with the Nakata index greater than 200 mm2/m2 and Z-score greater than -4 survived after a complete repair. One of 4 patients with Nakata index less than 200 mm2/m2 and Z-score less than -4 died after surgery. CONCLUSIONS: Majority of patients with tetralogy of Fallot and unilateral absence of the pulmonary artery require palliative intervention as a first step of surgical treatment. Nakata index greater than 200 mm2/m2 and Nakata index Z-score greater than -4 are criteria for a successful complete repair

%0 Journal Article
%C Department of Surgery, Brown Medical School, Rhode Island Hospital, APC Room 437, 593 Eddy Street, Providence, Rhode Island, 02903, USA, tminer@usasurg.org
%A Klaristenfeld, DD
%A Harrington, DT
%A Miner, TJ
%J Ann Surg Oncol
%D 2007 Mar
%T Teaching Palliative Care and End-of-Life Issues: A Core Curriculum for Surgical Residents
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17342567
%X BACKGROUND: Most surgical training programs have no curriculum to teach palliative care. Programs designed for nonsurgical specialties often do not meet the unique needs of surgeons. With 80-hour workweek limitations on in-hospital teaching, new methods are needed to efficiently teach surgical residents about these problems. METHODS: A pilot curriculum in palliative surgical care designed for residents was presented in three 1-hour sessions. Sessions included group discussion, role-playing exercises, and instruction in advanced clinical decision making. Residents completed pretest, posttest, and 3-month follow-up surveys designed to measure the program's success. RESULTS: Forty-seven general surgery residents from Brown University participated. Most residents (94%) had "discussed palliative care with a patient or patient's family" in the past. Initially, 57% of residents felt "comfortable speaking to patients and patients' families about end-of-life issues," whereas at posttest and at 3-month intervals, 80% and 84%, respectively, felt comfortable (P < .01). Few residents at pretest (9%) thought that they had "received adequate training in palliation during residency," but at posttest and at 3-month follow-up, 86% and 84% of residents agreed with this statement (P < .01). All residents believed that "managing end-of-life issues is a valuable skill for surgeons." Ninety-two percent of residents at 3-month follow-up "had been able to use the information learned in clinical practice." CONCLUSIONS: With a reasonable time commitment, surgical residents are capable of learning about palliative and end-of-life care. Surgical residents think that understanding palliative care is a useful part of their training, a sentiment that is still evident 3 months later

%0 Journal Article
%C Department of Languages, Literature, and Philosophy at Mississippi University for Women
%A Hilliard, Bryan
%J J Law Med Ethics
%D 2007 Spring
%N 1
%P 158-74
%T The Politics of Palliative Care and the Ethical Boundaries of Medicine: Gonzales v. Oregon as a Cautionary Tale
%V 35
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17341225
%X The U.S.Supreme Court's 6-decision in Gonzales v. Oregon is the latest defeat for the Bush administration in its sustained attack on Oregon's physician-assisted suicide law. Both the majority opinion and the major dissent in Oregon provide an opportunity to assess the dangers inherent in allowing a political agenda that emphasizes the sanctity of life and minimizes professional ethical obligations to overshadow quality patient care at the end of life

%0 Journal Article
%C Harran University, Faculty of Medicine, Department of Medical Ethics and History of Medicine, Sanliurfa, Turkey
%A Aksoy, Sahin
%J Reprod Biomed Online
%D 2007 Feb
%P 86-91
%T The beginning of human life and embryos: a philosophical and theological perspective
%V 14 Suppl 1
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17341353
%X Life is a process that has a beginning and an end. Every health care professional, especially the one who works more at these edges, should have a very clear position on when a human life begins and ends. This is very important, since the moral acceptability of some medical applications depends on the definition of these times. There are different views from the scholars in different academic fields on the time of the beginning of human life. Although there is not much debate on the 'humanity' of a newborn, except some marginal philosophers, the moral status of the embryos and fetuses are still debated. Since determining the beginning and the end of life is a matter of moral decisions, the concept of human life shall be defined from a social sciences perspective, so the time of its beginning can be explored. The paper refers some bioethical concepts, like 'human being', 'human person' and 'moral being'. By examining the issue from philosophical and different religious perspectives, it is argued that human life begins, therefore morally matters, in the womb at the beginning of the eighth week after conception

