%0 Journal Article
%J Lancet
%D 2007 May
%N 9573
%P 1576
%T Improving end-of-life care for children
%V 369
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17499580

%0 Journal Article
%J Home Healthc Nurse
%D 2007 May
%N 5
%P 305-6
%T Post-traumatic Stress Disorder at the End of Life: Wounded Warriors: Their Last Battle
%V 25
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17495558

%0 Journal Article
%C Department of Nursing, University of Professional Education at Nijmegen, P.O. Box 6960, 6503 GL Nijmegen, The Netherlands
%A Adriaansen, M
%A van, Achterberg T
%J Int J Nurs Stud
%D 2007 May
%T The content and effects of palliative care courses for nurses: A literature review
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17509596
%X OBJECTIVES: The present literature review describes the literature (1990-2005) that concerns the effects of courses in palliative care at the pre- and postgraduate levels. DATA SOURCES: A search was made for literature from the period between 1990 and 2005 using CINAHL, Pubmed and Psychlit, supplemented with a search for relevant systematic reviews from the Cochrane Library. DESIGN: The research questions were directed on the areas of expertise and skills, the didactical methods, the effects of the courses and the standards to measure these effects. RESULTS: The studies were all focused on general palliative care. Out of 27 studies 21 reported positive effects for communication, attitude, empathy and pain. Six of these 21 positive trails were studies with good quality designs, whereas 15 had moderate designs. The six studies with a lack of effects was one study with good quality and five studies with moderate quality designs. The effects on patients were described in only a few cases. There was still frequent use of self-constructed rating scales, where data about validity and reliability were lacking or where these aspects were not studied. CONCLUSIONS: The most successful were integrated courses focused on several themes with a variety of didactical methods

%0 Journal Article
%C Section of Oncology, University of Sheffield, Academic Urology Unit, Royal Hallamshire Hospital, Sheffield, UK
%A Ali, Ased S M
%A Hamdy, Freddie C
%J Curr Urol Rep
%D 2007 May
%N 3
%P 245-52
%T The spectrum of prostate cancer care: from curative intent to palliation
%V 8
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17459275
%X Prostate cancer is one of the most prevalent malignancies affecting men in the developed world. A spectrum of disease states exists and management is tailored to individual patients. Increasing public awareness and prostate-specific antigen testing have led to earlier detection and the possibility of cure but have increased the risk of overtreatment of indolent disease. Advances in curative modalities have reduced side effects and offer patients a choice of treatments. Nonetheless, many need no intervention and may be safely treated with active monitoring. Choice and timing of therapy for locally advanced and recurrent disease are variable, with potential benefits of early intervention counterbalanced by side effects of treatment. Progress has been made in the management of advanced disease; skeletal-related events have been reduced and survival has been increased. This review examines the evidence and rationale behind the treatment options from curative intent to management of locally advanced disease and palliation of metastatic disease

%0 Journal Article
%C Wagga Wagga Base Hospital, Wagga Wagga NSW, Australia
%A Alphonso, Colleen Dianne
%J Contemp Nurse
%D 2007 Feb
%N 1
%P 89-92
%T Reflection on a critical incident
%V 24
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17348786
%X Critical incidents are snapshots of something that happens to a patient, their family or nurse. It may be something positive, or it could be a situation where someone has suffered in some way (Rich & Parker 2001). Reflection and analysis of critical incidents is widely regarded as a valuable learning tool for nurses. The practice requires us to explore our actions and feelings and examine evidence-based literature, thus bridging the gap between theory and practice (Bailey 1995). It also affords us the opportunity of changing our way of thinking or practicing, for when we reflect on an incident we can learn valuable lessons from what did and did not work. In this way we develop self-awareness and skills in critical thinking and problem solving (Rich & Parker 2001). The central aim of the following discussion is to explore and analyse an incident that occurred while attending a clinical placement at a hospital in rural New South Wales. To begin, the incident will be briefly described and the people involved introduced (The names of the people involved have been changed to protect their privacy). A wide range of literature will then be drawn upon in examining how this particular incident reflects specific Australian Nursing and Midwifery Council 'National Competency Standards for the Registered Nurse' (ANMC competencies). The outcome and implications for the writers' nursing practice will complete this reflection

%0 Journal Article
%C Departement de medecine, institut Gustave-Roussy, Villejuif cedex. besse@igr.fr
%A Besse, Benjamin
%A Soria, Jean-Charles
%J Rev Prat
%D 2007 Feb
%N 4
%P 429-40; quiz 440
%T [Treatment of cancer: surgery, radiotherapy, chemotherapy, hormonal therapy. Multidisciplinary therapeutic decision making and informing the patient]
%V 57
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17455746

%0 Journal Article
%C School of Social Science, University of Queensland, Australia
%A Broom, Alex
%A Tovey, Philip
%J Sociol Health Illn
%D 2007 May
%N 4
%P 551-69
%T Therapeutic pluralism? Evidence, power and legitimacy in UK cancer services
%V 29
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17498168
%X The integration of complementary and alternative medicine (CAM) into cancer services is increasingly discussed as a potential part of UK health policy but as yet there has been little sociological research examining this process. This paper examines the results of a study on the provision of CAM to cancer patients in two distinct organisational contexts: the hospice and the hospital. It is based on interviews with medical specialists, nursing staff and CAM therapists. This paper focuses on how integration is managed in each organisation, examining professional boundary disputes and inter-professional dynamics. Discussion focuses on the rhetorical and practical strategies that are employed by a variety of differently positioned interviewees to negotiate the complexities of the interface of CAM and biomedicine. The results show significant differentiation in how differently positioned cancer clinicians view and utilise the biomedical hierarchy of evidence. We argue that the integration of CAM should not be conceptualised as a mere challenge to biomedicine, or, as resulting in a linear process of deprofessionalisation. Rather, it should be seen as producing a complex array of processes, including strategic adaptation on the part of medical specialists and NHS organisations

%0 Journal Article
%C The Prince and Princess of Wales Hospice, Glasgow, UK. marjory.byrne@ppwh.org.uk
%A Byrne, Marjory
%J Int J Palliat Nurs
%D 2007 Mar
%N 3
%P 118-24
%T Spirituality in palliative care: what language do we need? Learning from pastoral care
%V 13
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17505404
%X This article is a sequel to 'Spirituality in palliative care: what language do we need?' (Byrne, 2002). It looks at the language of pastoral care, its place in palliative settings and how it is regarded by patients and carers. Spirituality and spiritual need is multifaceted, and the various beliefs regarding the concept of spirituality and the spiritual needs of terminally ill patients are appraised, and the methods of spiritual assessment reviewed. The role of the chaplain in spiritual care is also assessed, and an ability to move beyond the boundaries of their own denominational position addressed. Several components of the language of pastoral care are identified

%0 Journal Article
%C Australian Health and Welfare Chaplains Association, and the School of Public Health, La Trobe University, Melbourne, VIC, Australia. carey_l@optusnet.com.au
%A Carey, Lindsay B
%A Newell, Christopher J
%J Crit Care Resusc
%D 2007 Mar
%N 1
%P 34-9
%T Withdrawal of life support and chaplaincy in Australia
%V 9
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17352665
%X OBJECTIVE: To explore the role of health care chaplains in providing pastoral care to patients, their families and clinical staff considering decisions to withdraw life support. METHODS: Quantitative data were obtained retrospectively from a survey of 327 Australian health care chaplains (both staff and volunteer chaplains) to initially identify chaplaincy participation in withdrawal-of-life-support issues. Qualitative data were subsequently obtained by in-depth interview of 100 of the surveyed chaplains and thematically coded using the World Health Organization Pastoral Intervention (WHO-PI) codings to explore chaplains' roles. RESULTS: Over half the staff chaplains surveyed (57%) and over a quarter of the volunteer chaplains (28%) indicated that they had been involved with patients or their families in withdrawal-of-life-support decisions. Over a third of staff chaplains (37%) and 16% of volunteer chaplains had assisted clinical staff concerning withdrawal-of-life-support issues. The qualitative data revealed that chaplains were involved with patients, their families and clinical staff at all levels of pastoral intervention, including "pastoral assessment", "pastoral ministry", "pastoral counselling and education" and "pastoral ritual and worship". The specific nature of chaplaincy involvement varied considerably depending on the idiosyncratic issues faced by patients, families and clinical staff. These activities indicated that pastoral care could be provided for the support and benefit of patients, their families and clinical staff facing a complex bioethical issue. CONCLUSIONS: Through a variety of pastoral interventions, some chaplains (mostly staff chaplains) were involved in assisting patients, their families and clinical staff concerning withdrawal-of-life-support issues and thus helped ensure an holistic approach within the health care context. Given this involvement and the future potential benefit for patients, families and clinical staff, there is a need to develop continuing education and research on pastoral care and chaplaincy services

%0 Journal Article
%A Carlo, Waldemar A
%A Schelonka, Robert
%J Am J Obstet Gynecol
%D 2007 May
%N 5
%P 422-3
%T The outcome of infants with an Apgar score of zero at 10 minutes: past and future
%V 196
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17466692

%0 Journal Article
%C Department of Radiation Oncology, Toronto Sunnybrook Regional Cancer Centre, University of Toronto, Toronto, Ontario, Canada. edward.chow@sunnybrook.ca
%A Chow, Edward
%A Harris, Kristin
%A Fan, Grace
%A Tsao, May
%A Sze, Wai M
%J J Clin Oncol
%D 2007 Apr
%N 11
%P 1423-36
%T Palliative radiotherapy trials for bone metastases: a systematic review
%V 25
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17416863
%X PURPOSE: The objective is to update previous meta-analyses with a systematic review of randomized palliative radiotherapy (RT) trials comparing single fractions (SFs) versus multiple fractions (MFs). METHODS: The analysis includes all published reports from randomized trials comparing SF or MF schedules for the treatment of painful bone metastases with localized RT. A systematic review was performed using the random-effects model with Review Manager version 4.1 (Cochrane Collaboration, Oxford, UK). The odds ratio and 95% CI were calculated for each trial and presented in a forest plot. RESULTS: A total of 16 randomized trials from 1986 onward were identified. For intention-to-treat patients, the overall response (OR) rates for pain were similar for SF at 1,468 (58%) of 2,513 patients and MF RT at 1,466 (59%) of 2,487 patients. The complete response (CR) rates for pain were 23% (545 of 2,375 patients) for SF and 24% (558 of 2,351 patients) for MF RT. No significant differences were found in response rates. Trends showing an increased risk for SF RT arm patients in terms of pathological fractures and spinal cord compressions were observed, but neither were statistically significant (P = .75 and P = .13, respectively). The likelihood of re-treatment was 2.5-fold higher (95% CI, 1.76 to 3.56) in SF RT arm patients (P < .00001). Repeated analysis of these end points, excluding dropout patients, did not alter the conclusions. Generally, no significant differences with respect to acute toxicities were observed between the arms. CONCLUSION: No significant differences in the arms were observed for overall and CR rates in both intention-to-treat and assessable patients. However, a significantly higher re-treatment rate with SFs was evident

%0 Journal Article
%C Dayna F. Cooper, MSN, RN, is HBPC Program Director, Bay Pines VA Health Care System, Bay Pines, Florida. Ofelia R. Granadillo, MSW, is HBPC Program Director, James A. Haley Veterans Hospital, Tampa, Florida. Cynthia Mace Stacey, ARNP, is HBPC Program Director, North Florida/South Georgia Health Care System, Gainesville, Florida
%A Cooper, DF
%A Granadillo, OR
%A Stacey, CM
%J Home Healthc Nurse
%D 2007 May
%N 5
%P 315-322
%T HOME-BASED PRIMARY CARE: The Care of the Veteran at Home
%V 25
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17495561
%X Home-Based Primary Care is a program designed by the Department of Veteran Affairs (VA) to care for frail, medically complex, elderly veteran patients in their home setting. Unique to the VA, the program has similarities and differences in relation to typical Medicare/Medicaid home health and hospice programs. The VA has demonstrated success in maintaining the patients' independence and quality of life as well as exceptional management of chronic disease and prevention

