%0 Journal Article
%C Community Palliative Care Team at Harris Hospicare, Caritas House, Tregony Road, Orpington, Kent, BR6 9XA, UK
%A Hinsley, Ros
%A Hughes, Rhidian
%J Int J Palliat Nurs
%D 2007 Feb
%N 2
%P 84-9
%T 'The reflections you get': an exploration of body image and cachexia
%V 13
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17363866
%X Background: cachexia has a detrimental effect on quality of life and is an indicator of poor prognosis. The meanings people attach to their lived experiences of cachexia are unknown. Aims: to explore the impact of cachexia on body image of people with advanced cancer, their emotions, relationships and social functioning. Design: qualitative study using face-to-face in-depth interviews of a conversational style. Rich narrative data analysed by thematic content analysis. Participants: 12 participants recruited from two community palliative care teams in south east England. Results: altered body image impacts on other aspects of embodiment: the emotions, spirituality, relationships and social functioning. Lives were restricted and isolated, which was compounded by emotional distancing by carers and health care professionals. Participants discussed their repeated attempts to re-adapt to disruptions of self caused by an altered body image. Conclusions: the key study implications focus on the need for (i) improved holistic care and support, and advice; (ii) training and awareness raising of care professionals; (iii) further research on the lived experiences of the condition and the development of effective measures of cachexia

%0 Journal Article
%C Buehler Center on Aging, Society and Health (C.-H.C., D.T.L., L.L.E.), Northwestern University Feinberg School of Medicine, Chicago, Illinois; Harvard Law School, (A.A.B.-S.), Boston, Massachusetts; Department of Preventive Medicine and Epidemiology (R.A.D.-A.), Loyola University Stritch School of Medicine, Maywood, Illinois; and Department of Health Evaluation Sciences (S.D.), Penn State College of Medicine, Hershey, Pennsylvania, USA
%A Chang, CH
%A Boni-Saenz, AA
%A Durazo-Arvizu, RA
%A Desharnais, S
%A Lau, DT
%A Emanuel, LL
%J J Pain Symptom Manage
%D 2007 Mar
%T A System for Interactive Assessment and Management in Palliative Care
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17360148
%X The availability of psychometrically sound and clinically relevant screening, diagnosis, and outcome evaluation tools is essential to high-quality palliative care assessment and management. Such data will enable us to improve patient evaluations, prognoses, and treatment selections, and to increase patient satisfaction and quality of life. To accomplish these goals, medical care needs more precise, efficient, and comprehensive tools for data acquisition, analysis, interpretation, and management. We describe a system for interactive assessment and management in palliative care (SIAM-PC), which is patient centered, model driven, database derived, evidence based, and technology assisted. The SIAM-PC is designed to reliably measure the multiple dimensions of patients' needs for palliative care, and then to provide information to clinicians, patients, and the patients' families to achieve optimal patient care, while improving our capacity for doing palliative care research. This system is innovative in its application of the state-of-the-science approaches, such as item response theory and computerized adaptive testing, to many of the significant clinical problems related to palliative care

%0 Journal Article
%C Heidelberg Centre, 100 Oriel Road, Heidelberg 3081, Victoria, Australia. fmcleod@rdns.com.au
%A McLeod, Fiona
%A Flowers, Charne
%J Int J Palliat Nurs
%D 2006 Dec
%N 12
%P 558, 560-65
%T A practical guide for nurses in diluent selection for subcutaneous infusion using a syringe driver
%V 12
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17353841
%X Appropriate diluent selection in continuous subcutaneous infusion optimises symptom management and client well-being. The responsibility of diluent selection is commonly one of the attending nurse. This paper was developed with the intention of providing nurses with practical instruction for diluent selection when preparing medications for administration subcutaneously using a syringe driver. A literature review was undertaken of published journal databases and published guidelines sites. Recommendations regarding diluent choice were reviewed in two iterations by an expert panel of palliative care nurse clinicians. The principles for diluent selection are presented. They are based primarily on expert opinion level of evidence given a lack of primary research evidence in the area of diluent selection. There is a pressing need for manufacturers' guidance on diluent selection and independent research to establish the impact of diluents on drug and drug combinations when using syringe drivers. Until such time that this evidence is available to guide practice, clinicians need to be trained to inspect solutions and assess the effectiveness of the medication in controlling symptoms. The capacity of this paper to provide practical instruction has been limited by the lack of rigorous evidence available, and indeed, the process of developing this guide identified perhaps more questions than answers available at the present time

%0 Journal Article
%A Freeman, Phyllis
%J J Public Health Policy
%D 2007 
%N 1
%P 62-70
%T A visit to hospice Africa
%V 28
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17363938

%0 Journal Article
%C Acute and Specialised Care, University of Glamorgan, Faculty of Health, Sport and Science, Glyntaff, Pontypridd, CF37 1DL
%A Jones, Sian
%A Jones, Bridie
%J Br J Nurs
%D 2007 Feb
%N 4
%P 220-3
%T Advanced directives and implications for emergency departments
%V 16
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17363852
%X What are the implications of caring for patients with advance directives in emergency care contexts? This paper examines legal and professional perspectives and highlights the challenges that practitioners face. Emergency care contexts necessitate the need for timely decision making regarding care and treatment options. Fundamental to the decision-making process is the need to take into consideration the wishes and preferences of the patient. Advance directives are expressions of choice. They are also legally binding documents and represent the wishes of a patient, but often with little prior knowledge of the patient, practitioners may be unsure whether to act on an advance directive. This paper makes some attempt to examine key components of this debate

%0 Journal Article
%C Be'er Sheva Mental Health Center, PO Box 4600, Be'er Sheva 84170, Israel. lernervld@yahoo.com
%A Lerner, Vladimir
%A Witztum, Eliezer
%J J Med Biogr
%D 2007 Feb
%N 1
%P 4-8
%T Alexey Kondratyevich Savrasov (1830-1897): the muse and the bottle
%V 15
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17356723
%X The Russian landscape painter Alexey Savrasov lived in the middle of the 19th century. He was overwhelmed with grief at the loss of several of his children and he used alcohol to blunt the pain and anguish. The effects of psychoactive substances and especially alcohol have been linked closely to creativity. His life story demonstrates the bitter relationship between the bottle and the muse. He became dependent on alcohol, his family broke up and he was fired from work, his creativity declined and his health deteriorated. At death, he was a lonely and a forgotten man and only two persons attended his funeral

%0 Journal Article
%C Laboratory for Advances in Consciousness and Health, Department of Psychology, The University of Arizona, USA. beischel@email.arizona.edu
%A Beischel, Julie
%A Schwartz, Gary E
%J Explore (NY)
%D 2007 Jan-Feb
%N 1
%P 23-7
%T Anomalous information reception by research mediums demonstrated using a novel triple-blind protocol
%V 3
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17234565
%X CONTEXT: Investigating the information reported by mediums is ultimately important in determining the relationship between brain and consciousness in addition to being of deep concern to the public. OBJECTIVE: This triple-blind study was designed to examine the anomalous reception of information about deceased individuals by research mediums under experimental conditions that eliminate conventional explanations. PARTICIPANTS: Eight University of Arizona students served as sitters: four had experienced the death of a parent; four, a peer. Eight mediums who had previously demonstrated an ability to report accurate information in a laboratory setting performed the readings. METHODOLOGY: To optimize potential identifiable differences between readings, each deceased parent was paired with a same-gender deceased peer. Sitters were not present at the readings; an experimenter blind to information about the sitters and deceased served as a proxy sitter. The mediums, blind to the sitters' and deceased's identities, each read two absent sitters and their paired deceased; each pair of sitters was read by two mediums. Each blinded sitter then scored a pair of itemized transcripts (one was the reading intended for him/her; the other, the paired control reading) and chose the reading more applicable to him/her. RESULTS: The findings included significantly higher ratings for intended versus control readings (p = 0.007, effect size = 0.5) and significant reading-choice results (p = 0.01). CONCLUSIONS: The results suggest that certain mediums can anomalously receive accurate information about deceased individuals. The study design effectively eliminates conventional mechanisms as well as telepathy as explanations for the information reception, but the results cannot distinguish among alternative paranormal hypotheses, such as survival of consciousness (the continued existence, separate from the body, of an individual's consciousness or personality after physical death) and super-psi (or super-ESP; retrieval of information via a psychic channel or quantum field)

%0 Journal Article
%A Kelly, Daniel
%J Int J Palliat Nurs
%D 2006 Dec
%N 12
%P 552
%T Avoiding complacency in palliative care
%V 12
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17353839

%0 Journal Article
%C Syracuse VA Medical Center, Syracuse, New York
%A Iraqi, Abid
%A Hughes, Terry Lynn
%J J Am Med Dir Assoc
%D 2007 Mar
%N 3
%P 197-8
%T Barriers to effective palliative care in the nursing home setting
%V 8
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17349950

%0 Journal Article
%C Department of Family and Geriatric Medicine, University of Louisville, Louisville, KY
%A Furman, Christian Davis
%A Pirkle, Rebecca
%A O'brien, James G
%A Miles, Toni
%J J Am Med Dir Assoc
%D 2007 Mar
%N 3 Suppl 2
%P e45-8
%T Barriers to the implementation of palliative care in the nursing home
%V 8
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17352986

%0 Journal Article
%A Furman, C D
%J J Am Med Dir Assoc
%D 2007 Mar
%N 3 Suppl 2
%P e43
%T Barriers to the implementation of palliative care in the nursing home
%V 8
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17352985

%0 Journal Article
%C Faculty of Health Studies, Hedmark University College, Elverum, Norway. reidun.hov@hse.hihm.no
%A Hov, Reidun
%A Hedelin, Birgitta
%A Athlin, Elsy
%J J Clin Nurs
%D 2007 Jan
%N 1
%P 203-11
%T Being an intensive care nurse related to questions of withholding or withdrawing curative treatment
%V 16
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17181683
%X AIMS AND OBJECTIVES: The aim of the study was to acquire a deeper understanding of what it is to be an intensive care nurse in situations related to questions of withholding or withdrawing curative treatment. BACKGROUND: Nurses in intensive care units regularly face critically ill patients. Some patients do not benefit from the treatment and die after days or months of apparent pain and suffering. A general trend is that withdrawal of treatment in intensive care units is increasing. Physicians are responsible for decisions concerning medical treatment, but as nurses must carry out physicians' decisions, they are involved in the consequences. DESIGN AND METHODS: The research design was qualitative, based on interpretative phenomenology. The study was carried out at an adult intensive care unit in Norway. Data were collected by group interviews inspired by focus group methodology. Fourteen female intensive care nurses participated, divided into two groups. Colaizzi's model was used in the process of analysis. RESULTS: The analysis revealed four main themes which captured the nurses' experiences: loneliness in responsibility, alternation between optimism and pessimism, uncertainty--a constant shadow and professional pride despite little formal influence. The essence of being an intensive care nurse in the care of patients when questions were raised concerning curative treatment or not, was understood as 'being a critical interpreter and a dedicated helper.' CONCLUSIONS: The findings underpin the important role of intensive care nurses in providing care and treatment to patients related to questions of withholding or withdrawing curative treatment. RELEVANCE TO CLINICAL PRACTICE: The findings also show the need for physicians, managers and intensive care nurses themselves to recognize the burdens intensive care nurses carry and to appreciate their knowledge as an important contribution in decision making

%0 Journal Article
%C Center for Palliative Studies, San Diego Hospice & Palliative Care, San Diego, California, USA
%A von Gunten, Charles F
%A Soskins, Matthew
%J J Pain Symptom Manage
%D 2007 Mar
%N 3
%P 236-7
%T Bone marrow biopsy symptom control and palliative care consultation
%V 33
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17349492