%0 Journal Article
%C Department of Medical Humanities at the Brody School of Medicine in Greenville, NC
%A Kopelman, Loretta M
%J J Law Med Ethics
%D 2007 Spring
%N 1
%P 187-96
%T The best interests standard for incompetent or incapacitated persons of all ages
%V 35
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17341227
%X When making decisions for adults who lack decision-making capacity and have no discernable preferences, widespread support exists for using the Best Interests Standard. This policy appeals to adults and is compatible with many important recommendations for persons facing end-of-life choices.Common objections to the policy are discussed as well as different meanings of this Standard identified, such as using it to express goals or ideals and to make practical decisions incorporating what reasonable persons would want. For reasons of consistency, fairness, and compassion, this standard should be used for all incapacitated persons

%0 Journal Article
%C Department of Nursing, Chang Gung Institute of Nursing
%A Jiang, Ru-Shang
%A Chou, Chuan-Chiang
%A Tsai, Pi-Lan
%J J Nurs Res
%D 2006 Dec
%N 4
%P 279-85
%T The grief reactions of nursing students related to the sudden death of a classmate
%V 14
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17345757
%X More than one-thousand adolescents are killed in accidents in Taiwan every year. Developmental factors shape young people's various reactions and responses to the death of their peers. While counseling research has been conducted in a few studies to address this issue of general bereavement, there remains a need for more knowledge on the grieving process and the needs of undergraduate nurse students who experience the loss of a classmate. The purpose of this study was to explore nursing student fears of death and their grief reactions in such a situation. The phenomenological method was used to uncover the meanings of eleven 19-year-old female nursing students' feelings and narratives about their grieving process in relation to the loss of a classmate, who died in a car accident. All interviews were tape recorded and then transcribed. Descriptions were analyzed using Colaizzi's phenomenological methodology (Colaizzi, 1978). The following core themes emerged from the data: morbid anxiety, helplessness after death, fear of disappearance, and thinking of one's own future. The study also found that, while nursing students could cope with their grief, they rarely shared their feeling with others. Young nursing students require careful step-by-step caring to pass successfully through the grieving process. In view of this gap, this study aspires to serve as a useful reference in understanding the sense of loss felt by grieving young people and providing effective and individualized bereavement counseling to nursing students

%0 Journal Article
%C University of Victoria, British Columbia, Canada. l.schultz@telus.net
%A Schultz, Lara E
%J Death Stud
%D 2007 Jan-Feb
%N 1
%P 17-43
%T The influence of maternal loss on young women's experience of identity development in emerging adulthood
%V 31
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17131560
%X A qualitative approach was used to study the influence of adolescent maternal loss on identity development in 6 young women. In-depth, semi-structured interviews were audiotaped, transcribed, and analyzed for recurrent themes. Three metathemes emerged from the narratives: Loss of Mother Impacts Identity, Relatedness on the Path of Identity Development, and Integration of Loss into Emergent Identity. Findings indicate that the experience of maternal loss influenced aspects of the women's identity development and initiated a need to seek new connections and redefine aspects of self in order to integrate the loss. Practical implications of these findings are presented for clinicians who work with bereaved young women

%0 Journal Article
%C Geriatric Division, The Chaim Sheba Medical Center, Tel Hashomer, and Human Suffering and Satisfaction Research Center, El-Ad, Israel bechorz@yahoo.com
%A Aminoff, Bechor Zvi
%J Am J Hosp Palliat Care
%D 2007 Jan-Feb
%N 1
%P 54-8
%T The new israeli law "the dying patient" and relief of suffering units
%V 24
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17347506
%X The new Israeli Law "The Dying Patient" provides avenues for possible medical, ethical, and Halachic (Jewish religious law) solutions in view of the complexity of the treatment of an end-stage dementia patient. The establishment of a hospice-like setting for dementia patients in Israel, based on palliative treatment only, similar to the Jewish hospices in the United States, is extremely important. This article proposes a new, alternative approach and setting for patients with end-stage dementia that could pertain to the Israeli setting and could possibly also be acceptable in other countries. Short hospitalization periods of approximately 1 month and treatment in Relief of Suffering End-of-Life With Dementia Units may be a new palliative approach and present a possible solution for coping with the burden of the suffering of end-state dementia patients, their families, and the medical and nursing staff