%0 Journal Article
%C Worthing and Southlands Hospitals NHS Trust, Worthing, West Sussex, UK. phil.cotterell@wash.nhs.uk
%A Cotterell, Phil
%A Lynch, Carmel
%A Peters, Debbie
%J Int J Palliat Nurs
%D 2007 Mar
%N 3
%P 102-8
%T Bridging the gap: can a link nurse initiative influence palliative care in an acute hospital?
%V 13
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17505402
%X With 90% of people needing some inpatient hospital care in the final year of life, it is evident that the provision and awareness of palliative care, and education surrounding this, are widely needed. This study aims to evaluate a palliative care link nurse initiative (PCLN) in an NHS acute hospital, identifying key factors affecting link nurses' ability to influence palliative care practice. This qualitative study used semi-structured interviews and a focus group to show the anticipated and actual influence of link nurses on practice. Findings suggest that link nurses had increased knowledge and skills in palliative care due to education provided. Link nurses were seen to have an influence on the presence and quality of palliative care practice in hospital wards. Factors that could help link nurses to have greater influence are reported, as are difficulties in providing care and accessing training

%0 Journal Article
%C Izmir Oncology Center, 1428 sok. 24/B Kahramanlar. 35230, Izmir, Turkey. agdiniz@gmail.com
%A Diniz, Gulden
%A Unlu, Ismet
%A Gokce, Tumay
%A Kilciksiz, Sevil
%A Gayaf, Mine
%A Komurcuoglu, Berna
%A Karadogan, Ilker
%A Aktas, Safiye
%A Akcay, Cimen
%J Saudi Med J
%D 2006 Jul
%N 7
%P 992-6
%T Evaluation of curative and palliative radiotherapy efficacy in extensive stage small cell lung cancer
%V 27
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=16830017
%X OBJECTIVE: To evaluate the efficacy of curative and palliative radiotherapy in the treatment of extensive stage small cell lung cancer (E-SCLC), and compare therapy effect on survival with or without metastatic disease. METHODS: From January 1998 through December 2004, 128 patients with E-SCLC were treated with radiotherapy and concomitants combined chemotherapy. Radical radiotherapy, consisting of approximately 60 Gy given in up to 30 fractions was performed in 53 (41.4%) of these patients. Others (58.6%) were treated with palliative dose radiotherapy. In all patients, chemotherapy was planned with cisplatin (80 mg/m2) intravenously (i.v.) on day 1, and etoposide (120 mg/m2) i.v. on days 1, 2 and 3, every 3 weeks for 3-6 cycles. Conventional follow-up of patients was conducted at Izmir Oncology Center, Izmir, Turkey. All results were evaluated statistically. RESULTS: One hundred and twenty-four patients (96.9%) were males. The mean age was 58.49 (+/- 9.01), ranging from 37-78 years. Metastases were initially determined in 64 patients (50%). The median follow up of patients was 287.41 days and median survival was 354.87 days. One year survival rate was 35.8%, and 2-year survival rates was 16.9% in the radical radiotherapy group, while these rates were 26.6% and 8% in the others. According to the statistical findings; the gains in duration of median survival with the curative thoracic irradiation are 151.97 days in all 128 patients. CONCLUSION: This study shows that curative radiotherapy at the primary tumor provides an additional survival benefit in patients with metastatic disease compared with palliative radiotherapy. This finding raises the question of whether treatment with radical thoracic radiotherapy with concomitant chemotherapy, consisting of first-line drugs, might be more beneficial and cost-effective as well as a less toxic treatment of E-SCLC

%0 Journal Article
%C College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada. wendy.duggleby@usask.ca
%A Duggleby, Wendy D
%A Degner, Lesley
%A Williams, Allison
%A Wright, Karen
%A Cooper, Dan
%A Popkin, David
%A Holtslander, Lorraine
%J J Pain Symptom Manage
%D 2007 Mar
%N 3
%P 247-57
%T Living with hope: initial evaluation of a psychosocial hope intervention for older palliative home care patients
%V 33
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17349494
%X The overall purpose of this study was to evaluate the effectiveness of a psychosocial supportive intervention called the "Living with Hope Program" (LWHP) in increasing hope and quality of life for older adult, community-living, terminally ill cancer patients. Using a mixed method concurrent nested experimental design, 60 terminally ill cancer patients over the age of 60 years were randomly assigned to a treatment group and a control group. Baseline hope (Herth Hope Index [HHI]) and quality-of-life scores (McGill Quality of Life Questionnaire [MQOL]) were collected at the first visit in the patients' homes by trained research assistants. Those in the treatment group received the LWHP, which consisted of viewing an international award-winning video on hope and a choice of one of three hope activities to work on over a one-week period. The control group received standard care. Hope and quality-of-life data were collected one week later from both groups. Qualitative data using open-ended hope questions were collected from the treatment group. Patients receiving the LWHP had statistically significant higher hope (U=255, P=0.005) and quality-of-life scores at Visit 2 (U=294.5, P=0.027) than those in the control group. Qualitative data confirmed this finding, with the majority (61.5%) of patients in the treatment group reporting the LWHP increased their hope. This preliminary evaluation of the effectiveness of the LWHP suggests that it may increase hope and quality of life for older terminally ill cancer patients at home

%0 Journal Article
%C The University of Texas at Tyler, College of Nursing and Health Sciences, 3900 University Blvd, Texas, USA. gduke@uttyler.edu
%A Duke, Gloria
%A Thompson, Sue
%J Int J Palliat Nurs
%D 2007 Mar
%N 3
%P 109-15
%T Knowledge, attitudes and practices of nursing personnel regarding advance directives
%V 13
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17505403
%X The aim of the study was to describe the knowledge, attitudes and practices of nursing personnel working in acute care settings regarding advance directives (ADs). The study was descriptive using a 40-item, newly developed tool (Update on Advance Directives questionnaire) distributed to 108 nursing personnel (mostly registered nurses) who were willing to complete the questionnaire. The findings were that nursing personnel reflected a lack of knowledge concerning federal and state laws and general information about ADs. Nursing personnel had very low rates of AD completion but most felt ADs were valuable for the patient. We concluded that nurses need more resources, e.g. knowledge, administrative and physician support, and communication tools to facilitate advance planning for end-of-life care for patients. The role of the health care provider, be it the nurse, physician or other, needs to be clarified regarding the most practical setting for AD formulation

%0 Journal Article
%C BMJ
%A Ferriman, A
%J BMJ
%D 2007 May
%N 7602
%P 1022
%T Exploring ageing and bereavement
%V 334
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17510122

%0 Journal Article
%A Fisher, Kenneth A
%J N Engl J Med
%D 2007 May
%N 19
%P 2004; author reply 2004-5
%T Communicating about dying in the ICU
%V 356
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17506162

%0 Journal Article
%C Acute Inpatient Palliative Care Unit, The University of Texas M.D. Anderson Cancer Center, Houston, USA
%A Flannagan, Patricia Ewert
%J Oncology (Williston Park)
%D 2007 Apr
%N 4 Suppl
%P 45-7
%T Communicating with oncology patients about palliative care
%V 21
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17508502
%X Achieving expertise in communication requires a long-term commitment. There are many strategies available for nurses seeking to accomplish this task. Many online resources (for example, http://www.conversationsincare.com/web-bookchapter05.html and http://www.breakingbadnews.co.uk/) and helpful pocket cards intended to assist in improving communication skills are available

%0 Journal Article
%C Agency for Public Health, Lazio Region, via di S Costanza 53, 00198 Rome, Italy. giorgirossi@asplazio.it
%A Giorgi Rossi, Paolo
%A Beccaro, Monica
%A Miccinesi, Guido
%A Borgia, Piero
%A Costantini, Massimo
%A Chini, Francesco
%A Baiocchi, Diego
%A De Giacomi, Giovanna
%A Grimaldi, Maria
%A Montella, Maurizio
%J J Epidemiol Community Health
%D 2007 Jun
%N 6
%P 547-54
%T Dying of cancer in Italy: impact on family and caregiver. The Italian Survey of Dying of Cancer
%V 61
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17496265
%X OBJECTIVE: To describe the effect of terminal cancer on the patient's family, finances and daily life. METHODS: A cluster sample of 2000 adults (>/=18 years old) who had died from cancer, and who were representative of Italy, was studied. 1900 caregivers were identified and 68% responded to a post-bereavement survey. Caregivers included the patient's child (46%), his/her spouse (31%), other relatives or friends (20%) or a health professional (3%). The median age of a caregiver was 54 years and 69% were females. During the last 3 months of the patient's life, 44% of caregivers reported difficulties in their regular employment. RESULTS: Of the 68% of families who had to pay for some of the care, 37% had to pay for drugs, 36% for nursing and assistance and 22% for physicians. Paying for care was more frequent in the south of Italy (OR 2.5; 95% CI 1.0 to 6.3) and when the patient was a housewife (OR for unit increase 2.7; 95% CI 1.6 to 6.1). To cover the costs of patient care, 26% of families used all or most of their savings. Economic difficulties were greater in the south of Italy (OR 3; 95% CI 1.8 to 5.1), for female caregivers (OR 1.4; 95% CI 1.0 to 1.9) and for disadvantaged patients. The duration of time the patient was completely dependent strongly determined the effect caregiving had on their regular employment and on the family's financial situation. CONCLUSIONS: Although in Italy families are responsible for a small percentage of the overall costs of patient care, the effect of cancer on savings and daily life can be substantial. Strong geographical and gender differences emerged from this study

%0 Journal Article
%A Goren, Elizabeth
%J Am J Psychoanal
%D 2007 Mar
%N 1
%P 37-52
%T Society's Use of the Hero Following a National Trauma
%V 67
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17510618
%X The terrorist nature of the attacks on September 11th, the number of deaths on American soil and the direct involvement of society as virtual eyewitnesses of the events of that day had a traumatizing impact on the cultural consciousness. The interpersonal, socio-cultural manifestations of traumatic grief are explored through an analysis of the creation and transformation of its national heroes, the New York City firefighters, in the public mind over time. Mechanisms of identification, dissociation and splitting were manifested through the erection of physical and social boundaries around 9/11, which allowed for idealization at a safe distance followed by de-cathexis when the collective sought to abort the mourning process and overcome the pain and helplessness of traumatic grief by going to war.The American Journal of Psychoanalysis (2007) 67, 37-52. doi:10.1057/palgrave.ajp.3350013

%0 Journal Article
%C Deborah Grassman, ARNP, MSN, is Hospice Coordinator, Bay Pines VA Medical Center, St. Petersburg, Florida. Deborah has pioneered identifying the unique experience of veterans at end of life
%A Grassman, Deborah
%J Home Healthc Nurse
%D 2007 May
%N 5
%P 299-304
%T Wounded warriors: their last battle
%V 25
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17495557