%0 Journal Article
%A Stenseth, G
%A Bjornes, M
%A Kaasa, S
%A Klepstad, P
%J BMC Palliat Care
%D 2007 Mar
%N 1
%P 2
%T Can cancer patients assess the influence of pain on functions? A randomised, controlled study of the pain interference items in the Brief Pain Inventory
%V 6
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17349052
%X ABSTRACT: BACKGROUND: The Brief Pain Inventory (BPI) is recommended as a pain measurement tool by the Expert Working Group of the European Association of Palliative Care. The BPI is designed to assess both pain severity and interference with functions caused by pain. The purpose of this study was to investigate if pain interference items are influenced by other factors than pain. METHODS: We asked adult cancer patients to complete the original and a revised BPI on two study days. In the original version of the BPI the patients were asked how, during the last 24 hours, pain has interfered with functions. In the revised BPI this question was changed to how, during the last 24 hours, these functions are affected in general. Heath related quality of life was assessed at both study days applying the European Organization for Research and Treatment of Cancer quality of life questionnaire. RESULTS: Forty-eight of the 55 included patients completed both assessments. The BPI pain intensities scores and the health related quality of life scores were similar at the two study days. Except for mood this study observed no significant distinctions between the patients; BPI interference items scores in the original (pain influence on function) and the revised BPI (function in general). Seventeen patients reported higher influence from pain on functions than the total influence on function from all causes. CONCLUSION: We observed similar scores in the original BPI interference scores (pain influence on function) compared with the revised BPI interference scores (decreased function in general). This finding might imply that the BPI interference scale measures are partly responded to as more of a global interference measure

%0 Journal Article
%C arothschild@optusnet.com.au
%A Rothschild, Alan
%J J Law Med
%D 2007 Feb
%N 3
%P 403-24
%T Capacity and medical self-determination in Australia
%V 14
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17355102
%X The expansion of patients' rights and the increasing complexity of the science of medicine raises serious legal and social questions, particularly when they pertain to end-of-life decision-making. Medical science continues to find ways of maintaining or extending life in a body or mind affected by disease or trauma and regular advances in medical technology and practice mean that the natural course of illness or injury will rarely be uninterrupted by some form of medical intervention. This progressive "medicalisation" of death, together with enhanced patient autonomy, means that choices can increasingly be made regarding medical treatment which may ultimately influence both the time and the way in which a person dies. This article examines both legislation and the common law in Australia particularly as it pertains to medical decision-making at end-of-life and the patient's right of self-determination

%0 Journal Article
%A Kertesz, Louise
%J AHIP Cover
%D 2007 Jan-Feb
%N 1
%P 36-42, 44-5
%T Caring at all stages of life and health
%V 48
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17315557

%0 Journal Article
%C Cathy Romeo, CHSM, is Cultural Competency Program Manager, VNA Care Network & Hospice, Needham, Massachusetts
%A Romeo, Cathy
%J Home Healthc Nurse
%D 2007 Mar
%N 3
%P 206-13
%T Caring for Culturally Diverse Patients: One Agency's Journey Toward Cultural Competence
%V 25
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17353714
%X Across the United States, spanning urban, suburban, and rural areas, racial and ethnic minority populations are growing faster than White English-speaking populations. Increasingly, healthcare professionals are providing care to patients from diverse cultures with traditions and beliefs that may be unfamiliar and with health practices that may conflict with western medicine. How can home care and hospice professionals navigate this new terrain and communicate effectively across cultural boundaries? One agency's journey toward cultural competency may provide a road map for others

%0 Journal Article
%C Chronic Intractable Disease Center, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
%A Ideguchi, H
%A Ohno, S
%A Ueda, A
%A Ishigatsubo, Y
%J Lupus
%D 2007 
%N 1
%P 59-64
%T Catastrophic antiphospholipid syndrome associated with malignancies (case report and review of the literature)
%V 16
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17283588
%X We describe a 58-year old female patient with rapid development of arterial and venous thromboembolisms, including deep vein thrombosis (DVT) in the lower limbs, recurrent cerebral infarctions and bilateral pulmonary emboli. Her laboratory data on admission showed positive anticardiolipin antibody of IgG isotype (IgG aCL) and positive anti-beta2 glycoprotein-I antibody of IgG isotype (IgG abeta2-GPI), and decreased protein C activity and protein S antigen. Systemic examinations revealed the presence of an ovarian cancer. Surgical resection was attempted, but her cancer infiltrated the pelvic wall and could not be resected. Despite treatment with unfractionated heparin followed by warfarin, she died due to recurrent episodes of cerebral infarction. This case was considered as probable catastrophic antiphospholipid syndrome (CAPS), which might be associated with ovarian cancer. Known as Trousseau's syndrome, arterial and, more commonly, venous thrombosis is a frequent complication of cancer and sometimes a harbinger of occult cancer. Our case indicates that there is an overlap between antiphospholipid syndrome (APS) and Trousseau's syndrome. It is important to bear in mind that a thrombotic event associated with cancer can be the first manifestation of CAPS

%0 Journal Article
%C Department of Health Sciences, Orebro University, Orebro, Sweden. karin.blomberg@hi.oru.se
%A Blomberg, Karin
%A Sahlberg-Blom, Eva
%J J Clin Nurs
%D 2007 Feb
%N 2
%P 244-54
%T Closeness and distance: a way of handling difficult situations in daily care
%V 16
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17239059
%X AIMS AND OBJECTIVES: The aim of this study was to describe how care team members caring for patients with advanced cancer describe how they handle difficult situations in daily care. In this paper 'difficult situations' refers to those situations team members themselves describe as difficult. BACKGROUND: Serious illness and impending death involve great changes in a person's life. The care of patients with advanced cancer is complex and many different factors influence each care situation. This places demands on the way care team members handle problems and difficulties in daily care. DESIGN: Qualitative descriptive study. METHODS: The study is based on 16 focus group discussions with care team members who were caring for patients with advanced cancer at three different care units in two Swedish cities. The focus group discussions included 77 participants. The procedure for data analysis was inspired by the phenomenological method. FINDINGS: The results show that care team members handled difficult situations by balancing between being close and distancing themselves. In most situations their choice of strategy seemed spontaneous rather than being a conscious decision, although it was sometimes described as a more conscious approach. Variations of closeness and distance that were identified were Identity, Meaning, Limit-setting and touching, Prioritization, the Team and the Organization. These could also be seen as tools that could facilitate or impede the use of closeness and distance. CONCLUSIONS: The results show that care team members have a need to reflect over daily care and to become aware of what governs different care actions. RELEVANCE TO CLINICAL PRACTICE: If the experienced difficult situation is not handled in a way that is beneficial to the care team member, patient and relatives, it is assumed that this can result in stress, burnout and, above all, non-optimal care

%0 Journal Article
%A Haas, Kenneth B
%J J Am Vet Med Assoc
%D 2007 Feb
%N 3
%P 341
%T Comments on veterinarians' responsibility to society
%V 230
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17323535

%0 Journal Article
%C National Hospice and Palliative Care Organization (S.R.C., C.S.), Alexandria, Virginia; and Milliman, Inc. (B.P., K.F., K.I.), New York, New York, USA
%A Connor, Stephen R
%A Pyenson, Bruce
%A Fitch, Kathryn
%A Spence, Carol
%A Iwasaki, Kosuke
%J J Pain Symptom Manage
%D 2007 Mar
%N 3
%P 238-46
%T Comparing hospice and nonhospice patient survival among patients who die within a three-year window
%V 33
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17349493
%X There is a widespread belief by some health care providers and the wider community that medications used to alleviate symptoms may hasten death in hospice patients. Conversely, there is a clinical impression among hospice providers that hospice might extend some patients' lives. We studied the difference of survival periods of terminally ill patients between those using hospices and not using hospices. We performed retrospective statistical analysis on selected cohorts from large paid claim databases of Medicare beneficiaries for five types of cancer and congestive heart failure (CHF) patients. We analyzed the survival of 4493 patients from a sample of 5% of the entire Medicare beneficiary population for 1998-2002 associated with six narrowly defined indicative markers. For the six patient populations combined, the mean survival was 29 days longer for hospice patients than for nonhospice patients. The mean survival period was also significantly longer for the hospice patients with CHF, lung cancer, pancreatic cancer, and marginally significant for colon cancer (P=0.08). Mean survival was not significantly different (statistically) for hospice vs. nonhospice patients with breast or prostate cancer. Across groups studied, hospice enrollment is not significantly associated with shorter survival, but for certain terminally ill patients, hospice is associated with longer survival times. The claims-based method used death within three years as a surrogate for a clinical judgment to recommend hospice, which means our findings apply to cases where a clinician is very sure the patient will die within three years, and it points to the need to validate these findings

%0 Journal Article
%C Department of Radiation Oncology, Izmir Oncology Center, Izmir, Turkey
%A Unlu, Ismet
%A Diniz, Gulden
%A Komurcuoglu, Berna
%A Gayaf, Mine
%A Gokce, Tumay
%A Karadogan, Ilker
%A Akcay, Cimen
%J Saudi Med J
%D 2006 Jun
%N 6
%P 849-53
%T Comparison of curative and palliative radiotherapy efficacy in unresectable advanced non-small cell lung cancer patients with or without metastasis
%V 27
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=16758049
%X OBJECTIVE: To evaluate the efficacy of curative and palliative radiotherapy in inoperable advanced non-small cell lung cancer (NSCLC) patients with a performance status (PS) equal or greater than 2, and to compare the therapy effect on survival with or without metastatic disease. METHODS: From January 1998 through December 2004, 797 patients with inoperable stage III and IV NSCLC were treated with radiotherapy alone because of older age, cardiovascular disease, insufficient respiratory reserve or general frailty. Radical radiotherapy, consisting of approximately 60 Gy, given in 30 fractions was performed in 363 (45.5 %) of these patients. The other 434 patients (54.5%) were treated with palliative dose radiotherapy. Conventional follow-up of the patients was conducted at Izmir Oncology Center. All results were evaluated statistically. RESULTS: Seven hundred and sixty-three patients (95.7%) were male. The mean age was 61.02 years (+/- 9.678), ranging from 30-88 years. The prominent histology was squamous cell carcinoma (70.7%). Sixty-five patients (8.2%) have been staged IIIA, 419 (52.6%) IIIB, and 313 (39.3%) IV. The median follow up of patients was 274.19 days. One-year survival rate was 37%, and 2-year survival rate was 11% in the radical radiotherapy group, while these rates were 20% and 5% in the others. CONCLUSION: Although radical thoracic radiotherapy for metastatic NSCLC has not been adopted universally, this study shows that curative radiotherapy for the primary tumor provides additional survival benefit in patients with metastatic disease compared with palliative radiotherapy. This result raises the question of whether treatment with radical radiotherapy alone might be the most beneficial and cost-effective treatment of advanced stage NSCLC

%0 Journal Article
%C University of Wisconsin Children's Hospital, USA
%A Jackson, Lori Williams
%J Neonatal Netw
%D 2007 Jan-Feb
%N 1
%P 47-55
%T Congenital nephrotic syndrome
%V 26
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17285887
%X When presented with an edematous infant who may be experiencing a severe infection, particularly an unusual one, it is important to include nephrotic syndrome in the differential diagnosis. Because drastic measures may be required to manage this illness, it is important to be able to recognize symptoms, compile needed diagnostic data, and commence appropriate treatment. A referred pediatric nephrologist can aid in diagnosis, direct management, and educate and support parents. The nephrologist is also instrumental in guiding ongoing care and preparing the infant for transplantation when it becomes necessary