%0 Journal Article
%A Strandberg, EL
%A Ovhed, I
%A Borgquist, L
%A Wilhelmsson, S
%J BMC Fam Pract
%D 2007 Mar
%N 1
%P 8
%T The perceived meaning of a (w)holistic view among general practitioners and district nurses in Swedish primary care: a qualitative study
%V 8
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17346340
%X ABSTRACT: BACKGROUND: The definition of primary care varies between countries. Swedish primary care has developed from a philosophic viewpoint based on quality, accessibility, continuity, co-operation and a holistic view. The meaning of holism in international literature differs between medicine and nursing. The question is, if the difference is due to different educational traditions. Due to the uncertainties in defining holism and a holistic view we wished to study, in depth, how holism is perceived by doctors and nurses in their clinical work. Thus, the aim was to explore the perceived meaning of a holistic view among general practitioners (GPs) and district nurses (DNs). METHODS: Seven focus group interviews with a purposive sample of 22 GPs and 20 nurses working in primary care in two Swedish county councils were conducted. The interviews were transcribed verbatim and analysed using qualitative content analysis. RESULTS: The analysis resulted in three categories, attitude, knowledge, and circumstances, with two, two and four subcategories respectively. A professional attitude involves recognising the whole person; not only fragments of a person with a disease. Factual knowledge is acquired through special training and long professional experience. Tacit knowledge is about feelings and social competence. Circumstances can either be barriers or facilitators. A holistic view is a strong motivator and as such it is a facilitator. The way primary care is organised can be either a barrier or a facilitator and could influence the use of a holistic approach. Defined geographical districts and care teams facilitate a holistic view with house calls being essential, particularly for nurses. In preventive work and palliative care, a holistic view was stated to be specifically important. Consultations and communication with the patient were seen as important tools. CONCLUSIONS: 'Holistic view' is multidimensional, well implemented and very much alive among both GPs and DNs. The word holistic should really be spelt 'wholistic' to avoid confusion with complementary and alternative medicine. It was obvious that our participants were able to verbalise the meaning of a 'wholistic' view through narratives about their clinical, every day work. The possibility to implement a 'wholistic' perspective in their work with patients offers a strong motivation for GPs and DNs

%0 Journal Article
%A Elison, Jennifer
%J Newsweek
%D 2007 Jan
%N 5
%P 18
%T The stage of grief no one admits to: relief
%V 149
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17346013

%0 Journal Article
%C Department of Palliative Care and Policy, Kings College London, Weston Education Centre, London. fliss.murtagh@kcl.ac.uk
%A Murtagh, Fliss E M
%A Addington-Hall, Julia M
%A Higginson, Irene J
%J Palliat Med
%D 2007 Mar
%N 2
%P 87-93
%T The value of cognitive interviewing techniques in palliative care research
%V 21
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17344256
%X BACKGROUND: In answering questionnaires, research participants undertake complex cognitive processes, including understanding/interpreting questions, retrieval of information from memory, decision processes to estimate answers and response formulation. Cognitive interviewing techniques are widely used in large surveys, to improve questionnaires by understanding these processes, but their use is less familiar in other areas of palliative research. AIM: This study applied cognitive interviewing techniques, alongside standard piloting, to refine a questionnaire for survey of symptoms in end-stage renal disease patients. METHODS: Ten consecutive renal patients were invited to undertake a cognitive interview, while completing a questionnaire comprised of the Memorial Symptom Assessment, Geriatric Depression and Palliative Care Outcomes Scales. Interviews were conducted using 'think-aloud' and concurrent probing techniques, and recorded, transcribed and analysed using content analysis. RESULTS: Nine interviews were completed. A variety of cognitive problems were identified, including legibility/format, comprehension of specific words/phrases, inapplicability of some questions, response estimation and difficulties caused by combining instruments. These were categorized, using Tourangeau's information processing model, and used to refine the symptom questionnaire. CONCLUSION: Cognitive interviewing was able to helpfully identify the range and depth of difficulties with questions, to a greater degree than with standard piloting. It may be of particular benefit when instruments are used in different combinations, or applied to new study populations. Wider use of these techniques in palliative research is recommended

%0 Journal Article
%C Department of Cardiology, The Royal Children's Hospital, Flemington Road, Parkville, Melbourne, Vic. 3052, Australia
%A Abdullah, Al Furqani
%A Menahem, Samuel
%J Heart Lung Circ
%D 2006 Dec
%N 6
%P 393-6
%T Transcatheter closure of dilated left superior vena cava for resolution of late cyanosis following fontan palliation
%V 15
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=16759911
%X We report two adolescents with late cyanosis post-Fontan palliation arising from a persistent and dilated left superior vena cava (LSVC) draining into the pulmonary venous circulation. One has undergone successful transcatheter closure of the left superior vena cava while the other is waiting closure. There is a need for long-term follow-up of Fontan patients including adequate clarification of increasing cyanosis which may be correctable