%0 Journal Article
%C Altalanos Orvostudomanyi Kar, Anaesthesiologiai es Intenziv Terapias Tanszek, Budapest
%A Gyulai, Marton
%A Slavei, Krisztina
%A Penzes, Istvan
%A Strausz, Janos
%J Orv Hetil
%D 2006 Nov
%N 45
%P 2163-6
%T [Management of malignant and benign airway stenosis by stent implantation]
%V 147
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17402209
%X INTRODUCTION: In the last few decades the different bronchoscopic procedures have gained an important role in the treatment of airway stenosis, and the number of implanted airway stents has also greatly increased. PATIENTS: Between 1998 and 2004 the authors implanted altogether 108 airway prosthesis in 90 patients at the Institute of Pulmonology of Pest County. 58% of the patients were males, 42% females, the average age was 57.5 years, the average follow-up time was 7 months. RESULTS: On the basis of different etiology the patients were separated into two main groups. In 57% the airway stenosis was caused by malignant illnesses, in these cases stents can be used only with palliative purpose. However, in case of benign lesions they can offer a long-term solution and require an adequate follow-up of the patients. The authors' main aim was to get an overall picture of the interventions they had done by processing the data, with the help of the measurable characteristics that make possible to follow the airways' permeability and its changes. Analysing the results of the respiratory function and blood gas examinations they didn't find a significant difference inspite of the subjective improvement

%0 Journal Article
%C Division of Pulmonary Medicine and Critical Care, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania. andrew.haas@jefferson.edu
%A Haas, Andrew R
%J Am J Hosp Palliat Care
%D 2007 Apr-May
%N 2
%P 144-51
%T Recent advances in the palliative management of respiratory symptoms in advanced-stage oncology patients
%V 24
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17502441
%X Advanced-stage malignancies are often characterized by systemic complications related to primary tumor progression. Pulmonary complications such as cough and dyspnea are relatively common and can dramatically reduce quality of life and lead to inpatient or intensive care unit admission. Although cancer-induced cough can be improved with radiation therapy or chemotherapy, or both, it is often best managed with central-acting opioids. Dyspnea can arise from a range of etiologies that may or may not be related to the underlying malignant pulmonary disease. Recent advances in the management of malignant pleural effusion, central airway obstruction, and superior vena cava syndrome have allowed relatively noninvasive interventions to be performed that can significantly reduce dyspnea, minimize inpatient hospitalization, and improve the quality of life in patients where the major focus is palliative care

%0 Journal Article
%A Hansen-Flaschen, John
%J N Engl J Med
%D 2007 May
%N 19
%P 2003-4; author reply 2004-5
%T Communicating about dying in the ICU
%V 356
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17494939

%0 Journal Article
%C Mater Health Services, South Brisbane, Queensland, Australia. janet.hardy@mater.org.au
%A Hardy, J R
%A Haberecht, J
%A Maresco-Pennisi, D
%A Yates, P
%J Intern Med J
%D 2007 May
%N 5
%P 315-9
%T Audit of the care of the dying in a network of hospitals and institutions in Queensland
%V 37
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17504279
%X BACKGROUND: Most Australians die in institutions and there is evidence to suggest that the care of these patients is not always optimal. Care pathways for the dying have been designed to transfer benchmarked hospice care to other settings (e.g. acute hospitals and residential age-care facilities) by defining goals of best care, providing guidelines to provide that care and documenting outcome. METHOD: A retrospective audit was undertaken across a network of health-care institutions in Queensland. The 18 goals considered essential for the care of the dying within the Liverpool Care Pathway were taken as a benchmark. Documentation of achievement of each of these goals was sought. RESULTS: The notes of 160 patients who had died in eight institutions (four hospitals, three hospices, one nursing home) were reviewed. Several areas for improvement were identified, particularly in those goals relating to communication, resuscitation orders and care after death. Few units documented the provision of written information to families. Most patients were prescribed medications in anticipation of pain and agitation but less were prescribed drugs for other common symptoms in the dying. Most of the goals were achieved in a higher percentage of cases in hospice units. Marked differences in practice were noted between different institutions. CONCLUSION: The audit identified several aspects in the care of the terminally ill that could be improved. End-stage pathways may provide a model for improving the care of patients dying in hospitals and institutions in Australia

%0 Journal Article
%C Department of Obstetrics and Gynaecology, John Radcliffe Hospital, University of Oxford, Oxford, UK. deborah.harrington@orh.nhs.uk
%A Harrington, Deborah J
%A Redman, Christopher W
%A Moulden, Mary
%A Greenwood, Catherine E
%J Am J Obstet Gynecol
%D 2007 May
%N 5
%P 463.e1-5
%T The long-term outcome in surviving infants with Apgar zero at 10 minutes: a systematic review of the literature and hospital-based cohort
%V 196
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17466703
%X OBJECTIVE: The purpose of this study was to investigate the outcomes of infants who had Apgar scores of zero at 10 minutes and were resuscitated successfully. STUDY DESIGN: The literature was reviewed systematically to identify the outcomes of cases; in addition, the perinatal database at the John Radcliffe Hospital, Oxford, was used to identify similar cases. Eligible infants were identified through hospital records, and outcomes of all infants with an Apgar score of zero at 10 minutes, who were born between January 1991 and December 2004, were reviewed. RESULTS: Eighty-five cases were identified from the literature. With the Oxford database, 9 of 83,065 infants (0.12/1000 births) met our study criteria. Six of the 9 infants died before leaving hospital. One infant with severe quadriparesis and microcephaly died at 11 months of age. One infant at follow-up examination at 5 years had severe spastic quadriparesis with severe global delay. One infant with grade 2 hypoxic-ischemic encephalopathy, who was born with severe anemia that was corrected promptly at birth, had mild disability at follow-up examination at 2 years. Thus, death or severe disability occurred in 8 of 9 infants. Combining the results of metaanalysis of published data with our results of 94 infants, 88 infants (94%) either died or were handicapped severely; 2 infants (2%) were handicapped moderately, and 1 infant (1%) was handicapped mildly. For 3 infants (3%), the long-term outcome could not be determined. CONCLUSION: The outcome of infants with an Apgar score of zero at 10 minutes is almost universally poor

%0 Journal Article
%C University of North Florida and the Department of Public Health
%A Harrison, Jeffrey P
%A Ford, Dennis
%J Am J Hosp Palliat Care
%D 2007 Apr-May
%N 2
%P 119-25
%T A comprehensive community-based model for hospice care
%V 24
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17502436
%X This study discusses the unique characteristics of a comprehensive community-based model for hospice care. The data demonstrate that community-based hospice programs serve a population composed primarily of Medicare patients 75 years and older. It also addresses the primary clinical diagnoses for hospice patients, which include lung cancer, cognitive disability, cerebrovascular disease, congestive heart failure, chronic airway obstruction, colon cancer, renal failure, and prostrate cancer. Finally, the study found that the primary caregiver for community-based hospice patients is the spouse, followed by other family members

%0 Journal Article
%A Hartling, Ole J
%J Ugeskr Laeger
%D 2007 Apr
%N 17
%P 1594
%T [Power as intention?]
%V 169
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17491124

%0 Journal Article
%C Dept. of Surgery II, Tokyo Women's Medical University
%A Hirai, Eiichi
%A Shirotani, Noriyasu
%A Mitsuhashi, Maki
%A Seshimo, Akiyoshi
%A Kameoka, Shingo
%J Gan To Kagaku Ryoho
%D 2006 Dec
%P 291-2
%T [A discussion on surgical procedures to palliate symptoms for home medical care]
%V 33 Suppl 2
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17469364
%X In the field of digestive tract surgery, QOL can be significantly decreased in patients who experience recurrence or metastasis of a cancer, not only by digestive tract disorders that prevent the patient from taking a meal, but also by installation of gastric or ileus tubes. For such patients, surgical procedures aimed to palliate their symptoms are necessary, rather than radical surgeries. We examined 24 cases at our department, for which operations were performed with the aim of palliating their symptoms, during the 4-year period from October 2001 to December 2005. Sixteen (89%) out of 18 symptomatic cases (i.e. patients who could not take a meal, or who had undergone tracheal intubation) exhibited confirmed improvement in their symptoms after the operations. On the other hand, we also experienced one case in which installation of an ileus tube was necessary after the operation (1 case, 5.5%). Five patients (20.9%) died after the operation, before they were discharged from the hospital. For such patients, additional minimally invasive procedures should have been taken into consideration

%0 Journal Article
%A Jacobson, Jeffrey M
%A Turner, Barbara J
%A Abrutyn, Elias
%J Ann Intern Med
%D 2007 May
%N 9
%P 682-3
%T Trials that matter: CD4+ T-lymphocyte count-guided interruption of antiretroviral therapy in HIV-infected patients
%V 146
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17470837

%0 Journal Article
%C Department of Internal Medicine, Gachon Medicine School and Science, Gil Medical Center, Incheon, Korea
%A Jeon, Hyo Keun
%A Kim, Jung Ho
%A Cho, Gwon Hyun
%A Kyung, Sun Young
%A Jeong, Sung Hwan
%A Chung, Wook Jin
%A Kim, Na Rae
%J Korean J Intern Med
%D 2007 Mar
%N 1
%P 32-6
%T A case of pulmonary vein tumor presenting as a left atrial mass
%V 22
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17427644
%X Primary cardiac tumors are extremely rare and can originate within the heart or be the result of tumor spread from other sites. We report a female patient with a pulmonary vein tumor extending into the left atrium that had a suspicious primary malignant origin with a sacral metastatic carcinoma. The patient was admitted complaining of pain in her buttock area as a result of a sacral tumor. It was believed that the sacral tumor was a metastasis from the imaging study and clinical manifestation. The primary malignant origin was evaluated. The chest CT showed a left atrium thrombus-like lesion without a pulmonary abnormality. After a transesophageal echocardiogram, the patient was diagnosed with a pulmonary vein tumor extending to the left atrium. The patient was given palliative radiotherapy for the sacral pain. Initially, the clinical impression was a metastatic sacral tumor with a thromboembolism of the left atrium. However, this patient was finally diagnosed with a pulmonary vein tumor with a left atrium extension by a transesophageal echocardiogram

%0 Journal Article
%C University at Buffalo, the State University of New York. jezewski@buffalo.edu
%A Jezewski, MA
%A Meeker, MA
%A Sessanna, L
%A Finnell, DS
%J J Aging Health
%D 2007 Jun
%N 3
%P 519-536
%T The Effectiveness of Interventions to Increase Advance Directive Completion Rates
%V 19
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17496248
%X OBJECTIVE: Despite federal and state laws governing advance directives (ADs), interventions to increase rates of legally completed ADs have not produced significant results. This study synthesizes the state of the science regarding effectiveness of interventions to increase AD completion rates. METHODS: Garrard's method for conducting a systematic literature review was followed. In all, 25 studies meeting inclusion criteria were reviewed. Interventions fell into two types: (a) didactic-information distributed through an educational program or clinical encounter or by a mailing and (b) interactive-person-to-person interaction where participants had the opportunity to ask questions and/or receive assistance completing the forms. RESULTS: Postintervention rates of AD completion were: didactic = no change to 34% increase; interactive = 23% to 71% increase. DISCUSSION: Education without the ability to ask questions does not significantly increase the AD completion rate. Didactic interventions did not usually increase completion rates higher than the predicted average rate for the general population

%0 Journal Article
%A Karakitsos, Dimitrios
%A Karabinis, Andreas
%J N Engl J Med
%D 2007 May
%N 19
%P 2004; author reply 2004-5
%T Communicating about dying in the ICU
%V 356
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17506161

%0 Journal Article
%A Khochikar, Makarand
%J BJU Int
%D 2007 Apr
%N 4
%P 942
%T Palliative transurethral resection of the prostate: functional outcome and impact on survival
%V 99
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17378857

