%0 Journal Article
%C , Box 436, Durham, NC, 27710, amy.abernathy@duke.edu
%A Abernethy, A
%J J Pain Palliat Care Pharmacother
%D 2007 
%N 1
%P 71-78
%T Palliative Care Pharmacotherapy Literature Summaries and Analyses
%V 21
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17430837
%X Timely and important studies are reviewed and commentaries provided by leading palliative care clinicians. Symptoms addressed in this issue are donepezil for Alzheimer's Disease, beta-blockers and quality of life in heart failure, a randomized controlled trial of three antiemetics in the emergency department, acceptability of low molecular weight heparin in a specialist palliative care unit, and pyridostigmine for neurogenic orthostatic hypotension. doi:10.1300/J354v21n01_17

%0 Journal Article
%C Joensuuvej 122, DK-4000 Roskilde. nicolaballin@hotmail.com
%A Ballin, NH
%J Ugeskr Laeger
%D 2007 Mars
%N 13
%P 1201-1204
%T [Do-not-resuscitate orders - ethical and legal considerations.]
%V 169
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17425922
%X The article is based on a structured literature review. Practicing DNR orders in Denmark has not yet been described and there are no national guidelines. Generally patients must give informed consent before do-not-resuscitate (DNR) orders. Only 32% of competent patients are involved prior to the decision even though patients wish to talk about decisions regarding the end of life . In general doctors cannot predict patients' do-not-resuscitate preferences and doctors underestimate patients' self-estimated quality of life. Doctors rarely contact the Danish Living Will Registry. Patients with do-not-resuscitate orders may be subject to other therapeutic reductions. In conclusion, patient autonomy should also be respected in the case of do-not-resuscitate orders

%0 Journal Article
%A Bristol, Nellie
%J Lancet
%D 2007 Mar
%N 9564
%P 815-6
%T Should terminally ill patients have access to phase I drugs?
%V 369
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17366691

%0 Journal Article
%C Palliative Medicine, Dartmouth Hitchcock Medical Center, One Medical Center Dr, Lebanon, NH 03756-0001, USA. Ibyock@aol.com
%A Byock, Ira R
%J Am J Hosp Palliat Care
%D 2006 Dec-2007
%N 6
%P 436-8
%T To life! Reflections on spirituality, palliative practice, and politics
%V 23
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17210996

%0 Journal Article
%C Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, Centralia, WA 98531, USA. gtcarter@comcast.net
%A Carter, Gregory T
%A Han, Jay J
%A Abresch, R Ted
%A Jensen, Mark P
%J Am J Hosp Palliat Care
%D 2006 Dec-2007
%N 6
%P 493-7
%T The importance of assessing quality of life in patients with neuromuscular disorders
%V 23
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17211006

%0 Journal Article
%C School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
%A Chan, HY
%A Pang, SM
%J J Clin Nurs
%D 2007 Apr
%T Quality of life concerns and end-of-life care preferences of aged persons in long-term care facilities
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17419782
%X Aims and objectives. This study aimed at understanding quality of life (QOL) concerns and end-of-life care preferences of older people living in long-term care facilities in Hong Kong. Background. Previous studies about the QOL of residents in long-term care facilities were often from a qualitative perspective, because it could yield an in-depth description of the experience. Quantitative studies in this area were not only scarce, but also less specific in capturing the concerns of this vulnerable group. Their forethought about their care planning was also overlooked. Design and method. We successfully interviewed 287 older residents from 10 long-term care homes using the modified Quality-of-Life Concerns in the End of Life Questionnaire (QOLC-E) in a cross-sectional survey. Results. The mean (SD) ages of the frail and non-frail groups were 83.8 (6.74) and 82.35 (5.82) respectively. The majority of them were female and widowed. Existential distress, value of life and food-related concerns were the least desirable QOL concerns in both groups. Considerable numbers were uncertain about their end-of-life care preferences and they preferred their physician to be their surrogate. Conclusion. The older residents had similar QOL concerns as patients with terminal or advanced diseases. Most of the older residents welcomed discussion about death and dying but had not planned for their end-of-life care and had a high regard for their physicians' authority. Relevance to clinical practice. The results reveal the major QOL concerns among the older residents living in long-term care facilities. This study, which is an initial step in profiling the older people's end-of-life care preferences, also shed light on how to formulate advance care planning in long-term care facilities

%0 Journal Article
%C Weill Medical College of Cornell University-New York Presbyterian Hospital, USA
%A Chervenak, Frank A
%A McCullough, Laurence B
%A Arabin, Birgit
%J Hastings Cent Rep
%D 2006 Sep-Oct
%N 5
%P 30-3
%T Why the Groningen Protocol should be rejected
%V 36
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17091699

%0 Journal Article
%C Division of Cardiovascular Surgery, Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201-2196, USA. rdelius@dmc.org
%A Delius, Ralph
%J Ann Thorac Surg
%D 2007 Apr
%N 4
%P 1436-7
%T Invited commentary
%V 83
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17383353

%0 Journal Article
%A Demmy, Todd L
%J Ann Thorac Surg
%D 2007 Apr
%N 4
%P 1578
%T Thoracoscopic lobectomy for impaired or complex patients: an update
%V 83
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17383397

%0 Journal Article
%C Fox Chase Cancer Center, Thoracic & Head & Neck Oncology, Medical Oncology, 333 Cottman Avenue, PA 19111, USA. john.devlin@fccc.edu
%A Devlin, John G
%A Langer, Corey J
%J Expert Rev Anticancer Ther
%D 2007 Mar
%N 3
%P 331-50
%T Combined modality treatment of laryngeal squamous cell carcinoma
%V 7
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17338653
%X Squamous cell carcinoma of the larynx is a major public health concern; it causes substantial morbidity and mortality, and arises chiefly as a result of tobacco and alcohol consumption. Early stage disease is best treated with radiation or surgery alone, but for patients with more locally advanced squamous cell carcinoma of the larynx, combined modality treatment has been shown to benefit selected patients, particularly when cisplatin-based chemotherapy and concurrent radiation therapy are employed, with or without altered fractionated radiation therapy. Substantial laryngectomy-associated quality-of-life decrements can be avoided in selected, potentially resectable patients with organ-sparing approaches, without sacrificing survival. Recently, trials have addressed the role of targeted systemic agents to the epidermal growth factor receptor, and other targets are under investigation. The addition of induction chemotherapy to concurrent chemoradiotherapy is a promising treatment strategy that warrants further evaluation, but has not yet emerged as a standard of care; the toxicity of such regimens must be balanced with the potential benefits on a case-by-case basis, and functional outcomes are often quite variable. Treatment planning, management and follow-up are complex, and thus should ideally be performed in a comprehensive, multidisciplinary fashion, in a center accustomed to a high volume of such cases. Future research directions are described herein