%0 Journal Article
%C Institute of Nursing Science, University Hospital Basel, Switzerland
%A Kesselring, A
%A Kainz, M
%A Kiss, Alexander
%J Am J Transplant
%D 2007 Jan
%N 1
%P 211-7
%T Traumatic memories of relatives regarding brain death, request for organ donation and interactions with professionals in the ICU
%V 7
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17227569
%X Little is known about the memories of relatives after they have been confronted with the brain death of a loved one and the request for organ donation. We conducted this study, guided by Grounded Theory, to explore relatives' experiences, their interactions with health care providers and what influenced their memories. We interviewed 40 relatives (31 consenting to and 9 refusing organ donation) of 33 brain-dead individuals. Relatives described their experiences as a difficult process composed of several stages spanning from the initial encounter to the final decision about donation. Long-term memories of bereaved relatives were influenced by the characteristics of their decision-making style (clear vs. ambivalent) and the perceived quality of the interaction with professionals on the intensive care unit. Organ-focused behavior of professionals and an ambivalent decision-making style of relatives appear to be risk factors for traumatic memories

%0 Journal Article
%C Department of Palliative Medicine, University Hospital, Cologne and Department of Anaesthesiology and Palliative Medicine, Malteser Hospital, University Bonn, Bonn. christoph.ostgathe@uk-koeln.de
%A Ostgathe, Christoph
%A Voltz, Raymond
%A Nauck, Friedemann
%A Klaschik, Eberhard
%J Palliat Med
%D 2007 Mar
%N 2
%P 155-6
%T Undergraduate training in palliative medicine in Germany: what effect does a curriculum without compulsory palliative care have on medical students' knowledge, skills and attitudes?
%V 21
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17344264
%X INTRODUCTION: The effect of a curriculum without compulsory courses in palliative medicine on students' knowledge, kills and attitudes towards the care of dying patients and decisions at the end of life was investigated. METHODS: In a cross sectional, questionnaire based survey at the medical school of Bonn 1st, 3rd and 5th year students had to grade their knowledge and skills in items concerning palliative medicine. Attitudes towards end of life decisions were queried. RESULTS: The return rate was 78%. Significant increase in self estimation of certainty comparing 1st to 5th year students were detected for the items distinction between palliative and curative medicine (p <0.001), symptom control (p <0.001), pain management (p =0.001) and communication (p =0.036). No significant differences were recorded for the items accompaniment of dying patients, breaking bad news and integration of spiritual aspects. The low overall certainty is reflected in poor knowledge. A significant decrease of the approval for euthanasia by request was evident (p =0.012). DISCUSSION: A medical curriculum without compulsory course does increase confidence in some of the core competencies in palliative care, but the overall results at the end of the training are poor. The WHO claims that palliative care has to be "compulsory in courses leading to a basic professional qualification" has still to be fulfilled in Germany. This study can serve as a baseline to evaluate the effect of mandatory courses in palliative care

