%0 Journal Article %J Physiologist %D 2007 Apr %N 2 %P 68-9 %T PETA kills animals %V 50 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17479489 %0 Journal Article %J Treat Guidel Med Lett %D 2007 Apr %N 56 %P 23-32 %T Drugs for pain %V 5 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17375032 %0 Journal Article %C Department of Health Sciences, Division of Gerontology and Caring Sciences, P.O. Box 157, SE-221 00 Lund, Sweden; The Vardal Institute, The Swedish Institute for Health Sciences, Lund University, P.O. Box 187, SE-221 00 Lund, Sweden %A Andersson, M %A Hallberg, IR %A Edberg, AK %J Int J Nurs Stud %D 2007 May %T Old people receiving municipal care, their experiences of what constitutes a good life in the last phase of life %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17540379 %X BACKGROUND: Old people's life situation when receiving municipal help and care in their last period of life is sparsely investigated from their own perspective. OBJECTIVE: The aim of this study was to investigate the experiences of aspects that bring about a good life in the last phase of life among people (75+ years) receiving municipal care. PARTICIPANTS: Older people living in a municipality in Southern Sweden being 75 years or older, receiving help and/or care from the municipality, and having a life-threatening disease and/or receiving palliative care were asked to participate. In all 17 people, 10 women and 7 men, aged 78-100 years were included. METHODS: Qualitative interviews, with the emphasis on their present life situation especially what brought about a good life, were performed. The interviews were analysed using qualitative content analysis. RESULTS: The experience was interpreted to be Turning inwards to come to peace with the past, the present and approaching death while being trapped by health complaints. Six categories embraced the experience of aspects that constitute a good life in the last phase of life: Maintaining dignity, Enjoying small things, Feelings of "being at home", Being in the hands of others, trying to adjust, Still being important for other people and Completing life while facing death. CONCLUSION: This study confirm theories suggesting that the last phase of life in old age meant focusing inwards, reflecting on the entire life as a way of completing it as well as enjoying small things and also viewing oneself in the perspective of contributing to the future. It also indicated that this phase of life meant being trapped by health complaints and functional limitations. The struggle to maintaining dignity as opposed to being in the hands of others implies that the concept of palliative care may be useful as a framework for providing nursing care to very old people, especially at the end of life %0 Journal Article %C Medizinische Universitatsklinik, Knappschaftskrankenhaus, Bochum. meduni-kkh@rub.de %A Andre, N %A Schmiegel, W %J Schweiz Rundsch Med Prax %D 2007 Feb %N 9 %P 327-36 %T [Medical therapy of progressive colorectal cancer] %V 96 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17361634 %X Progress in the systemic treatment of colorectal cancer is evident, not only due to the significant increase in life expectancy in advanced colorectal cancer. It became possible mainly through the consequent and broad clinical introduction of irinotecan and oxaliplatin who should be embraced as standard chemotherapy treatment by now. Oral fluoropyrimidines are on their way to replace parenteral fluorouracil application not only in single drug regimens but also in the new and effective combination protocols. And the innovative concepts of targeted therapies against VEGF and the EGF-receptor have entered clinical treatment. How therapy standards will emerge from the current multiplicity of possible combinations can not be answered yet. The rapid approval of multiple active substances has made the design and completion of clinical trials to answer this question difficult. It has also led to uncertainty in the choice of wich therapy to choose at what time and in wich combination. And escalating costs caused mainly by the use of targeted therapies will seriously challenge the already restricted resources of public healthcare. Carefully defined, individual treatment indications using yet to be developed predictive tools are urgently needed to adress this problem. In conclusion further progress is at the horizon but can only take place through interdisciplinary cooperation and careful design and completion of randomized clinical trials %0 Journal Article %A Baider, Lea %A Surbone, Antonella %J Onkologie %D 2007 Mar %N 3 %P 94-5 %T Patients' choices of the place of their death: a