%0 Journal Article %C Mildura Base Hospital, Mildura, Victoria, Australia. acacia_avenue@yahoo.com %A Sidhu, Navdeep S %A Dunkley, Margaret E %A Egan, Melinda J %J Med J Aust %D 2007 Jan %N 2 %P 72-5 %T "Not-for-resuscitation" orders in Australian public hospitals: policies, standardised order forms and patient information leaflets %V 186 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17223767 %X OBJECTIVE: To determine the prevalence and content of policies, standardised order forms (SOFs) and patient information leaflets (PILs) pertaining to "not-for-resuscitation" (NFR) orders in Australian public hospitals. DESIGN AND SETTING: Cross-sectional postal survey conducted across Australia from August to December 2005, using a one-page questionnaire. PARTICIPANTS: Directors of Medical, Nursing or Clinical Services of all public hospitals in Australia with 60 or more beds, excluding psychiatric, military and private hospitals. MAIN OUTCOME MEASURES: Prevalence of documented NFR policies, by hospital characteristics, and content of these policies, SOFs and PILs. RESULTS: 222 hospitals were surveyed, and 157 responded (71%). Of these, 85 (54%) had NFR policies, 62 (39%) had SOFs, and four (3%) had PILs. Hospitals with more than 200 beds were more likely to have NFR policies than those with 60-200 beds (P = 0.04). More metropolitan than rural hospitals had NFR policies (P = 0.01). More hospitals with 60-100 beds had SOFs than hospitals with 101-200 beds (P = 0.03). "NFR" was defined in 53% of policies, while 97% of policies explicitly stated where NFR orders were to be documented, 89% stated who was allowed to make them, 37% stated that advanced care directives ("living wills") were to be respected, and 89% stated that competent patients should be involved in discussions regarding their NFR status. The most common items noted in SOFs were the name and signature of the issuing medical practitioner (92%) and documentation of the discussion with the patient (81%). CONCLUSIONS: There was wide variation in the content of hospital policies, SOFs and PILs pertaining to NFR orders. Aspects of current policies show room for improvement %0 Journal Article %A Mitty, Ethel %A Flores, Sandi %J Geriatr Nurs %D 2007 Jan-Feb %N 1 %P 27-30 %T Assisted living nursing practice: admission assessment %V 28 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17292794 %X Admission assessment, generally conducted by a registered nurse, is autonomous, without opportunity for dialogue with colleagues and other health care professionals and bounded by the nurse's knowledge and skills, state regulations, facility practices, and marketing. The fact that some states permit admission and retention of nursing home level-of-care residents and provision of end-of-life care means that the assessment has to be able to predict the resident's likely trajectory of well-being as well as chronic illness exacerbation. The nurse must have a clear perspective on staff competencies and judge whether additional education or training will be necessary. This article reviews assessment standards of practice as put forth by the American Assisted Living Nurses Association as part of its application for recognition of assisted living nursing as specialty nursing practice by the American Nurses Association. The role of the Licensed Practical Nurse/Licensed Vocational Nurse in resident assessment is also discussed %0 Journal Article %C Center for Gerontology and Health Care Research, Brown Medical School, Providence, Rhode Island %A Teno, Joan M %A Gruneir, Andrea %A Schwartz, Zachary %A Nanda, Aman %A Wetle, Terrie %J J Am Geriatr Soc %D 2007 Feb %N 2 %P 189-94 %T Association Between Advance Directives and Quality of End-of-Life Care: A National Study %V 55 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17302654 %X OBJECTIVES: To examine the role of advance directives (ADs) 10 years after the Patient Self-Determination Act. DESIGN: Mortality follow-back survey. SETTING: People who died in a nursing home, hospital, or at home. PARTICIPANTS: Bereaved family member or other knowledgeable informant. MEASUREMENTS: Telephone interviewers that asked about the use of written ADs, use of life-sustaining treatment, and quality of care by asking whether staff provided desired symptom relief, treated the dying with respect, supported shared decision-making, coordinated care, and provided family with the needed information and emotional support. RESULTS: Of the 1,587 people who died, 70.8% had an AD. Persons who died at home with hospice or in a nursing home were more likely to have an AD. In addition, those with an AD were less likely to have a feeding tube (17% vs 27%) or use a respirator in the last month of life (11.8% vs 22.0%). Bereaved family members who reported that the decedent did not have an AD were more likely to report concerns with physician communication (adjusted odds ratio (AOR)=1.4, 95% confidence interval (CI)=1.1-1.6) and with being informed about what to expect (AOR=1.2, 95% CI=1.0-1.3). No statistically significant differences were observed in other outcomes. Even in those with an AD, important quality concerns remained; one in four reported an unmet need in pain, one in two reported inadequate emotional support for the patient, and one in three stated inadequate family emotional support. CONCLUSION: Bereaved family member report of completion of an AD was associated with greater use of hospice and fewer reported concerns with communication, yet important opportunities remain to improve the quality of end-of-life care %0 Journal Article %C 1UCLA Neuropsychiatric Institute, Cousins Center for Psychoneuroimmunology, Los Angeles, CA, USA %A O'connor, MF %A Gundel, H %A McRae, K %A Lane, RD %J Neuropsychopharmacology %D 2007 Feb %T Baseline Vagal Tone Predicts BOLD Response during Elicitation of Grief %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17299507 %X Previous studies of the relationship between autonomic and central nervous system activity using fMRI have primarily utilized cognitive, motor or conditioning tasks. The present study investigated the association between the regional brain activity during the evocation of grief and baseline parasympathetic activity. Eight right-handed women who had experienced the death of a loved one in the past 18 months were scanned during the presentation of personalized pictures and words that evoked grief and had a measure of baseline parasympathetic activity taken. Greater posterior cingulate cortex (PCC) activity was associated with lower parasympathetic activity (eg more arousal). Connectivity has been demonstrated between the ventral PCC (vPCC) and the subgenual ACC (sACC), which then projects to the autonomic nuclei. In the present study, functional connectivity analysis revealed a positive correlation between vPCC and sACC/orbitofrontal cortical activity. Additionally, bilateral cuneus and parahippocampus were associated with higher baseline parasympathetic tone, important to visual perception in emotional processing and episodic memory respectively. Future studies should compare differences between central and peripheral arousal in complicated and non-complicated grief.Neuropsychopharmacology advance online publication, 14 February 2007; doi:10.1038/sj.npp.1301342 %0 Journal Article %C Department of Epidemiology and Public Health, Yale School of Medicine, New Haven, Connecticut %A Cherlin, Emily J %A Barry, Colleen L %A Prigerson, Holly G %A Green, Dena Schulman %A Johnson-Hurzeler, Rosemary %A Kasl, Stanislav V %A Bradley, Elizabeth H %J J Palliat Med %D 2007 Feb %N 1 %P 148-58 %T Bereavement services for family caregivers: how often used, why, and why not %V 10 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17298263 %X Background: Bereavement services are central to high-quality end-of-life care, however, little is known about how frequently and why such bereavement services are used and not used. We examined family caregiver reports about how often they used bereavement services, predictors of their use, and reported reasons for not using bereavement services. Methods: Prospective cohort study of family caregivers (n = 161) of patients with cancer enrolled with hospice between October 1999 and September 2001. We conducted bivariate and multivariable analyses to determine predictors of bereavement service use, adjusted for a broad range of factors including caregiving experiences, major depressive disorder (MDD), relationship with the deceased, and demographic factors. We used content analysis to summarize responses to open-ended questions concerning why individuals did not use bereavement services. Results: We found that approximately 30% of family caregivers used bereavement services in the year postloss, and the majority of these caregivers used services in the first 6 months postloss. Even among bereaved caregivers with MDD, less than half (47.6%) used bereavement services. Factors associated with using bereavement services included being a spouse caregiver, younger age, having MDD at study enrollment, witnessing highly distressing events pertaining to the patient's death, having assisted the patient with more Instrumental Activities of Daily Living (IADLs) prior to the patient's death, having greater availability of instrumental support for oneself, and physician communication with the caregiver about the patient's prognosis before the patient's death. The most common given reason for nonuse was the perception that bereavement services were not needed or would not help. Conclusion: Addressing caregiver receptivity to bereavement services will be an important aspect of increasing appropriate use of such services. Future studies might examine specific interventions for reducing barriers and increasing receptivity to bereavement service use %0 Journal Article %C McMaster University and Hamilton Health Sciences Foundation, Hamilton, Ontario, Canada. odonnm@mcmaster.ca %A O'Donnell, Martin J %A Kearon, Clive %A Johnson, Judy %A Robinson, Marlene %A Zondag, Michelle %A Turpie, Irene %A Turpie, Alexander G %J Ann Intern Med %D 2007 Feb %N 3 %P 184-7 %T Brief communication: Preoperative anticoagulant activity after bridging low-molecular-weight heparin for temporary interruption of warfarin %V 146 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17283349 %X BACKGROUND: Preoperative low-molecular-weight heparin (LMWH) is often used when warfarin therapy is interrupted for surgery. OBJECTIVE: To determine the preoperative anticoagulant activity of LMWH following a standardized "bridging" regimen. DESIGN: Prospective cohort study. SETTING: Single university hospital. PATIENTS: Consecutive patients who had warfarin therapy interrupted before an invasive procedure. INTERVENTION: Enoxaparin, 1 mg/kg of body weight, twice daily. The last dose was administered the evening before surgery. MEASUREMENTS: Blood anti-factor Xa heparin levels measured shortly before surgery. RESULTS: Preoperative anti-Xa heparin levels were obtained in 80 patients at an average of 14 hours after the last dose of enoxaparin was administered. The average anti-Xa heparin level was 0.6 U/mL. The anti-Xa heparin level, measured shortly before surgery, was 0.5 U/mL or greater in 54 (68%) patients and 1.0 U/mL or greater in 13 (16%) patients. A shorter interval since the last dose (P < 0.001) and a higher body mass index (P = 0.001) were associated with higher preoperative anti-Xa heparin levels. LIMITATIONS: The small sample size