%0 Journal Article
%C Department of Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, Maryland 21224, USA. fkisuul1@jhmi.edu
%A Kisuule, Flora
%A Minter-Jordan, Myechia
%A Zenilman, Jonathan
%A Wright, Scott M
%J J Hosp Med
%D 2007 Mar
%N 2
%P 93-101
%T Expanding the roles of hospitalist physicians to include public health
%V 2
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17427252
%X Several years after the inception of the hospitalist movement, hospitalist roles have evolved in breadth and sophistication. Although public health is not formally recognized or previously described as an arena for hospitalists, hospitalists are often engaged in public health practice. This article attempts to alert hospitalists to the potential to make contributions to the field of public health and defines the public health skills that can positively affect the lives of their patients and the communities they serve. In a public health role, hospitalists may improve the quality of inpatient care. This article reviews how public health and hospital-based practices have already intersected and proposes further development within this discipline. In our ever-changing health care system, hospitalists play key roles in the central public health domains of assessment, assurance, and policy development. Insightful hospitalists will recognize and embrace these responsibilities in caring for patients and society

%0 Journal Article
%A Kovach, Christine R
%J J Gerontol Nurs
%D 2007 Apr
%N 4
%P 3-4
%T Dying in nursing homes
%V 33
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17436863

%0 Journal Article
%C Anaesthesia, Glan Clwyd Hospital, Bodelwyddan, UK. apjlake@aol.com
%A Lake, Alfred
%J J R Soc Med
%D 2007 Mar
%N 3
%P 157-8
%T Listening, or just hearing what they say?
%V 100
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17339313

%0 Journal Article
%C Joy A. Laramie, MSN, CANP, BC-PC, is a Nurse Practitioner at the Veterans' Affairs Medical Center in Washington, DC, working in Hospice and Palliative Care and Long-Term Care. She received her BSN from Boston College in 1987 and her MSN from George Mason University in 1992. She is board certified as an adult nurse practitioner and in advanced practice palliative care
%A Laramie, JA
%J Home Healthc Nurse
%D 2007 May
%N 5
%P 293-298
%T Post-traumatic Stress Disorder at the End of Life
%V 25
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17495556

%0 Journal Article
%C General surgeon Springfield, Massachusetts. kflee@acucern.com
%A Lee, K Francis
%A Ennis, William J
%A Dunn, Geoffrey P
%J Am J Hosp Palliat Care
%D 2007 Apr-May
%N 2
%P 154-60
%T Surgical palliative care of advanced wounds
%V 24
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17502444
%X The history of surgery is rich with accomplishments in wound care, a legacy that recently has been abandoned by many surgeons only to be taken up by nonsurgical providers. When dealing with advanced wounds at the end of life, such as pressure ulcers or venous stasis ulcers, goals of treatment are relief of pain, elimination of odor, and control of wound exudates and infection. Benefits and risks of surgical intervention must be discussed with the patient and family in terms of the patient's perceived prognosis, extent of tissue necrosis and infection, the rate of deterioration, and the underlying wound pathogenesis. When appropriate, the role of surgery looms large in the treatment of chronic, advanced wounds, especially when minimally invasive surgical techniques are used

%0 Journal Article
%C Carolyn Markey, RN, is the President and CEO of the Visiting Nurse Associations of America, Boston, MA
%A Markey, Carolyn
%J Home Healthc Nurse
%D 2007 May
%N 5
%P 343-4
%T What might the 110th congress have in store for home health and hospice care in 2007-2008?
%V 25
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17495567

%0 Journal Article
%C International Program for Psycho-Social Health Research, Central Queensland University, Rockhampton, Queensland, Australia. pam_mcgrath@bigpond.com
%A McGrath, Pam
%A Holewa, Hamish
%A Kail-Buckley, Stasia
%J Am J Hosp Palliat Care
%D 2007 Apr-May
%N 2
%P 105-13
%T "They should come out here ...": research findings on lack of local palliative care services for Australian aboriginal people
%V 24
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17502434
%X Although Aboriginal Australians experience morbidity and mortality rates far greater than that of the wider Australian population, to date, their access to culturally appropriate palliative care services has remained unexplored. This article provides findings from an Australian National Health and Medical Research funded study that documents the availability of palliative care services to Aboriginal peoples of the Northern Territory, Australia. The data were collected through a series of open-ended, qualitative interviews with a cross section of Aboriginal peoples and health professionals conducted during a 2-year period. The findings provide an overview of the palliative care services that are presently available and reflect a serious lack of local, culturally appropriate palliative care services. This research shows the similarities in the struggles and difficulties faced by Australian Aboriginals and Indigenous peoples worldwide. The hope is that the suggestions put forward for improvement will one day be useful for the world's Indigenous peoples

%0 Journal Article
%C Department of Pediatrics, MacLean Center for Clinical Medical Ethics, The University of Chicago, 5801 South Ellis, Chicago, IL 60637, USA. wlm1@uchicago.edu
%A Meadow, William
%J Acta Paediatr
%D 2007 Feb
%N 2
%P 153
%T Babies between a rock and a hard place--neonatologists vs parents at the edge of infant viability
%V 96
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17429894

%0 Journal Article
%A Michael, N
%J Ir Med J
%D 2007 Feb
%N 2
%P 377
%T Dissatisfaction with "do not attaempt resuscitation" orders, a nationwide study of Irish consultant physician practices
%V 100
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17436460

%0 Journal Article
%C Center for Hospice and Palliative Care, Cheektowaga, New York. RMilch@Palliativecare.org
%A Milch, Robert A
%J Am J Hosp Palliat Care
%D 2007 Apr-May
%N 2
%P 153
%T Introduction to surgical palliative care
%V 24
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17502443

%0 Journal Article
%C Dept of Biomedical Ethics, School of Health Science and Nursing, The University of Tokyo Graduate School of Medicine
%A Minooka, Masako
%A Inaba, Kazuto
%J Gan To Kagaku Ryoho
%D 2006 Dec
%P 267-9
%T [Withholding and withdrawing life-prolonging treatment--from the bioethical and legal viewpoints]
%V 33 Suppl 2
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17469356
%X In Japan we have not reached an agreement on 'Withholding and Withdrawing Life-prolonging Treatment' among medical, bioethical and legal views. To achieve consensus on this issue, we should take several problems into consideration. They include: (1) Medical judgment; 'Is the patient in the end-stage of illness?' 'Is the futility of the treatment evident?' (2) Autonomy of the patient; 'Is the patient competent?' 'Is the Advanced Directive effective?' 'Is this the decision for the patient's best interest?' (3) Decision making by the family; 'Who is the most appropriate surrogate?' 'Does the decision reflect the patient's values?' or 'Is it for the patient's best interest?' (4) Procedural Justice; Enough communication, enough visibility and respecting the opinions by the third party are important to realize procedural justice. (5) To deliberate the difference between ethical and legal judgment, an interdisciplinary approach should be carried out. (6) To achieve consensus among the people, the importance of an Advanced-Directive should prevail widely

%0 Journal Article
%C Pain and Supportive Care Program, Joan Karnell Cancer Center, Pennsylvania Hospital, Philadelphia, Pennsylvania. dmmonc@aol.com
%A Mintzer, David M
%A Zagrabbe, Kathryn
%J Am J Hosp Palliat Care
%D 2007 Apr-May
%N 2
%P 126-30
%T On how increasing numbers of newer cancer therapies further delay referral to hospice: the increasing palliative care imperative
%V 24
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17502437
%X Delay in referral of cancer patients to hospice until very near the end of life may deny patients and families optimal palliative care. A variety of factors may contribute to these delays. This article describes how the proliferation of newer anticancer therapies, although desirable overall, may further increase these delays. It is important for hospice personnel to understand these changes in medical oncology and to work to optimize palliative care delivery concomitantly with disease-remitting therapies

%0 Journal Article
%C Institute for Aging Research (S.L.M., D.K.K.), Hebrew SeniorLife, Boston, and Beth Israel Deaconess Medical Center (S.L.M., D.K.K.), Boston, Massachusetts; Center for Gerontology and Health Care Research (S.C.M., J.M.T.), Department of Community Health, Brown Medical School, Providence, Rhode Island; and National Hospice and Palliative Care Organization (S.R.C., C.S.), Alexandria, Virginia, USA
%A Mitchell, SL
%A Kiely, DK
%A Miller, SC
%A Connor, SR
%A Spence, C
%A Teno, JM
%J J Pain Symptom Manage
%D 2007 May
%T Hospice Care for Patients with Dementia
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17509813
%X Dementia is a leading cause of death in the USA. Although guidelines exist to determine hospice eligibility for dementia, only a small percentage of patients dying with this condition receive hospice care. Hospice recipients with dementia have not been well characterized, and little is known about the quality of care they receive. The Family Evaluation of Hospice Care (FEHC) survey was adopted by the National Hospice and Palliative Care Organization (NHPCO) in 2003 as a standard benchmarking tool. The FEHC collects data from bereaved families regarding the quality of hospice care. An online repository of 2005 FEHC data was used to describe hospice recipients over 65 years of age who died with dementia and to examine their families' evaluation of hospice care. Decedents with cancer and chronic terminal conditions were also analyzed for comparison purposes. A total of 77,123 surveys submitted by 796 hospices nationwide met the study's eligibility criteria. Decedent diagnoses were as follows: dementia, n=8,686 (11.3%); cancer, n=35,693 (46.3%); and other chronic diseases, n=32,744 (42.4%). Decedents with dementia were more likely to be >85 years, female, and have length of stays >180 days. Evaluation of care in all FEHC domains did not significantly differ between groups. Approximately three-quarters of bereaved family members of decedents in all groups perceived the overall quality of care as excellent; however, opportunities to improve care were also identified. These data suggest that the evaluation of hospice care for older patients is generally high, and does not vary with respect to terminal diagnoses

%0 Journal Article
%C Department of Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
%A Mohan, A
%A Singh, P
%A Singh, S
%A Goyal, A
%A Pathak, A
%A Mohan, C
%A Guleria, R
%J Eur J Cancer Care (Engl)
%D 2007 May
%N 3
%P 268-76
%T Quality of life in lung cancer patients: impact of baseline clinical profile and respiratory status
%V 16
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17508948
%X As cure is attainable in very few cases of lung cancer, the imperative issue is to make quality of life (QOL) as good as possible as part of the palliative care package. The aim of this paper was to evaluate the baseline QOL of lung cancer patients and observe its association with various clinical parameters and overall respiratory status. A total of 101 patients were administered the European Organization for Research and Treatment of Cancer core quality of life (EORTC QLQ-C30, version 3) questionnaire. Clinical profile and measures of respiratory status, including spirometry, measures of dyspnoea, and 6-min walk test, were recorded. Higher Karnofsky Performance Status (KPS) significantly correlated with better global health status (P < 0.001) and healthy level of functioning (P < 0.001). The cumulative symptom burden was significantly associated with global QOL (P = 0.01) and physical, role and cognitive function scales (P < 0.05). All dyspnoea measures negatively correlated with global QOL and functioning scales. Spirometric indices showed a positive correlation with all functional scales (P < 0.05) except social. In conclusion, lung cancer patients have unsatisfactory QOL, with the global health status and physical functions being most affected. Number of symptoms, KPS, dyspnoea and spirometry significantly affect QOL