complex, culturally and socially charged issue %V 30 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17341894 %0 Journal Article %C Departments of Medicine II (G.B., R.S., H.E.B.), Medical Biometry and Statistics (M.O.), and Radiotherapy (C.X., F.M.), University Hospital Freiburg, Freiburg, Germany %A Becker, Gerhild %A Sarhatlic, Robert %A Olschewski, Manfred %A Xander, Carola %A Momm, Felix %A Blum, Hubert E %J J Pain Symptom Manage %D 2007 Jun %N 6 %P 711-9 %T End-of-Life Care in Hospital: Current Practice and Potentials for Improvement %V 33 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17531911 %X From July until September 2004, all deaths were registered prospectively in all departments of Freiburg University Hospital, Germany, a large teaching hospital with approximately 55,000 inpatient admissions per year. A retrospective chart review was done for all patients who died during this time period using a tool validated in two American and Australian projects. Main outcome measures were patients' identification as dying by medical staff, Do-Not-Resuscitate (DNR) orders, and the presence of comfort care plans. The cohort comprised 226 consecutive death events. Seven percent of patients had a written advance directive. DNR orders were available for 65% of patients and were entered into the charts on average 5.9 days prior to death. Thirty-eight percent of charts had evidence that staff recognized that the patients were dying. This prognosis was noted on average 3.8 days prior to death. According to chart notes, clinicians documented cancer patients as dying more frequently than patients with cardiovascular disease (P=0.029). In the chart entries, comfort care plans were completed fully for 14% and partially for 27% of patients. On average, comfort care plans were put in place nine days prior to death. Cancer patients had significantly more frequent comfort care plans than patients with cardiovascular diseases (P<0.001). In 59% of medical charts, there was no evidence of a comfort plan. Approximately one-third of dying patients received active life-sustaining treatment at time of death. These data highlight the need for systematic strategies to monitor patients' needs and to improve quality of care, especially during the last four days before death %0 Journal Article %C Dalens Hospital, Unit of Palliative Care, Enskededalen, Sweden. bergdahl_elisabeth@hotmail.com %A Bergdahl, Elisabeth %A Wikstrom, Britt-Maj %A Andershed, Birgitta %J J Clin Nurs %D 2007 Apr %N 4 %P 752-60 %T Esthetic abilities: a way to describe abilities of expert nurses in palliative home care %V 16 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17402957 %X AIM: The aim of this paper is to focus on the abilities needed to create the caring relation in palliative home care and to find ways to describe these abilities and skills from an esthetic perspective. BACKGROUND: Nurses in Palliative home care have to create a functioning relationship between themselves the patient and the patient's next of kin, this puts special demands on the nurse. A number of abilities, such as creativity, intuition, empathy and self-knowledge are mentioned in literature related to the caring relation. Many nursing theorists have referred to the art and esthetic of nursing when trying to describe these abilities. METHODS: Data were collected using semi-structured interviews with eight expert nurses in palliative home care. The transcribed interviews were analysed using qualitative content analyses. FINDINGS: Three main categories where found: The will to do good, Knowledge and Perceptiveness. Subcategories that can be seen as abilities where found in the main categories knowledge and perceptiveness. CONCLUSIONS: The main categories can be seen as expressions for abilities, personal qualities and skills needed to create the caring relation in palliative home care. We found interesting connections between the three main categories and the concepts of esthetics, ethics and science. We also found that nurses develop in a way, i.e. similar to an artist. RELEVANCE TO CLINICAL PRACTICE: The concepts brought forward in this paper could be used in clinical supervision and education as well as in clinical practice. If nurses think about the three aspects: Knowledge, the will to do good and perceptiveness, the chance for a positive relation between the nurse and the patient, and the patient's next of kin might increase. One could speculate that perceptiveness is a vital ability in order to achieve the expert level of nursing and that this perspective should be taken in consideration when recruiting nurses and in curriculum development %0 Journal Article %C Cecil