limits accurate estimates of the frequency of the clinical outcomes. A single regimen of LMWH was evaluated. CONCLUSIONS: Anti-Xa heparin levels often remain high at the time of surgery if a last dose of a twice-daily regimen of LMWH is given the evening before surgery %0 Journal Article %C Department of Colorectal Surgery, Royal Bournemouth Hospital, Bournemouth, UK %A Jones, O M %A John, S K P %A Horseman, N %A Lawrance, R J %A Fozard, J B J %J Colorectal Dis %D 2007 Mar %N 3 %P 253-7 %T Cause and place of death in patients dying with colorectal cancer %V 9 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17298624 %X Objective Few studies on colorectal cancer look at the one-third of patients for whom treatment fails and who need a management strategy for death. This paper has examined the mode and place of death in patients with colorectal cancer. Method This study was a review of 209 deaths, analysed between January 2001 and September 2004 by retrospective review of a prospectively collected database. Results A total of 118 patients (group 1) had undergone resection of their primary colorectal cancer, 20 (group 2) had had a defunctioning stoma or bypass surgery and the remaining 71 patients (group 3) had either had no surgery, an open and close laparotomy or had a colonic stent. One hundred and fifty-six (75%) patients died of colorectal cancer with the remainder dying of other causes. The number of admissions to hospital and the number of days spent in hospital from diagnosis to death were greatest in group 1. Overall, only 34 patients (22%) dying from colorectal cancer died at home. Forty (26%) died in hospital and 70 (45%) died in a palliative care unit. Conclusions Patients dying from colorectal cancer who undergo surgical resection of their primary tumour spend more time between diagnosis and death in hospital. They are also more likely to die in hospital than patients treated by surgical palliation or nonsurgically. Patients who are treated palliatively from the outset (group 3) are most likely to die at home. If hospital is accepted as an appropriate place for death from colorectal cancer, then greater provision for this should be made %0 Journal Article %C Programa em Saude e Comportamento, Psicologia Medica, Pontificia Universidade Catolica de Pelotas, Pelotas, RS, Brazil. lpcasa@brturbo.com %A Casaretto, L %A Sousa, P L R %A Mari, J J %J Braz J Med Biol Res %D 2006 Apr %N 4 %P 431-40 %T Chemotherapy versus support cancer treatment in advanced gastric cancer: a meta-analysis %V 39 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=16612465 %X The aim of the present study was to compare the efficacy of chemotherapy and support treatment in patients with advanced non-resectable gastric cancer in a systematic review and meta-analysis of randomized clinical trials that included a comparison of chemotherapy and support care treatment in patients diagnosed with gastric adenocarcinoma, regardless of their age, gender or place of treatment. The search strategy was based on the criteria of the Cochrane Base, using the following key words: 1) randomized clinical trials and antineoplastic combined therapy or gastrointestinal neoplasm, 2) stomach neoplasm and drug therapy, 3) clinical trial and multi-modality therapy, 4) stomach neoplasm and drug therapy or quality of life, 5) double-blind method or clinical trial. The search was carried out using the Cochrane, Medline and Lilacs databases. Five studies fulfilled the inclusion criteria, for a total of 390 participants, 208 (53%) receiving chemotherapy, 182 (47%) receiving support care treatment and 6 losses (1.6%). The 1-year survival rate was 8% for support care and 20% for chemotherapy (RR = 2.14, 95% CI = 1.00-4.57, P = 0.05); 30% of the patients in the chemotherapy group and 12% in the support care group attained a 6-month symptom-free period (RR = 2.33, 95% CI = 1.41-3.87, P < 0.01). Quality of life evaluated after 4 months was significantly better for the chemotherapy patients (34%; RR = 2.07, 95% CI = 1.31-3.28, P < 0.01) with tumor mass reduction (RR = 3.32, 95% CI = 0.77-14.24, P = 0.1). Chemotherapy increased the 1-year survival rate of the patients and provided a longer symptom-free period of 6 months and an improvement in quality of life %0 Journal Article %J Colo Nurse %D 2006 Dec %N 4 %P 17 %T Color-coded wristband standardization in Colorado %V 106 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17193888 %0 Journal Article %C Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Brightleaf Square Suite 23-A, 905 West Main Street, DUMC Box 3071, Durham, NC, 27710,, USA, eric.elbogen@duke.edu %A Elbogen, EB %A Swanson, JW %A Appelbaum, PS %A Swartz, MS %A Ferron, J %A Van, Dorn RA %A Wagner, HR %J Law Hum Behav %D 2007 Feb %T Competence to Complete Psychiatric Advance Directives: Effects of Facilitated Decision Making %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17294136 %X Psychiatric advance directives (PADs) statutes presume competence to complete these documents, but the range and dimensions of decisional competence among people who actually complete PADs is unknown. This study examines clinical and neuropsychological correlates of performance on a measure to assess competence to complete PADs and investigates the effects of a facilitated PAD intervention on decisional capacity. N=469 adults with psychotic disorders were interviewed at baseline and then randomly assigned to either a control group in which they received written materials about PADs or to an intervention group in which they were offered an opportunity to meet individually with a trained facilitator to create a PAD. At baseline, domains on the Decisional Competence Assessment Tool for PADs (DCAT-PAD) were most strongly associated with IQ, verbal memory, abstract thinking, and psychiatric symptoms. At one-month follow-up, participants in the intervention group showed more improvement on the DCAT-PAD than controls, particularly among participants with pre-morbid IQ estimates below the median of 100. The results suggest that PAD facilitation is an effective method to boost competence of cognitively-impaired clients to write PADs and make treatment decisions within PADs, thereby maximizing the chances their advance directives will be valid %0 Journal Article %C School of Nursing, Queensland University of Technology, Queensland. p.yates@qut.edu.au %A Yates, Patsy %A Evans, Alison %A Moore, Andy %A Heartfield, Marie %A Gibson, Terri %A Luxford, Karen %J Collegian %D 2007 Jan %N 1 %P 11-5 %T Competency standards and educational requirements for specialist breast nurses in Australia %V 14 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17294681 %X There is substantial evidence that Specialist Breast Nurses (SBNs) make an important contribution to improved outcomes for women with breast cancer, by providing information and support and promoting continuity of care. However, a recent study has identified significant variation in how the role functions across individual nurses and settings, which is likely to contribute to varied outcomes for women with breast cancer. The project reported in this paper illustrates how a set of competency standards for SBNs were developed by the National Breast Cancer Centre. The competency standards were developed through a review of published literature and consultation with key stakeholders. The resulting SBN Competency Standards reflect the core domains and elements of SBN practice seen as integral to achieving optimal outcomes for women with breast cancer. This project identifies the SBN as a registered nurse who applies advanced knowledge of the health needs, preferences and circumstances of women with breast cancer to optimise the individual's health and well-being at various phases across the continuum of care, including diagnosis, treatment, rehabilitation, follow-up and palliative care. The five core domains of practice identified are: Supportive care; Collaborative care; Coordinated care; Information provision and education; and Clinical leadership. A variety of education programs are currently available for nurses who wish to learn about breast cancer nursing. The majority of stakeholders consulted in this project agreed that a Graduate Diploma level of education is required at minimum in order for an SBN to develop the minimum level of competence required to perform the role. The evidence supports the view that as an advanced role, nurses practising as SBNs require high-quality programs of sufficient depth and scope to achieve the required level of competence %0 Journal Article %C Diane E. Meier, M.D., FACP, is director of the Center to Advance Palliative Care at Mount Sinai School of Medicine, director of The Lilian and Benjamin Hertzberg Palliative Care Institute, Professor of Geriatrics and Internal Medicine at Mount Sinai School of Medicine, and Catherine Gaisman Professor of Medical Ethics at Mount Sinai School of Medicine in New York City %A Meier, DE %A Beresford, L %J J Palliat Med %D 2007 Feb %N 1 %P 7-11 %T Consultation Etiquette Challenges Palliative Care To Be on its Best Behavior %V 10 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17298244 %0 Journal Article %C School of Social Work, University of Wisconsin-Madison, Madison, Wisconsin %A Schroepfer, Tracy A %J J Palliat Med %D 2007 Feb %N 1 %P 136-47 %T Critical events in the dying process: the potential for physical and psychosocial suffering %V 10 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17298262 %X Background: Understanding what aspects of the dying process motivate terminally ill individuals to consider hastening their death, can lead to improving end-of-life care. Objective: Advance knowledge regarding critical events within the dying process that have the potential to give rise to physical and psychosocial suffering such that an elder wishes for or considers a hastened death. Design and methods: Face-to-face in-depth qualitative interviews conducted with 96 terminally ill elders, 15 of whom discussed an event in their dying process that resulted in suffering so great they wished for, or considered, a hastened death. Data were content analyzed to identify and categorize the main themes and patterns involved in these elders' experiences. Setting: The interviews were conducted on palliative care hospital units, and in outpatient clinics, free standing hospice facilities, and home hospice. Results: Four critical events emerged: perceived insensitive and uncaring communication of a terminal diagnosis; experiencing unbearable physical pain; unacknowledged feelings regarding undergoing chemotherapy or radiation treatment; and dying in a distressing environment. Respondents discussed physical and/or psychosocial suffering that occurred at these events, and the end-of-life care practices that reduced their suffering. Conclusion: Awareness of events common to the dying process, the potential physical and psychosocial suffering that may arise at these events, and the end-of-life care practices associated with reducing that suffering can lead to health care professionals being able to take a proactive rather than reactive approach to end-of-life care %0 Journal Article %C Academic Medical Center, University of Amsterdam %A Gevers, Sjef %J Eur J Health Law %D 2006 Sep %N 3 %P 209-17 %T Dementia and the law %V 13 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17190348 %X The care for patients with dementia raises many legal (and ethical) issues. This article