%0 Journal Article
%C Faculty of Nursing, University of Manitoba, Winnipeg, Manitoba, Canada
%A Enns, C
%A Gregory, D
%J J Adv Nurs
%D 2007 Apr
%T Lamentation and loss: expressions of caring by contemporary surgical nurses
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17425600
%X Aim. This paper is a report of a phenomenological study of caring from the perspective of nurses working on surgical wards. Background. While care and caring are complex foundational nursing concepts which have received considerable and ongoing attention from theorists, researchers and clinicians, there has been little research into caring on surgical units. Method. A convenience sample of ten nurses working on surgical units in a public teaching hospital in Canada was interviewed using van Manen's phenomenological approach. Data were collected during 2001 using semi-structured interviews. Findings. The major theme of lamentation and loss was identified from the data. Participants revealed a dichotomous tension between what caring should be and what actually occurs. This tension was pervasive and generated lament - an expression of grief and mourning for the loss of caring. The essential structures supporting this theme included lack of time, lack of caring support, tasking, increased acuity, lack of continuity of care, emotional divestment and not caring for each other. Loss and sadness were articulated and participants lamented and grieved about the loss of care in contemporary practice. Conclusion. The forces and influences described by participants undermined caring in the new practice milieu. If this is a glimpse of the future, then the values of the nursing profession may be under siege. Caring as the central core, the essence or unifying concept of nursing may be subject to marginalization in contemporary practice

%0 Journal Article
%C Department of Surgery, Children's Hospital, Omaha, Nebraska, USA. kathleennf@msn.com
%A Fenton, Kathleen N
%A Lessman, Katherine
%A Glogowski, Kimberly
%A Fogg, Sherrie
%A Duncan, Kim F
%J Ann Thorac Surg
%D 2007 Apr
%N 4
%P 1431-6
%T Cerebral oxygen saturation does not normalize until after stage 2 single ventricle palliation
%V 83
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17383352
%X BACKGROUND: In an effort to optimize neurologic outcome, cerebral oxygen saturation (SCO2) is often measured intraoperatively and postoperatively. We hypothesized that SCO2 would be related to stage of palliation in children with single ventricle congenital heart disease. METHODS: Cerebral oxygen saturation was continuously recorded intraoperatively in 34 infants and children undergoing palliative surgery on cardiopulmonary bypass for single ventricle congenital heart defects and in a control group of 12 neonates with ductus-dependent circulation undergoing complete repair. Saturations were correlated with the patient's stage and outcome. RESULTS: Baseline SCO2 was 61% in single ventricle neonates (group P1, n = 10), 55% in neonates undergoing repair (group R), 42% in infants undergoing stage 2 palliation (group P2, n = 6), and 70% in children undergoing Fontan (group P3, n = 14). Baseline was lowest (41%) in infants undergoing interstage operations (group I, n = 4). After bypass, there was a significant improvement in SCO2 to 53% in group P2 infants (p = 0.04); there were no significant changes in the other groups. By the end of the operation, there was a significant decrease in SCO2 to 48% in group P1 (p = 0.001), with other groups unchanged from baseline. There were five perioperative deaths. Cerebral oxygen saturation at the conclusion of surgery was lower in children who died (38% versus 61%, p = 0.01). CONCLUSIONS: In children with single ventricle physiology, SCO2 decreases after initial palliation, remains low before second-stage palliation, but is normal before and after the Fontan. This has implications for perioperative mortality, neurologic injury, and potentially for interim mortality. Low postoperative SCO2 predicts perioperative mortality

%0 Journal Article
%A Fisken, Roger A
%J Clin Med
%D 2006 Sep-Oct
%N 5
%P 509; author reply 509
%T Assisted dying
%V 6
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17080904

%0 Journal Article
%C Department of Women's and Children's Health, Uppsala University, S-751 85 Uppsala, Sweden; Center for Clinical Research Dalarna and Department of Pediatrics, Falun Hospital, S-791 82 Falun, Sweden
%A Flacking, R
%A Ewald, U
%A Starrin, B
%J Soc Sci Med
%D 2007 Apr
%T "I wanted to do a good job": Experiences of 'becoming a mother' and breastfeeding in mothers of very preterm infants after discharge from a neonatal unit
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17428597
%X In mothers of preterm infants, the process of becoming a mother is initiated in a public and medical environment, in which the mothers become dependent on the benevolence and support of the staff. This setting and an experience of insecure social bonds impair the ability to become a mother during the infant's stay at the neonatal unit (NU), and breastfeeding may become a duty and not be mutually satisfying. Studies on how women experience becoming a mother and breastfeeding after the infant's discharge are sparse and this question is addressed in the present grounded theory study. Twenty five mothers, whose very preterm infants had received care in seven NUs in Sweden, were interviewed once, 1-12 months after discharge. We propose a model to increase understanding of the process of becoming a mother and breastfeeding, after the infant's discharge from the NU. The mother's emotional expressions in this process showed pendular swings from feeling emotionally exhausted to feeling relieved, from experiencing an insecure to a secure bond, and from regarding breastfeeding as being non-reciprocal to being reciprocal. Unresolved grief, the institutional authority at the NU and experiences of shame were three of the central barriers to a secure and reciprocal relationship. The pendular changes give us a deeper understanding of the variations in both attachment and attunement. Perhaps the negative extremes are more prominent among these mothers on account of their infant's illness and their NU experiences. If our proposed model is valid, it is vital that these findings are considered by those involved in the short- and long-term care in order to support the mothers to establish a secure bond, comprising both attachment and attunement

%0 Journal Article
%C Institute of Health and Care Sciences, The Sahlgrenska Academy, Goteborg University, Goteborg, Sweden
%A Fridh, Isabell
%A Forsberg, Anna
%A Bergbom, Ingegerd
%J Scand J Caring Sci
%D 2007 Mar
%N 1
%P 25-31
%T End-of-life care in intensive care units - family routines and environmental factors
%V 21
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17428211
%X The purpose of this study was to describe family care routines and to explore environmental factors when patients die in Swedish intensive care units (ICUs). The main research questions were: what are the physical environmental circumstances and facilities when caring for patients in end-of-life and are there any routines or guidelines when caring for dying patients and their families? A questionnaire was sent to 79 eligible Swedish ICUs in December 2003, addressed to the unit managers. The response rate was 94% (n = 74 units). The findings show that, despite recommendations highlighting the importance of privacy for dying ICU patients and their families, only 11% of the respondents stated that patients never died in shared rooms in their ICU. If a patient dies in a shared room, nurses strive to ensure a dignified good-bye by moving the body to an empty room or to one specially designated for this purpose. The majority (76%) of the units had waiting rooms within the ICU. The study also revealed that there is a need for improvements in the follow-up routines for bereaved families. Many units reported (51%) that they often or almost always offer a follow-up visit, although in most cases the bereaved family had to initiate the follow-up by contacting the ICU. Guidelines in the area of end-of-life care were used by 25% of the ICUs. Further research is necessary to acquire a deeper knowledge of the circumstances under which patients die in ICUs and what impact the ICU environment has on bereaved families