%0 Journal Article
%C West Chester University College of Health Sciences, Department of Nursing, West Chester, PA 19383, USA. cmonturo@wcupa.edu
%A Monturo, Cheryl A
%A Strumpf, Neville E
%J J Am Med Dir Assoc
%D 2007 May
%N 4
%P 224-8
%T Advance directives at end-of-life: nursing home resident preferences for artificial nutrition
%V 8
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17498605
%X OBJECTIVE: Nursing homes are increasingly the place where many Americans die. Thus, advance directives are critical to the preservation of the autonomous wishes at end-of-life. The purpose of this paper is to determine if preferences for artificial nutrition, as stated in the advance directives of nursing home residents, are honored in the last 2 months of life. DESIGN: Secondary analysis. SETTING: Six Maryland community nursing homes. PARTICIPANTS: Fifty-seven consented residents (age 62 to 98) from the parent study who died during the study period. MEASUREMENTS: Retrospective document review including advance directives and clinical care provided in the last 2 months of life. RESULTS: Most of the nursing home residents in this sample refused feeding tubes, and these preferences were honored during the last 2 months of life (93%), despite some (17% to 26%) with documented weight loss. A small percentage (8.8%) of residents received feeding tubes at end-of-life and, of those, only 1 was consistent with advance directive preferences. Most advance directives in this study included feeding tube preferences. CONCLUSION: In this nursing home sample, advance directives were significant documents guiding decisions on artificial nutrition, and feeding tubes were in fact uncommon at the end of life. The study suggests that advance care planning, quality palliative care training, and administrative support are necessary for the honoring of preferences. Future research is needed to examine more broadly tube-feeding practices and prevalence in nursing homes

%0 Journal Article
%A Morrison, Wynne
%A Nelson, Robert M
%J Crit Care Med
%D 2007 Apr
%N 4
%P 1208-9
%T Should we talk to patients (and their families) about God?
%V 35
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17413794

%0 Journal Article
%C Pain Relief and Palliative Care Unit, Department of Radiology, Areteion Hospital, School of Medicine, University of Athens, Athens, Greece
%A Mystakidou, K
%A Tsilika, E
%A Parpa, E
%A Smyrniotis, V
%A Galanos, A
%A Vlahos, L
%J Eur J Cancer Care (Engl)
%D 2007 May
%N 3
%P 244-50
%T Beck Depression Inventory: exploring its psychometric properties in a palliative care population of advanced cancer patients
%V 16
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17508944
%X To validate the Greek version of the Beck Depression Inventory (BDI)-21 items in advanced cancer patents attending a palliative care unit. The scale was translated with the forward-backward procedure into Greek. It was administered twice, with a 1-week interval, to 105 patients with advanced cancer. The patients also completed the Hospital Anxiety and Depression (HAD) scale, while researchers recorded data on demographic characteristics, disease status and treatment regimen. The Greek version of the BDI had overall Cronbach's alpha 0.906. The most significant correlations were found between BDI and performance status (P < 0.0005), gender (P = 0.031) and family status (P = 0.009). The test-retest reliability in terms of Spearman-rho, Pearson-rho coefficient and Kendall's tau-b was also satisfactory (P < 0.0005). Validity as performed using known-group analysis showed good results. The Inventory discriminated well between subgroups of patients differing in disease severity as defined by the Eastern Cooperative Oncology Group performance status. Correlations between the BDI and the HAD scale was 0.544 for the anxiety subscale and 0.657 for the depression subscale. Multiple regression analysis was conducted and predicted that the contribution of gender, family status and performance status to BDI is high. These psychometric properties of the Greek version of the BDI confirm it as a valid and reliable measure when administered to patients with advanced cancer

%0 Journal Article
%C Third Surgical Clinic of Ataturk Training Hospital, izmir, Turkey
%A Nazli, Okay
%A Yaman, Ismail
%A Tansug, Tugrul
%A Isguder, Ali Serdar
%A Bozdag, Ali Dogan
%A Bolukbasi, Hakan
%J Hepatogastroenterology
%D 2007 Jan-Feb
%N 73
%P 298-303
%T Palliative surgery for advanced stage (stage IV) gastric adenocarcinoma
%V 54
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17419279
%X BACKGROUND/AIMS: The factors that effect resectability, major morbidity, early mortality, and survival in advanced stage gastric adenocarcinoma patients are evaluated. METHODOLOGY: Records of 74 patients that underwent surgery for stage IV gastric adenocarcinoma in the Third Surgical Clinic of Izmir Ataturk Training Hospital between January 1997 and January 2004 were reviewed retrospectively. Two groups (the patients with resectable disease and those with unresectable disease) were compared with regard to age, gender, primary complaint, symptoms, site of the tumor, involvement of adjacent organs, lymph node involvement, distant metastases, differentiation of tumor, surgical procedure, perioperative blood transfusions, and postoperative hospital stay. RESULTS: Mean age of the 74 patients was 58.4 years. Forty-five cases (60.8%) were considered as unresectable and 29 (39.2%) patients underwent a palliative resection. There was a significant relation between resectability and site of the tumor, and severity of invasion. As the number of perioperative blood transfusions increased, morbidity and mortality increased significantly. Although early mortality was high in the palliative resection group, survival (mean 10.4 months, longest 25 months) was better compared to that of the unresectable gastric cancer group (mean 3.5 months, longest eight months). CONCLUSIONS: A palliative gastric surgery may be applied to improve prognosis of advanced gastric cancer patients, even at the presence of peritoneal dissemination, hepatic metastases, N3 lymph node involvement, adjacent organ invasion, or poor differentiation of the tumor

%0 Journal Article
%C Dept of Surgery, Koto Hospital
%A Nishina, Haruhiro
%A Honda, Toru
%A Koizumi, Tomotake
%A Murai, Noriyuki
%A Kato, Hirohisa
%J Gan To Kagaku Ryoho
%D 2006 Dec
%P 320-2
%T [Three case reports of effective home palliative chemotherapy with an infuser pump]
%V 33 Suppl 2
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17469374
%X We report three cases of home palliative chemotherapy with an infuser pump (IP) for continuous infusion of anticancer drugs, which is as effective as being treated at the hospital. Cases are: A 74-year-old man with intraperitoneal metastasis after rectal operation, a 43-year-old woman with pelvis metastasis after a uterus cervical operation and a 70-year-old man with gastric cancer and massive metastases of the liver. Their performance status (PS) ranged from 3-4. All cases underwent continuous infusion of cisplatin 20-30 mg/w with IP and CPT-11:10-40 mg/w in 1 hour. For case 1/2, 5-FU 1,750 mg/w was carried out continuously, and TS-1 80 mg/day/body was administered for case 3. After 4 courses of chemotherapy, all cases indicated effective changes such as decrease of pain, reduction of metastatic tumor size, decrease of tumor bleeding and tumor makers. Their quality of life (QOL) improved. Palliative chemotherapy to improve QOL can be performed at home if used with IP for poor PS patients

%0 Journal Article
%C Dept. of Home Care Support/Promotion, Tokyo Women's Medical University
%A Numata, Kumiko
%A Shirotani, Noriyasu
%A Iwamoto, Yasuhiko
%J Gan To Kagaku Ryoho
%D 2006 Dec
%P 299-301
%T [Home medical treatment and the transfer of medical care of patients at Tokyo Women's Medical University]
%V 33 Suppl 2
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17469367
%X We inquired the current status of our home care transfer patients who are highly dependent on medical treatment, and examined the factors that are needed to pay attention to keep a high level of QOL and to give a better long-term home care. The subjects are 380 patients who requested a homecare transfer. The following items were inquired: (1) the length of time from the request to home care transfer, (2) the length of home care, and (3) a place for the peaceful death. In addition to that, we asked for additional remarks. Fifty nine (59) % of the patients are over 65 years old, and 69% of the diseases were malignant neoplasms. The number of patients that requested a home care transfer was 68%, and for 70% of the patients it took 20 days or less after requesting a home care transfer to leaving the hospital. Forty five (45) % of the patients died within one month of home care, 70% within 2 months, 37% died at home and 45% died after reentering the hospital. There were many time consuming cases with respect to: guidance about medical treatment, guidance about alleviation of the symptoms and guidance about adjusting a patient out of the hospital. There were also cases where the patients had to be readmitted to the hospital. In fact, some of the patients died from an aggravation of disease symptoms and a breakdown of nursing care right after the start of home care. In cases of terminal stage patients with limited prognosis, we found that a long-term preservation of a patients' stable condition would lead to fill a satisfaction of patients cared at home. It is important to start adjusting things like the coordination of medical examination and treatment with local institutions in which a status of the patient and family needs is fulfilled individually at the earliest time, in order to reduce anxiety including the length of hospitalization in short by alleviating disease symptoms

%0 Journal Article
%C Nursing Research and Education Department, City of Hope National Medical Center, Duarte, California 91010-3000, USA. sotis-green@coh.org
%A Otis-Green, Shirley
%J J Cancer Educ
%D 2006 Spring
%N 1
%P 23-5
%T The transitions program: existential care in action
%V 21
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=16918284

%0 Journal Article
%C Departement de Pediatrie, Hopital Sainte-Justine, Universite de Montreal, Montreal, QC, Canada. antoine.payot@umontreal.ca
%A Payot, Antoine
%A Gendron, Sylvie
%A Lefebvre, Francine
%A Doucet, Hubert
%J Soc Sci Med
%D 2007 Apr
%N 7
%P 1487-500
%T Deciding to resuscitate extremely premature babies: how do parents and neonatologists engage in the decision?
%V 64
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17196312
%X Parents at risk of delivering a baby at the threshold of viability are faced with a critical decision. When a child is born between 23 and 25 weeks of gestation, parents are asked to decide whether or not to resuscitate their child. In essence, they are faced with a choice between life and death. We conducted a qualitative study to explore how parents and neonatologists engage in decision-making in a context of imminent and unplanned delivery at the threshold of viability. Twelve parents and attending neonatologists in a specialized tertiary care centre in Montreal, Canada were separately interviewed immediately following neonatal consultation. Results highlight how neonatologists and parents engage in decision making from different standpoints: while neonatologists focus on the management of the unborn baby, parents have yet to fully conceptualize their infant as a distinct entity since they are in a process of grieving their pregnancy and their parenthood project. Moreover, in their attempt to ensure an informed decision, neonatologists adopt either of two models through provision of the most up-to-date and objective information available: "remaining as neutral as possible to allow parents to make their own decision", or, "formulating a proposal to which parents can choose or not to assent". Overall, if the provided information fits parents' expectations, they tend to feel confident with their decision. However, if it does not take their experience into account, their decision is experienced as a solitary process. Parents express the need to receive more than just factual information from neonatologists. They also require support and engagement from caregivers to manage the uncertainty. This brings into question the traditional concept of neutral informed consent and suggests the necessity of a shared decision-making model to ensure that the decision to resuscitate extremely premature babies, at the limits of viability, becomes a truly ethical task

%0 Journal Article
%C Center for Ethics, Humanities, and Palliative Care at the University of Rochester School of Medicine, Rochester, NY, USA
%A Quill, Timothy E
%J N Engl J Med
%D 2007 May
%N 19
%P 1911-3
%T Legal regulation of physician-assisted death--the latest report cards
%V 356
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17494924

%0 Journal Article
%C Palliative Care, Abington Memorial Hospital, Abington, Pennsylvania. frainone@amh.org
%A Rainone, Francine
%A Blank, Arthur
%A Selwyn, Peter A
%J Am J Hosp Palliat Care
%D 2007 Apr-May
%N 2
%P 137-40
%T The early identification of palliative care patients: preliminary processes and estimates from urban, family medicine practices
%V 24
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17502439
%X Primary care providers are positioned to identify patients, well in advance of their deaths, who could benefit from palliative care services, but little is known about how to correctly identify these upstream palliative care patients. This article reports on efforts to devise a methodology for identifying such patients and to offer preliminary estimates of their prevalence in urban, primary care practices. The data presented here suggest 2 conclusions: (1) that electronic databases may be used to create a preliminary screen to assist clinicians in the early identification of patients in need of palliative care, and (2) that 1% to 3% of patients in primary care practices may benefit from palliative care services. Currently, there are no standards regarding the role of primary care providers in end-of-life care and it is hoped that this article will contribute to developing such standards