explores some of the more important topics, i.e. (early) diagnosis of the disease, the availability and provision of care, treatment and non treatment decisions, and medical research with dementia patients %0 Journal Article %C Hannover Medical School %A Schneider, Nils %A Buser, Kurt %A Amelung, Volker E %J Eval Health Prof %D 2007 Mar %N 1 %P 96-109 %T Discrepancies in the viewpoints of different german health care providers on palliative care %V 30 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17293611 %X In many countries with highly developed health care systems, significant improvements in end-of-life care are strongly recommended. Up to the present, the assessment of perceived deficits predominantly reflects the point of view of experts in the palliative and hospice movement, with very little being known about the perspective of other professionals. The aim of this study was to assess the points of view of a wide range of different health care providers who treated or interacted with palliative care patients. The authors subsequently performed 597 semistructured telephone interviews with a wide range of German health care professionals. Overall, the assessment of the current situation was better than expected, although statistically significant differences existed among the groups surveyed. However, there is an unquestionable need for improvement, although opinions regarding the extent of these deficits depend significantly on the individual respondents' roles and professional orientation %0 Journal Article %A Menten, Johan %A de Lepeleire, Jan %J Eur J Gen Pract %D 2006 %N 3 %P 133-4 %T Emergency hospital admission for pain in palliative patients: a crucial role for general practitioners %V 12 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17002962 %0 Journal Article %C Health Policy Center, The Urban Institute, Washington, DC 20037, USA. kliu@ui.urban.org %A Liu, Korbin %A Wiener, Joshua M %A Niefeld, Marlene R %J Health Care Financ Rev %D 2006 Summer %N 4 %P 95-110 %T End of life Medicare and Medicaid expenditures for dually eligible beneficiaries %V 27 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17290660 %X In 1995, combined Medicare and Medicaid spending in the last year of life for dually eligible beneficiaries was more than $40,000 per beneficiary. Medicaid's share, primarily for long-term care (LTC), constituted about 40 percent of the total. Beneficiaries under age 65, Black persons, and individuals who died in a hospital had higher than average expenditures. The vast majority (86 percent) received some form of supportive services (nursing home, home care, hospice services). It is critical that policy deliberations consider both acute and LTC use concurrently because of their extensive use by dually eligible beneficiaries, as well as the interaction of the two funding sources (Medicare and Medicaid) that cover them %0 Journal Article %C School of Social Work, University of Missouri, Columbia, Missouri %A Bickel-Swenson, Denise %J J Palliat Med %D 2007 Feb %N 1 %P 229-35 %T End-of-Life Training in U.S. Medical Schools: A Systematic Literature Review %V 10 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17298271 %X Physicians are educated and trained to cure illness and save lives. The traditional educational model in U.S. medical schools allows for generalist training as well as specialization in specific areas of practice such as pediatrics, geriatrics, or oncology. As the population continues to age, and chronic illnesses challenge cancer diagnoses as the predominant precursor to palliative care, medical students must be educated and trained in the specialties of palliative medicine and end-of-life care. The purpose of this study was to review systematically the empirical evidence related to the ways in which end-of-life care is included in U.S. medical school training %0 Journal Article %C Institut Universitaire de Medecine Legale, 9 avenue de Champel, 1211 Geneve 4, Switzerland. sandra.burkhardt@hcuge.ch %A Burkhardt, S %A La Harpe, R %A Harding, T W %A Sobel, J %J Med Sci Law %D 2006 Oct %N 4 %P 287-94 %T Euthanasia and assisted suicide: comparison of legal aspects in Switzerland and other countries %V 46 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17191631 %X The purpose of this paper is to present the legal aspects associated with assisted suicide in Switzerland and compare them with those in other countries. Like euthanasia, assisted suicide is a subject that induces much discussion in many countries. While the law is very liberal in some countries, such as Belgium and the Netherlands (where both euthanasia and assisted suicide take place), these practices are very controversial in other countries, such as France, where they remain taboo subjects. In the United States of America, the laws concerning assisted suicide can differ greatly from one state to another. For example, in Oregon, assisted suicide is allowed if applied by a medical doctor; in others, this act is illegal. In Canada, it is punishable according to the Criminal Code. In Switzerland euthanasia is punishable by law. However, the penal code does not condemn assisted suicide, whether carried out by a medical doctor or another person, provided it is not carried out through selfish motives. The application of these practices has become simplified in recent years and societies for the right to die with dignity based on this principle have come into being (Exit and Dignitas). In the French- and German-speaking parts of Switzerland the association Exit assists individuals living in Switzerland with serious progressive and incurable disease in their engagement to end their life. The association Dignitas, in the German-speaking part of Switzerland, also undertakes--in the same circumstances--to assist individuals coming from foreign countries. Dignitas welcomes several such individuals every year, especially from Germany, where a similar approach does not currently exist %0 Journal Article %C Geriatrics Research, Education, and Clinical Center, VA Medical Center, Bronx, New York., Hertzberg Palliative Care Institute of the Brookdale Department of Geriatrics and Adult Development, The Mount Sinai School of Medicine, New York, New York %A Carlson, Melissa D A %A Morrison, R Sean %J J Palliat Med %D 2007 Feb %N 1 %P 17-8 %T Evaluating palliative care programs: let's do it right %V 10 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17298246 %0 Journal Article %C Center for Biomedical Ethics and Law, Graduate School of Medicine, University of Tokyo, Tokyo, Japan. tmizuno-tky@umin.ac.jp %A Mizuno, Toshinari %A Slingsby, Brian Taylor %J South Med J %D 2007 Jan %N 1 %P 115-7 %T Eye on religion: considering the influence of Buddhist and Shinto thought on contemporary Japanese bioethics %V 100 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17269549 %X Religious traditions can play a significant role in the shaping of bioethical thought. In Japan, traditional Buddhist and Shinto thought continue to influence contemporary bioethical perspectives. To better define this relationship, this paper examines the correlation between Japanese bioethical perspectives and Buddhist and Shinto thought. An in-depth discussion explores how Buddhist and Shinto scholars have used fundamental concepts with each religious tradition to agree and disagree with the disclosure of an incurable disease to a patient, brain death, and brain-dead organ transplantation %0 Journal Article %C Department of General Internal Medicine University of Pittsburgh 920E MUH 200 Lothrop Street Pittsburgh. PA 15213 E-mail: fischerg@upmc.edu %A Fischer, Gary S %A Arnold, Robert M %J J Palliat Med %D 2007 Feb %N 1 %P 19-23 %T Feasibility of a brief workshop on palliative care communication skills for medical interns %V 10 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17298247 %X Objective: This report describes a novel 3-hour workshop on delivering bad news and discussing end-of-life goals of care for internal medicine interns, and its effect on the interns' attitudes, knowledge, and confidence in discussing these topics with patients. Intervention: Interns participated in a 3-hour workshop involving role-playing, focused on teaching core knowledge, skills, and attitudes associated with delivering bad news and discussing goals of care at the end of life. Measurements: One to 3 weeks before and after the workshop, participants completed a written questionnaire that included 54 knowledge questions, 6 questions eliciting their perceived level of confidence, and 11 questions about attitudes toward delivering bad news or discussing goals of care. Immediately after the workshop, interns answered questions rating their satisfaction with the workshop. Results: Of 43 interns who took the pretest, 29 completed the posttest. There was a high degree of satisfaction with the workshop. Mean knowledge scores increased by 4 points (from 41.4 to 45.4, p < 0.001). The percentage of interns who expressed confidence increased. There was no change in interns' attitudes %0 Journal Article %C Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT 84132, USA. bsilver@hsc.utah.edu %A Silver, Robert M %J Obstet Gynecol %D 2007 Jan %N 1 %P 153-67 %T Fetal death %V 109 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17197601 %X The death of a formed fetus is one of the most emotionally devastating events for parents and clinicians. With improved care for conditions such as RhD alloimmunization, diabetes, and preeclampsia, the rate of fetal death in the United States decreased substantially in the mid twentieth century. However, the past several decades have seen much greater reductions in neonatal death rates than in fetal death rates. As such, fetal death remains a significant and understudied problem that now accounts for almost 50% of all perinatal deaths. The availability of prostaglandins has greatly facilitated delivery options for patients with fetal death. Risk factors for fetal death include African American race, advanced maternal age, obesity, smoking, prior fetal death, maternal diseases, and fetal growth impairment. There are numerous causes of fetal death, including genetic conditions, infections, placental abnormalities, and fetal-maternal hemorrhage. Many cases of fetal death do not undergo adequate evaluation for possible causes. Perinatal autopsy and placental examination are perhaps the most valuable tests for the evaluation of fetal death. Antenatal surveillance and emotional support are the mainstays of subsequent pregnancy management. Outcomes may be improved in women with diabetes, hypertension, red cell alloimmunization, and antiphospholipid syndrome. However, there is considerable room for further reduction in the fetal death rate %0 Journal Article %C Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada. piper@interchange.ubc.ca %A Piper, William E %A Ogrodniczuk, John S %A Joyce, Anthony S %A Weideman, Rene %A Rosie, John S %J J Consult Clin Psychol %D 2007 Feb %N 1 %P 116-25 %T Group composition and group therapy for complicated grief %V 75 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17295570 %X This prospective study investigated the impact of group composition on the outcome of 2 forms of time-limited, short-term group therapy (interpretive, supportive) with 110 outpatients from 18 therapy groups, who presented with complicated grief. The composition variable was based on the patient's level of quality of object relations. The