%0 Journal Article
%C Department of Cardiothoracic and Vascular Surgery, The University of Texas-Houston Medical School, Houston, Texas 77030, USA. anthony.l.estrera@uth.tmc.edu
%A Estrera, Anthony L
%A Miller, Charles C
%A Goodrick, Jennifer
%A Porat, Eyal E
%A Achouh, Paul E
%A Dhareshwar, Jayesh
%A Meada, Riad
%A Azizzadeh, Ali
%A Safi, Hazim J
%J Ann Thorac Surg
%D 2007 Feb
%N 2
%P S842-5; discussion S846-50
%T Update on outcomes of acute type B aortic dissection
%V 83
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17257938
%X BACKGROUND: The optimal treatment of acute type B aortic dissection remains controversial. This study reports early clinical outcomes of medical management for acute type B aortic dissection. METHODS: Between January 2001 and April 2006, data on 159 consecutive patients (55 women [35%]) with the confirmed diagnosis of acute type B aortic dissection were prospectively collected and analyzed. Mean age was 62 years (range, 29 to 94). On admission, all patients were initiated on an acute type B aortic dissection protocol with the intent to manage all patients medically. Indications for surgical intervention included rupture, aortic expansion, retrograde dissection, malperfusion (visceral, peripheral), and intractable pain. All patients were followed up after discharge with serial clinical and radiographic examinations. RESULTS: Overall hospital mortality was 8.8% (14/159): 17% (4/23) with procedural intervention, and 7.4% (10/136) when medical management was maintained. Early intervention was required in 23 patients (14.5%), of which 21 (13.2%) were open vascular/aortic procedures, and two (1.3%) were percutaneous aortic interventions. Morbidity included rupture (5.0%), stroke (5.0%), paraplegia (8.2%), bowel ischemia (5.7%), acute renal failure (20.1%), dialysis requirement (13.8%), and peripheral ischemia (3.8%). Mortality associated with complicated dissection (74/159) was 17%, and mortality associated with uncomplicated dissection (85/159) was 1.2% (p < 0.0003). Late vascular related procedures were performed in 11 (7.6%) of 144 cases (9 aortic, 2 peripheral vascular). The only independent risk factors for hospital mortality by multiple logistic regression analysis was rupture (p < 0.0009). Independent risk factors for mid-term death were history of chronic obstructive pulmonary disease (p < 0.002) and glomerular filtration rate at admission (p < 0.0001). CONCLUSIONS: Medical management, especially for uncomplicated acute type B aortic dissection, is associated acceptable outcomes. This study provides current data for initial medical management of acute type B aortic dissection. Alternative strategies for the treatment of acute Type B aortic dissection should be compared with these results

%0 Journal Article
%C Radboud University Nijmegen Medical Centre, Department of Ethics, Philosophy and History of Medicine (137), PO Box 9101, 6500 HB Nijmegen, The Netherlands. G.Olthuis@efg.umcn.nl
%A Olthuis, Gert
%A Leget, Carlo
%A Dekkers, Wim
%J Nurs Ethics
%D 2007 Jan
%N 1
%P 62-71
%T Why hospice nurses need high self-esteem
%V 14
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17334171
%X This article discusses the relationship between personal and professional qualities in hospice nurses. We examine the notion of self-esteem in personal and professional identity. The focus is on two questions: (1) what is self-esteem, and how is it related to personal identity and its moral dimension? and (2) how do self-esteem and personal identity relate to the professional identity of nurses? We demonstrate it is important that the moral and personal goals in nurses' life coincide. If nurses' personal view of the good life is compatible with their experiences and feelings as professionals, this improves their performance as nurses. We also discuss how good nursing depends on the responses that nurses receive from patients, colleagues and family; they make nurses feel valued as persons and enable them to see the value of the work they do

%0 Journal Article
%A Murai, Atsushi
%J Nippon Ronen Igakkai Zasshi
%D 2007 Jan
%N 1
%P 126
%T [A guide line of end-of-life care for the older residents living in care facilities]
%V 44
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17342824

%0 Journal Article
%C noricats@med.showa-u.ac.jp
%A Kurata, Norimitsu
%A Masamoto, Tamiko
%A Yasuhara, Hajime
%J Nippon Yakurigaku Zasshi
%D 2007 Jan
%N 1
%P 24-30
%T [Animal experiment ethics committee of Showa University]
%V 129
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17220572

%0 Journal Article
%C ymatsuda@med.akita-u.ac.jp
%A Matsuda, Yukihisa
%J Nippon Yakurigaku Zasshi
%D 2007 Jan
%N 1
%P 19-23
%T [Assessment and criteria of pain, distress, and euthanasia]
%V 129
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17220571

%0 Journal Article
%C PADES-Manresa (ICS), Comite de Etica Asistencial, Fundacion Jordi Col i Gurina, Barcelona, Spain
%A Busquet Duran, Xavier
%J Aten Primaria
%D 2006 Nov
%N 9
%P 523-5
%T [Bioethics and home care]
%V 38
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17194360

%0 Journal Article
%C Unite de Soins Palliatifs et Equipe Mobile, Hopital Bretonneau, (AP-HP), Paris
%A Remy, Isabelle
%J Soins Gerontol
%D 2006 Nov-Dec
%N 62
%P 28-30
%T [Caring and help in a funeral room at the hospital in Breton ]
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17274560