%0 Journal Article
%C Department of Psychology, Norwegian University of Science and Technology (NTNU), N-7491 Trondheim, Norway. gerd.inger.ringdal@svt.ntnu.no
%A Ringdal, Gerd Inger
%A Ringdal, Kristen
%A Jordhoy, Marit S
%A Kaasa, Stein
%J Palliat Support Care
%D 2007 Mar
%N 1
%P 61-9
%T Does social support from family and friends work as a buffer against reactions to stressful life events such as terminal cancer?
%V 5
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17461372
%X OBJECTIVE: To examine the relationship between social support and emotional functioning and stress reactions. Our hypothesis is that patients who reported a high degree of social support will experience better emotional functioning and less serious stress reactions than patients with a low degree of social support. METHOD: The sample was comprised of 434 patients at the Palliative Medicine Unit (PMU), University Hospital of Trondheim in Norway. The patients completed a questionnaire monthly including questions about social support from the MacAdam's Scale, subjective stress measured by the Impact of Event Scale (IES), and emotional functioning measured by the subscale in the EORTC QLQ-30. RESULTS: Although our hypothesis was not supported at the baseline assessment, it was supported at the second assessment, 2 months later. Patients with high social support reported better emotional functioning and less serious stress reactions, in terms of lower scores on the IES avoidance subscale, than patients with a low degree of social support. SIGNIFICANCE OF THE RESULTS: The mixed findings may indicate that social support has only small effects on emotional functioning and stress reactions. Our results on the second assessment indicate, however, that social support might work as a buffer against reactions toward external stressful events such as terminal cancer

%0 Journal Article
%C Division of Geriatrics and Gerontology, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas. sanchezreill@uthscsa.edu
%A Sanchez-Reilly, Sandra E
%A Wittenberg-Lyles, Elaine M
%A Villagran, Melinda M
%J Am J Hosp Palliat Care
%D 2007 Apr-May
%N 2
%P 131-6
%T Using a pilot curriculum in geriatric palliative care to improve communication skills among medical students
%V 24
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17502438
%X The purpose of this study was to assess the impact of an elective geriatric palliative care course on medical students' attitudes, knowledge, and behaviors regarding communication with terminally ill patients. Surveys were administered at the beginning and end of the elective. Despite a significant increase in knowledge about geriatric and palliative medicine (F = 24.80; P < .001), there were no significant changes in students' self-reported behaviors when applying curriculum-based communication strategies. However, the qualitative analysis of open-ended questions showed that the curriculum intervention did result in an improvement in empowering message strategies for breaking bad news. The evaluation of the end-of-life curriculum needs to exceed the measurement of attitudes and knowledge and include behavioral assessment of end-of-life communication skills

%0 Journal Article
%C Department of Epidemiology, Social Medicine and Health System Research, Hannover Medical School, Germany. schneider.nils@mh-hannover.de
%A Schneider, Nils
%A Walter, Ulla
%J Am J Hosp Palliat Care
%D 2007 Apr-May
%N 2
%P 114-8
%T Where do Prevention and Palliative Care Meet? A Systematic Literature Study on the Interfaces of two Different Health Care Sectors
%V 24
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17502435
%X The objective of this study was to elaborate aspects of prevention in palliative care on the basis of available literature sources. We analyzed 223 articles from 145 different journals covering the period from April 2001 to April 2006. Subject-related categories were derived from the contents of these articles. Each article was subsequently allocated to one of the categories. In addition, we performed a free search in 6 selected text books on palliative care. The results revealed that the main textual emphasis had been placed on pain therapy and controlling the symptoms of bone metastasis. Altogether, the focus was on measures of tertiary prevention, whereas measures of primary prevention and preventive medicine received little attention. Therefore, the accentuation of the preventive aspect in the World Health Organization definition of palliative care is only rudimentarily reflected in the literature

%0 Journal Article
%C Dept. of In-home Medical Care, Tokai University Hospital
%A Seida, Mitsuko
%A Sawamura, Midori
%A Suzuki, Hatsumi
%A Kawasaki, Hiromi
%A Ara, Kazuko
%A Kasori, Yoko
%A Takahashi, Natsuko
%A Yagame, Mitsunori
%J Gan To Kagaku Ryoho
%D 2006 Dec
%P 335-7
%T [A study to improve the quality of visiting nursing care at Isehara City]
%V 33 Suppl 2
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17469379
%X As for Isehara City Visiting Nursing Liaison Congress, we investigated and analyzed the actual conditions of visiting nursing care development at Isehara city by using the NADA nursing diagnosis. It is desirable that a visiting nurse should have skills in evacuation, suction of the respiratory tract, rehabilitation, prevention of complications and an early detection of a poor condition of the patient. In addition, we found that it is also desirable that a visiting nurse fulfill a leadership function in coordinating to support home-care, have a communication skill to anticipate potential problems of patients and counsel his or her family concerns in a short period of time

%0 Journal Article
%C Dept. of Visiting Nurses, Community Health Care, Tokai University Ohiso Hospital
%A Seki, Mitsuko
%J Gan To Kagaku Ryoho
%D 2006 Dec
%P 282-4
%T [Consideration of a local cooperation system for the terminal stage cancer patient who is under the nursing care service insurance--be thoughtful with the bereaved family]
%V 33 Suppl 2
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17469361
%X Although a number of terminal stage cancer patients exist who strongly desire their last moment to be at home, there are many cases where patients die at the hospital. One of the factors that patients die at the hospital is due to inadequacy in providing home care services. Because of a recent revision of the nursing care service insurance, a terminal stage cancer patient now could use this service as a specially designated disease patient. We also received candid ideas and suggestions from the bereaved families who were home care givers, on how to help maintain the patients' QOL at the last stage of their life at home. As a result, we acknowledged that the most urgent solution to the problem is to establish a local cooperation system to support a patient whose final stage of life is to be meaningful

%0 Journal Article
%C Higashi Yamato Home Nursing Center
%A Shinohara, Kaoru
%A Ono, Tomoko
%A Terauchi, Sanae
%A Nakayama, Miyuki
%J Gan To Kagaku Ryoho
%D 2006 Dec
%P 332-4
%T [An experimental weekly visit of the ward at Higashi Yamato Hospital--a holistic cooperation]
%V 33 Suppl 2
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17469378
%X The city of Higashi Yamato is located in the northern part of Tama, Suburbs of Tokyo, and the population of Higashi Yamato is approximately 80,000. The Higashi Yamato visiting nursing station was opened in April 1998. As of April 2006, we have over 100 patients, and the aggregate visiting nursing services have provided more than 600 cases. Our station's uniqueness is that forty percent of the patients have malignant neurological disorders and are terminal stage patients, and that they are all covered by medical care insurance. We also provide nursing services to patients who are expected to be dying peacefully at home averaging 4 patients per month. Higashi Yamato Hospital, attached to the visiting nursing station, is an acute phase hospital and has 274 beds. The average hospital stay for our patients was 13 days in 2005. We promote an early discharge from the hospital for patients who have a high need of medical and nursing care and for the patients who are at the terminal stage. However, there were many cases where visiting nursing care services were provided because of a local care manager's request rather than a visiting nursing care need for patients who will be discharged soon from the hospital and for those expecting to have the service. In reality, we have observed a family being felt that his or her patient was pushed out from the hospital, a family who has no confidence in taking a nursing task at home, and a family who could not cope with the patient's changing condition. Therefore, we wanted resolve these observed problems urgently to create close cooperation with the hospital in order to provide continued nursing care after a patient is discharged from the hospital and to have home medical care safely. As a result, we planned a visit to the ward on a weekly basis starting on February 2006. We report here because we had a good result

%0 Journal Article
%A Simms, Roslyn
%A Cole, F Sessions
%J Pediatr Nurs
%D 2007 Jan-Feb
%N 1
%P 51-2, 70
%T The many roles of family members in "family-centered care"--part II. Interview by Deborah Dokken
%V 33
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17411001
%X This article highlights the role parents can play as advocates for their own children. A mother who is interviewed describes a nurse's support in helping her claim her baby as her own in the midst of the NICU environment and how that claiming led her to become involved in his care and a strong advocate for his needs. She shares advice for parents and health care providers. A physician who is interviewed discusses working with this mother and other parents, and describes ways health care professionals can support parents as advocates

%0 Journal Article
%A Sironi, Orsola
%A Sbanotto, Alberto
%A Banfi, Maria Grazia
%A Beltrami, Carmen
%J J Pain Symptom Manage
%D 2007 Mar
%N 3
%P 233-4; author reply 234-6
%T Midazolam as adjunct therapy to morphine to relieve dyspnea?
%V 33
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17349490

%0 Journal Article
%C Universitair Medisch Centrum Groningen, Centrum voor Ouderengeneeskunde, Postbus 30.001, 9700 RB Groningen. j.slaets@inter.nl.net
%A Slaets, J P J
%J Ned Tijdschr Geneeskd
%D 2007 Apr
%N 16
%P 905-6
%T ['The old man's friend': differences between The Netherlands and the United States with regards to decision-making for the treatment of pneumonia in nursing home patients with dementia]
%V 151
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17500341
%X Lower respiratory-tract infections are a leading cause of death in frail elderly patients. A comparative study of nursing home patients with dementia in The Netherlands and the United States found a difference in attitudes regarding the treatment of pneumonia. Specifically, treatment regimens were far more aggressive in the United States than in The Netherlands for patients with severe illness. Antibiotics were withheld in 56% of these patients in The Netherlands compared with 15% in the United States. Despite the different treatment approaches, adjusted mortality rates were similar. In The Netherlands, geriatricians and family members of patients with dementia have become aware of the potentially harmful effects of the aggressive treatment approaches that are often part of professional treatment protocols, particularly in patients for whom palliative care is more appropriate

%0 Journal Article
%A Slater, Sharon
%J Vet Rec
%D 2007 Mar
%N 13
%P 451
%T Older cattle disposal scheme
%V 160
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17400908

%0 Journal Article
%C Universitair Medisch Centrum St Radboud, Nijmegen. p.soetekouw@sint.azm.nl
%A Soetekouw, P M M B
%A van Dongen, R
%A Maas, R
%A Bult, P
%A Boetes, C
%A Tjan-Heijnen, V C G
%J Ned Tijdschr Geneeskd
%D 2007 Mar
%N 12
%P 673-8
%T [Palliation in patients with metastatic breast cancer often better with antitumour treatment than with only symptomatic treatment]
%V 151
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17447590
%X Two women, aged 57 and 55 years, with metastatic breast cancer were admitted for uncontrolled pain due to bone metastases. Despite the fact that progressive disease was evident, a change in antitumour therapy had not been recommended. The pain control was optimised in both patients. In one patient, palliative chemotherapy was installed, combined with trastuzumab because of HER2/neu overexpression. She was still alive after one and a half year of treatment. The other patient could not adjust mentally to the fact that her palliative therapy was changed to antitumour therapy; she died one month later. It is important to be aware of the various kinds of therapy in metastatic breast cancer because palliative treatment is more than just symptomatic treatment. Systemic antitumour therapy includes hormone therapy, chemotherapy and targeted therapy. Furthermore, in patients with bone metastases, radiotherapy combined with bisphosphonates results in pain relief and can reduce skeletal complications. Because of the ensuing complexity of the treatment of metastatic breast cancer, these patients should be regularly managed by a breast-cancer care team in order to improve the quality of care