higher the percentage of patients in a therapy group who had a history of relatively mature relationships, the better the outcome for all patients in the group, regardless of the form of therapy or the individual patient's quality of object relations score. The findings have direct clinical implications for composing short-term therapy groups for outpatients with complicated grief and possibly for other types of group therapies and patient problems. ((c) 2007 APA, all rights reserved) %0 Journal Article %J Health Serv J %D 2006 Dec %N 6035 %P suppl 42-3 %T HSJ Awards. Patient-centred care. Winner: Croydon PCT %V 116 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17228633 %0 Journal Article %C The Johns Hopkins Medical Institutions Baltimore, MD 21287, USA. bblack@jhmi.edu %A Black, Betty S %A Finucane, Thomas %A Baker, Alva %A Loreck, David %A Blass, David %A Fogarty, Linda %A Phillips, Hilary %A Hovanec, Linda %A Steele, Cynthia %A Rabins, Peter V %J Alzheimer Dis Assoc Disord %D 2006 Oct-Dec %N 4 %P 283-90 %T Health problems and correlates of pain in nursing home residents with advanced dementia %V 20 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17132974 %X This study describes the health problems and comorbid illnesses of nursing home (NH) residents with advanced dementia (n=123) and identifies correlates of staff-identified pain. Study participants were residents of 3 NHs in Maryland, their surrogate decision makers and their physicians. Residents' cognitive function was assessed at study enrollment, and their medical records were reviewed to identify all health problems/illnesses and use of pain medications during the 6 months before their enrollment. The most prevalent health problems were skin problems (95%), nutrition/hydration problems (85%), psychiatric/behavioral problems (85%), gastrointestinal problems (81%), and infections (80%). Sixty-three percent of residents had recognized pain, and 95% of those residents received pain medications. In a multivariate regression analysis, staff-identified pain was associated with aspiration (P=0.008), peripheral vascular disease (P=0.021), musculoskeletal disorders (P=0.032), higher cognitive function (P=0.013), and use of pain medications, including non-opiates (P=0.004) and the combination of opiates and non-opiates (P=0.001). NH residents with advanced dementia experience a complex mixture of multiple chronic and acute comorbidities. These results suggest the need for clinicians in long-term care facilities to be vigilant in assessing and treating pain, particularly as cognitive function declines in those with advanced dementia %0 Journal Article %C Department of Palliative Medicine, Universidad Libre, Seccional Cali, Cali, Colombia %A Rodriguez, Rene Fernando %A Bravo, Luis Eduardo %A Castro, Fernando %A Montoya, Olga %A Castillo, Javier Mauricio %A Castillo, Maria Pilar %A Daza, Paola %A Restrepo, Jose Manuel %A Rodriguez, Mario Fernando %J J Palliat Med %D 2007 Feb %N 1 %P 56-60 %T Incidence of weak opioids adverse events in the management of cancer pain: a double-blind comparative trial %V 10 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17298254 %X With the objective of comparing incidence of adverse events of the opioids codeine, hydrocodone, and tramadol in the relief of cancer pain, we conducted a randomized controlled trial in which patients with cancer were randomly assigned according to a computer-generated schedule to receive one of the three opioids. Of the 177 patients who participated, 62 patients received hydrocodone, 59 patients received codeine, and 56 patients received tramadol. The pain experienced by the participants originated most frequently from the stomach, breast, or prostate gland and was classified as either somatic (33%), visceral (52%), mixed (6%), or neuropathic (9%). At the first visit, 60% of the patients described their pain intensity as moderate (4-6/10), with the remaining 40% of the patients describing their pain as severe (7-10/10). The symptoms most associated with pain were weakness, insomnia. and anorexia. In 77% of the total number of cases, the patient was aware of his/her diagnosis prior to admittance to the palliative care unit. Of the total number of cases, 57% fell in the age range of 60-89 years old and 50% of the participants were female. No significant statistical difference in the analgesic efficacy of the three opioids was found (p: 0.69; chi(2): 0.73). Use of tramadol produced higher rates of adverse events than codeine and hydrocodone: vomiting, dizziness, loss of appetite, and weakness (p < 0.05) %0 Journal Article %C Dorothy P. & Richard P. Simmons Center for Interstitial Lung Disease, Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America %A Lindell, Kathleen Oare %A Erlen, Judith A %A Kaminski, Naftali %J PLoS Med %D 2006 Jul %N 7 %P e234 %T Lessons from our patients: development of a warm autopsy program %V 3 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=16724871 %0 Journal Article %C Stanford University School of Medicine, Stanford, California., VA Palo Alto Health Care System, Palo Alto, California %A Periyakoil, Vyjeyanthi S %A Von Gunten, Charles F %J J Palliat Med %D 2007 Feb %N 1 %P 40-2 %T Mainstreaming palliative care %V 10 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17298251 %0 Journal Article %C Specialists in Cancer Care, Saint Luke's Cancer Institute, Kansas City, Missouri %A Salacz, Michael E %A Lankiewicz, Michael W %A Weissman, David E %J J Palliat Med %D 2007 Feb %N 1 %P 236-44 %T Management of thrombocytopenia in bone marrow failure: a review %V 10 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17298272 %X The clinical course of many neoplastic and primary bone marrow diseases will result in cytopenias secondary to bone marrow failure or infiltration. Acute and chronic leukemias, the myelodysplastic syndromes (MDS), aplastic anemia, breast and prostate cancer, as well as other hematologic and solid tumors, all may lead to chronic, severe cytopenias. Management of anemia and neutropenia are well described in the medical literature. Less well detailed are management approaches for patients with chronic thrombocytopenia, with or without active bleeding. Severe thrombocytopenia presents many difficult management choices for caregivers, patients and their families, especially near the end of life. The use of platelet transfusions in this patient population presents complex issues; platelets are logistically more difficult to transfuse than red cells and carry risks including acute febrile episodes, alloimmunization, and infection. In this review, we discuss the association of chronic thrombocytopenia to serious bleeding and the role of various prophylactic and therapeutic interventions available to palliative care and hospice providers. Specifically, this review examines the following issues: What is the morbidity and mortality from chronic thrombocytopenia in the setting of cancer or other bone marrow failure states? Is there a role for prophylactic platelet transfusions in the palliative care setting, and if so, with what frequency of monitoring, and at what transfusion threshold? What is the impact of alloimmunization and how can it be minimized? What treatments are available besides, or in addition to, platelet transfusions for acute bleeding episodes? %0 Journal Article %C Department of Neurology, Henry Ford Hospital, Detroit, Michigan %A Schuh, Lori A %A Biondo, Andrew %A An, Andrea %A Newman, Dan %A Ryczko, Stephanie %A Remer, Sandra %A Bricker, Leslie %J J Palliat Med %D 2007 Feb %N 1 %P 178-81 %T Neurology Resident Learning in an End-of-Life/Palliative Care Course %V 10 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17298266 %X Objectives: The Accreditation Council for Graduate Medical Education (ACGME) requires neurology residents receive instruction in End-of-Life Care/Palliative Care (EOLPC), but survey data from 24 neurology programs in the National Residency End-of-Life Physician Education Project (NRELEP) demonstrated faculty and residents tend to rate themselves as able to perform EOLPC despite significant knowledge gaps. We participated in the NRELEP to develop an EOLPC course and assess resident learning following this new curriculum. Methods: Fifteen residents and 8 nonparticipant faculty completed a content validated knowledge pretest and precourse EOLPC confidence self-assessment tool. The course plan developed during a NRELEP conference consisted of 14 weekly 1-hour sessions covering a variety of topics pertinent to EOLPC care in neurology. Sessions included lectures, role-play, and group problem-solving formats. Residents attended sessions while faculty did not. The postcourse assessment included a posttest and the EOLPC self-assessment, and was completed by 14 residents and 5 comparison faculty. Results: The mean pretest score was 48.1% ± 16.9% for residents and 59.0% ±8.2% for faculty. Posttest scores improved to 67.2% ± 10.6% for residents (t test, p ± 0.001), but not for the faculty group (52.4% ± 9.9%, p = 0.2). Resident EOLPC confidence self-assessment significantly improved after the course (precourse mean, 3.09 ± 1.01; postcourse mean, 3.40 ± 0.93, p < 0.001), while there was no change in faculty confidence (precourse mean, 3.48 ± 0.82; postcourse mean, 3.41 ± 0.82, p = 0.5). Residents performed significantly better than faculty on the posttest (p = 0.01). Conclusions: An EOLPC course was developed and implemented in this program. Residents exhibited demonstrable learning and improved self-assessment of confidence in providing EOLPC following introduction of the course %0 Journal Article %A Natelson, Stephen E %J J Neurosurg Spine %D 2007 Jan %N 1 %P 97; author reply 97-8 %T Nonoperative treatment %V 6 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17233303 %X OBJECT: Despite extensive published research on thoracolumbar burst fractures, controversy still surrounds which is the most appropriate treatment. The objective of this study was to evaluate the scientific literature on operative and nonoperative treatment of patients with thoracolumbar burst fractures and no neurological deficit. METHODS: In their search of the literature, the authors identified all possible relevant studies concerning thoracolumbar burst fracture without neurological deficit. Two independent observers performed study selection, methodological quality assessment, and data extraction in a blinded and objective manner for all papers identified during the search. In a synthesis of the literature, the authors obtained evidence for both operative and nonoperative treatments. CONCLUSIONS: There is a lack of evidence demonstrating the superiority of one approach over the other as measured using generic and disease-specific health-related quality of life scales. There is no scientific evidence linking posttraumatic kyphosis to clinical outcomes. The authors found that there is a strong need for improved clinical research methodology to be applied to this patient population %0 Journal Article %C End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium %A De Gendt, Cindy %A Bilsen, Johan %A Vander Stichele, Robert %A Van Den Noortgate, Nele %A Lambert, Margareta %A Deliens, Luc %J J Adv Nurs %D 2007 Feb %N 4 %P 404-9 %T Nurses' involvement in 'do not resuscitate' decisions on acute elder care wards %V 57 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17291204 %X Aim. This paper reports the involvement of nurses in 'do not