%0 Journal Article
%C Thames Valley University, Slough SL1 1YG, UK. Gaye.kyle@tvu.ac.uk
%A Kyle, Gaye
%J Int J Palliat Nurs
%D 2007 Jan
%N 1
%P 6-16
%T Constipation and palliative care - where are we now?
%V 13
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17353846
%X Constipation is an unpleasant and distressing symptom that many palliative care patients may experience, often having a profound effect on their quality of life. The many management options available reflect the multifactorial nature of constipation. The article explores the complexity of constipation in palliative care and highlights the challenge of managing opioid-induced constipation. Advances in the pharmacological and non-pharmacological management of constipation are reviewed and discussed in the light of relevant research. Further discussion includes definitions, incidence and causes of constipation in palliative care

%0 Journal Article
%C Faculty of Health and Caring Sciences, Institute of Nursing, The Sahlgrenska Academy at Goteborg University, Goteborg, Sweden. usse.knut@telia.com
%A Knutsson, Susanne Em
%A Bergbom, Ingegerd L
%J J Clin Nurs
%D 2007 Feb
%N 2
%P 362-71
%T Custodians' viewpoints and experiences from their child's visit to an ill or injured nearest being cared for at an adult intensive care unit
%V 16
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17239072
%X AIMS AND OBJECTIVES: To describe custodians' experiences of their child's visit to an ill/injured nearest being cared for at an adult intensive care unit (ICU), their thoughts about the visit in relation to the child's health/well being and who initiated the visit. BACKGROUND: Custodians can feel undecided about whether to allow their children to visit the ICU or not. They wonder how important it is for the child to visit, as well as the consequences, and attempt to protect the child from information/experiences that could provoke anxiety or threaten the child's health. DESIGN: Quantitative and descriptive. METHOD: Thirty custodians answered a questionnaire. RESULTS: It was mainly custodians and their children and not staff who initiated the children's visits. Many children were not informed by staff and the responsibility lay instead with the custodians. The importance of giving children adequate information before, during and after the visit was pointed out. The custodians reported that their child's reactions to the visit differed, i.e. reactions reflecting happiness but also sadness; the visit was good for the child, increased awareness of the nearest's condition and appreciation of the hospital staff and their work; if the visit did not take place the child would be left with thoughts and conjectures; their children were not frightened when they saw the equipment and instead they became curious; older children were more focused on the patient while younger children were interested in both the equipment and the patient. Many children asked questions/made comments during the visit. Many custodians were of the opinion that visiting is not a risk to future health and well being. CONCLUSIONS: This issue must be addressed and discussed and strategies need to be developed to improve the nurses' obligation to involve visiting children in the care that is/should be provided to a member of the patient's family. RELEVANCE TO CLINICAL PRACTICE: Nurses need to take more initiative when discussing children's visits with the custodians. Nurses also need to discuss how to meet, inform, support and care for visiting children and their custodians in relation to health and well being. Recommendations/guidelines about children visiting that take both the patient's and child's needs into consideration needs to be developed based on scientific knowledge. Findings from this study may draw attention to children visiting ICUs and encourage nurses to discuss children visiting with custodians and to develop family-centred care at the ICU that includes children

%0 Journal Article
%C University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
%A Feinstein, James A
%J Acad Med
%D 2007 Feb
%N 2
%P 183
%T Death, quietly?
%V 82
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17264698

%0 Journal Article
%C SCO Health Service, Ottawa. Ontario. Canada
%A Hall, P Assistant Professor
%A Weaver, L
%A Gravelle, D
%A Thibault, H
%J J Interprof Care
%D 2007 Jan
%N 1
%P 69-81
%T Developing collaborative person-centred practice: A pilot project on a palliative care unit
%V 21
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17365375
%X Maximizing interprofessional collaborative patient-centred practice holds promise for improving patient care and creating satisfying work roles. In Canada's evolving health care system, there are demands for increased efficiency, cost-effectiveness, and quality improvement. Interprofessional collaboration warrants re-examination because maximizing interprofessional collaboration, especially nurse-physician collaboration, holds promise for improving patient care and creating satisfying work roles. A palliative care team seized the opportunity to pilot a different approach to patient and family care when faced with a reduction in medical staff. Grounded in a collaborative patient-centred practice approach, the Canadian Hospice Palliative Care Association's National Model to Guide Hospice Palliative Care (2002), and outcomes from program retreats and workgroups, a collaborative person-centred model of care was developed for a 12-bed pilot project. Preliminary findings show that the pilot project team perceived some specific benefits in continuity of care and interprofessional collaboration, while the presence of the physician was reduced to an average of 3.82 hours on the pilot wing, compared with 8 hours on the non-pilot wings. This pilot study suggests that a person-centred model, when focused on the physician-nurse dyad, may offer improved efficiency, job satisfaction and continuity of care on a palliative care unit. Incorporating all team members and developing strategies to successfully expand the model across the whole unit are the next challenges. Further research into the impact of these changes on the health care professionals, management and patients and families is essential

%0 Journal Article
%C Physicians for a Smoke-Free Canada and University of Alberta, 1E7.14 Walter C. Mackenzie Centre, 8440 - 112 Street, Edmonton, Alberta, Canada T6G 2B7. Email: cels@ualberta.ca
%A Els, Charl
%A Kunyk, Diane
%A Predy, Gerry
%A Haase, Mary
%J Prev Chronic Dis
%D 2007 Apr
%N 2
%P A30
%T Development and introduction of a comprehensive tobacco control policy in a canadian regional health authority
%V 4
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17362621
%X BACKGROUND: Tobacco control policies in health care settings are necessary to protect patients, employees, physicians, visitors, and volunteers from the dangers of secondhand smoke. This report documents the process of developing and introducing a comprehensive tobacco control policy in one Canadian regional health authority. CONTEXT: Capital Health (CH), a health authority that has 30,000 employees and serves 1.6 million people, is responsible for 18 hospitals and primary care facilities, 33 continuing care facilities, 29 public health locations, and 9 community care facilities. CH recently determined that it needed to revise its tobacco control policy because its facilities had different directives regarding tobacco use, some of which did not reflect the best current knowledge about the health risks associated with exposure to secondhand smoke. METHODS: The new smoke-free policy needed to be developed and executed within a narrow time frame, which required careful planning as well as the support of patients and CH staff members. An essential part of the new policy was the prevention of nicotine withdrawal among people required to undergo involuntary tobacco abstinence. The plan also included an integrated screening, intervention, and referral process designed to optimize health benefits for patients and staff members who smoked, as well as for those who did not. CONSEQUENCES: CH decided to close all smoking rooms (including those in psychiatry, palliative care, geriatrics, eating disorder, and tuberculosis units), to ban smoking in outdoor areas, to stop all sales of tobacco products in CH facilities, to require smoke-free environments during home visitations, and to reject funding from the tobacco industry. INTERPRETATION: By implementing a consistent ban on indoor and outdoor smoking, CH is contributing to a comprehensive tobacco control policy that is arguably a regional health authority's most profound opportunity for health promotion

%0 Journal Article
%A Regnard, Claud
%J BMJ
%D 2007 Mar
%N 7591
%P 440
%T Double effect is a myth leading a double life
%V 334
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17332545

%0 Journal Article
%C Department of Surgery, Kidney Center, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
%A Kato, Yojiro
%A Tojimbara, Tamotsu
%A Iwadoh, Kazuhiro
%A Koyama, Ichiro
%A Nanmoku, Koji
%A Kai, Kotaro
%A Sannomiya, Akihito
%A Nakajima, Ichiro
%A Fuchinoue, Shohei
%A Teraoka, Satoshi
%J Int Immunopharmacol
%D 2006 Dec
%N 13-14
%P 1984-92
%T Early steroid withdrawal protocol with basiliximab, cyclosporine and mycophenolate mofetil in renal-transplant recipients
%V 6
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17161352
%X OBJECTIVE: Adverse effects of steroids have led to efforts to minimize their use in recipients of organ transplants. This study evaluated an early steroid withdrawal protocol including basiliximab, cyclosporine (CsA) and mycophenolate mofetil (MMF) in renal-transplant recipients. METHODS: Between January 2001 and April 2005, our early steroid withdrawal protocol was used in 130 patients who underwent renal transplantation. Immunosuppression consisted of CsA (6-8 mg/kg), MMF (2 g/kg) and methylprednisolone (MP); basiliximab was given as induction therapy (steroid withdrawal group). MP was administered in a dose of 500 mg or 250 mg at renal transplantation; thereafter, the dose was rapidly tapered and MP was withdrawn on day 14 post-transplant. RESULTS: The incidence of acute rejection in the steroid withdrawal group was similar to that in the conventional steroid treatment group (without basiliximab) (18% vs. 21%). The severity of rejection episodes was similar in the two groups. Patient and graft survivals were 100% and 97% in the steroid withdrawal group. In 80 of the 130 patients (62%) in the steroid withdrawal group, MP was successfully withdrawn, with good allograft function during follow-up. In the other 50 patients (38%), MP was reinitiated because of acute rejection or other reasons. The success rate of steroid withdrawal 12 months after transplantation in recipients of ABO-compatible grafts was significantly higher than that in recipients of ABO-incompatible grafts (66% vs. 44%). The dose of MMF during the 12 months after renal transplantation was significantly lower in steroid reinitiated group than in the successful withdrawn group (p<0.05). Patients in the successful withdrawn group showed metabolic benefits such as lower cholesterol levels as compared with the steroid reinitiated group. CONCLUSION: Although further follow-up is necessary to confirm our results, our protocol successfully permitted the early withdrawal of steroids in 62% of renal-transplant recipients, with no resumption of steroid treatment during 3 years of follow-up

%0 Journal Article
%C Departments of Medicine
%A Back, Anthony L
%A Arnold, Robert M
%A Baile, Walter F
%A Fryer-Edwards, Kelly A
%A Alexander, Stewart C
%A Barley, Gwyn E
%A Gooley, Ted A
%A Tulsky, James A
%J Arch Intern Med
%D 2007 Mar
%N 5
%P 453-60
%T Efficacy of communication skills training for giving bad news and discussing transitions to palliative care
%V 167
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17353492
%X BACKGROUND: Few studies have assessed the efficacy of communication skills training for postgraduate physician trainees at the level of behaviors. We designed a residential communication skills workshop (Oncotalk) for medical oncology fellows. The intervention design built on existing successful models by teaching specific communication tasks linked to the patient's trajectory of illness. This study evaluated the efficacy of Oncotalk in changing observable communication behaviors. METHODS: Oncotalk was a 4-day residential workshop emphasizing skills practice in small groups. This preintervention and postintervention cohort study involved 115 medical oncology fellows from 62 different institutions during a 3-year study. The primary outcomes were observable participant communication skills measured during standardized patient encounters before and after the workshop in giving bad news and discussing transitions to palliative care. The standardized patient encounters were audiorecorded and assessed by blinded coders using a validated coding system. Before-after comparisons were made using each participant as his or her own control. RESULTS: Compared with preworkshop standardized patient encounters, postworkshop encounters showed that participants acquired a mean of 5.4 bad news skills (P<.001) and a mean of 4.4 transitions skills (P<.001). Most changes in individual skills were substantial; for example, in the bad news encounter, 16% of participants used the word "cancer" when giving bad news before the workshop, and 54% used it after the workshop (P<.001). Also in the bad news encounter, blinded coders were able to identify whether a standardized patient encounter occurred before or after the workshop in 91% of the audiorecordings. CONCLUSION: Oncotalk represents a successful teaching model for improving communication skills for postgraduate medical trainees