%0 Journal Article
%C Naval Medical Center Portsmouth, Portsmouth, Virginia, USA. jagalle@mac.com
%A Galle, John A
%J Am J Hosp Palliat Care
%D 2006 Dec-2007
%N 6
%P 498-9
%T The first patient who broke my heart
%V 23
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17211007

%0 Journal Article
%C Department of Philosophy, Boston College, Boston, Massachusetts, USA. JLAGarcia@aol.com
%A Garcia, J L A
%J J Med Philos
%D 2007 Jan-Feb
%N 1
%P 7-24
%T Health versus harm: euthanasia and physicians' duties
%V 32
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17365443
%X This essay rebuts Gary Seay's efforts to show that committing euthanasia need not conflict with a physician's professional duties. First, I try to show how his misunderstanding of the correlativity of rights and duties and his discussion of the foundation of moral rights undermine his case. Second, I show aspects of physicians' professional duties that clash with euthanasia, and that attempts to avoid this clash lead to absurdities. For professional duties are best understood as deriving from professional virtues and the commitments and purposes with which the professional as such ought to act, and there is no plausible way in which her death can be seen as advancing the patient's medical welfare. Third, I argue against Prof. Seay's assumption that apparent conflicts among professional duties must be resolved through "balancing" and argue that, while the physician's duty to extend life is continuous with her duty to protect health, any duty to relieve pain is subordinate to these. Finally, I show that what is morally determinative here, as throughout the moral life, is the agent's intention and that Prof. Seay's implicitly preferred consequentialism threatens not only to distort moral thinking but would altogether undermine the medical (and any other) profession and its internal ethics

%0 Journal Article
%C Department of Surgery, Division of Thoracic Surgery, University of Calgary, Institute of Health Economics, Calgary, Alberta, Canada. andrew.graham@calgaryhealthregion.ca
%A Graham, Andrew J
%A Shrive, Fiona M
%A Ghali, William A
%A Manns, Braden J
%A Grondin, Sean C
%A Finley, Richard J
%A Clifton, Joanne
%J Ann Thorac Surg
%D 2007 Apr
%N 4
%P 1257-64
%T Defining the optimal treatment of locally advanced esophageal cancer: a systematic review and decision analysis
%V 83
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17383322
%X BACKGROUND: The objective of this study was to combine systematic review and decision analytic techniques to determine the optimal treatment strategy for patients with locally advanced esophageal cancer. METHODS: We performed a systematic review of all randomized trials of patients with locally advanced esophageal cancer that included one of the following strategies compared with surgery alone: chemoradiotherapy followed by surgery, chemotherapy followed by surgery, or surgery with adjuvant chemoradiotherapy. Using the estimates of relative risk for mortality and overall quality of life we constructed a decision model. The outcome of interest was expected quality-adjusted life-years (QALY). RESULTS: The meta-analysis showed for the first year, the relative risk (95% confidence interval) of death for treatments compared with surgery were 0.87 (0.75 to 1.02) for chemoradiotherapy followed by surgery, 0.94 (0.82 to 1.08) for chemotherapy followed by surgery, and 1.33 (0.93 to 1.93) for surgery with adjuvant chemoradiotherapy. The QALYs gained for surgery alone, chemoradiotherapy followed by surgery, chemotherapy followed by surgery, and surgery with adjuvant chemoradiotherapy strategies were 2.07, 2.18, 2.14, and 1.99, respectively. If the reduction in utility for multimodality treatment was increased to 21%, the QALYs gained for surgery alone, chemoradiotherapy followed by surgery, chemotherapy followed by surgery, and surgery with adjuvant chemoradiotherapy were 2.07, 2.03, 1.99, and 1.85, respectively. CONCLUSIONS: Chemoradiotherapy followed by surgery appears to be associated with the best survival and the largest expected gain in QALYs. However, the improvement in quality-adjusted life expectancy is modest at 40 days, and surgery alone becomes the preferred strategy if the reduction in utility associated with multimodality treatment is increased to 21%

%0 Journal Article
%A Griffith, David
%J Clin Med
%D 2006 Sep-Oct
%N 5
%P 510
%T Assisted dying
%V 6
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17080905

%0 Journal Article
%C Psychological Society of Ireland (PSI) Training Scheme, Green Park Healthcare Trust, Belfast, UK
%A Harrison, Nicola
%A Wilson, F Colin
%J Disabil Rehabil
%D 2007 Feb
%N 4
%P 347-52
%T Independent living following a 'Do Not Resuscitate' order after subarachnoid haemorrhage
%V 29
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17364785
%X PURPOSE: The recovery and psychosocial adjustment of a 41-year-old right handed women (K.E.) following subarachnoid haemorrhage (SAH) with initially poor predicted prognosis is presented. METHOD: A single case report with an early post surgery 'Do Not Resuscitate' order following SAH with a significant period of impaired consciousness is outlined. RESULTS: Following a right frontal craniotomy and clipping of a left distal anterior communicating artery (AcoA) aneurysm, K.E. was unresponsive for 23 days and 'minimally conscious' for a further 5+ weeks post surgery (36 days). At two months post insult, after some neurological improvement, she was transferred for post-acute goal directed neurorehabilitation. At 8 months post insult, after 4 months inpatient and 2 months intensive outpatient neurorehabilitation, K.E. was largely independent, did not require home care services and had made a good psychosocial adjustment to her acquired difficulties. CONCLUSIONS: The potential for recovery following a significant period of reduced consciousness after SAH is highlighted despite initially poor prognostic indicators

%0 Journal Article
%A Hill, Robin Renee
%J Am J Health Syst Pharm
%D 2007 Apr
%N 8
%P 806-10
%T Clinical pharmacy services in a home-based palliative care program
%V 64
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17420193

%0 Journal Article
%A Hospice, And Palliative Care IA
%J J Pain Palliat Care Pharmacother
%D 2007 
%N 1
%P 31-33
%T The Declaration of Venice:Palliative Care Research in Developing Countries
%V 21
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17430827
%X In May 2006 at the Fourth Research Forum of the European Association for Palliative Care (EAPC) in Venice Italy, recognizing that the World Health Organization definition of palliative care calls for "impeccable assessment and treatment of physical symptoms and of psychological, social and spiritual problems," the EAPC and the International Association for Hospice and Palliative Care (IAPC) introduced a declaration to develop a global palliative care research initiative. doi:10.1300/J354v21n01_07