resuscitate' decision-making on acute elder care wards and their adherence to such decisions in the case of an actual cardiopulmonary arrest. Background. Previous literature showed that nurses are involved in half or less than half of 'do not resuscitate' decisions in hospitals, but their involvement in this decision-making on acute elder care wards in particular has not been investigated. Method. A questionnaire was sent in 2002 to the head nurses of all acute elder care wards in Flanders, Belgium (n = 94). They were asked whether nurses had been involved in the last 'do not resuscitate' decision-making process on their ward and whether nurses 'never', 'rarely', 'sometimes', 'often' or 'always' started resuscitation in case of cardiopulmonary arrest of patients with 'do not resuscitate' status and of those without. Results. The response rate was 86.2% (n = 81). In 74.7% of the last 'do not resuscitate' decisions on acute elder care wards in Flanders, a nurse was involved in the decision-making process. For patients with 'do not resuscitate' status, 54.3% of respondents reported that cardiopulmonary resuscitation was 'never' started on their ward, 'rarely' on 39.5% and 'sometimes' on 6.2%. For patients without 'do not resuscitate' status, nurses started cardiopulmonary resuscitation 'rarely' or 'sometimes' on 22.2% of all wards, and 'often' or 'always' on 77.8%. Conclusion. To make appropriate 'do not resuscitate' decisions and to avoid rash decision-making in cases of actual cardiopulmonary arrest, nurses should be involved early in 'do not resuscitate' decision-making. If institutional 'do not resuscitate' guidelines were to stress more clearly the important role of nurses in all kinds of end-of-life decisions, this might improve the 'do not resuscitate' decision-making process %0 Journal Article %C Sutter VNA and Hospice, Emeryville, California %A Stuart, Brad %J J Palliat Med %D 2007 Feb %N 1 %P 210-28 %T Palliative care and hospice in advanced heart failure %V 10 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17298270 %X This paper provides an evidence-based review of the principles underlying palliative care for heart failure (HF), including its pathogenesis, staging, assessment, prognosis, and treatment. Approaches to advanced care planning, symptom management, hospice eligibility, home inotropic infusions, device management and improving the continuum of care in HF are discussed. The reader will be able to recognize advanced HF, use important elements of physical assessment, utilize Web-based prognostic and risk-stratification models, facilitate advance care planning, ensure optimal treatment, manage common symptoms and comorbid conditions, determine hospice eligibility, and consider issues related to withholding or withdrawal of inotropic infusions and devices used in HF refractory to standard treatment. The ultimate goal of palliative care for heart failure is to integrate knowledge of treatment advances and comfort measures and to provide them concurrently in a seamless continuum to patients with late-stage disease %0 Journal Article %C Midwest Palliative & Hospice CareCenter, Glenview, Illinois %A Twaddle, Martha L %A Maxwell, Terri L %A Cassel, J Brian %A Liao, Solomon %A Coyne, Patrick J %A Usher, Barbara M %A Amin, Alpesh %A Cuny, Joanne %J J Palliat Med %D 2007 Feb %N 1 %P 86-98 %T Palliative care benchmarks from academic medical centers %V 10 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17298257 %X Introduction: Palliative care is growing in the United States but little is known about the quality of care delivered. Objective: To benchmark the quality of palliative care in academic hospitals. Design: Multicenter, cross-sectional, retrospective chart review conducted between October 1, 2002 and September 30, 2003. Setting: Thirty-five University HealthSystem Consortium (UHC) academic hospitals across the United States. Participants: A total of 1596 patient records. Inclusion criteria: (1) adults, (2) high-mortality diagnoses: selected cancers, heart failure, human immunodeficiency virus (HIV), and respiratory conditions requiring ventilator support, (3) length of stay (LOS) more than 4 days, and (4) two prior admissions in the preceding 12 months. Main outcome measures: Compliance with 11 key performance measures (KPM) derived from practice standards, literature evidence, and input from a multidisciplinary expert committee. Analyses examined relationships between provision of the KPM and specific outcomes. Results: Wide variability exists among academic hospitals in the provision of the KPM (0%-100%). The greater the compliance with KPM, the greater the improvement in quality outcomes, cost and LOS. Assessment of pain (96.1%) and dyspnea (90.2%) was high, but reduction of these symptoms was lower (73.3% and 77.2%). Documentation of prognosis (33.4%), psychosocial assessment (26.2%), communication with family/patient (46%), and timely planning for discharge disposition (53.4%) were low for this severely ill population (16.8% hospital mortality). Only 12.9% received a palliative care consultation. Conclusions: The study reveals significant opportunities for improvement in the effective delivery of palliative care. Care that met KPM was associated with improved quality, reduced costs and LOS. Institutions that benchmarked above 90% did so by integrating KPM into daily care processes and utilizing systematized triggers, forms and default pathways. The presence of a formalized palliative care program within a hospital system had a positive effect on the achievement of KPM, whether or not formal consultation occurred. Hospitals need to develop systematic methods to improve access to palliative care %0 Journal Article %C Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia %A Lyckholm, Laurie J %A Coyne, Patrick J %A Smith, Thomas J %J J Palliat Med %D 2007 Feb %N 1 %P 118-26 %T Palliative care consultation in the process of organ donation after cardiac death* %V 10 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17298260 %X Palliative care consultation has been demonstrated to be useful in many situations in which expert symptom management, communication around sensitive issues, and family support may serve to enhance or improve care. The process of organ donation is an example of this concept, specifically the process of donation after cardiac death (DCD). DCD allows patients with severe, irreversible brain injuries that do not meet standard criteria for brain death to donate organs when death is declared by cardiopulmonary criteria. The DCD method of donation has been deemed an ethically appropriate means of organ donation and is supported by the organ procurement and medical communities, as well as the public. The palliative care (PC) team can make a significant contribution to the care of the patient and family in the organ donation process. In this paper we describe the controlled DCD process at one institution that utilizes the PC team to provide expert end-of-life care, including comprehensive medical management and family support. PC skills and principles applicable to the DCD process include communication, coordination of care, and skillful ventilator withdrawal. If death occurs within 90 minutes of withdrawal of life support, organs may be successfully recovered for transplantation. If the patient survives longer than 90 minutes, his or her care continues to be provided by the PC team. Palliative care can contribute to standardizing quality endof- life care practices in the DCD process and provide education for involved personnel. Further experience, research and national discussions will be helpful in refining these practices, to make this difficult and challenging experience as gentle and supportive as possible for the courageous families who participate in this process %0 Journal Article %C Inspire Team, Lincolnshire PCT - Provider Services, Boston West Business Park, Sleaford Road, Boston, Lincolnshire, PE21 8EG %A O'kelly, Noel %A Smith, Jude %J Prim Care Respir J %D 2007 Feb %N 1 %P 57-8 %T Palliative care for patients with end-stage COPD %V 16 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17297528 %0 Journal Article %C University of Pennsylvania, Philadelphia, Pennsylvania %A Kapo, Jennifer %A Morrison, Laura J %A Liao, Solomon %J J Palliat Med %D 2007 Feb %N 1 %P 185-209 %T Palliative care for the older adult %V 10 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17298269 %X The majority of deaths in the United States occur in the geriatric population. These older adults often develop multiple chronic medical problems and endure complicated medical courses with a variety of disease trajectories. Palliative care physicians need to be skilled in addressing the needs of these frail elders with life-limiting illness as they approach the end of life. Although geriatrics and palliative medicine share much in common, including an emphasis on optimizing quality of life and function, geriatric palliative care is distinct in its focus on the geriatric syndromes and on the provision of care in a variety of long-term care settings. Expertise in the diagnosis and management of the geriatric syndromes and in the complexities of long-term care settings is essential to providing high-quality palliative care to the elderly patient. This paper is a practical review of common geriatric syndromes, including dementia, delirium, urinary incontinence, and falls, with an emphasis on how they may be encountered in the palliative care setting. It also highlights important issues regarding the provision of palliative care in different long-term care settings %0 Journal Article %C Community Health and Family Medicine University of Florida College of Medicine 655 West 8th Street Jacksonville, FL 32209 E-mail: gary.reisfield@jax.ufl.edu %A Reisfield, Gary M %A Wilson, George R %J J Palliat Med %D 2007 Feb %N 1 %P 247-8 %T Palliative care issues in heart failure #144 %V 10 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17298274 %0 Journal Article %C Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands %A Graeff, Alexander De %A Dean, Mervyn %J J Palliat Med %D 2007 Feb %N 1 %P 67-85 %T Palliative sedation therapy in the last weeks of life: a literature review and recommendations for standards %V 10 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17298256 %X Purpose: Palliative sedation therapy (PST) is a controversial issue. There is a need for internationally accepted definitions and standards. Methods: A systematic review of the literature was performed by an international panel of 29 palliative care experts. Draft papers were written on various topics concerning PST. This paper is a summary of the individual papers, written after two meetings and extensive e-mail discussions. Results: PST is defined as the use of specific sedative medications to relieve intolerable suffering from refractory symptoms by a reduction in patient consciousness, using appropriate drugs carefully titrated to the cessation of symptoms. The initial dose of sedatives should usually be small enough to maintain the patients' ability to communicate periodically. The team looking after the patient should have enough expertise and experience to judge the symptom as refractory. Advice from palliative care specialists is strongly recommended before initiating PST. In the case of continuous and deep PST, the disease should be irreversible and advanced, with death expected within hours to days. Midazolam should be considered