%0 Journal Article
%C Department of Family and Geriatric Medicine, University of Louisville, Louisville, KY
%A Furman, Christian Davis
%A Kelly, Susan E
%A Knapp, Keith
%A Mowery, Robyn L
%A Miles, Toni
%J J Am Med Dir Assoc
%D 2007 Mar
%N 3 Suppl 2
%P e35-41
%T Eliciting goals of care in a nursing home
%V 8
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17352984
%X OBJECTIVES: To identify enablers and barriers facing providers and staff in initiating Goals of Care (GOC) discussions with patients in the nursing home. DESIGN: Qualitative methods, one-on-one interviews. The interviews began with eliciting the participant's definition of GOC. The open-ended questions were designed to assess recent experience and satisfaction with the participant's role in the GOC discussion. SETTING: Nursing home. PARTICIPANTS: We interviewed 23 nursing home staff and providers. MEASUREMENTS: Transcripts were qualitatively analyzed. RESULTS: Five themes emerged that were identified as barriers to discussing GOC: (1) Fear of legal ramifications; (2) Not enough education on how to have a GOC discussion; (3) Family not involved on a regular basis; (4) Time pressure; (5) Interdisciplinary team not involved. Five themes also emerged that were identified as enablers to the GOC discussion: (1) Education/experience with the GOC discussion; (2) Interdisciplinary team involved in the discussion; (3) Established trusting relationship with the patient/family/other staff; (4) Terminal diagnosis/hospice involvement; (5) Discussion occurs in-person. CONCLUSION: A major finding of these interviews is the lack of systematic attention to GOC in the nursing home setting. Since education and experience were identified as crucial to understanding GOC, more formal education and observed practice discussing GOC is needed for all staff. The outcomes of GOC discussions should be documented in the patient record and be accessible to all staff and communicated systematically to all staff. Addressing these barriers and facilitating these enablers to the GOC discussion will improve the care of nursing home patients

%0 Journal Article
%C Office of Nursing Research and Scholarship, The University of Texas at Tyler, College of Nursing and Health Sciences, 3900 University Blvd, Tyler, Texas, USA. gduke@uttyler.edu
%A Duke, Gloria
%A Thompson, Sue
%A Hastie, Mariane
%J Int J Palliat Nurs
%D 2007 Jan
%N 1
%P 39-43
%T Factors influencing completion of advanced directives in hospitalized patients
%V 13
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17353849
%X AIM: A cross-sectional, descriptive study to describe characteristics and other factors that influenced the decision by hospitalized patients in the East Texas area to formulate an advanced directive (AD). FINDINGS: Spouses, family members and sense of spirituality were the strongest influential factors for completion of an AD. Most learned about ADs from family, friends, personal attorneys, and others, while less than a quarter of the sample learned about ADs from health care providers. Not wanting to be a burden on their family was the major reason cited for completing an AD. CONCLUSIONS: Health care provider roles are vague in terms of responsibility for AD discussion and education. Further exploration of the attitudes, knowledge and practices concerning ADs of nurses and primary health care providers is recommended to provide focal points for future research in order to facilitate peace of mind for patients and families at end-of-life

%0 Journal Article
%C Center for Outcomes Research and Education (Ms London), and Regional Nursing Administration (Ms Lundstedt), Providence Health System, Portland, Ore
%A London, Marla R
%A Lundstedt, Janyce
%J J Nurs Care Qual
%D 2007 Apr-Jun
%N 2
%P 152-8
%T Families Speak About Inpatient End-of-Life Care
%V 22
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17353752
%X Death is an emotional event that leaves lasting memories for the bereaved. This article describes the qualitative analysis of a mailed family survey addressing experiences with community hospital inpatient end-of-life care. Family members identified and appreciated symptom management and caring behaviors such as compassion and communication; they also noted the absence of these caring behaviors. Effective application of these behaviors to the dying experience should improve family satisfaction with end-of-life care

%0 Journal Article
%C The Hospice Institute of the Florida Suncoast, Clearwater 33760, USA. kathyegan@thehospice.org
%A Egan, Kathleen A
%A Horvath, Gay Lynn S
%J Home Healthc Nurse
%D 2006 Oct
%N 9
%P 554-8
%T Family caregiving in the last years of life: positive experiences in the midst of suffering
%V 24
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17252961
%X Rising awareness of the physical and emotional toll of caregiving for a loved one highlights the need for health and human service providers to be able to effectively address the needs of caregivers. Through the Caregiving Near Life's End national caregiver research and education project, caregivers shared their experiences, needs, and hopes as the basis for developing tools to help other caregivers. Their wisdom about the challenges and the meaningful opportunities that the last years of life bring can help each of us develop skills to serve families who are living with illness, change, and loss in a better way

%0 Journal Article
%A Diggins, Kristene
%J J Christ Nurs
%D 2007 Jan-Mar
%N 1
%P 30-1
%T Generating hope
%V 24
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17283821

%0 Journal Article
%C Department of Adult Nursing/Palliative Care Nursing, School of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo
%A Miyashita, M
%A Sanjo, M
%A Morita, T
%A Hirai, K
%A Uchitomi, Y
%J Ann Oncol
%D 2007 Mar
%T Good death in cancer care: a nationwide quantitative study
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17355953
%X BACKGROUND: The aims of this study were to (i) conceptualize dimensions of a good death in Japanese cancer care, (ii) clarify the relative importance of each component of a good death and (iii) explore factors related to an individual's perception of the domains of a good death. METHODS: The general population was sampled using a stratified random sampling method (n = 2548; response rate, 51%) and bereaved families from 12 certified palliative care units were surveyed as well (n = 513; 70%). We asked the subjects about the relative importance of 57 components of a good death. RESULTS: Explanatory factor analysis demonstrated 18 domains contributing to a good death. Ten domains were classified as 'consistently important domains', including 'physical and psychological comfort', 'dying in a favorite place', 'good relationship with medical staff', 'maintaining hope and pleasure', 'not being a burden to others', 'good relationship with family', 'physical and cognitive control', 'environmental comfort', 'being respected as an individual' and 'life completion'. CONCLUSIONS: We quantitatively identified 18 important domains that contribute to a good death in Japanese cancer care. The next step of our work should be to conduct a national survey to identify what is required to achieve a good death

%0 Journal Article
%C Cumberland Infirmary, Carlisle, UK
%A Irving, Mark J
%A Irving, Ray J
%A Sutherland, Stuart
%J Int J Palliat Nurs
%D 2007 Feb
%N 2
%P 56-62
%T Graseby MS16A and MS26 syringe drivers: 56 reported effectiveness of an online learning programme
%V 13
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17363863
%X Syringe drivers are commonly used within palliative care to assist with maintaining adequate symptom control. Two of the most common, the Graseby MS16A and MS26, have been associated with a number of serious clinical incidents which have been linked, in part, to inadequate training. This article reports on the results of an online learning programme on managing syringe drivers in palliative care undertaken by 5380 learners between September 2003 and October 2006. The results show that this flexible form of learning environment is acceptable to learners and can lead to improvements in both knowledge and understanding of palliative care issues. Using an online learning model allows large numbers of learners to be educated at minimal cost to either them or their organisation

%0 Journal Article
%C Center for Gerontology and Health Care Research, Department of Community Health, Brown University School of Medicine, Box G-ST211, 2 Stimson Street, Providence, RI 02912
%A Gozalo, Pedro L
%A Miller, Susan C
%J Health Serv Res
%D 2007 Mar
%N 2
%P 587-610
%T Hospice enrollment and evaluation of its causal effect on hospitalization of dying nursing home patients
%V 42
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17362208
%X Objective. To examine the patient, nursing home (NH), hospice provider, and local market factors associated with the selection of the Medicare hospice benefit by eligible NH residents, and evaluate the causal effect of hospice on end-of-life hospitalization rates. Data Sources/Study Setting. Secondary data for 1995-1997 for NH residents. Study Design. This retrospective cohort study includes NH residents in five states (Kansa, Maine, New York, Ohio, South Dakota) who died in the years 1995-1997. Medicare claims identified hospice enrollment and hospitalizations. Geocoding of NHs, hospice providers, and hospitals was used to identify local markets. The two outcome measures are hospice enrollment and hospitalization of NH residents in their last 30 days of life. Data Collection/Extraction Method. A file was constructed linking MDS assessments to Medicare claims and denominator files, NH provider files (OSCAR), hospice provider of service files, and the area resource file. Principal Findings. Twenty-six percent of hospice and 44 percent of nonhospice residents were hospitalized in their last 30 days of life (odds ratio [OR] 0.45; 95 percent confidence interval [CI]: 0.42-0.48). Adjusting for confounders, hospice patients were less likely than nonhospice residents to be hospitalized (OR 0.47; 95 percent CI: 0.45-0.50). Adding inverse propensity score weighting, hospice patients were still less likely than nonhospice residents to be hospitalized (OR 0.56; 95 percent CI: 0.53-0.61). Conclusions. Hospice selection introduces some bias in the evaluation of the causal effect of hospice on end-of-life hospitalization rates. However, even after adjusting for selection bias, hospice does have a powerful effect in reducing end-of-life hospitalization rates

%0 Journal Article
%A Reynolds, Debby
%J Vet Rec
%D 2006 Feb
%N 6
%P 210
%T Humane slaughter of birds
%V 158
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=16474060

%0 Journal Article
%A Leslie, Norman W
%J Vet Rec
%D 2006 Feb
%N 6
%P 210
%T Humane slaughter of birds
%V 158
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=16474059

%0 Journal Article
%C School of Nursing, Room 342, HNES Building, York University, 4700 Keele Street, Toronto, ON M3J 1P3 Canada. rsteele@yorku.ca
%A Steele, Rose
%A Davies, Betty
%J Int J Palliat Nurs
%D 2006 Dec
%N 12
%P 576-85
%T Impact on parents when a child has a progressive, life-threatening illness
%V 12
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17353843
%X Children with neurodegenerative, life-threatening illnesses (NLTIs) account for a significant proportion of children requiring palliative care, yet there is a lack of of research that examines families' experiences. This grounded theory study generated a contextually-grounded description of the experiences of families living with a child who has an NLTI. Data were collected from eight families (n=29 family members) through observations and audiotaped interviews. The impact on parents was pervasive and multidimensional. Parents faced many emotional, physical, financial, and spiritual impacts on their lives. Parents often needed help to alleviate the impact of their experience, but it was not always available in a useful manner. Despite the negative aspects, caring for the child was never viewed by parents as a burden. Fatigue was a particularly prevalent symptom that held the potential to impact on parents in multiple ways. Suggestions for practice and research are offered to assist health care professionals in providing optimal pediatric palliative care to these families