%0 Journal Article
%A Sorger, BM
%A Rosenfeld, B
%A Pessin, H
%A Timm, AK
%A Cimino, J
%J Behav Sci Law
%D 2007 May
%T Decision-making capacity in elderly, terminally ill patients with cancer
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17506076
%X Despite the importance and complexity of evaluating decision-making capacity at the end of life, little research has focused on terminally ill patients' decision-making ability. The purpose of this study was to explore the decision-making capacity of elderly, terminally ill patients and the psychological and physical factors that affect decision making. Decision-making capacity and cognitive abilities were assessed using four measures: the Hopkins Competency Assessment Kit, the Bechara Gambling Task, the Concept Assessment Kit, and the Mini Mental Status Exam. In addition, symptoms of depression, level of physical functioning, and extent of physical symptoms were evaluated in order to identify correlates of decision-making ability. Two samples were compared: elderly, terminally ill patients with cancer (n = 43) and elderly, physically healthy adults living in supportive community residence (n = 35). Results revealed significantly poorer decision-making abilities among the terminal ill sample compared with healthy comparisons, but no association between demographic variables (e.g., age, race, or education) or clinical variables (depression or physical symptoms) and decision making. Implications for evaluating decision-making capacity are addressed. Copyright (c) 2007 John Wiley & Sons, Ltd

%0 Journal Article
%C Department of Oncology, St. Olavs Hospital, University Hospital of Trondheim, Norway. Stein.Sundstrom@stolav.no
%A Sundstrom, Stein
%A Bremnes, Roy M
%A Brunsvig, Paal
%A Aasebo, Ulf
%A Kaasa, Stein
%J J Thorac Oncol
%D 2006 Oct
%N 8
%P 816-24
%T Palliative thoracic radiotherapy in locally advanced non-small cell lung cancer: can quality-of-life assessments help in selection of patients for short- or long-course radiotherapy?
%V 1
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17409965
%X PURPOSE: Patient-assessed health-related quality-of-life (HRQOL) scores, together with demographic and clinical factors in stage III non-small cell lung cancer (NSCLC) patients, are important prognostic factors for survival and may be helpful in determining thoracic radiotherapy (TRT) strategy. METHODS: In a previously published randomized trial, 301 patients were treated with different palliative radiotherapy schedules, comparing short-term hypofractionated TRT (arm A: 17 Gy/2 fractions [n = 105]) with more protracted TRT (arm B: 42 Gy/15 fractions [n = 104]); arm C: 50 Gy/25 fractions [n = 92]). Baseline HRQOL, demographic, and clinical data were available for all patients. All possible prognostic factors from univariate analysis were entered into the Cox multivariate regression model to identify variables of independent prognostic relevance. RESULTS: Overall survival was similar, whereas long-term survival was restricted to higher-dose radiotherapy with 3-year survival rates of 1, 8, and 6% (p = 0.40) and 5-year survival rates of 0, 4, and 3% (p = 0.12) in arms A, B, and C, respectively. In univariate analysis, Karnofsky performance status, use of analgesics, and weight loss were highly significant non-HRQOL factors (p < 0.001), and physical function, appetite loss, cough, and pain were the most powerful HRQOL factors (p < 0.001). In multivariate analysis, appetite loss appeared as the most powerful independent prognostic indicator. In the group of patients treated with protracted fractionation (n = 196), the 2-, 3-, and 5-year survival rates in patients with no appetite loss (n = 95) were 22% (21/95), 12% (11/95), and 8% (8/95) compared with 3% (3/101), 1% (1/101), and 1% (1/101) in patients with appetite loss present at baseline (n = 101). CONCLUSION: In addition to performance status and weight loss, patient-reported appetite loss should be assessed in stage III NSCLC patients before administrating TRT; such assessment is a valuable tool for selecting patients to normofractionated or lower-dose hypofractionated palliative TRT

%0 Journal Article
%C Medical Centre Haaglanden, Department of Neurology/Neuro-Oncology, PO Box 432, 2501 CK, The Hague, The Netherlands
%A Taphoorn, Martin J B
%J Eur J Cancer Care (Engl)
%D 2007 May
%N 3
%P 305
%T Palliative care in neurology
%V 16
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17508955

%0 Journal Article
%C Marie Curie Cancer Centre, Marie Curie Hospice, Glasgow. Liz.Travers@mariecurie.org.uk
%A Travers, Elizabeth
%A Jones, Kate
%A Nichol, Jacqueline
%J Int J Palliat Nurs
%D 2007 Mar
%N 3
%P 125-30
%T Palliative care provision in Huntington's disease
%V 13
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17505405
%X There is currently much interest regarding the needs of people affected by non-malignant disease and whether or not these are being met by palliative care services. The evidence available appears to support the conclusion that while there is a general inequality of access, some individuals with non-malignant conditions such as cardiac disease and motor neurone disease are able to access palliative care services more readily than others. Huntington's disease (HD) is a devastating neurological condition of long duration and as such may have a lengthy palliative phase. Consequently, a diagnosis of HD will have a major impact on the quality of life of the affected individual and their family. For carers, an understanding of this challenging disease and its prognosis is essential for the provision of appropriate and effective care. This article reviews the links between HD and palliative care and discusses some of the challenges facing patients, families and health care professionals in adopting a palliative approach in the management of the disease

%0 Journal Article
%A Tyminski, Marie Ortman
%J J Law Health
%D 2004-2005 
%N 2
%P 411-49
%T The current state of advance directive law in Ohio: more protective of provider liability than patient rights
%V 19
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17424778

%0 Journal Article
%C Kingston University, Kingston upon Thames, Surrey. p.wainwright@hscs.sgul.ac.uk
%A Wainwright, Paul
%A Gallagher, Ann
%J Nurs Stand
%D 2007 Apr
%N 33
%P 46-50
%T Ethical aspects of withdrawing and withholding treatment
%V 21
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17494444
%X Decisions about withdrawing and withholding treatment are common in health care. During almost every encounter between health professionals and patients a decision needs to be made about treatment options. In most cases these choices do not pose any difficulty, for example, starting antibiotics when a patient has an infection. However, decisions not to treat, or to stop treating, raise fundamental questions about the nature and purpose of nursing and the ethics of end-of-life care. This article argues that nurses need to be proactive in deciding what is nursing care and what is treatment. An ethical distinction is drawn between acts and omissions. How this distinction relates to withdrawing and withholding treatment will be considered. Further ethical issues discussed relate to judgements about the futility of treatment, patient autonomy and nurses' duty of care to patients at the end of life

%0 Journal Article
%C North Wales Cancer Treatment Centre, Denbighshire, Wales, UK. dexywest@yahoo.co.uk
%A West, Diane
%J Int J Palliat Nurs
%D 2007 Mar
%N 3
%P 137-42
%T A palliative approach to the management of malodour from malignant fungating tumours
%V 13
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17505407
%X The aim of this case study is to explore the role of palliative care and the importance of a multidisciplinary team approach for the management of malodour from malignant fungating tumours. Nurses in my practice area in the UK rarely see them, find them particularly difficult to manage and the experience is often personally distressing. The disturbing nature of these tumours inflicts so much suffering on the patient and those around them that the concept of palliative care is often severely challenged and can prove to be difficult for nurses to achieve. Palliative care aims to provide a holistic team approach in addressing the complex individual needs of these patients and their families

%0 Journal Article
%C Chorlton cum Hardy, Manchester, UK
%A Wilson, K
%A Ganley, A
%A Mackereth, P
%A Rowswell, V
%J Eur J Cancer Care (Engl)
%D 2007 May
%N 3
%P 291-9
%T Subsidized complementary therapies for staff and volunteers at a regional cancer centre: a formative study
%V 16
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17508952
%X In the United Kingdom, the Government has acknowledged workplace stress and burnout in the National Health Service by establishing Improving Working Lives Standards, which recognize the need for a range of support mechanisms. Staff in oncology hospitals experience considerable stress because of the emotional intensity of work that involves limited clinical success, sustained contact with seriously ill/dying people, and serial bereavement. Evidence suggests that providing complementary therapies at work can help to reduce anxiety, depression and blood pressure and, thus, increase well-being. We used a purpose-designed questionnaire to assess awareness of, access to and the value placed on a complementary therapy service for staff and volunteers at a regional cancer centre. Free-text data from 167 completed questionnaires, subjected to qualitative analysis, revealed an overwhelmingly positive view of the service, but concerns about access. The service appeared to be a victim of its own success in that it could not meet demand within its existing resources and, thus, meet its potential for improving working lives; limits to resources also affected the conduct and rigour of our evaluation. We conclude by discussing the impact of the evidence-based practice culture on levels of funding for complementary therapy services operating in hospital settings

%0 Journal Article
%C Institute for Rehabilitation Research and DevelopmentThe Rehabilitation Centre, The Ottawa Hospital, Ottawa, ON, Canada. kewilson@ottawahospital.on.ca
%A Wilson, Keith G
%A Chochinov, Harvey Max
%A McPherson, Christine J
%A Skirko, Merika Graham
%A Allard, Pierre
%A Chary, Srini
%A Gagnon, Pierre R
%A Macmillan, Karen
%A De Luca, Marina
%A O'shea, Fiona
%A Kuhl, David
%A Fainsinger, Robin L
%A Karam, Andrea M
%A Clinch, Jennifer J
%J Health Psychol
%D 2007 May
%N 3
%P 314-23
%T Desire for euthanasia or physician-assisted suicide in palliative cancer care
%V 26
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17500618
%X Objective: To investigate the attitudes of terminally ill individuals toward the legalization of euthanasia or physician-assisted suicide (PAS) and to identify those who would personally desire such a death. Design: In the Canadian National Palliative Care Survey, semistructured interviews were administered to 379 patients who were receiving palliative care for cancer. Patients who expressed a desire for physician-hastened death were followed prospectively. Main Outcome Measures: Attitudes toward the legalization of euthanasia or PAS were determined, as was the personal interest in receiving a hastened death. Demographic and clinical characteristics were also recorded, including a 22-item structured interview of symptoms and concerns. Results: There were 238 participants (62.8%) who believed that euthanasia and/or PAS should be legalized, and 151 (39.8%) who would consider making a future request for a physician-hastened death. However, only 22 (5.8%) reported that, if legally permissible, they would initiate such a request right away, in their current situations. This desire for hastened death was associated with lower religiosity (p = .010), reduced functional status (p = .024), a diagnosis of major depression (p < .001), and greater distress on 12 of 22 individual symptoms and concerns (p < .025). In follow-up interviews with 17 participants, 2 (11.8%) showed instability in their expressed desire. Conclusion: Among patients receiving palliative care for cancer, the desire to receive euthanasia or PAS is associated with religious beliefs; functional status; and physical, social, and psychological symptoms and concerns. Although this desire is sometimes transitory, once firmly established, it can be enduring. ((c) 2007 APA, all rights reserved)

%0 Journal Article
%C University of Leeds, ugm2fjw@leeds.ac.uk
%A Wood, Felicity Juliette
%J Int J Palliat Nurs
%D 2007 Mar
%N 3
%P 131-5
%T The challenge of providing palliative care to terminally ill prison inmates in the UK
%V 13
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17505406
%X Terminally ill prison inmates have a right to all aspects of health care including palliative care provision. However, there are numerous difficulties in providing palliative care to high-security prisoners in the UK. Local community hospices may be reluctant to admit terminally ill prisoners and therefore initiatives must be established to provide appropriate palliative care within the prison itself. Dying prisoners need companionship and to be shown respect and compassion to avoid feelings of loneliness and hopelessness. Inmate volunteers can provide an invaluable source of support and friendship for the terminally ill prisoner, helping to improve quality of life