%0 Journal Article
%C Department of Nursing, Kaohsiung Chang Gung Memorial Hospital, ROC. tuan681018@yahoo.com.tw
%A Huang, MT
%A Juang, CM
%A Yai, CY
%A Chiou, YG
%J Hu Li Za Zhi
%D 2007 Apr
%N 2
%P 98-102
%T [An Experience Providing Terminal Care Based on Watson's Theory to a Cancer Patient Who Lived Alone.]
%V 54
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17431850
%X This article presents the case of a terminal stage cancer patient who lived alone and had a detached relationship with his family, and negative behaviors such as: depression, passivity, silence, refusal of treatment, and inability to trust others because of lack of family care during hospitalization. We cared for the patient with direct personal nursing care, using skillful physical evaluation, conversation and close observation from June 11, 2004, to July 11, 2004. Using Watson's theory, we successfully instilled trust in the patient and developed a positive relationship with him. We took care of his needs in a timely manner, used physical care to make him feel comfortable, showed concern about what he was really feeling, provided him with medical information, and helped him to manage his physiological, psychological, social, and spiritual problems. We enabled the patient to face his disease, in the hope that he would experience the end of his life peacefully under our warm and professional nursing care

%0 Journal Article
%C Department of Nursing, Tungs' Taichung MetroHarbor Hospital, ROC. jesihuang@hotmail.com
%A Huang, YY
%A Yang, CL
%A Lin, SY
%A Chang, CC
%A Chen, SC
%J Hu Li Za Zhi
%D 2007 Apr
%N 2
%P 79-84
%T [Strategies for Discussing Death With Child Cancer Sufferers.]
%V 54
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17431847
%X Since a curriculum concerning life and death was established and palliative care began to be promoted, people have gradually awakened to the needs of dying patients. Because of the nature of oriental culture, however, ultimate decisions concerning someone with a terminal disease have traditionally been made by family, so dying patients, especially children with cancer, have usually not been told of their true condition. The purpose of this article was to gain an understanding of the necessity of talking about death with child cancer patients and how to communicate with these children. The results show that helping the family to talk about death and decision making concerning treatment can help them to adapt to the grieving period when the children pass away. The tactics that nurses can use for communication with dying children include: to acknowledge the decision maker in the family, adopt the concept of death appropriate to a person of the child's age, discuss the prognosis for the development of the disease, and opt to use the medium of communication. The findings of this article may serve as a source of reference for nurses caring for dying children, and cause greater attention to be paid to these issues

%0 Journal Article
%C Department of Respiratory Medicine, Bristol Royal Infirmary, Bristol, United Kingdom. dr_arshad_husain@yahoo.co.uk
%A Husain, Syed A
%A Finch, David
%A Ahmed, Manzoor
%A Morgan, Anthony
%A Hetzel, Martin R
%J Ann Thorac Surg
%D 2007 Apr
%N 4
%P 1251-6
%T Long-term follow-up of ultraflex metallic stents in benign and malignant central airway obstruction
%V 83
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17383321
%X BACKGROUND: We report experience with Ultraflex metallic stents (Boston Scientific, Natick, MA) inserted at rigid bronchoscopy under general anesthesia for palliation of benign and malignant upper airway obstruction. METHODS: Notes of all patients treated with Ultraflex stents from 1999 to 2003 were reviewed for symptomatic response, spirometric data, and any complications before discharge home. Long-term outcome was assessed by questionnaires sent to patients' general practitioners. RESULTS: Recruited were 66 patients (12 benign, 54 malignant airway obstructions). Before discharge home, breathlessness improved in 11 of 12 patients with benign obstruction and in 39 of 54 with malignancies. Postoperative complications in 10 patients with malignant obstructions and in 2 patients with benign obstruction were successfully controlled. It was not possible to perform preoperative pulmonary function tests in most of the patients who presented as emergencies. Mean improvement in forced expiratory volume in 1 second was 0.88 liters in 3 patients with benign obstruction and 0.28 liters in 14 patients with malignant obstruction, and mean peak expiratory flow rate improved by 109 L/min and 97 L/min, respectively. General practitioners completed questionnaires for 12 benign patients and 46 of 54 patients with malignancies. At a mean follow-up of 1017 days (range, 46 to 1120 days), 10 of the 12 patients with benign disease were alive and 7 of 46 patients with malignant airway obstruction were alive, with a median survival of 128 days (mean, 361; range, 3 to 1859 days). Most survivors had Medical Research Council grade III breathlessness or better, with few stent-related symptoms. CONCLUSIONS: Ultraflex stents proved safe and effective in prolonged palliation of benign and malignant airways obstruction

%0 Journal Article
%C H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida 33612, USA
%A Jensen, Eric H
%A Kvols, Larry
%A McLoughlin, James M
%A Lewis, James M
%A Alvarado, Michael D
%A Yeatman, Timothy
%A Malafa, Mokenge
%A Shibata, David
%J Ann Surg Oncol
%D 2007 Feb
%N 2
%P 780-5
%T Biomarkers predict outcomes following cytoreductive surgery for hepatic metastases from functional carcinoid tumors
%V 14
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17146740
%X BACKGROUND: Cytoreductive therapy for metastatic carcinoid provides symptomatic relief and improvement in overall survival. We evaluated whether CgA and 5HIAA could predict symptomatic relief and control of disease progression after cytoreductive surgery. METHODS: We retrospectively reviewed 70 patients who underwent cytoreductive surgery for neuroendocrine hepatic metastases between 1996 and 2005. Twenty-two patients had pre and post-operative CgA and/or 5HIAA levels measured. Reduction of biomarkers following cytoreduction was correlated with patient symptoms and progression of disease following surgery. RESULTS: Our study consisted of 14 males and 8 females with a mean age of 55 (+/-12 years). Median follow-up was 18 months (range 5-64 months). Six patients (26.1%) had complete (R0) cytoreduction, while 4 (17.4%) and 13 (56.5%) had microscopic (R1) and gross (R2) disease remaining. All patients reported improvements in their symptoms, with 12 (54.5%) reporting complete resolution (CR) and 10 (45.5%) reporting partial resolution (PR). Reduction of CgA of >or= 80% was highly predictive of complete resolution of symptoms (P = 0.007) and stabilization of disease (P = 0.034). Reduction of 5HIAA levels of >or= 80% (or normalization) was predictive of symptomatic relief, but not progression of disease (P = 0.026 and P = 0.725). Five of six patients who had R0 resections had CR and were free of disease at last follow-up (median 24.5 months, range: 11-48, P = 0.002). CONCLUSIONS: We conclude that >or= 80% reduction in CgA level following cytoreductive surgery for carcinoid tumors is predictive of subsequent symptom relief and disease control. Substantial reduction in CgA is associated with improved patient outcomes, even after incomplete cytoreduction