%0 Journal Article
%C Center for Research on Health Care, University of Pittsburgh, 200 Meyran Ave., Suite 200, Pittsburgh, PA, 15213, USA, barnatoae@upmc.edu
%A Barnato, Amber E
%A Chang, Chung-Chou H
%A Saynina, Olga
%A Garber, Alan M
%J J Gen Intern Med
%D 2007 Mar
%N 3
%P 338-45
%T Influence of race on inpatient treatment intensity at the end of life
%V 22
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17356965
%X OBJECTIVE: To examine inpatient intensive care unit (ICU) and intensive procedure use by race among Medicare decedents, using utilization among survivors for comparison. DESIGN: Retrospective observational analysis of inpatient claims using multivariable hierarchical logistic regression. SETTING: United States, 1989-1999. PARTICIPANTS: Hospitalized Medicare fee-for-service decedents (n = 976,220) and survivors (n = 845,306) aged 65 years or older. MEASUREMENTS AND MAIN RESULTS: Admission to the ICU and use of one or more intensive procedures over 12 months, and, for inpatient decedents, during the terminal admission. Black decedents with one or more hospitalization in the last 12 months of life were slightly more likely than nonblacks to be admitted to the ICU during the last 12 months (49.3% vs. 47.4%, p <.0001) and the terminal hospitalization (41.9% vs. 40.6%, p < 0.0001), but these differences disappeared or attenuated in multivariable hierarchical logistic regressions (last 12 months adjusted odds ratio (AOR) 1.0 [0.99-1.03], p = .36; terminal hospitalization AOR 1.03 [1.0-1.06], p = .01). Black decedents were more likely to undergo an intensive procedure during the last 12 months (49.6% vs. 42.8%, p < .0001) and the terminal hospitalization (37.7% vs, 31.1%, p < .0001), a difference that persisted with adjustment (last 12 months AOR 1.1 [1.08-1.14], p < .0001; terminal hospitalization AOR 1.23 [1.20-1.26], p < .0001). Patterns of differences in inpatient treatment intensity by race were reversed among survivors: blacks had lower rates of ICU admission (31.2% vs. 32.4%, p < .0001; AOR 0.93 [0.91-0.95], p < .0001) and intensive procedure use (36.6% vs. 44.2%; AOR 0.72 [0.70-0.73], p <.0001). These differences were driven by greater use by blacks of life-sustaining treatments that predominate among decedents but lesser use of cardiovascular and orthopedic procedures that predominate among survivors. A hospital's black census was a strong predictor of inpatient end-of-life treatment intensity. CONCLUSIONS: Black decedents were treated more intensively during hospitalization than nonblack decedents, whereas black survivors were treated less intensively. These differences are strongly associated with a hospital's black census. The causes and consequences of these hospital-level differences in intensity deserve further study

%0 Journal Article
%C Radiology Residency Training Program, University of Toronto, Toronto, Ont
%A Baerlocher, Mark O
%A Asch, Murray R
%J CMAJ
%D 2007 Mar
%N 6
%P 762-3
%T Interventional radiology in palliative care
%V 176
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17353527

%0 Journal Article
%C Department of Psychiatry, Riga Mental Health Care Centre, Tvaika Street 2, Riga, 1005, Latvia
%A Andrezina, Raisa
%A Josiassen, Richard C
%A Marcus, Ronald N
%A Oren, Dan A
%A Manos, George
%A Stock, Elyse
%A Carson, William H
%A Iwamoto, Taro
%J Psychopharmacology (Berl)
%D 2006 Oct
%N 3
%P 281-92
%T Intramuscular aripiprazole for the treatment of acute agitation in patients with schizophrenia or schizoaffective disorder: a double-blind, placebo-controlled comparison with intramuscular haloperidol
%V 188
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=16953381
%X INTRODUCTION: This double-blind, placebo-controlled study investigated the efficacy and safety of intramuscular (IM) aripiprazole and IM haloperidol for the treatment of acute agitation in patients with schizophrenia or schizoaffective disorder. MATERIALS AND METHODS: Four-hundred and forty-eight patients were randomized (2:2:1 ratio) to IM aripiprazole 9.75 mg, IM haloperidol 6.5 mg, or IM placebo. Patients could receive up to three injections over the first 24 h, with second and third injections administered > or =2 and > or =4 h, respectively, after the first if deemed clinically necessary. Primary efficacy measure was mean change in Positive and Negative Syndrome Scale Excited Component (PEC) score from baseline to 2 h. RESULTS: Mean improvement in PEC at 2 h was significantly greater for IM aripiprazole (-7.27) vs placebo (-4.78; p<0.001); IM aripiprazole was noninferior to IM haloperidol (-7.75) on PEC. All secondary efficacy measures showed significantly greater improvements at 2 h for IM aripiprazole and IM haloperidol over placebo. Mean number of injections/patient and percentage of patients requiring benzodiazepines were significantly lower for IM aripiprazole vs placebo (p<0.01). IM aripiprazole was well tolerated. Extrapyramidal symptom-related adverse events were similar for aripiprazole (1.7%) and placebo (2.3%) and lower than with haloperidol (12.6%). CONCLUSION: These results show that IM aripiprazole is an effective treatment, comparable to IM haloperidol, and well-tolerated for acute agitation in patients with schizophrenia

%0 Journal Article
%C Clinical Genetics Centre, First Floor Argyll House, Cornhill Road, Aberdeen AB25 2ZR, Scotland, UK
%A Simpson, Sheila A
%J Brain Res Bull
%D 2007 Apr
%N 2-3
%P 179-81
%T Late stage care in Huntington's disease
%V 72
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17352944
%X Huntington's disease (HD) is a relentlessly progressive neurodegenerative disease, which is presently incurable. Despite the hope for future therapies that exists for the families, they meantime are aware that there is little that their clinicians can do to delay either onset or progression of the disease. There are unique issues to address in a disorder where patients are aware in advance that their ability to communicate, as well as their cognitive capacity, will become impaired. Most affected individuals have experience of the disease in its late stages because of their parent's and other family member's illness. Many have their own ideas and anxieties about how their own care ought to proceed. There are no published guidelines for management of this stage of disease, although all clinicians involved in the care of HD will have their own experiences to share. This paper describes one method for such management, which includes discussion about placement for care advance directives for feeding and treatment

%0 Journal Article
%A Schroeder-Sheker, Therese
%J Explore (NY)
%D 2007 Mar-Apr
%N 2
%P 161-3
%T Letting Go: The Paradox of Cultural Competence in End-of-Life Care
%V 3
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17362854

%0 Journal Article
%C Cedarville University in Cedarville, Ohio, USA
%A Gibbs, David C
%A Orr, Robert
%J J Christ Nurs
%D 2007 Jan-Mar
%N 1
%P 38-40
%T Life and death disagreements. Interview by Susan A Salladay
%V 24
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17283825

%0 Journal Article
%A Rocker, Graeme
%J Intensive Care Med
%D 2006 Oct
%N 10
%P 1464-6
%T Life-support limitation in the pre-hospital setting
%V 32
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=16896860

%0 Journal Article
%C Centre for Complementary Healthcare and Integrative Medicine (CCHIM), Faculty of Health and Human Science, Thames Valley University, London
%A Buckle, Jane
%J Br J Nurs
%D 2007 Jan
%N 2
%P 116-20
%T Literature review: should nursing take aromatherapy more seriously?
%V 16
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17353823
%X Aromatherapy is often misunderstood and consequently somewhat marginalized. Because of a basic misinterpretation, the integration of aromatherapy into UK hospitals is not moving forward as quickly as it might. Aromatherapy in UK is primarily aimed at enhancing patient care or improving patient satisfaction, and it is frequently mixed with massage. Little focus is given to the real clinical potential, except for a few pockets such as the Micap/South Manchester University initiative which led to a Phase 1 clinical trial into the effects of aromatherapy on infection carried out in the Burns Unit of Wythenshawe Hospital. This article discusses the expansion of aromatherapy within the US and follows 10 years of developing protocols and policies that led to pilot studies on radiation burns, chemo-induced nausea, slow-healing wounds, Alzheimers and end-of-life agitation. The article poses two questions: should nursing take aromatherapy more seriously and do nurses really need 60 hours of massage to use aromatherapy as part of nursing practice?

%0 Journal Article
%C Division of General Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 1620 Tremont Street, Boston, MA, 02120-1613, USA, jhaas@partners.org
%A Haas, JS
%A Earle, CC
%A Orav, JE
%A Brawarsky, P
%A Neville, BA
%A Acevedo-Garcia, D
%A Williams, DR
%J J Gen Intern Med
%D 2007 Mar
%N 3
%P 396-399
%T Lower Use of Hospice by Cancer Patients who Live in Minority Versus White Areas
%V 22
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17356975
%X BACKGROUND: Although hospice care can alleviate suffering at the end of life for patients with cancer, it remains underutilized, particularly by African Americans and Hispanics. OBJECTIVE: To examine whether the racial composition of the census tract where an individual resides is associated with hospice use. DESIGN: Retrospective analysis of the Surveillance, Epidemiology, and End Results-Medicare file for individuals dying from breast, colorectal, lung, or prostate cancer (n = 70,669). MEASUREMENTS: Hospice use during the 12 months before death. RESULTS: Hospice was most commonly used by individuals who lived in areas with fewer African-American and Hispanic residents (47%), and was least commonly used by individuals who lived in areas with a high percentage of African-American and Hispanic residents (35%). Hispanics (odds ratio 0.51, 95% confidence interval 0.29-0.91) and African Americans (0.56, 0.44-0.71) were less likely to use hospice if they lived in a census tract with a high percentage of both African Americans and Hispanics than if they lived in a low minority tract. African Americans and whites were less likely to receive hospice care if they lived in a census tract with a high percentage of Hispanics than if they lived in a low minority area. CONCLUSIONS: Increasing hospice use may require interventions to improve the delivery of hospice care in minority communities

%0 Journal Article
%C University of Louisville, School of Nursing, Louisville, KY 40292, USA. cahoyt01@louisville.edu
%A Zambroski, Cheryl Hoyt
%J Int J Palliat Nurs
%D 2006 Dec
%N 12
%P 566-73
%T Managing beyond an uncertain illness trajectory: palliative care in advanced heart failure
%V 12
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17353842
%X A lack of comprehensive and effective palliative care is clearly evident in a number of studies describing the end of life for patients with advanced heart failure. These patients have been portrayed as experiencing a wide array of poorly managed symptoms. The primary rationale for the lack of care has been the uncertain illness trajectory that characterizes living with advanced heart failure. Nurses must manage care beyond the illness trajectory from an emphasis of palliative care as each of these patients may face significant illness burden and even sudden death. The purpose of this paper is to: discuss the current status of palliative care for patients with advanced heart failure; explain the basic pathophysiology and resulting signs and symptoms of advanced heart failure; describe pharmacological and non-pharmacological symptom management strategies for patients with advanced heart failure

%0 Journal Article
%C Department of Family and Community Medicine, Southern Illinois University School of Medicine, Carbondale, Illinois, USA
%A Shea, Sandra L
%J Acad Med
%D 2006 Jul
%N 7
%P 646-7
%T Medicine and the arts. All Things Wise and Wonderful [excerpt] by James Herriot. Commentary
%V 81
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17354336

%0 Journal Article
%C Ansan College, Korea
%A Ahn, Taesung
%A Kim, Kwibun
%J J Transcult Nurs
%D 2007 Jan
%N 1
%P 28-34
%T Mutual caring of elderly Korean couples
%V 18
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17202526
%X The article described the experiences of elderly couples caring for each other using ethnographic methodology. Ten couples were interviewed in depth. The presence of a support system was found to be the primary requirement of elderly couples. Three taxonomies comprised the support system: (a) desire for respect in care, (b) desire for reliance, and (c) expectation. The close linkage and interaction of desire for care, desire for reliance, and expectations were confirmed. The findings suggested establishing a holistic support network for these elders