%0 Journal Article
%C Department of Radiotherapy with RID sector, Department of Social Medicine and Health Care Management, University Hospital "St.George", Medical University, Plovdiv, Bulgaria
%A Yaneva, Marianna P
%A Semerdjieva, Maria A
%J Folia Med (Plovdiv)
%D 2006 
%N 2
%P 23-9
%T Assessment of the effect of palliative radiotherapy for cancer patients with intracranial metastases using EORTC-QOL-C30 questionnaire
%V 48
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17408073
%X Assessment of quality of life (QOL) is of crucial importance when assigning palliative radiotherapy of brain metastases in cancer patients. AIM: To investigate the influence of whole brain radiotherapy on brain symptoms in patients with cerebral metastases; to evaluate their quality of life before and after radiation therapy using the EORTC-QOL-C30 questionnaire, as well as its influence on patients' survival. PATIENTS AND METHODS: Sixty-five patients with various locations of the primary tumor and brain metastases were included in this study. All of them underwent radiotherapy with cobalt unit. The realized dose of the whole brain was above 30 Gy: 10 x 3 Gy or 15 x 2 Gy. The patients filled in the EORTC-QOL-C30 questionnaire before radiation, at the end of the radiotherapeutic course and a month after it. Clinical characteristics of patients before and after radiotherapy were compared and assessed. All patients were treated with radiotherapy and concurrent corticosteroid treatment. RESULTS: The mean age of the patients was 53 ± 7.8 years and the median survival was 6.6 months for lung cancer patients and 9.8 months for breast cancer patients. Each EORTC-QOL-C30 questionnaire assessed the patients in three main aspects: functional aspects, general symptoms and global health. Improvement was reported (p < 0.001) for functional indicators and health related quality of life (HRQOL). Several symptoms did not change significantly--financial difficulties, dyspnea and diarrhea. CONCLUSIONS: Whole brain radiation of cancer patients with cerebral metastases is very well tolerated. Side effects are frequently met and can be compensated by applying steroids. The assessment of quality of life gives information on patients' improvement which is more substantial in functioning, symptoms and global health. This study is a precondition for future investigations of the effect of whole brain radiation on cancer patients' quality of life

%0 Journal Article
%C Department of Radiation Oncology, Boston University Medical Center, Boston, MA, USA
%A Yi, Sun K
%A Yoder, Mark
%A Zaner, Ken
%A Hirsch, Ariel E
%J Pain Physician
%D 2007 Mar
%N 2
%P 285-90
%T Palliative radiation therapy of symptomatic recurrent bladder cancer
%V 10
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17387350
%X BACKGROUND: Palliative radiation therapy (RT) is an established tool in the management of symptoms caused by malignancies. RT is effective at palliating both locally advanced and metastatic cancer, including related symptoms of pain, bleeding, or obstruction. Most data on palliative RT is in regard to its use in the treatment of painful bone metastases. There are also data that support RT palliation for locally advanced or recurrent rectal, prostate, and gynecological cancers. With regard to bladder cancer there is some evidence of the benefit of palliative RT for the control of urinary symptoms and hematuria; however, there is little evidence for the use of palliative RT for pain associated with locally recurrent bladder cancer. We report a case of locally advanced recurrent bladder cancer which was refractory to medical pain management, and was found to be highly responsive to palliative RT. CASE REPORT: An 80-year-old woman with recurrent bladder cancer and intractable pelvic pain refractory to oral and transdermal pain medications, received palliative pelvic RT to a dose of 50 Gy (5000 cGy) in 25 fractions with complete resolution of pain. The patient was originally found to have dysuria, frequency, and hematuria, secondary to an invasive high grade transitional cell carcinoma of the bladder with an adenocarcinoma component, AJCC pT2b N1 M0 Stage IV, for which she underwent a radical cystectomy, total abdominal hysterectomy, bilateral salpingo-oophorectomy, partial vaginectomy, and ileal conduit reconstruction. After undergoing 4 cycles of adjuvant chemotherapy, the patient did well for 5 months with no evidence of symptomatic, clinical, or radiographic recurrence of disease. Repeat staging CT of the abdomen and pelvis confirmed tumor recurrence in the left pelvis. The patient was treated with another course of chemotherapy and pain was managed with relatively low doses of opioid medication (25mcg transdermal fentanyl patch, and oxycodone 5mg bid). However at the fourth month, there was rapid escalation of severe pain with the patient becoming bed bound due to pain with an associated decrease in ambulation and anorexia. Ultimately a pain medication regimen of 200mcg transdermal fentanyl patch q2 days, oxycontin 20mg bid, oxycodone 5 - 10mg q 4 hours, ibuprofen 400mg q 8 hours, and gabapentin 600mg TID was not effective in controlling pain. The patient was then referred to Radiation Oncology 6 months after the pain initially began for evaluation. She received a total of 5000cGy over 25 fractions to a small pelvis field over 5 weeks and reported complete pain resolution. She was able to decrease pain medications, increase overall activity, and gain significant improvement in sleep quality and appetite even early on in the course of her radiation therapy. CONCLUSIONS: Palliative radiation therapy has been well studied in the setting of bone metastases and treatment of hematuria for locally advanced bladder cancer. There is little data that we are aware of on the use of RT for pain control with patients that have recurrent, locally advanced bladder cancer. We have presented a case in which an excellent outcome in pain control was seen for a patient with medically unmanageable pain. RT is an excellent option for pain management in recurrent bladder cancer and should be offered to patients whose pain is not otherwise optimally controlled. Palliative RT is an important component in the multimodality approach to cancer pain management and optimization of quality of life

%0 Journal Article
%C Communication, Humboldt State University, Arcata, California. jmy2@humboldt.edu
%A Yingling, Julie
%A Keeley, Maureen
%J Am J Hosp Palliat Care
%D 2007 Apr-May
%N 2
%P 95-7
%T A Failure to Communicate: Let's Get Real About Improving Communication at the End of Life
%V 24
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17502432

%0 Journal Article
%C Hautklinik und Poliklinik der Georg-August-Universitat Gottingen. mzutt@gwdg.de
%A Zutt, M
%A Hanssle, H
%A Emmert, S
%A Neumann, C
%A Kretschmer, L
%J Hautarzt
%D 2006 May
%N 5
%P 423-7
%T [Dronabinol for supportive therapy in patients with malignant melanoma and liver metastases]
%V 57
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=16408219
%X BACKGROUND: Loss of appetite and nausea can reduce the quality of life of patients with malignant melanoma and liver metastases. Often established antiemetic drugs fail to bring relief. Tetrahydrocannabinol (THC, Marinol), which is the active agent of Indian hemp, has been used successfully in this situation for other malignant tumors. PATIENTS AND METHODS: We treated 7 patients with hematogenous metastatic melanoma and liver metastases suffering from extensive loss of appetite and nausea supportively with dronabinol (Marinol. All of these patients had previously received standard antiemetic therapy without adequate relief. Dronabinol is a synthetic Delta-tetrahydrocannabinol. The drug was administered in capsule form. We evaluated the palliative effects of dronabinol with a special patient evaluation form, which was filled out at the beginning of the therapy and again after 4 weeks. RESULTS: The majority of patients described a significant increase in appetite and decrease in nausea. These effects remained for some weeks, but then decreased as metastases progressed and the general condition worsened. All of the patients experienced slight to moderate dizziness, but it was not sufficiently troubling to cause interruption or termination of therapy. CONCLUSION: Loss of appetite and nausea due to liver metastases of malignant melanoma can be treated in individual cases supportively with Dronabinol

%0 Journal Article
%C Institute for Research in Extramural Medicine, Department of Public and Occupational Health, VU University Medical Centre, Amsterdam, The Netherlands. p.vanwigcheren@vumc.nl
%A van Wigcheren, Petra T
%A Onwuteaka-Philipsen, Bregje D
%A Pasman, H Roeline W
%A Ooms, Marcel E
%A Ribbe, Miel W
%A van der Wal, Gerrit
%J Aging Clin Exp Res
%D 2007 Feb
%N 1
%P 26-33
%T Starting artificial nutrition and hydration in patients with dementia in The Netherlands: frequencies, patient characteristics and decision-making process
%V 19
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17332718
%X BACKGROUND AND AIMS: In many patients with dementia, the oral intake of fluids and nutrients becomes insufficient and a decision has to be made whether to start artificial nutrition or hydration (ANH). This study examines the incidence of ANH in nursing-home patients with dementia in The Netherlands, the methods of administration used, patient characteristics, and the characteristics of the ANH decision- making process. METHODS: In June 2001, a postal questionnaire was sent to all nursing-home physicians (NHPs) (n=1054) in The Netherlands. The response rate was 77%. RESULTS: Of the NHPs, 39% had started ANH during the 1-year study period, mostly by hypodermoclysis. As calculated from the total number of patients in The Netherlands, the incidence density for ANH in demented nursing-home patients was 3.4 per 100 patient-years. The most important considerations in taking this decision were the patient's physical condition, the expected result of rehydration, and the (presumed) wishes of the patient. Decisions to start hydration resembled decisions to start nutrition, but more frequently concerned incompetent patients with an intercurrent infectious disease. CONCLUSIONS: Compared with the USA literature, ANH is practised less in The Netherlands. This practice conforms to the prevailing treatment policy endorsed by the Dutch Association of Nursing-Home Physicians. In starting nutrition and/or hydration, an agreement about the (limited) duration of ANH is generally made, and the NHPs generally involve relatives and nurses in the decision-making process. Almost always, all parties involved agreed with decisions taken

%0 Journal Article
%C Department of Public Health, Erasmus Medical Center, Rotterdam, Netherlands. a.vanderheide@erasmusmc.nl
%A van der Heide, Agnes
%A Onwuteaka-Philipsen, Bregje D
%A Rurup, Mette L
%A Buiting, Hilde M
%A van Delden, Johannes J M
%A Hanssen-de Wolf, Johanna E
%A Janssen, Anke G J M
%A Pasman, H Roeline W
%A Rietjens, Judith A C
%A Prins, Cornelis J M
%A Deerenberg, Ingeborg M
%A Gevers, Joseph K M
%A van der Maas, Paul J
%A van der Wal, Gerrit
%J N Engl J Med
%D 2007 May
%N 19
%P 1957-65
%T End-of-life practices in the Netherlands under the Euthanasia Act
%V 356
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17494928
%X BACKGROUND: In 2002, an act regulating the ending of life by a physician at the request of a patient with unbearable suffering came into effect in the Netherlands. In 2005, we performed a follow-up study of euthanasia, physician-assisted suicide, and other end-of-life practices. METHODS: We mailed questionnaires to physicians attending 6860 deaths that were identified from death certificates. The response rate was 77.8%. RESULTS: In 2005, of all deaths in the Netherlands, 1.7% were the result of euthanasia and 0.1% were the result of physician-assisted suicide. These percentages were significantly lower than those in 2001, when 2.6% of all deaths resulted from euthanasia and 0.2% from assisted suicide. Of all deaths, 0.4% were the result of the ending of life without an explicit request by the patient. Continuous deep sedation was used in conjunction with possible hastening of death in 7.1% of all deaths in 2005, significantly increased from 5.6% in 2001. In 73.9% of all cases of euthanasia or assisted suicide in 2005, life was ended with the use of neuromuscular relaxants or barbiturates; opioids were used in 16.2% of cases. In 2005, 80.2% of all cases of euthanasia or assisted suicide were reported. Physicians were most likely to report their end-of-life practices if they considered them to be an act of euthanasia or assisted suicide, which was rarely true when opioids were used. CONCLUSIONS: The Dutch Euthanasia Act was followed by a modest decrease in the rates of euthanasia and physician-assisted suicide. The decrease may have resulted from the increased application of other end-of-life care interventions, such as palliative sedation