%0 Journal Article
%C Department of Oncology, Head and Neck Oncology Group, University of Liverpool, United Kingdom
%A Jones, Andrew S
%A Rafferty, Mark
%A Fenton, John E
%A Jones, Terence M
%A Husband, David J
%J Ann Otol Rhinol Laryngol
%D 2007 Feb
%N 2
%P 92-9
%T Treatment of squamous cell carcinoma of the tongue base: irradiation, surgery, or palliation?
%V 116
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17388231
%X OBJECTIVES: Squamous cell carcinoma of the tongue base has a poor prognosis, and treatment is accompanied by a number of major problems. In view of this, it is important to recognize which patients will benefit from treatment with curative intent and which treatment method to use. METHODS: One hundred sixty-five patients with squamous cell carcinoma of the tongue base were identified on our database. Eighty-two patients were treated by radical irradiation, and 41 by surgery. A further 42 patients were considered unsuitable for curative treatment. RESULTS: The 5-year cause-specific survival rate was 41% for those treated by irradiation, 58% for those treated by surgery, and 9% for untreated patients. There was no difference in the efficacy of treatment methods (p = .5362), but a highly significant difference was seen in survival rate between treated and untreated patients (p = .0028). The decision regarding administration of curative treatment was based on the extent of locoregional involvement at the primary site (p = .0139; odds ratio, 0.43) and in the neck (p = .0078; odds ratio, 0.23). No factors affected the decision to treat by irradiation or surgery. When the observed survival rate was calculated, there was no significant difference in 5-year survival rate between treated and untreated patients (p = .2762). Those with early (T1-2) disease at the primary site had an improved survival rate from 0.5 to 4 years compared with those who were untreated (T3-4; p = .0081; odds ratio, 2.2). In addition, those with early (T1-2) disease had a better survival rate than those with advanced cancers (p = .0139; odds ratio, 2.09). There was, however, no difference in survival rate at 5 years. Those with early disease compared with those with advanced disease were twice as likely to be alive at 2 years; however, all survival advantages had disappeared by 5 years. CONCLUSIONS: In terms of observed survival, treating tongue base squamous cell carcinoma that is locally advanced (T3-4) at presentation offers no survival advantage over palliation alone. Treating early disease (T1-2) doubles the survival rate for up to 4 years, but by 5 years this survival advantage is lost. The present study finds radiotherapy and surgery to be equivalent at controlling this disease

%0 Journal Article
%C Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH 44106-4945, USA. skoroukian@case.edu
%A Koroukian, Siran M
%A Beaird, Heather
%A Madigan, Elizabeth
%A Diaz, Mireya
%J Health Care Financ Rev
%D 2006 Winter
%N 2
%P 65-80
%T End-of-life expenditures by Ohio Medicaid beneficiaries dying of cancer
%V 28
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17427846
%X We evaluate the extent to which the Ohio Medicaid Program serves as a safety net to terminally ill cancer patients, and the costs associated with providing care to this patient population. Over a 10-year period, Ohio Medicaid served nearly 45,000 beneficiaries dying of cancer, and spent more than $1 billion in medical care expenditures in their last year of life. Eighty percent of the expenditures were incurred by 67 percent of the decedents who had been enrolled in Medicaid for at least 1 year before death, implying an opportunity for the Medicaid Program to ensure timely transition to palliative care and hospice

%0 Journal Article
%C , 9515 Seabreeze Terrace, Malibu, CA, 90265-2223, lamers@earthlink.net
%A Lamers, WM
%J J Pain Palliat Care Pharmacother
%D 2007 
%N 1
%P 85-90
%T Defining Palliative Care, Cancer Without Pain, When to Contact Hospice, When to Treat Multiple Myeloma, Meaning of Physical Signs, Pneumonia at End-of-Life
%V 21
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17430839
%X This feature is based on actual questions and answers received and responded to by the Hospice Foundation of America (HFA). This is a service provided for families and support group members of patients with advanced disease by William M. Lamers, MD, HFA Medical Consultant amember of this Journal's Editorial Board. Effective ways to communicate with families and support groups of patients with advanced disease are presented. In this issue, queries and responses are presented addressing the definition of palliative care, cancer without pain, when to contact a hospice, when to treat multiple myeloma, pneumonia at end-of-life. doi:10.1300/J354v21n01_19

%0 Journal Article
%C The National University of Ireland, Galway, Ireland, The Catholic University of Leuven, Belgium
%A Larkin, Philip J
%A Dierckx de Casterle, Bernadette
%A Schotsmans, Paul
%J Qual Health Res
%D 2007 Apr
%N 4
%P 468-76
%T Multilingual translation issues in qualitative research: reflections on a metaphorical process
%V 17
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17416700
%X Focus on the translation and validation of measurement instruments has left a gap in the discussion on how to construct multilingual qualitative tools, such as interviews. Traditional methods of forward and backward translation have been criticized for weak conceptual equivalence, a crucial issue when multiple language interview methods are used.Through a creative arts metaphor of weaving, the authors describe an alternative process of multicentric translation used in the development of an interview guide designed to explore the impact of transition on palliative care patients in six European countries. Four identified core constructs illuminate this multicentric process: Cohesion, Congruence, Clarity, and Courtesy. Mutual reciprocity between researcher and translator offers greater possibility for construction of nuance and meaning, particularly where cultural parameters influence the collection and meaning of sensitive data from vulnerable populations. The translator therefore becomes a collaborator in the research process, which strengthens the rigor of language-based inquiry

%0 Journal Article
%C Transplant Services, Washington Hospital Center, Georgetown University Hospital, Washington DC, USA
%A Light, Jimmy A
%A Cecka, J Michael
%J Clin Transpl
%D 2005 
%P 235-45
%T Trends in donation after cardiac death
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17424743
%X The deceased cardiac donor (DCD) can provide organs that are suitable for transplantation. However, in order to increase recovery and utilization of this under-utilized organ donor source, a number of issues remain to be resolved. First, the public understanding is essential for support of this end-of-life option to donate after cardiac death. Extensive education of donor hospitals will be needed to identify potential donors and arrange for their care. Organ procurement organizations will have to commit to the extra effort required to identify and manage these donors and to design recovery techniques to maximize procurement of abdominal and thoracic organs. Pulsatile machine perfusion may be needed for assessing viability of DCD kidneys, although the evidence is lacking that pump preservation improves survival of DCD kidneys that are transplanted. It will also be important to identify transplant centers and suitable patients within those centers that will accept DCD organs. Preselecting recipients will speed allocation as has been the case for expanded criteria donors. Special efforts to minimize reperfusion injury should be made initially to protect what might be more "injury-prone" DCD organs and calcineurin inhibitors should probably be avoided during the early posttransplant period. The graft survival rates for DCD kidneys and pancreata have been comparable to those for conventional deceased donor grafts, whereas graft survival rates for DCD liver recipients have been significantly poorer than with conventional livers. Thus, we need to continue exploring approaches to improve patient and graft survival for DCD liver transplant recipients