%0 Journal Article
%C Division of Gastroenterology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
%A Yan, Brian M
%A Myers, Robert P
%J Am J Gastroenterol
%D 2007 Feb
%N 2
%P 430-8
%T Neurolytic celiac plexus block for pain control in unresectable pancreatic cancer
%V 102
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17100960
%X BACKGROUND: A major focus of palliation in patients with unresectable pancreatic cancer is pain control. The aim of this systematic review was to examine the efficacy and safety of neurolytic celiac plexus blockade (NCPB) compared with standard treatment in randomized controlled trials (RCTs) involving patients with unresectable pancreatic cancer. METHODS: An electronic search was completed (1966 through August, 2005) for RCTs comparing NCPB versus control (standard treatment and/or sham NCPB) in patients with unresectable pancreatic cancer. The primary outcome was pain measured on a 10-point visual analogue scale (VAS). Secondary outcomes included opioid usage, adverse effects, quality of life (QOL), and survival. All outcomes were assessed at 2, 4, and 8 wk. RESULTS: Five RCTs involving 302 patients (NCPB, N = 147; control, N = 155) met the inclusion criteria. Mean age was 61.0 ± 4.3 yr. Compared with control, NCPB was associated with lower VAS scores for pain at 2, 4, and 8 wk (weighted mean difference [WMD]-0.60, 95% CI -0.82 to -0.37). Opioid usage (in mg/d oral morphine) was also reduced at 2, 4, and 8 wk (WMD -85.9, 95% CI -144.0 to -27.9). NCPB was associated with a reduction in constipation (relative risk 0.67, 95% CI 0.49-0.91), but not other adverse events. No differences in survival were observed. QOL could not be adequately analyzed due to differences in outcome scales among studies. CONCLUSIONS: In patients with unresectable pancreatic cancer, NCPB is associated with improved pain control, and reduced narcotic usage and constipation compared with standard treatment, albeit with minimal clinical significance

%0 Journal Article
%C Department of Nursing and Health Care Practices, Southern Cross University, Lismore, New South Wales, Australia. nel.glass@scu.edu.au
%A Rose, Jayln
%A Glass, Nel
%J Int J Palliat Nurs
%D 2006 Dec
%N 12
%P 588-94
%T Nurses and palliation in the community: the current discourse
%V 12
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17353844
%X A core component of community nursing practice in Australia is the provision of palliative care, however this area of practice has been minimally researched. We, therefore, undertook a broader review of the contemporary literature in community nursing; palliative nursing; and community nursing palliative care. Literature was searched electronically in OVID, CINAHL and nursing databases and manually in relevant journals. Findings revealed community and palliative care nursing to be both complex and challenging. Community and palliative nurses ideals for care are compromised by competing practice demands. Changing health systems and philosophical views, limited resources and the perceived 'visibility/invisibility' polarity are identified as major job stressors. Therapeutic use of 'self' and interpersonal communication are recognized as contributing to job satisfaction. Community nurses providing palliative care is as an under researched area yet it is a role that arguably requires critical understanding and recognition. Further research is needed into the relationship between emotional well-being and professional satisfaction for community and palliative care nurses providing palliation

%0 Journal Article
%C Canterbury Christchurch University College, North Holmes Road, Kent, CT1 1QU. mvm1@canterbury.ac.uk
%A Morrissey, Mathhew V
%J Int J Psychiatr Nurs Res
%D 2007 Jan
%N 2
%P 1415-28
%T Our first child was incompatible with life: understanding miscarriage as a lived experience
%V 12
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17283956
%X Miscarriage as a medical experience is removed several times from the lived experience of a mother, partner and family. Often there is no space to grieve and mourn to facilitate that. In this article it will be shown that the lived experience of a miscarriage challenges the notion of care and loss forever. Ask a woman the memory is always there and very often the pain. It's important to let the wisdom of sadness speak and emotions to flow unhurried. Emotions need to be set free. What is less appreciated is that professional carers often feel at a loss themselves and they too need love and support. Staff and relatives are sometimes in different contexts of awareness and information about diagnosis and all aspects of care often need to be translated The experience of loss is not only related to death but to loss of hope, dreams, function and handing over care to another carer. Dealing with loss is a feature of being human, but dealing with multiple losses is sadly often a part of being a practicing nurse and midwife. It is time to really appreciate what it means to live through a miscarriage. What we need now to do is move beyond a medical experience into creating a space where a woman can feel safe and loved to grieve for all that is lost and all that could have been

%0 Journal Article
%A Soyannwo, Olaitan A
%J J Public Health Policy
%D 2007 
%N 1
%P 56-8
%T Palliative care and public health, a perspective from Nigeria
%V 28
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17363936

%0 Journal Article
%A Mwangi-Powell, Faith
%J J Public Health Policy
%D 2007 
%N 1
%P 59-61
%T Palliative care and public health, a perspective from the african palliative care association
%V 28
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17363937

%0 Journal Article
%C Department of Family and Geriatric Medicine, University of Louisville School of Medicine, Louisville, Kentucky
%A Furman, Christian Davis
%A Pirkle, Rebecca
%A O'brien, James G
%A Miles, Toni
%J J Am Med Dir Assoc
%D 2007 Mar
%N 3
%P 198
%T Palliative care in the nursing home
%V 8
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17349951

%0 Journal Article
%A Webster, Ruth
%A Lacey, Judith
%A Quine, Susan
%J J Public Health Policy
%D 2007 
%N 1
%P 28-39
%T Palliative care: a public health priority in developing countries
%V 28
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17363933
%X Palliative care is an emerging specialist discipline worldwide with the majority of services located in developed countries. Developing countries, however, have higher incidences of cancer and AIDS and most of these patients would benefit from palliative care. While there is prominent coverage of this issue in the palliative care literature, there is limited coverage in the specialist public health literature, which suggests that the challenges of palliative care may not yet have been generally recognized as a public health priority, particularly in developing countries. The aim of this article is to introduce the topic of "Palliative care in developing countries" into the specialist public health literature to raise awareness and stimulate debate on this issue among public health professionals and health policy makers, thereby potentially facilitating establishment of palliative care services in developing countries.Journal of Public Health Policy (2007) 28, 28-39. doi:10.1057/palgrave.jphp.3200097

%0 Journal Article
%A Stjernsward, Jan
%J J Public Health Policy
%D 2007 
%N 1
%P 42-55
%T Palliative care: the public health strategy
%V 28
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17363935
%X There is the knowledge to improve the Quality of Life, Dying and Death of cancer sufferers, other patients dying of chronic diseases, HIV/AIDS and the children and elderly terminally ill and their caring family members, an estimated 100 million people globally, if palliative care and pain relief would be available. Tragically however, palliative care is only reaching a lucky few. Two third of those in need of palliative care are in the low or middle income countries.The World Health Organization (WHO) has pioneered a public health strategy to integrate palliative care into existing healthcare systems as this offers the best approach for translating new knowledge and skills into evidence-based, cost-effective interventions that can reach everyone in the population, when incorporated by governments into all levels of their healthcare systems and owned by the community. The WHO Strategy starts by establishing four foundation measures, key components that are: 1) appropriate policies, 2) adequate drug availability, 3) education of the public, policymakers and the public and 4) implementation.The WHO Model has shown that it provides an effective strategy for countries to establish palliative care. The Open Society Institute has actively supported countries to establish National Palliative Care Programs according to these principles. Combined with a community strategy that involves the society through collective and social action"Palliative Care for All" indeed could become a reality.Journal of Public Health Policy (2007) 28, 42-55. doi:10.1057/palgrave.jphp.3200115

%0 Journal Article
%A Wijngaards-de, Meij L
%A Stroebe, M
%A Schut, H
%A Stroebe, W
%A van, den Bout J
%A van, der Heijden PG
%A Dijkstra, I
%J Pers Soc Psychol Bull
%D 2007 Mar
%T Patterns of Attachment and Parents' Adjustment to the Death of Their Child
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17363759
%X The impact of adult attachment on psychological adjustment among bereaved parents and the mediating effect of relationship satisfaction were examined among a sample of 219 couples of parents. Data collection took place 6, 13, and 20 months after loss. Use of the actor partner interdependence model in multilevel regression analysis enabled exploration of both individual as well as partner attachment as predictors of grief and depression. Results indicated that the more insecurely attached parents were (on both avoidance and anxiety attachment), the higher the symptoms of grief and depression. Neither the attachment pattern of the partner nor similarity of attachment within the couple had any influence on psychological adjustment of the parent. Marital satisfaction partially mediated the association of anxious attachment with symptomatology. Contrary to previous research findings, avoidant attachment was associated with high grief intensity. These findings challenge the notion that the avoidantly attached are resilient

%0 Journal Article
%C Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA. carol.kelley@case.edu
%A Kelley, Carol G
%A Daly, Barbara J
%A Douglas, Sara L
%A Standing, Theresa
%J Int J Palliat Nurs
%D 2007 Jan
%N 1
%P 30-8
%T Racial differences in perceptions held by caregivers of long-term ventilator patients at end of life
%V 13
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17353848
%X AIM: The purpose of this pilot study was to describe and compare perceptions of preparation for death and satisfaction with end-of-life care in African American and Caucasian caregivers of long-term ventilator (LTV) patients. DESIGN: A comparative descriptive design was used to pilot test items from specific domains from the After-Death Bereaved Family Member Interview. Interviews were conducted on 37 bereaved caregivers of LTV patients who participated in a large experimental study. FINDINGS: There was a statistically significant association between African American and Caucasian caregivers in the area of being informed of the patient's condition. African American caregivers felt more informed than Caucasian caregivers. Over half of African American and Caucasian caregivers reported feeling 'fairly to very confident' about what to expect when their loved one was dying. CONCLUSION: Health care providers should be sensitive to potential differences between African American and Caucasian family caregivers in providing end-of-life care

%0 Journal Article
%A Smith, Gerald D
%J J Am Vet Med Assoc
%D 2007 Feb
%N 3
%P 338-9; author reply 339
%T Requests information on euthanasia method in a budgerigar
%V 230
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17326288

%0 Journal Article
%C Department of Psychiatry, Columbia University, and the Department of Neuroscience, New York State Psychiatric Institute, Unit 42, 1051 Riverside Dr., New York, NY 10032, USA
%A Freed, Peter J
%A Mann, J John
%J Am J Psychiatry
%D 2007 Jan
%N 1
%P 28-34
%T Sadness and loss: toward a neurobiopsychosocial model
%V 164
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17202540

%0 Journal Article
%A Kammler, Jurgen
%A Hofmann, Robert
%A Steinwender, Clemens
%A Kypta, Alexander
%A Leisch, Franz
%J Clin Res Cardiol
%D 2006 Oct
%N 10
%P 560-4
%T Simultaneous angiographic late stent thrombosis in two different coronary vessels after withdrawal of the combined anti-platelet therapy
%V 95
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=16897146

%0 Journal Article
%A Freeman, Phyllis
%J J Public Health Policy
%D 2007 
%N 1
%P 26-7
%T Special section: palliative care as a public health issue in the developing world
%V 28
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17363932

%0 Journal Article
%C Division of Pediatric Cardiology, Department of Pediatrics and Communicable Diseases, University of Michigan Health System, Ann Arbor, Michigan 48109-0204, USA
%A Gossett, Jeffrey G
%A Rocchini, Albert P
%A Armstrong, Aimee K
%J Catheter Cardiovasc Interv
%D 2007 Jan
%N 1
%P 28-32
%T Superior vena cava thrombectomy with the X-SIZER catheter system in a child with Fontan palliation
%V 69
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17139678
%X A 4-year-old female with hypoplastic left heart syndrome and Fontan palliation presented with severe neurologic impairment from thrombosis of the superior vena cava (SVC). She underwent successful SVC thrombectomy with the X-SIZER Thrombectomy Catheter System, followed by balloon angioplasty. She demonstrated rapid improvement in her neurologic deficits after the procedure. This represents the first published use of the X-SIZER in a child and its first published use for SVC thrombectomy