first-line choice. The decision whether or not to withhold or withdraw hydration should be discussed separately. Hydration should be offered only if it is considered likely that the benefit will outweigh the harm. PST is distinct from euthanasia because (1) it has the intent to provide symptom relief, (2) it is a proportionate intervention, and (3) the death of the patient is not a criterion for success. PST and its outcome should be carefully monitored and documented. Conclusion: When other treatments fail to relieve suffering in the imminently dying patient, PST is a valid palliative care option %0 Journal Article %C General Surgery 3 Unit, Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand. narwon@kku.ac.th %A Wongkonkitsin, Narongchai %A Phugkhem, Ake %A Jenwitheesuk, Kriangsak %A Saeseow, O-Tur %A Bhudhisawasdi, Vajarabhongsa %J J Med Assoc Thai %D 2006 Nov %N 11 %P 1890-5 %T Palliative surgical bypass versus percutaneous transhepatic biliary drainage on unresectable hilar cholangiocarcinoma %V 89 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17205870 %X OBJECTIVE: To compare the survival probability of unresectable hilar cholangiocarcinoma patients who have been managed by palliative surgical bypass versus percutaneous transhepatic biliary drainage (PTBD). MATERIAL AND METHOD: A historical (retrospective) cohort study was performed by retrospective and prospective data collection. From January 1, 2000 to December 31, 2002, all unresectable hilar cholangiocarcinoma patients who received only one type of palliative surgical bypass or PTBD in Srinagarind Hospital, Khon Kaen University were included in the present study. The patients were followed until December 31, 2004. Survival analysis was completed for all of the patients. STATISTIC ANALYSIS: Survival analysis was analyzed with the Kaplan-Meier method, Cox regression analysis, and Log-rank test. A p-value of less than 0.05 was considered significant. RESULTS: During the study period, 83 patients were included. Palliative surgical bypass was performed in 42 patients and PTBD was performed in 41 patients. Demographic data, peri-operative complication rate, and late complication rate were comparable. The median survival time of the palliative surgical bypass group was 160 days,(95% CI: 85.33, 234.67) and 82 days (95% CI: 29.76, 134.24)for PTBD group. Comparing survival experience by Log-rank test gave statistical significant diference (p = 0.0276). Hazard ratio was 0.599 (p = 0.03) CONCLUSION: Survival rate of the palliative surgical bypass group was higher than the PTBD group. The survival rate of both groups was comparable to previous reports %0 Journal Article %C Department of Urology and Andrology, Donauspital, Vienna, Austria %A Marszalek, Martin %A Ponholzer, Anton %A Rauchenwald, Michael %A Madersbacher, Stephan %J BJU Int %D 2007 Jan %N 1 %P 56-9 %T Palliative transurethral resection of the prostate: functional outcome and impact on survival %V 99 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17034496 %X OBJECTIVE: To assess the long-term functional and oncological outcome in a consecutive series of patients undergoing palliative transurethral resection of the prostate (pTURP). PATIENTS AND METHODS: We retrospectively assessed all patients who had a pTURP between 1992 and 2004 at our institution. Patients with incidental prostate cancer (pT1a/pT1b) were excluded. In all, 89 patients (mean age 75.9 years, sd 0.9, at diagnosis) entered the study. RESULTS: The median (range) prostate-specific antigen level at diagnosis was 25.7 (0.7-5000) ng/mL and the mean Gleason score was 7. The mean (sd, range) interval between the diagnosis of prostate cancer and pTURP was 1.5 (0.3, 0.5-10.9) years. The indications for pTURP were refractory urinary retention in 30%, severe bladder outlet obstruction with a postvoid residual urine volume of > 100 mL in 43%, and bladder stones, haematuria and hydronephrosis in 9% each. The mean (sd, range) follow-up after pTURP was 2.6 (0.2, 0.1-7.3) years. The peri-operative mortality (<30 days) was 2%, and 22 patients (25%) died during the follow-up. As estimated by Kaplan-Meier analysis, the 1-, 2- and 5-year survival rates were 83%, 70% and 61%, respectively. Patients with prostate cancer in the pTURP specimen had a shorter 3-year survival (52%) than those with a negative histology (89%, P = 0.03). At the last follow-up, 79% of men voided spontaneously and were continent. A repeat pTURP was necessary in 25% of patients, 11% required permanent catheterization and 10% were incontinent. CONCLUSION: Despite greater peri-operative mortality and morbidity than conventional TURP, pTURP is a fairly safe and effective procedure. Although a potential negative impact of pTURP on survival cannot be excluded, the estimated 5-year survival of 61% in this series seems to justify this intervention %0 Journal Article %C Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania., Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania %A Rodriguez, Keri L %A Barnato, Amber E %A Arnold, Robert M %J J Palliat Med %D 2007 Feb %N 1 %P 99-110 %T Perceptions and utilization of palliative care services in acute care hospitals %V 10 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17298258 %X Objective: To understand perceptions of palliative care in acute care hospitals and identify barriers to earlier use of palliative care in the illness trajectory. Methods: In Pennsylvania hospitals, we completed semistructured interviews with 131 providers involved in decision making or discharge planning. We used qualitative methods to analyze transcripts. Results: Most interviewees characterized palliative care as end-of-life or hospice care that is initiated after the decision to limit curative treatment is made. Few recognized the role of palliative care in managing symptoms and addressing psychosocial needs of patients with chronic illnesses other than cancer. Interviewees viewed earlier and broader palliative care consultations less in terms of clinical benefits than in terms of cost savings accrued from shorter terminal hospitalizations. In general, they thought nurses were most likely to facilitate these consultations, surgeons were most likely to resist them, and intensive care specialists were most likely to view palliative care as within their own scope of practice. Suggestions for broadening palliative care utilization included providing education and training, improving financial reimbursement and sustainability for palliative care, and fostering a hospital culture that turns to high-intensity care only if it meets individual needs and goals of chronically ill patients. Conclusions: In acute care hospitals, palliative care is primarily perceived as a means to limit life-sustaining treatment or allow death. Moving consultation earlier in the hospitalization of "dying" patients is a greater preoccupation than increasing palliative service use earlier in the illness trajectory. Any move short of far upstream will require palliative care specialists to market benefits to patients and referring providers in ways that emphasize compatibility with parallel treatment plans and do not threaten provider autonomy %0 Journal Article %C The Eye Department, University Hospital Kralovske Vinohrady, Prague, Czech Republic. soucek@fnkv.cz %A Soucek, Petr %A Cihelkova, Ilona %J Neuro Endocrinol Lett %D 2006 Dec %N 6 %P 725-8 %T Photodynamic therapy with Verteporfin in subfoveal choroidal metastasis of breast carcinoma (a controlled case) %V 27 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17187011 %X A 55-year old woman with growing unilateral subfoveal choroidal metastasis of breast carcinoma was treated by photodynamic therapy (PDT) with verteporfin. Best corrected visual acuity remained stable during the whole follow-up of 6 months. Tumor flattened from 2.2 mm to 0 mm on ultrasound one month after the therapy. PDT with verteporfin appears to be the best tolerated method for palliative treatment of growing subfoveal choroidal metastasis of the breast carcinoma %0 Journal Article %C Departments of *Psychiatry double daggerObstetrics and Gynecology, Faculty of Medicine, University of British Columbia daggerReproductive Mental Health Programs, St Paul's Hospital and BC Women's Hospital and Health Centre, Vancouver, British Columbia, Canada %A Carter, D %A Misri, S %A Tomfohr, L %J Clin Obstet Gynecol %D 2007 Mar %N 1 %P 154-165 %T Psychologic Aspects of Early Pregnancy Loss %V 50 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17304032 %X Early pregnancy loss is a complicated psychologic event that occurs in 12% to 24% of recognized pregnancies. Women who have experienced miscarriage often have common bereavement reactions and while the intensity and experience of these reactions diminishes over time for most women, a substantial minority will develop long-term psychiatric consequences. Depression, symptoms of anxiety, obsessive-compulsive disorder, and posttraumatic stress disorder are the most commonly reported psychologic reactions to miscarriage. The course and impact of these disorders on a grieving mother and her partner are discussed and treatment recommendations are made. The psychologic effects of therapeutic abortion are also be briefly discussed %0 Journal Article %C VA Palo Alto HCS, Palo Alto, California; Stanford University, Stanford, California %A Hallenbeck, James %A Hickey, Elaine %A Czarnowski, Elaine %A Lehner, Laura %A Periyakoil, Vyjeyanthi S %J J Palliat Med %D 2007 Feb %N 1 %P 127-35 %T Quality of care in a veterans affairs' nursing home-based hospice unit %V 10 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17298261 %X Objectives: To report on quality of care in a Veterans Affairs (VA) dedicated hospice unit. Design: Mortality follow-back survey of bereaved family members, using a quality of care instrument. Setting: A VA inpatient hospice unit. Participants: Bereaved family members. Measurements: Satisfaction with care as perceived by family members using a telephone survey. Results: 159 family members were contacted with 102 completing full and 37 completing abbreviated surveys. (Overall response rate: 87.4%, complete responses: 64.2%) 98% of all respondents reported overall quality of care as Excellent or Very Good. Conclusion: High levels of satisfaction were reported by family members. Implications of this initiative for the provision of hospice care in nursing homes are discussed, including replication of the model in both VA and non-VA nursing home settings %0 Journal Article %C Department of Medicine, University of Chicago, Chicago, IL 60637, USA. fcurlin@medicine.bsd.uchicago.edu %A Curlin, Farr A %A Lawrence, Ryan E %A Chin, Marshall H %A Lantos, John D %J N Engl J Med %D 2007 Feb %N 6 %P 593-600 %T Religion, conscience, and controversial clinical practices %V 356 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17287479 %X BACKGROUND: There is a heated debate about whether health professionals may refuse to provide treatments to which they object on moral grounds. It is important to understand how physicians think about their ethical rights and obligations when such conflicts emerge in clinical practice. METHODS: We conducted a cross-sectional survey of a stratified, random sample of 2000 practicing U.S. physicians from all specialties by mail. The primary criterion variables were physicians' judgments about their ethical rights and obligations when patients request a legal medical procedure to which the