%0 Journal Article
%C Pbe Consulting, Verona. chiara.schivazappa@pbe.it
%A Schivazappa, Chiara
%A Baldini, Editta
%A Cortesi, Enrico
%A Dauria, Giuliana
%A Roila, Fausto
%A Berto, Patrizia
%J Recenti Prog Med
%D 2007 Jan
%N 1
%P 12-5
%T [Cost analysis of tumor-induced osteolysis treated with intravenous zoledronic acid and pamidronate: a time-motion study]
%V 98
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17345874
%X A time-motion study was performed by evaluating time and use of medical supply resources in the administration of zoledronic acid and pamidronate as palliative care of tumor-induced osteolysis within the clinical setting of three Italian oncology day-hospital sites. The direct medical costs were similar for both treatments (Euro 226 for zoledronic acid versus Euro 231 for pamidronate). With the exclusion of the pharmacological therapy, most of the difference in costs derives from nurses' labor costs, which is related to the longer infusion time for pamidronate (1 h, 47 min versus 28 min for zoledronic acid)

%0 Journal Article
%C Division Terapia Intensiva, Hospital de Clinicas Jose de San Martin, Facultad de Medicina, Universidad de Buenos Aires, Argentina. carlosgherardi@speedy.com.ar
%A Gherardi, Carlos
%A Chaves, Miguel
%A Capdevila, Abelardo
%A Tavella, Margarita
%A Sarquis, Sergio
%A Irrazabal, Celica
%J Medicina (B Aires)
%D 2006 
%N 3
%P 237-41
%T [Death in an intensive care unit. Influence of life support withholding and withdrawal]
%V 66
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=16871911
%X The influence of life support withholding and withdrawal on the deaths which occurred in an Intensive Care Unit (ICU) over a period of 32 months was analysed. Of 2640 patients admitted in ICU, one of the following five mutually exclusive categories was registered on the 548 patients who died: (i) complete treatment; (ii) complete treatment with non-resuscitation order (NRO); (iii) withholding of life-sustaining treatment; (iv) withdrawal of life-sustaining treatment; and (v) brain death. There was therapeutic limitation of life support in 45.6% of cases (n = 250), with an important majority of withholding (NRO and withholding) in 32.6% of cases, in comparison to withdrawal of life support (8.2% of cases). The comparative analysis with other statistic information suggests the existence of a similar global therapeutic limitation mean in communities with similar cultural background, even if there is a lower influence of life support withdrawal (8.2%) when compared to other countries regardless of their attitude towards the need to establish different degrees of control over technological resources applied to the critically ill. Further research should analyze the influence that moral perception of withdrawal as inconvenient in our society, has over our findings

%0 Journal Article
%C Cattedra di Geriatria, Centro per lo Studio dell'Invecchiamento Cerebrale, Memory Unit, Universita di Bari
%A Capurso, Antonio
%A Capurso, Cristiano
%A Solfrizzi, Vincenzo
%A Colacicco, Anna Maria
%A D'Introno, Alessia
%A Panza, Francesco
%J Recenti Prog Med
%D 2007 Jan
%N 1
%P 43-52
%T [Depression in old age: a diagnostic and therapeutic challenge]
%V 98
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17345879
%X In old age, depression mainly affects those with chronic medical illness, severe disability or mental decline. Depression in elderly worsens the outcomes of many medical illness and increases mortality. Age-related processes, including arteriosclerosis, inflammatory and degenerative diseases, may compromise the integrity of prefrontostriatal pathways and amygdala leading to increased vulnerability to depression. Environmental factors, such as impoverishment, isolation, relocation, caregiving and bereavement, contribute to further increase susceptibility to depression or triggering depression in already vulnerable elderly people. Suitable treatment of depression in elderly reduces the symptoms, prevents suicidal ideation, improves cognitive and functional status and helps patients to develop the skills needed to cope with their disability or psychosocial adversity. Prevention of depression in given pathological conditions may greatly improve the outcomes, mostly the recovery of function and quality of life, as well as the mortality risk. Therefore, it should be considered the opportunity of a depression prophylaxis, particularly in those circumstances in which the risk of depression is noteworthy increased, such as stroke, cancer, institutionalization, etc