%0 Journal Article
%C Griffin Hospital, Derby, CT, USA
%A Fazal, Salman
%A Saif, Muhammad Wasif
%J JOP
%D 2007 
%N 2
%P 240-53
%T Supportive and palliative care of pancreatic cancer
%V 8
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17356251
%X Pancreatic cancer is one of the most lethal malignancies. An estimated 32,300 patients will die of pancreatic cancer in year 2006. It is the tenth most common malignancy in the United States. Despite recent advances in pathology, molecular basis and treatment, the overall survival rate remains 4% for all stages and races. Palliative care represents an important aspect of care in patient with pancreatic malignancy. Identifying and treating disease related symptomology are priorities. As a physician taking care of these patients it is essential to know these symptoms and treatment modalities. This review discusses symptom management and supportive care strategies. Common problems include pain, intestinal obstruction, biliary obstruction, pancreatic insufficiency, anorexia-cachexia and depression. Success is needed in managing these symptoms to palliate patients with advanced pancreatic cancer. Pancreatic cancer is a model illness to learn the palliative and supportive management in cancer patient. It is important for oncologists to recognize the importance of control measures and supportive measures that can minimize the symptoms of advanced disease and side effects of cancer treatment

%0 Journal Article
%C Psychology Department, Pomona College, Claremont, CA, USA. ken.miller@pomona.edu
%A Miller, Kenneth E
%A Omidian, Patricia
%A Quraishy, Abdul Samad
%A Quraishy, Naseema
%A Nasiry, Mohammed Nader
%A Nasiry, Seema
%A Karyar, Nazar Mohammed
%A Yaqubi, Abdul Aziz
%J Am J Orthopsychiatry
%D 2006 Oct
%N 4
%P 423-33
%T The Afghan symptom checklist: a culturally grounded approach to mental health assessment in a conflict zone
%V 76
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17209710
%X This article describes a methodology for developing culturally grounded assessment measures in conflict and postconflict situations. A mixed-method design was used in Kabul, Afghanistan, to identify local indicators of distress and develop the 22-item Afghan Symptom Checklist (ASCL). The ASCL contains several indigenous items and items familiar to Western mental health professionals. The ASCL was pilot tested and subsequently administered to 324 adults in 8 districts of Kabul. It demonstrated excellent reliability (alpha=.93) and good construct validity, correlating strongly with a measure of exposure to war-related violence and loss (r=.70). Results of the survey indicate moderate levels of distress among Afghan men and markedly higher levels of distress and impaired functioning among women (and widows in particular)

%0 Journal Article
%A Kapp, Marshall B
%J J Opioid Manag
%D 2006 Mar-Apr
%N 2
%P 73-4
%T The US Supreme Court decision on assisted suicide and the prescription of pain medication: limit the celebration
%V 2
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17315421

%0 Journal Article
%C Professional Resource Center, National Multiple Sclerosis Society, 733 Third Avenue, New York, New York, 10017, USA
%A Kalb, R
%J J Neurol Sci
%D 2007 Mar
%T The emotional and psychological impact of multiple sclerosis relapses
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17350045
%X Acute relapses of multiple sclerosis (MS) are experienced as crises that disrupt the status quo for individuals with MS and their families. These unpredictable-and always unexpected-events elicit strong reactions, including grief, anxiety, anger, and guilt, as people struggle to understand why they occur. Although early relapses are a signal for most MS specialists to recommend treatment with one of the approved disease-modifying therapies, the remissions that follow contribute to patient and family denial about the realities of the disease, making it difficult for patients to begin and to adhere to ongoing treatment. Each ensuing attack confronts this denial, forcing patients and families to acknowledge the MS diagnosis and begin adapting to the demands of the illness in their daily lives. This paper discusses the meaning attributed by individuals and families to relapses leading to the MS diagnosis and the recommendation for disease-modifying therapy, the adjustments that are made by patients and their families to residual deficits following acute episodes, and suggestions for clinicians on how they might facilitate the adjustment process

%0 Journal Article
%C Community Health and Education Studies (CHESs) Research Centre, Coach Lane Campus East (H012), Coach Lane, Northumbria University, Newcastle upon Tyne NE7 7XA, UK. monique.lhussier@unn.ac.uk
%A Lhussier, Monique
%A Carr, Susan M
%A Wilcockson, Jane
%J Int J Palliat Nurs
%D 2007 Feb
%N 2
%P 74-81
%T The evaluation of an end-of-life integrated care pathway
%V 13
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17363865
%X Aim: this evaluation set out to examine the needs of staff as they adopted an end-of-life integrated Care Pathway (ICP), and its impact on both service users and providers. Method: semi-structured interviews were conducted with palliative care specialists, other health care professionals and bereaved carers. Results: the challenges encountered revolved around the multitude of settings, and professionals involved; around the diagnosing of dying; communication with patients and the provision of emotional or spiritual support. Ongoing challenges at the end of the evaluation were those of addressing spirituality and some of the established practices. However, there was general consensus that the ICP facilitated greater consistency of care, improved continuity, and ensured a proactive rather than a reactive approach to care. All these were recognised and appreciated by bereaved carers. Conclusion: end of life is now every health care professional's business and this may have the potential to raise the place of palliative care in general on the professional agenda

%0 Journal Article
%C Northumbria Healthcare Trust, North Tyneside General Hospital, Rake Lane, North Shields Tyne and Wear NE29 8NH
%A Tuffrey, Catherine
%A Finlay, Fiona
%A Lewis, Mary
%J Int J Palliat Nurs
%D 2007 Feb
%N 2
%P 64-71
%T The needs of children and their families at end of life: an analysis of community nursing practice
%V 13
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17363864
%X Background: there are few studies in the literature describing or evaluating the workload of children's community nurses prior to and following the death of a child with a non-oncological life-limiting disorder. Method: a documentary analysis of nursing records of all children under the care of the Lifetime Service who died during a 5-year period was carried out. Results: the number of visits and telephone calls involving children's community nurses in the end of life and bereavement periods was analysed and the level of the input to families found to vary widely. In total, the number of visits range from 0 to 50 (median 8). The total number of telephone calls made or received for each child ranged from 0 to 127 (median 20). Calls and visits were with a wide range of people relating to diverse subject areas and continued even when children were in hospital. Conclusion: community children's nurses liase with a wide range of professionals and organisations and the nature of their workload at the end of life is often hidden

%0 Journal Article
%C Division of Pulmonary and Critical Care Medicine and Program in Medical Ethics, Department of Medicine, School of Medicine, University of California, San Francisco
%A White, Douglas B
%A Braddock, Clarence H 3rd
%A Bereknyei, Sylvia
%A Curtis, J Randall
%J Arch Intern Med
%D 2007 Mar
%N 5
%P 461-7
%T Toward shared decision making at the end of life in intensive care units: opportunities for improvement
%V 167
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17353493
%X BACKGROUND: In North America, families generally wish to be involved in end-of-life decisions when the patient cannot participate, yet little is known about the extent to which shared decision making occurs in intensive care units. METHODS: We audiotaped 51 physician-family conferences about major end-of-life treatment decisions at 4 hospitals from August 1, 2000, to July 31, 2002. We measured shared decision making using a previously validated instrument to assess the following 10 elements: discussing the nature of the decision, describing treatment alternatives, discussing the pros and cons of the choices, discussing uncertainty, assessing family understanding, eliciting patient values and preferences, discussing the family's role in decision making, assessing the need for input from others, exploring the context of the decision, and eliciting the family's opinion about the treatment decision. We used a mixed-effects regression model to determine predictors of shared decision making and to evaluate whether higher levels of shared decision making were associated with greater family satisfaction. RESULTS: Only 2% (1/51) of decisions met all 10 criteria for shared decision making. The most frequently addressed elements were the nature of the decision (100%) and the context of the decision to be made (92%). The least frequently addressed elements were the family's role in decision making (31%) and an assessment of the family's understanding of the decision (25%). In multivariate analysis, lower family educational level was associated with less shared decision making (partial correlation coefficient, 0.34; standardized beta, .3; P = .02). Higher levels of shared decision making were associated with greater family satisfaction with communication (partial correlation coefficient, 0.15; standardized beta, .09; P = .03). CONCLUSIONS: Shared decision making about end-of-life treatment choices was often incomplete, especially among less educated families. Higher levels of shared decision making were associated with greater family satisfaction. Shared decision making may be an important area for quality improvement in intensive care units

%0 Journal Article
%C VA Palo Alto Health Care System, 795 Willow Road (152 MPD), Menlo Park, CA 94025, USA
%A Richardson, Samuel S
%A Sullivan, Greer
%A Hill, Ariel
%A Yu, Wei
%J Health Serv Res
%D 2007 Feb
%N 1 Pt 1
%P 183-200
%T Use of aggressive medical treatments near the end of life: differences between patients with and without dementia
%V 42
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17355588
%X OBJECTIVE: To analyze whether acute care patients with dementia are more or less likely to receive each of five aggressive medical services near the end of life, compared with patients without dementia. DATA SOURCES: Two years of Veterans Affairs (VA) and Medicare utilization data for all 169,036 VA users nationwide age 67 and older who died between October 1, 1999 and September 30, 2001. STUDY DESIGN: We performed a retrospective analysis of acute care stays discharged in the final 30 days of life. The main outcome measure was the patient's likelihood of receiving each of five aggressive services (intensive care unit [ICU] admission, ventilator, cardiac catheterization, pulmonary artery monitor, and dialysis), controlling for demographic and clinical factors in probit regressions. PRINCIPAL FINDINGS: There were 122,740 acute-stay discharges during the final 30 days of life, representing 94,100 unique patients (31,654 with dementia). In probit models comparing acute care patients with and without dementia, patients with dementia were 7.5 percentage points less likely to be admitted to the ICU (95 percent confidence interval [CI], 6.9-8.1; percent of stays with ICU admission=36.8 percent), 5.4 percentage points less likely to be placed on a ventilator (95 percent CI, 5.0-5.9; percent of stays with ventilator use=17.1 percent), 0.7 percentage points less likely to receive cardiac catheterization (95 percent CI, 0.6-0.8; percent of stays with cardiac catheterization=2.7 percent), 1.4 percentage points less likely to receive pulmonary artery monitoring (95 percent CI, 1.2-1.5; percent of stays with pulmonary artery monitoring=2.6 percent), and 0.6 percentage points less likely to receive dialysis (95 percent CI, 0.4-0.8; percent of stays with dialysis=4.6 percent). CONCLUSIONS: During the final 30 days of life, acute care patients with dementia are treated substantially less aggressively than patients without dementia. Further research is warranted to determine the causes and appropriateness of these patterns of care

%0 Journal Article
%C University of Minnesota, USA
%A Westra, Bonnie L
%A Solomon, Debra
%A Ashley, Donna M
%J J Healthc Inf Manag
%D 2006 Summer
%N 3
%P 88-94
%T Use of the Omaha System data to validate Medicare required outcomes in home care
%V 20
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=16903666
%X Millions of dollars have been spent developing standardized terminologies for nursing. However, many nurses are unaware of them, because vendors have not incorporated them into electronic health records (EHRs), and quality assurance staff and researchers have not benefited from reuse of the data to examine practice. Government regulations require the use of particular data sets, such as OASIS in home care. Most staff and agencies are focused on government-mandated data without realizing how the nationally recognized terminologies for nursing can benefit an agency. This article seeks to demonstrate the value of using the Omaha System in an EHR for documenting care and conducting Medicare's required Outcome-Based Quality Improvement process in one home care agency

%0 Journal Article
%A Sheldon, E C
%A Howe, R
%A Selman, T
%A Mann, C
%A Ganesan, R
%J Histopathology
%D 2007 Feb
%N 3
%P 397-400
%T Uterine malignant mesenchymoma, arising in a leiomyoma, with pulmonary metastases
%V 50
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17257144

%0 Journal Article
%A Charlton, Rodger
%J Br J Gen Pract
%D 2007 Mar
%N 536
%P 247
%T Viewpoint - the demise of palliative care
%V 57
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17359623