%0 Journal Article
%C , 30 S 2000 E RM 258
%A Lipman, AG
%J J Pain Palliat Care Pharmacother
%D 2007 
%N 1
%P 5-6
%T The Declarations of Venice of 1983 and 2006:Two Efforts to Improve Palliative Care
%V 21
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17430823

%0 Journal Article
%C Division of Pulmonary and Critical Care Medicine, Thomas Jefferson University, Philadelphia, PA 19107, USA
%A Marik, Paul E
%J Am J Hosp Palliat Care
%D 2006 Dec-2007
%N 6
%P 479-82
%T Management of patients with metastatic malignancy in the intensive care unit
%V 23
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17211003
%X Intensive care units serve to provide temporary physiologic support to patients with reversible organ failure. However, with increasing frequency, patients with end-stage and terminal illnesses are being admitted to the intensive care unit. Indeed, in the United States, a third of all patients with terminal metastatic malignancy are admitted to the intensive care unit, and 60% of all hospital deaths occur after such an admission. In many instances, admission to an intensive care unit serves only to transform death into a prolonged, painful, and undignified process. In patients with a terminal illness, the focus should be on measures that ensure comfort, and admission to an intensive care unit should generally be avoided. Intensivists, who are charged with making the best use of limited resources, should ultimately be the individuals who determine the appropriateness of admitting such patients to the intensive care unit

%0 Journal Article
%A McCarron, Mary
%A McCallion, Philip
%J Intellect Dev Disabil
%D 2007 Apr
%N 2
%P 128-31
%T End-of-Life Care Challenges for Persons With Intellectual Disability and Dementia: Making Decisions About Tube Feeding
%V 45
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17428136

%0 Journal Article
%C Department of Child and Adolescent Psychiatry, University of Pittsburgh Medical Center, Western Psychiatric Institute and Clinic, Pittsburgh, PA 15213, USA
%A Melhem, Nadine M
%A Moritz, Grace
%A Walker, Monica
%A Shear, M Katherine
%A Brent, David
%J J Am Acad Child Adolesc Psychiatry
%D 2007 Apr
%N 4
%P 493-9
%T Phenomenology and correlates of complicated grief in children and adolescents
%V 46
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17420684
%X OBJECTIVE: To describe the phenomenology of complicated grief (CG) in parentally bereaved children and adolescents and to examine its correlates. METHOD: This is a preliminary report from an ongoing 5-year, population-based, longitudinal study of the impact of parental loss on family members. Analyses of cross-sectional data at intake are presented. The sample consists of 129 children and adolescents of parents who died by suicide, accident, or sudden natural death. Their average age is 13.3 ± 3.1 years (range 7-18 years). A modified version of the Inventory of Complicated Grief-Revised (ICG-R) was administered and its factor structure, internal consistency, and convergent and discriminant validity were examined. RESULTS: CG was significantly related to functional impairment even after controlling for current depression, anxiety, and posttraumatic stress disorder. CG was also associated with other measures of psychopathology, including suicidal ideation. CONCLUSIONS: In this preliminary analysis, CG appears to be a clinically significant syndrome in children and adolescents. Longitudinal data will help to clarify the prognostic significance of CG as well as to examine the interrelationship of CG and other psychopathology over time

%0 Journal Article
%C School of Law, Deakin University, Melbourne, Australia
%A Mendelson, D
%J Int J Law Psychiatry
%D 2007 Apr
%T Roman concept of mental capacity to make end-of-life decisions
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17428540
%X When assessing decisional competence of patients, psychiatrists have to balance the patients' right to personal autonomy, their condition and wishes against principles of medical ethics and professional discretion. This article explores the age-old legal and ethical dilemmas posed by refusal of vital medical treatment by patients and their mental capacity to make end-of-life decisions against the background of philosophical, legal and medical approaches to these issues in the time of the Younger Pliny (c62-c113 CE). Classical Roman discourse regarding mental competency and "voluntary death" formed an important theme of the vast corpus of Greco-Roman writings, which was moulded not only by legal permissibility of suicide but also by philosophical (in modern terms, moral or ethical) considerations. Indeed, the legal and ethical issues of evaluating the acceptability of end of life decisions discussed in the Letters are as pertinent today as they were 2000 years ago. We may gain valuable insights about our own methodologies and frames of reference in this area of the law and psychiatry by examining Classical Roman approaches to evaluating acceptability of death-choices as described in Pliny's Letters and the writings of some of his peers

%0 Journal Article
%A Mullick, Anjali
%J Clin Med
%D 2006 Sep-Oct
%N 5
%P 509-10; author reply 510
%T Assisted dying
%V 6
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17083162

%0 Journal Article
%C From Critical Care Medicine and Medical Ethics Committee, Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, AR (ROC); and Section of Critical Care Medicine, Department of Pediatrics, and Center for Medical Ethics and Health Policy, Baylor College of Medicine, Texas Children's Hospital, Houston, TX (MM, LJ)
%A Okhuysen-Cawley, R
%A McPherson, M
%A Jefferson, L
%J Pediatr Crit Care Med
%D 2007 Apr
%T Institutional policies on determination of medically inappropriate interventions: Use in five pediatric patients*
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17417128
%X OBJECTIVE:: To describe recent experience using the Texas Advance Directives Act to facilitate care of terminally ill children managed in the two tertiary pediatric hospitals of the Texas Medical Center, Houston, TX. DESIGN:: Retrospective chart review. SETTING:: Two multidisciplinary pediatric intensive care units in Houston, TX. PATIENTS:: Five terminally ill children whose parents were unable to acquiesce to comfort or palliative care. INTERVENTIONS:: Implementation of the Texas Advanced Directives Act of 1999. RESULTS:: Suspension of interventions thought to be medically inappropriate by the physicians of record in four of the five cases, with transfer of care in one instance. CONCLUSIONS:: Use of institutional policies in accordance with the Texas Advance Directives Act may assist in the care of terminally ill children and their families

%0 Journal Article
%C School of Law, University of Manchester, Oxford Road, M13 9PL, Manchester, UK. suzanne.ost@manchester.ac.uk
%A Ost, Suzanne
%J Liverp Law Rev
%D 2006 Apr
%N 1
%P 5-30
%T Doctors and nurses of death: a case study of eugenically motivated killing under the Nazi 'euthanasia' programme
%V 27
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17340766
%X This article reviews newly declassified US intelligence files and other sources, including relevant trial documents, related to the Nazi killing of mentally and physically sick individuals deemed to be of little further use to society. It both supplements and revises existing work on the so-called 'Euthanasia' programme at the Kaufbeuren psychiatric institution in Bavaria, and highlights a series of gender issues related to the involvement of women nurses including Catholic nuns, in this institute. In addition, this study not only casts new light on the way in which patients were, from admission onwards, redefined as disposable objects but also emphasises contradictions within the defence case of the defendants