%0 Journal Article
%C Holbaek Sygehus, Intensiv Afdeling. hhbulow@dadlnet.dk
%A Bulow, Hans-Henrik
%A Hartling, Ole J
%J Ugeskr Laeger
%D 2007 Feb
%N 8
%P 717-9
%T [Discontinuation of futile therapy]
%V 169
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17313925
%X It is now documented that intensive care units do consider whether treatments promote "the good" and serve patients best. Uncritical use of technology to prolong the dying process must be avoided, and palliative principles worked out. Decisions to withhold or withdraw treatment are among the toughest for both patients and physicians. Legislation covering the area is sufficient, both with regard to competent as well as incompetent patients. However, there are major differences as to how the law is acted upon. Guidelines for futile intensive care treatment should therefore be worked out, and uncritical referral of patients to the ICU avoided

%0 Journal Article
%C Department Douleur/Soins Palliatifs, CHU de Besancon. soins-palliatifs@chu-besancon.fr
%A Aubry, Regis
%J Soins Gerontol
%D 2006 Nov-Dec
%N 62
%P 39-41
%T [Effects of the Leonetti Law in terms of responsibility and confidence]
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17274564

%0 Journal Article
%C Shandong University of TCM, Jinan. qmingqi@163.com
%A Qiao, Ming-Qi
%A Wang, Wen-Yan
%A Zhang, Hui-Yun
%J Zhongguo Zhong Xi Yi Jie He Za Zhi
%D 2007 Feb
%N 2
%P 117-9
%T [Epidemiological survey on etiology of Gan-qi inversion syndrome and Gan-qi stagnation syndrome and study on the evocative mode of emotional diseases]
%V 27
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17342996
%X OBJECTIVE: To investigate the etiology of Gan-qi inversion syndrome and Gan-qi stagnation syndrome, and to study the evocative mode of emotional diseases. METHODS: One thousand and twenty-six subjects, engaged as workers, cadres, teachers and farmers, come from Qingdao City, Jinan City and Qingyun County were surveyed adopting the on-spot investigation. RESULTS: The percentage of patients with Gan-qi inversion or stagnation syndrome caused by emotional internal injury was 53.9%; the emotional stimulations were primary the angry with compunction and the gloomy angry with grievance, secondly the unacquirable wishes, anxiety and grief. CONCLUSION: Emotional stimulation is the main cause of Gan-qi inversion or stagnation syndromes, cross actions of several emotional factors directly impairing Gan is the main evocative mode of emotional diseases

%0 Journal Article
%C Service d'anesthesie-reanimation, hopital Central, 29, avenue du Marechal-de-Lattre-de-Tassigny, CO n(o) 34, 54035 Nancy cedex, France
%A Cornet, C
%A Empereur, F
%A Heck, M
%A Gabriel, G
%A Commun, N
%A Laxenaire, MC
%A Bouaziz, H
%A Mertes, PM
%J Ann Fr Anesth Reanim
%D 2007 Mar
%T [Postoperative pain management on surgical wards in one university hospital: short and medium-term effects of a quality assurance program.]
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17337155
%X OBJECTIVES: Evaluation of the short- and medium-term impact of a postoperative pain management quality assurance programme in a university hospital. STUDY DESIGN: Prospective study. MATERIALS AND METHODS: In 1998: chart review and survey of patients and professionals. Principal corrective actions: support for evaluation and tracking of potentially painful surgical procedures, prescription form including an emergency treatment plan, distribution of a set of guidelines. Evaluation was identical during the quality assurance programme and three years later, in 2003. RESULTS: In 2003, information regarding postoperative analgesia was received by 70% of patients and understood by 99% (50% in 1998, p<0.001). Sixty-two percent of patients were totally satisfied with their doctors in 2003 vs 75% in 1998 (NS). Pain was documented in 63.1% of charts in 2003, vs 10% in 1998 (p<0.001). Hundred percent of doctors were aware of the analgesic protocols in 2003 vs 69% in 1998 (p<0.02). In 2003, the treatment of analgesic side effects was known by 86% of doctors vs 29% in 1998 and these effects were looked for by 57% of caregivers in 2003 vs 11% in 1998 (p<0.001). CONCLUSION: Management of postoperative pain has progress significantly and the quality indicators used for evaluation have improved. Patients are better informed, which raises standards. The programme will be extended to all other surgical departments of the hospital, under the authority of CLUDS (Committee for Pain Control and Palliative Care)

%0 Journal Article
%C Reseau de sante Agekanonix, Villeneuve-la-Garenne
%A Rogez, Elisabeth
%J Soins Gerontol
%D 2006 Nov-Dec
%N 62
%P 31-3
%T [Taking care of the body after death]
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17274561