%0 Journal Article
%C University of Maryland Center for Integrative Medicine, Baltimore, USA. wboggs@compmed.umm.edu
%A Boggs, William M
%J Explore (NY)
%D 2007 Jan-Feb
%N 1
%P 62-3
%T We can't go on dying this way
%V 3
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17234572

%0 Journal Article
%C Research College of Nursing in Kansas City, Missouri, USA
%A Sweat, Mary T
%J J Christ Nurs
%D 2007 Jan-Mar
%N 1
%P 42
%T What are the spiritual needs of terminally ill patients?
%V 24
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17283827

%0 Journal Article
%C Forest Holme, Poole Hospital NHS Trust. Poole
%A Dorman, S
%A Byrne, A
%A Edwards, A
%J Palliat Med
%D 2007 Mar
%T Which measurement scales should we use to measure breathlessness in palliative care? A systematic review
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17363394
%X Introduction: There is no universally accepted measurement scale to assess breathlessness in adult palliative care patients. This significantly hampers clinical practice and research into effective interventions. The aim is to systematically identify and appraise breathlessness measurement scales, which are validated for use in palliative care or which show potential for use. Methods: We undertook systematic searches of electronic databases (Cochrane databases 2005, MEDLINE 1966-2005, OLDMEDLINE 1950-1965, EMBASE 1980-2005, PsycINFO 1872-2005, AMED 1985-2005, CINAHL 1982-2005, SIGLE 1980-2005) with follow-up searches (reference lists of included papers, handsearches of relevant journals). The basic search strategy was 'breathlessness (etc.) AND measurement (scales, validation etc.) AND palliative care/cardiac failure/respiratory disease/neoplasm etc.', modified for each database, without language restriction. Patient-based scales with evaluations of at least two psychometric characteristics were included. Exercise-based tests were excluded. Scales were appraised with particular emphasis on construct validity and responsiveness.Results: We identified 29 scales: six to measure breathlessness severity, four to assess breathlessness descriptions, and 19 to measure functional impact of breathlessness.Severity: The Numeric Rating Scale (NRS) and modified Borg Scale have been evaluated in COPD (the NRS has also been evaluated in cancer). Both require further assessment of responsiveness and test-retest reliability over time intervals relevant to palliative care. Visual Analogue Scales have also been evaluated, but require larger sample sizes than NRS for evidence of intervention effectiveness. Descriptions: The Japanese Cancer Dyspnoea Scale (CDS) has been evaluated in patients with cancer, but requires further assessment of construct validity and responsiveness. Functional impact: The Chronic Respiratory Questionnaire dyspnoea subscale (CRQ-D) has been evaluated in chronic lung diseases and heart failure; the MND Respiratory Scale is similar. CRQ-D has face and construct validity, test-retest reliability and responsiveness, and shows promise for palliative care. Conclusion: The NRS, modified Borg, CRQ-D and CDS appear most suitable for use in palliative care, but further evaluation is required before adopting any scale as standard. This review has been registered with the Cochrane collaboration and will be published and updated as a Cochrane review

%0 Journal Article
%C Department of Medicine and Neiswanger Institute for Bioethics and Health Policy, Loyola University Medical Center, Maywood, Illinois, USA
%A Egan, Erin A
%J J Opioid Manag
%D 2005 Mar-Apr
%N 1
%P 11-2
%T Who should regulate the practice of medicine?
%V 1
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17315405

%0 Journal Article
%C School of Nursing, Otago Polytechnic, Dunedin. coletteb@tekotago.ac.nz
%A Blockley, Colette
%A Moore, Yvette
%J Nurs N Z
%D 2006 Dec-2007
%N 11
%P 23-5
%T Working among the poorest of the poor
%V 12
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17252752

%0 Journal Article
%C Klinik fur Psychiatrie und Psychotherapie, Technische Universitat Munchen, Ismaninger Strasse 22, 81675, Munchen, Germany. HansLauter@t-online.de
%A Lauter, H
%A Helmchen, H
%J Nervenarzt
%D 2006 Sep
%N 9
%P 1031-2, 1034-6, 1038-9
%T [Advance refusal of treatment in case of loss of autonomy due to persistent brain disease]
%V 77
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=16810526
%X A short overview is given of the current debate on ethics and legal clarification of the range and binding force of so-called living wills demanding interruption of treatment in case of loss of autonomy due to persistent or progressive brain disease. Using the examples of dementia and persistent vegetative states - conditions with growing significance for psychiatrists - the binding force of living wills is examined for cases in which the irreversibility and extent of consciousness loss cannot be predicted with certainty. The range of living wills' authority appears also unclear. Legal proposals for limiting them to disease conditions near death are confronted by other proposals that reject such limitations. Added to this is the medical uncertainty of assessing the criterion nearness to death in irreversible and life-limiting diseases. The patient's right of self-determination, confirmed by high court decisions, to refuse in advance treatments that are life-prolonging but require consent is opposed to the medical obligation to save life and act in the patient's best interest. Moral dilemmas caused by this situation on the part of physicians, carepersons, and relatives or others, particularly authorized persons, should be solved by an exhaustive discussion with all persons who are involved in such decisions, and in a way that comes as near as possible to the patients living will

%0 Journal Article
%C Palliative Care Department, St. Luke's International Hospital
%A Hayashi, Akitoshi
%J Nippon Rinsho
%D 2007 Jan
%N 1
%P 35-40
%T [Best practice of pain management with opioids]
%V 65
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17233413
%X Opioids are main drugs in pain management for terminal cancer patients. In these days, we have to choice suitable opioids for the terminal cancer patients with severe pain by opioids rotation. Morphine is a basic drug in opioids. To know about character of morphine make us easy for using other opioids. In this article, character and some points in using opioids were described in detail. For example, timing for administrating opioids, titration, rescue dose, and side effects were included in this article. We don't have to remember the aim of pain management. Pain control is not a purpose, but a way for keeping QOL of the terminal cancer patients

%0 Journal Article
%C Department of Anesthesiology And Resuscitology, Ehime University Graduate School of Medicine
%A Nagaro, Takumi
%A Tsubota, Shinzo
%J Nippon Rinsho
%D 2007 Jan
%N 1
%P 103-8
%T [Cancer pain treatment with nerve blocks and neuroablative procedures]
%V 65
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17233424
%X The management of opioid resistant cancer pain is a significant issue for palliative medicine. Certain types of pain can be relieved effectively using nerve blocks without exacerbating and sometimes improving daily activity as long as proper patient selection and technique are employed. Continuous epidural and subarachnoid block, celiac plexus block, superior hypogastric plexus block, subarachnoid phenol block and percutaneous cervical cordotomy are common pain treatment procedures. In our pain clinic, these procedures were performed on about 20% of cancer pain patients, most of whom experienced pain relief without serious complications. Proper use of nerve blocks and neuroablative procedures can undoubtedly improve the management of cancer pain and should be a significant component of the strategy for cancer pain relief

%0 Journal Article
%C Oncology Center, Division of Medical Oncology, University of Tokai School of Medicine
%A Eguchi, Kenji
%J Nippon Rinsho
%D 2007 Jan
%N 1
%P 11-5
%T [Current perspectives and future direction of palliative medicine for cancer patients in Japan]
%V 65
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17233409
%X Role of palliative medicine for cancer patients has been expanding to even in earlier stage of disease. We have various new drugs in palliation of symptoms and signs, such as severe pain due to tumor invasion, depression, nausea and vomiting, chemotherapy-induced anemia and neutropenia, etc. Recently pharmacogenomics and drug metabolism became to be focused in cancer treatment. It may cause unexpected toxicity due to drug-drug interaction and may raise unreasonably lower effect due to individual heterogeneity of drug metabolism. To facilitate and maintain better-quality palliative medicine allover Japan, a well-organized educational system and multi-institutional research groups should be established on the basis of a large academic and clinical association. The Japanese Society of Palliative Medicine (JSPM) is one of the candidate of these tasks. The JSPM consists with more than 4,900 members of doctors, nurses and other health professionals who are working in palliative cancer medicine. They have conducting to make guidelines for each symptom control and to increase lobby action to establish efficient networks of palliative cancer medicine in each district of Japan within several years

%0 Journal Article
%C Observatoire regional de la sante Provence Alpes Cote d'Azur (ORS Paca), Marseille (13); Inserm UMR 379, Marseille (13)
%A Bendiane, MK
%A Galinier, A
%A Obadia, Y
%A Favre, R
%A Ribiere, C
%A Moatti, JP
%A Peretti-Watel, P
%J Presse Med
%D 2007 Mar
%T [Knowledge and attitudes of private practice nurses about end-of-life pain.]
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17363210
%X BACKGROUND: Nurses play a crucial role in end-of-life care, especially for outpatients. It is important to assess their knowledge and attitudes regarding pain management during the end-of-life period. METHODS: A random national sample of 602 French nurses providing home care responded to a telephone survey. The questionnaire included a scale of knowledge about pain and a short clinical case related to severe pain management, requiring WHO level 3 analgesia, for a dying patient. RESULTS: The pain knowledge score depended on nurses' training and was higher for those living with another health professional. For the clinical case, only 60% of nurses favored the prescription of the analgesia recommended by international guidelines. This support depended on objective skills in pain management, but was less frequent for elderly or women patients. DISCUSSION: Attitudes toward pain management at the end of life do not depend only on book learning. They are also influenced by more subjective factors that may cause inequality in care for women and the elderly. Nurse training programs should take such factors into account

%0 Journal Article
%C Universitatsklinik Feiburg, Abteilung Psychosomatische Medizin und Psychotherapie, Freiburg. carl.eduard.scheidt@uniklinik-freiburg.de
%A Scheidt, Carl Eduard
%A Waller, Nicola
%A Wangler, Jutta
%A Hasenburg, Anette
%A Kersting, Anette
%J Psychother Psychosom Med Psychol
%D 2007 Jan
%N 1
%P 4-11
%T [Mourning after perinatal death--prevalence symptoms and treatment--a review of the literature]
%V 57
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17357028
%X Miscarriage and perinatal loss are associated with considerable psychosocial distress. A substantial proportion of women who suffered the loss of a child develop a psychological disorder. Depression, anxiety disorder, post-traumatic stress disorder and somatoform disorder all have been linked in various studies to grief reactions in response to perinatal loss. A number of studies based on clinical and empirical evidence suggest various therapeutic procedures. However, a current Cochrane review fails to provide empirical evidence favouring a specific treatment strategy. In Germany in routine care in gynaecology no psychological support is offered to women suffering from grief reactions due to perinatal loss. Further research is needed to develop evidence based treatment strategies for secondary prevention in this field

%0 Journal Article
%C Department of Medical Oncology, National Cancer Center Hospital
%A Katayama, Hirofumi
%A Katsumata, Noriyuki
%J Nippon Rinsho
%D 2007 Jan
%N 1
%P 98-102
%T [Palliative chemotherapy in cancer patients]
%V 65
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17233423
%X Palliative chemotherapy is applied for incurable cancer patients to prolong their survival, decrease their cancer-related symptoms, and improve their quality of life. These are important end points in clinical trials of palliative chemotherapy. A lot of clinical studies have demonstrated the palliative effect of chemotherapy for incurable cancers such as advanced pancreatic cancer, non-small cell lung cancer and so on. On the other hand, treatment with anti-cancer drugs can be harmful, and sometimes the toxicities may be very severe leading to worsened quality of life and shortened survival. So, we must carefully consider the application of palliative chemotherapy and discuss it with patients

%0 Journal Article
%A Diehl, Marion
%J Kinderkrankenschwester
%D 2006 Dec
%N 12
%P 531
%T [The bearer of the Antonie Zerwer Medal of Honor accompanies a "change of ends"]
%V 25
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17236689