%0 Journal Article
%C Department of General Oncologic Surgery, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010, USA
%A Podnos, Yale D
%A Juarez, Gloria
%A Pameijer, Colette
%A Choi, Kyong
%A Ferrell, Betty R
%A Wagman, Lawrence D
%J Ann Surg Oncol
%D 2007 Feb
%N 2
%P 922-8
%T Impact of surgical palliation on quality of life in patients with advanced malignancy: results of the decisions and outcomes in palliative surgery (DOPS) trial
%V 14
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17109081

%0 Journal Article
%C Medicina de Familia. Centro de Salud de Vilanova de Arousa. Pontevedra. Espana. regueiro@cmpont.es
%A Regueiro Martinez, Antonio Angel
%A Perez-Vazquez, Alberto
%A Gomara Villabona, Sonia M
%A Ferreiro Cruz, M Carmen
%J Aten Primaria
%D 2007 Apr
%N 4
%P 185-8
%T [Short zarit interview on burden of care for caregivers in primary care.]
%V 39
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17428422
%X OBJECTIVE: To determine which Short Zarit Interview behaves best for use in establishing caregivers' burden in primary care. DESIGN: Study of validation of diagnostic tests. LOCATION: Vilaboa Health Centre, Pontevedra, Spain. PARTICIPANTS: Main caregivers of elderly dependent patients who live at home. INTERVENTIONS: Katz Index to determine dependence, Zarit Burden of Care Interview and palliative care version of the Short Zarit Interview, Bedard, Bedard screening version, and the Japanese version. MAIN MEASUREMENTS: Zarit Interview in its 22-item version, with subsequent calculation of the sensitivity (S), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV) of the various reduced versions. RESULTS: The Short Zarit Interview used in palliative care cases to determine the family giving up has an S of 100%, Sp 90.5%, PPV 95.45%, and NPV 100% in defining caregivers' burden in primary care. CONCLUSIONS: The scale that behaves best in primary care is the Short Zarit Interview for palliative care

%0 Journal Article
%C Department of Medical Oncology and Hematology, Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada
%A Riechelmann, RP
%A Krzyzanowska, MK
%A O'carroll, A
%A Zimmermann, C
%J Support Care Cancer
%D 2007 Apr
%T Symptom and medication profiles among cancer patients attending a palliative care clinic
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17429699
%X BACKGROUND: Patients with advanced cancer frequently experience distressful symptoms and receive numerous medications. We describe the symptomatology and medication profile of ambulatory cancer patients receiving exclusively supportive care at the Princess Margaret Hospital. MATERIALS AND METHODS: This was a retrospective, cross-sectional study. We reviewed the charts of consecutive adult cancer patients attending palliative care clinics and who were no longer receiving cancer-directed therapy. From the medical records, we collected information about self-reported symptoms [screened for with the numerical Edmonton symptom assessment system (ESAS) scale; range, 0-10, with 10=worst symptom] and medication profiles. Summary statistics were used to describe the results. RESULTS: Two hundred fifty five patients met the inclusion criteria. The most frequent self-reported symptoms of any severity were fatigue (77%), pain (75%), and lack of appetite (66%). These were also the most severe symptoms: fatigue (median ESAS score=7), pain (median ESAS=5), and lack of appetite (median ESAS=5). The median number of medications per patient after consultation in the palliative care service was 6, and the most common classes of drugs prescribed were opioids (67%), laxatives/stool softeners (54%), corticosteroids (41%), and acetaminophen (41%). Palliative care physicians made at least one medication change in 75% of the patients, with the most frequent change being the addition of new medication(s); dexamethasone was the most commonly added individual drug (18% of the patients). CONCLUSION: Among patients with advanced cancer not receiving antineoplastic therapy, the most frequent and severe symptoms were fatigue, pain, and lack of appetite. The medication profile represented drugs that could both alleviate and contribute to these symptoms. Audit of patient symptoms and medication prescription in palliative care may inform clinical practice and help the development of research specific to patient symptoms

%0 Journal Article
%A Robinson, Jackie
%J Nurs N Z
%D 2007 Mar
%N 2
%P 4
%T Palliative care nurses form group
%V 13
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17429884

%0 Journal Article
%C Department of Psychiatry, University of Rochester Medical Center, USA
%A Russ, AJ
%A Shim, JK
%A Kaufman, SR
%J Soc Sci Med
%D 2007 Apr
%T The value of "life at any cost": Talk about stopping kidney dialysis
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17418924
%X With the trend toward an older, sicker dialysis population in the USA, discussions of ethical issues surrounding dialysis have shifted from concerns about access to and availability of the therapy, to growing unease about non-initiation and treatment discontinuation. Recent studies report treatment withdrawal as the leading cause of death among elderly dialysis patients. Yet, the actual activities that move patients toward stopping treatment often remain obscure, even to clinicians and patients themselves. This paper explores that paradox, drawing on anthropological research among patients over age 70, their families, and clinicians in two California renal dialysis units. It concludes that many older patients sacrifice a sense of choice about dialysis in the present to maintain "choice" as both value and possibility for the future. Even so, patients desire more information and communication, provided earlier in their illness, about prognosis, how long they can expect to be on dialysis, and what the impact of the treatment will be on their daily lives. That, with time, there is a transition to be made from dialysis as "treatment" to end of life care could be better explained and managed to alleviate patients' confusion and unneeded isolation

%0 Journal Article
%C Demelza House Children's Hospice, Sittingbourne, Kent, UK
%A Russell, Carol
%A Smart, Susan
%J Paediatr Nurs
%D 2007 Mar
%N 2
%P 24-5
%T Guided imagery and distraction therapy in paediatric hospice care
%V 19
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17425126
%X Available evidence indicates deficits in the pain management of children with analgesic drugs used outside licensed boundaries, in situations where their pharmacokinetics are untested. A case series is used to demonstrate the effectiveness of more holistic techniques such as guided imagery and distraction therapy in reducing the pain experienced by children in the hospice setting. Using these techniques it may be possible to reduce the amount of analgesia or the frequency of administration

%0 Journal Article
%C Bethel University, 3900 Bethel Drive, St Paul, MN 55112, USA. m-schaffer@bethel.edu
%A Schaffer, Marjorie A
%J Nurs Ethics
%D 2007 Mar
%N 2
%P 242-57
%T Ethical problems in end-of-life decisions for elderly Norwegians
%V 14
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17425152
%X Norwegian health professionals, elderly people and family members experience ethical problems involving end-of-life decision making for elders in the context of the values of Norwegian society. This study used ethical inquiry and qualitative methodology to conduct and analyze interviews carried out with 25 health professionals, six elderly people and five family members about the ethical problems they encountered in end-of-life decision making in Norway. All three participant groups experienced ethical problems involving the adequacy of health care for elderly Norwegians. Older people were concerned about being a burden to their families at the end of their life. However, health professionals wished to protect families from the burden of difficult decisions regarding health care for elderly parents at the end of life. Strategies are suggested for dialogue about end-of-life decisions and the integration of palliative care approaches into health care services for frail elderly people