physician objects for religious or moral reasons. These procedures included administering terminal sedation in dying patients, providing abortion for failed contraception, and prescribing birth control to adolescents without parental approval. RESULTS: A total of 1144 of 1820 physicians (63%) responded to our survey. On the basis of our results, we estimate that most physicians believe that it is ethically permissible for doctors to explain their moral objections to patients (63%). Most also believe that physicians are obligated to present all options (86%) and to refer the patient to another clinician who does not object to the requested procedure (71%). Physicians who were male, those who were religious, and those who had personal objections to morally controversial clinical practices were less likely to report that doctors must disclose information about or refer patients for medical procedures to which the physician objected on moral grounds (multivariate odds ratios, 0.3 to 0.5). CONCLUSIONS: Many physicians do not consider themselves obligated to disclose information about or refer patients for legal but morally controversial medical procedures. Patients who want information about and access to such procedures may need to inquire proactively to determine whether their physicians would accommodate such requests %0 Journal Article %J J Support Oncol %D 2006 Oct %N 9 %P 484 %T Second Annual Chicago Supportive Oncology Conference: treating symptoms, side effects, and the state of illness %V 4 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17080738 %0 Journal Article %C School of Nursing, Ryerson University, USA. mzanchet@ryerson.ca %A Zanchetta, Margareth S %A Moura, Shari L %J Clin J Oncol Nurs %D 2006 Dec %N 6 %P 803-7 %T Self-determination and information seeking in end-stage cancer %V 10 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17193946 %X When patients learn that their cancer has recurred after primary treatments or is no longer responding to therapy and no alternative treatment options exist, their motivation to carry on living may be impacted greatly. Using the Self-Determination Theory, this article's reflective analysis explores the unique situation of a woman with end-stage cancer and her continuous motivation to seek information about her illness. Information was gathered during clinical observations and informal conversations. The analysis showed how the patient sought information about her illness, how she manifested motivation, and how the hospital's social environment influenced her behavior. To understand the experience of being confronted with a terminal illness, the following issues are identified: expansion of awareness, life-facing knowledge contradictions, being open-minded and an active explorer of information sources, medical truth, and professional attitudes toward patients' informational needs. Nurses must understand patients' reasons for self-determination when facing illness uncertainty. Reflecting on such situations will strengthen nursing practice %0 Journal Article %C Department of Palliative Medicine, 3Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin %A Marr, Lisa %A Billings, J Andrew %A Weissman, David E %J J Palliat Med %D 2007 Feb %N 1 %P 169-77 %T Spirituality training for palliative care fellows %V 10 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17298265 %X Introduction: Spirituality is a major domain of palliative medicine training. No data exist on how it is taught, nor is there a consensus about the content or methods of such education. We surveyed palliative medicine fellowship directors in the United States to learn how they teach spirituality, who does the teaching, and what they teach. Methods: A PubMed (left angle bracket, doublewww.pubmed.govright angle bracket, double) search using the terms "spirituality" and "medical education" was completed. Thirty-two articles outlined spirituality education content and methods in medical schools and residency programs. From these articles, a survey on spirituality education in palliative medicine fellowship training was prepared, pilot-tested, revised, and then distributed by e-mail in June 2004 to the 48 U.S. palliative medicine fellowship directors listed on the American Board of Hospice and Palliative Medicine (AAHPM) website, but excluding the three fellowship programs represented by the authors. Follow up requests were sent by email twice during the 6-week collection period. The Institutional Review Board at the Medical College of Wisconsin approved the study. Results: Fourteen fellowship directors completed the survey (29% of all programs; 42% of those currently teaching fellows as indicated on the AAHPM website). All programs indicated they taught "spirituality"; 12 of 14 had separate programs for teaching spirituality and 2 of 14 reported they taught spirituality to their fellows but not as a distinct, separate program. All respondents taught the definitions of spirituality and religion, common spiritual issues faced by patients at end of life (which was not defined further), and the role of chaplains and clergy. Chaplains provided spirituality education in all of the responding programs, but other team members were frequently involved. The most common formats for education in the domains of knowledge and attitudes were small group discussion, lecture, and selfstudy. Small group discussion, supervision, and shadowing a chaplain or other professional were the most common methods used for skills. Faculty written or oral evaluations of fellows were the most common forms of evaluation, with little evidence of more robust assessment methods, such as structured role-play (none of the programs surveyed). Conclusions: Palliative medicine fellowship programs generally agree on the content of training on spirituality, but have not incorporated robust educational and evaluation methods to ensure that fellows have obtained the desired attitudes, knowledge, and skills to meet the Initial Voluntary Program Standards for Residency Education in Palliative Medicine of the American Board of Hospice and Palliative Medicine. Based on the survey data and results from the literature review, broad recommendations are made to enhance spirituality education %0 Journal Article %A Pai, Nitika Pant %A Klein, Marina B %J Expert Rev Anti Infect Ther %D 2006 Dec %N 6 %P 909-12 %T Structured treatment interruptions in chronic HIV management: where next? %V 4 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17181404 %0 Journal Article %J Ann Intern Med %D 2007 Feb %N 3 %P I35 %T Summaries for patients. Safety of surgery during bridging anticoagulation therapy with low-molecular-weight heparin %V 146 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17283344 %0 Journal Article %C Northwestern University, Chicago, Illinois %A Emanuel, Linda %A Bennett, Katherine %A Richardson, Virginia E %J J Palliat Med %D 2007 Feb %N 1 %P 159-68 %T The dying role %V 10 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17298264 %X Background: Roles are relevant during the last stage of the life cycle, as at any other stage. Awareness and an understanding of the dying role have the capacity to guide the process. Lack thereof can impede good deaths and may have been in part responsible for the intense and often futile interventions provided to many dying patients in the past. Objective and design: We describe relevant aspects of role theory and recent scholarship and then examine the dying role, describing three key elements: the practical element, which involves concrete tasks of preparation; the relational element, which involves engaging with others; and the personal element, which involves tasks that foster personal growth and finishing one's life story. We also identify some barriers to and misuses of the dying role that appear to limit productive engagement with it, and offer suggestions for how clinicians can assist patients with the dying role. Results and conclusion: The described elements of the dying role, and appreciation of how to avoid barriers and facilitate its implementation, can help patients access the unique quality of life that can occur near the end of life %0 Journal Article %C University of Rochester School of Medicine and Dentistry, USA. dgoldblattmd@verizon.net %A Goldblatt, David %J Perspect Biol Med %D 2006 Autumn %N 4 %P 537-41 %T The gift: when a patient chooses to die %V 49 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17146138 %0 Journal Article %C Georgetown University Hospital, Washington, DC, USA %A Al-Kawas, Firas H %J Acta Chir Iugosl %D 2006 %N 2 %P 15-6 %T The role of SEMS in malignant and benign colon obstruction %V 53 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17139878 %X SEMS are highly valuable in the management of pati-ents with malignant colon obstruction with high technical and clinical success. Currently, their role is in colon deco-mpression as a bridge before surgery and in the palliative management of inoperative patients. SEMS appear to be more effective and less costly than emergency surgery. SEMS should be avoided in benign strictures. More data is needed in reference to the role of plastic expandable stents in the management of patients with benign colon strictures %0 Journal Article %C Tata Memorial Hospital, Mumbai, India %A Agarawal, J P %A Swangsilpa, T %A van der Linden, Y %A Rades, D %A Jeremic, B %A Hoskin, P J %J Clin Oncol (R Coll Radiol) %D 2006 Dec %N 10 %P 747-60 %T The role of external beam radiotherapy in the management of bone metastases %V 18 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17168210 %X External beam radiotherapy is effective in the management of bone metastases for both local and more widespread pain. It is effective in spinal canal compression and pathological fracture where it also may have a prophylactic role. Single dose radiotherapy for bone metastases is a highly cost effective palliative treatment %0 Journal Article %C Universitatsklinikum Munster, Munster, Germany %A Muthny, F A %A Wiedebusch, S %A Blok, G A %A van Dalen, J %J Transplant Proc %D 2006 Nov %N 9 %P 2751-5 %T Training for doctors and nurses to deal with bereaved relatives after a sudden death: evaluation of the European Donor Hospital Education Programme (EDHEP) in Germany %V 38 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17112822 %X The sudden death of a person is one of the most extreme and painful experiences for the relatives, and doctors require special communication skills to deal adequately with the bereaved. The Dutch European Donor Hospital Education Programme was developed to train doctors and nurses in talking to the bereaved relatives and to make the donation request. In Germany, the one-day workshop has been adapted to the German language, law, and clinical practice. The evaluation data of 75 workshops and experiences of 760 participants (doctors, nurses, and psychologists) are reported. The framework of, methods used, and issues dealt with in the workshop were clearly appreciated by the great majority of the participants. Criticisms and suggestions were directed mainly at the duration of the workshop. One third of the participants pleaded for a 2-day workshop, two thirds for a refresher course half a year later. The main effects reported were that two thirds of the participants rated that relatives could be helped, talked with, and cared for in a better way. The workshop participants also reported that they themselves were better able to cope with the situation and were more inclined to take on the task following the workshop. Finally, the necessities and limits of psychosocial training for doctors and their staff are discussed %0 Journal Article %C Department of Neurosurgery, University of South Florida, Tampa, FL 33606, USA. dsachs12@hotmail.com %A Sachs, Donald C %A Inamasu, Joji %A Mendel, Ehud E %A Guiot, Bernard H %J Spine %D 2006 Nov %N 24 %P E925-8 %T Transoral vertebroplasty for renal cell metastasis involving the axis: case report %V 31 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17108824 %X STUDY DESIGN: Case report. OBJECTIVE: This is one of the first reported cases of transoral vertebroplasty for a solid metastatic tumor at C2 body. SUMMARY OF BACKGROUND DATA: Percutaneous vertebroplasty has gained popularity as a treatment option for painful neoplastic lesions of the spine. The technique has been useful in reducing pain and stabilizing the spinal segment that is vulnerable to fracture. However, there is very little experience with vertebroplasty in the cervical spine and, more specifically, at C2. METHODS: We present a case of metastatic renal cell carcinoma of the C2 body. The patient, a 61-year-old woman, presented with an excruciating neck pain. Diagnostic workup revealed the presence of tumor in the right kidney. Multiple spinal levels were involved in addition to C2, and the C2 lesion was treated for palliative purpose. Under biplanar fluoroscopy, a vertebroplasty trocar was placed transorally into the central portion of the C2 body, and polymethyl methacrylate was injected. RESULTS: The transoral vertebroplasty achieved complete pain relief and enhanced stability of an extensive osteolytic lesion involving the C2 body. CONCLUSIONS: This minimal access procedure was effective in completely relieving pain from a metastatic deposit at C2, while adequately stabilizing the vulnerable segment by the injection of polymethyl methacrylate. The transoral route requires meticulous fluoroscopic control to prevent the leakage of polymethyl methacrylate but provides the most direct access to the C2 body %0 Journal Article %C Department of Psychiatry, University of British Columbia, Vancouver, BC, V6t 123, Canada. ogrodnic@interchange.ubc.ca %A Ogrodniczuk, John S %A Piper, William E %A Joyce, Anthony S %J Psychiatry %D 2006 Fall %N 3 %P 249-61 %T Treatment compliance among patients with personality disorders receiving group psychotherapy: what are the roles of interpersonal distress and cohesion? %V 69 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17040176 %X It is often assumed that patients with personality disorders have worse compliance in psychotherapy (i.e., attend fewer sessions) than patients without personality disorders. Such an assumption can have negative consequences for the treatment of patients with personality disorders. It also denies the presence of variability in session attendance among patients with personality disorders. Research that attempts to identify the factors that are associated with variability in session attendance among patients with personality disorders is needed. The present study examined the role of interpersonal distress as a predictor of session attendance for patients with personality disorders (n = 72) in two different forms of group psychotherapy (interpretive, supportive). The study also investigated whether patients' cohesion to their group mediated the effect of interpersonal distress on attendance. Findings indicated that interpersonal distress had a strong, direct association with attendance in supportive group therapy, but minimal association in interpretive group therapy. High levels of interpersonal distress were associated with higher attendance in supportive therapy. Furthermore, cohesion to the group accounted for about two-thirds of the effect of interpersonal distress on attendance in supportive group therapy, thus providing compelling evidence for its role as a mediator. Possible explanations and clinical implications of these findings are discussed %0 Journal Article %C University of North Dakota College of Nursing in Grand Forks, USA %A Langemo, Diane %A Anderson, Julie %A Hanson, Darlene %A Thompson, Patricia %A Hunter, Susan %J Nursing %D 2007 Jan %N 1 %P 65-6 %T Understanding palliative wound care %V 37 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17198174 %0 Journal Article %C Department of Urology, Royal Hallamshire Hospital, Sheffield, UK. V.Natarajan@sth.nhs.uk %A Natarajan, Vaithianathan %A Boucher, Nigel R %A Meiring, Pieter %A Spencer, Paul %A Parys, Bo T %A Oakley, Neil E %J BJU Int %D 2007 Jan %N 1 %P 147-9 %T Ureteric embolization: an alternative treatment strategy for urinary fistulae complicating advanced pelvic malignancy %V 99 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17092290 %X OBJECTIVE: To report experience with a minimally invasive technique for palliation of urinary fistula/incontinence complicating advanced pelvic malignancy or its treatment. PATIENTS AND METHODS: We used ureteric embolization with permanent nephrostomy drainage in eight renal units in five patients for palliation of symptoms. All procedures were done under local anaesthesia as day-case procedures. Nephrostomy tubes were changed at regular intervals on an outpatient basis. Embolization was repeated when required. RESULTS: The follow-up was 2-84 months; four patients died from the underlying malignancy during the follow-up. All patients were continent and had effective palliation of their symptoms. Two patients required repeat embolization. There were no embolization-related complications. CONCLUSIONS: Ureteric embolization is a safe and effective minimally invasive palliative treatment option in urinary fistulae or incontinence complicating advanced pelvic malignancy %0 Journal Article %C School of Nursing, University of North Carolina, Greensboro, USA. meorourk@uncg.edu %A O'Rourke, Maureen E %J Clin J Oncol Nurs %D 2006 Dec %N 6 %P 825-6 %T Vacuum-assisted closure therapy %V 10 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17193949 %0 Journal Article %C Division of Hematology and Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina %A Olajide, Oludamilola %A Hanson, Laura %A Usher, Barbara M %A Qaqish, Bahjat F %A Schwartz, Robert %A Bernard, Stephen %J J Palliat Med %D 2007 Feb %N 1 %P 111-7 %T Validation of the palliative performance scale in the acute tertiary care hospital setting %V 10 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17298259 %X Background: Physicians are often asked to prognosticate patient survival. However, prediction of survival is difficult, particularly with critically ill and dying patients within the hospitals. The Palliative Performance Scale (PPS) was designed to assess functional status and measure progressive decline in palliative care patients, yet it has not been validated within hospital health care settings. Objective: This study explores the application of the PPS for its predictive ability related to length of survival. Other variables examined were correlates of symptom distress in a tertiary academic setting. Methods: Patients were assigned a score on the PPS ranging from 0% to 100% at initial consultation. Standardized symptom assessments were carried out daily, and survival was determined by medical record review and search of the National Death Index. Results: Of 261 patients seen since January 2002, 157 had cancer and 104 had other diagnoses. PPS scores ranged from 10% to 80% with 92% of the scores between 10% and 40%. Survival ranged from 0 to 30 months, with a median of 9 days. By 90 days, 83% of patients had died. Proportional hazards regression estimates showed that a 10% decrement in PPS score was associated with a hazard ratio of 1.65 (95% confidence interval [CI]: 1.42-1.92). Proportional odds regression models showed that a lower PPS was significantly associated with higher levels of dyspnea. Conclusion: The PPS correlated well with length of survival and with select symptom distress scores. We consider it to be a useful tool in predicting outcomes for palliative care patients %0 Journal Article %C Psychosocial aspects of end of life care %A Saunders, Judith M %J Perspect Psychiatr Care %D 2007 Feb %N 1 %P 30-7 %T Vulnerable populations in an american red cross shelter after hurricane katrina %V 43 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17295855 %X TOPIC. During Katrina, people suddenly encountered multiple losses, including homes, finances, medications, and death of loved ones. The Model of Vulnerable Populations illustrates how reduced resources placed individuals at greater risk for harm. PURPOSE. Using vignettes and the Model of Vulnerable Populations, a psychiatric nurse discusses her experiences as an American Red Cross psychiatric/mental health nurse volunteer after the Katrina disaster at a Mississippi shelter. CONCLUSIONS. The role of the mental health nurse volunteer was demonstrated by assessment and interventions of advocacy, referral, crisis intervention, and general support and education. PRACTICE IMPLICATIONS. Using the Model of Vulnerable Populations, psychiatric nurses can improve mental health assessment and services by counseling, advocacy, triage, and teaching disease prevention strategies such as hand washing %0 Journal Article %C Emergency Medicine, Erie, PA, USA %A Mirarchi, Ferdinando L %J Med Econ %D 2006 Dec %N 23 %P 71-2 %T When living wills become health hazards %V 83 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17214023 %0 Journal Article %C University of Pittsburgh, School of Medicine, Section of Palliative Care and Medical Ethics, Institute to Enhance Palliative Care, Pittsburgh, Pennsylvania %A Arnold, Robert M %A Jaffe, Emily %J J Palliat Med %D 2007 Feb %N 1 %P 182-3 %T Why palliative care needs geriatrics %V 10 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17298267 %0 Journal Article %J Clin J Oncol Nurs %D 2006 Dec %N 6 %P 721-2 %T World Cancer Declaration %V 10 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17193937 %0 Journal Article %A Hoffmann-Richter, Ulrike %J Psychiatr Prax %D 2006 Nov %N 8 %P 361-3 %T [Perspectives] %V 33 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17128392 %0 Journal Article %C Service de Chirurgie Maxillo-faciale et Plastique de la Face, Hopital Charles Nicolle, Tunis, Tunisie. bouguila_jed@yahoo.fr %A Bouguila, J %A Zairi, I %A Jablaoui, Y %A Haddad, S %A Hellali, M %A Azzouz, E %A Moustafa, M %A Adouani, A %J Rev Stomatol Chir Maxillofac %D 2006 Dec %N 6 %P 474-6 %T [Primary malignant melanoma of the nasal cavity presenting as a large tumor of the cheek] %V 107 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17195003 %X INTRODUCTION: Malignant melanoma of the nasal cavity is a rare tumor usually causing unilateral nasal obstruction and nasal bleeding. Diagnosis is achieved with immunohistochemistry analysis. Surgery is proposed for curative treatment.CASE REPORT: We report the case of a 60-year-old man with a malignant melanoma of the nasal cavity revealed by an important tumor of the cheek. Epistaxis and nasal obstructive syndrome occurred later. Because of the tumor stage, palliative chemotherapy was performed but the patient died 4 months after the diagnosis.DISCUSSION: This clinical presentation of malignant melanoma of the nasal cavity, related to local spreading, is exceptional. CT scan and MRI are essential for tumor staging and therapeutic decision-making. Prognosis remains poor