%0 Journal Article
%C Unite d'evaluation et de traitement de la douleur de l'enfant, hopital d'enfants, CHU de Nancy, 29, avenue du Marechal-de-Lattre-de-Tassigny, 54000 Nancy, France
%A Schmitt, C
%J Arch Pediatr
%D 2007 Apr
%T [Palliative care in pediatrics: myth of fact?]
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17419025

%0 Journal Article
%C Patty Sills, BSN, RN, is Clinical Systems Improvement Organ Donation Liaison, Department of Clinical Systems Improvement; Holly A. Bair, MSN, NP, is Trauma Program Manager; Randy J. Janczyk, MD, is Trauma Surgeon/Surgical Intensivist, Division of Trauma Service, Department of Surgery, William Beaumont Hospital, Royal Oak, and Liz Gates, BS, RN, is Hospital Development Associate, Gift of Life of Michigan, Ann Arbor, Mich
%A Sills, P
%A Bair, HA
%A Gates, L
%A Janczyk, RJ
%J J Trauma Nurs
%D 2007 January/March
%N 1
%P 47-50
%T Donation After Cardiac Death: Lessons Learned
%V 14
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17420653
%X ABSTRACT: Despite the increasingly positive outcome of organ transplantation as an accepted treatment of end-stage organ diseases, an average of 15 people die each day awaiting organ transplantation. According to the United Network for Organ Sharing, there are more than 90,000 people in the United States waiting for an organ transplant.In the United States, less than 1% of all deaths are attributed to brain death. A single brain-dead organ donor has the potential to save up to 8 individuals by donating organs and providing up to 50 people with tissue and cornea transplants. The reality is that the source of available brain-dead donors does not meet the needs of the growing waiting list. To help deal with the increasing demand for organs, donation after cardiac death has been reintroduced to families of patients with catastrophic brain injuries. Families have the right to be informed of all potential end-of-life options, including that of organ donation and the use of donation after cardiac death when appropriate. Hospitals and healthcare workers must be committed to provide the option of donation after cardiac death for both donor families and transplant recipients. The purpose of this article is to examine the process of implementing a donation after cardiac death policy in a 1,061-bed tertiary care hospital with level I trauma designation

%0 Journal Article
%A Thorns, A
%J Clin Med
%D 2007 Jan-Feb
%N 1
%P 91
%T A personal view of assisted dying
%V 7
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17348588

%0 Journal Article
%C , Mansfield Ave, Merivale, Christchurch, New Zealand, janevb@cdhb.govt.nz
%A Vella-Brincat, J
%A Macleod, AD
%J J Pain Palliat Care Pharmacother
%D 2007 
%N 1
%P 15-25
%T Adverse Effects of Opioids on the Central Nervous Systems of Palliative Care Patients
%V 21
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17430825
%X Opioids, defined as drugs that stimulate opioid receptors, are primarily used in the treatment of moderate to severe pain. They induce central nervous system (CNS) adverse effects which can be divided into three groups. The first group includes effects that lower the level of consciousness-sedation, drowsiness and sleep disturbance. The second group affects the thinking process and the ability to react-cognitive impairment, psychomotor impairment, delirium, hallucinations, dreams and nightmares. The third group is of the direct toxic effects of opioids on neurons and includes myoclonus (perhaps), hyperalgesia and tolerance. This review addresses the incidence, possible mechanisms, and treatment of each of these groups of opioid-induced adverse effects. doi:10.1300/J354v21n01_05

%0 Journal Article
%C The Advisory Team in Palliative Care, PRIVO, Vimmerby Health Care Centre, Vimmerby, Sweden
%A Wallerstedt, Birgitta
%A Andershed, Birgitta
%J Scand J Caring Sci
%D 2007 Mar
%N 1
%P 32-40
%T Caring for dying patients outside special palliative care settings: experiences from a nursing perspective
%V 21
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17428212
%X The aim of the study was to describe nurses' experiences in caring for gravely ill and dying patients outside special palliative care settings. Tape-recorded qualitative interviews were conducted with a total of nine nurses in primary home care, community care and hospitals. The interviews were analysed according to phenomenological methodology, which resulted in the three common structures: ambition and dedication, everyday encounters, and satisfaction/dissatisfaction. In the 'everyday encounters' structure, the following key constituents emerged: responsibility, cooperation, experience and knowledge, feelings, and time and resources. The results describe the nurses' high ambitions to give dying patients and their relatives high-quality care. Despite this, they experienced greater or lesser degrees of dissatisfaction because of insufficient cooperation, support, time and resources. They experienced satisfaction through contact with patients and relatives, functioning collegial cooperation, and the knowledge, experience and personal growth the care had given them. The results indicate that nurses need the resources such as time, improved methods of communication and cooperation as well as more support in order to give quality palliative care and achieve satisfaction with the outcome. The need for discussion about the conditions for giving palliative care outside the hospices and other special palliative care settings is also elucidated

%0 Journal Article
%C Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK. m.p.ward-platt@ncl.ac.uk
%A Ward Platt, Martin
%J Arch Dis Child Fetal Neonatal Ed
%D 2007 Mar
%N 2
%P F81-2
%T Fear of death and dying
%V 92
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17284474

%0 Journal Article
%C , Oxford, OX3 7LJ, UK, phil.wiffen@pain-relief-unit.oxford.ac.uk
%A Wiffen, PJ
%J J Pain Palliat Care Pharmacother
%D 2007 
%N 1
%P 53-56
%T Evidence-Based Pain Management and Palliative Care in Issue Three for 2006 of <i>The Cochrane Library</i>
%V 21
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17430832
%X <i>The Cochrane Library of Systematic Reviews</i> is published quarterly. It now contains 2785 complete reviews, 1625 protocols of reviews and 5574 one page summaries of systematic reviews published in the general medical literature. In addition there are citations of 477,942 randomized controlled trials, 23 methodology reviews and 8408 cited papers in the Cochrane methodology register. The health technology assessment database contains 6011 citations. This edition of the Library contains 111 new reviews of which 9 have potential relevance for practitioners in pain and palliative medicine. doi:10.1300/J354v21n01_12

%0 Journal Article
%A Witte, Klaus K
%A Parker, John D
%J J Cardiovasc Electrophysiol
%D 2007 Feb
%N 2
%P E12
%T Biventricular pacing in patients with right ventricular pacing-induced heart failure
%V 18
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17212593