G. Sheps Center for Health Services Research; Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill; and Department of Geriatrics, Duke University, Durham, North Carolina, USA %A Biola, Holly %A Sloane, Philip D %A Williams, Christianna S %A Daaleman, Timothy P %A Williams, Sharon W %A Zimmerman, Sheryl %J J Am Geriatr Soc %D 2007 Jun %N 6 %P 846-56 %T Physician communication with family caregivers of long-term care residents at the end of life %V 55 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17537084 %X OBJECTIVES: To assess family perceptions of communication between physicians and family caregivers of individuals who spent their last month of life in long-term care (LTC) and to identify associations between characteristics of the family caregiver, LTC resident, facility, and physician care with these perceptions. DESIGN: Retrospective study of family caregivers of persons who died in LTC. SETTING: Thirty-one nursing homes (NHs) and 94 residential care/assisted living (RC/AL) facilities. PARTICIPANTS: One family caregiver for each of 440 LTC residents who died (response rate 66.0%) was interviewed 6 weeks to 6 months after the death. MEASUREMENTS: Demographic and facility characteristics and seven items rating the perception of family caregivers regarding physician-family caregiver communication at the end of life, aggregated into a summary scale, Family Perception of Physician-Family caregiver Communication (FPPFC) (Cronbach alpha=0.96). RESULTS: Almost half of respondents disagreed that they were kept informed (39.9%), received information about what to expect (49.8%), or understood the doctor (43.1%); the mean FPPFC score (1.73 on a scale from 0 to 3) was slightly above neutral. Linear mixed models showed that family caregivers reporting better FPPFC scores were more likely to have met the physician face to face and to have understood that death was imminent. Daughters and daughters-in-law tended to report poorer communication than other relatives, as did family caregivers of persons who died in NHs than of those who died in RC/AL facilities. CONCLUSION: Efforts to improve physician communication with families of LTC residents may be promoted using face-to-face meetings between the physician and family caregivers, explanation of the patient's prognosis, and timely conveyance of information about health status changes, especially when a patient is actively dying %0 Journal Article %C , 5700 N Tamiami Drive, CPP #104, Sarasota, FL, 34243 %A Black, Kathy %A Fauske, Janice %J Home Health Care Serv Q %D 2007 %N 2 %P 41-58 %T Exploring influences on community-based case managers' advance care planning practices:facilitators or barriers? %V 26 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17537710 %X Community-based geriatric case managers work with an increasingly frail older population in need of advance care planning throughout the end of life. However, little is known regarding factors that influence their professional practices in this area. This qualitative study used four focus groups to explore case managers' (N = 27) perceptions of facilitators and barriers to advance care planning practices. Themes from the study suggest that case managers view five key influences that appear to either assist or impede practices, depending on case manager's perceptions and experiences. Themes include: (1) Paradox of case management and programmatic realities; (2) extent of family presence and involvement; (3) level of proficiency in advance care planning; (4) degree of client receptivity to planning; and (5) limited communication with providers. The findings suggest that case managers vary in their advance care planning practices by differing perceptions regarding clients, families, professional expertise, program effects, and communication within the network of providers. More research is needed to clarify the factors associated with case managers' divergent advance care planning practices in order to enhance professional practice in this area. doi:10.1300/J027v26n02_03 %0 Journal Article %C Abteilung fur Innere Medizin und Gefasskrankheiten, Universitatskrankenhaus Saint Eloi. g-boge@chu-montpellier.fr %A Boge, G %A Gallix, B %A Gresillon, C %A Khau Van Kien, A %A Veerapen, R %A Quere, I %J Vasa %D 2007 Feb %N 1 %P 33-40 %T [Primary angiosarcoma of the aorta] %V 36 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17323296 %X Primary angiosarcoma of the aorta is a rare disease. The prognosis is poor, resulting of embolic complications and early metastatic disease, with a median survival of nine months. Diagnosis is difficult and often made post-mortem. We report the case of a 68-year-old woman referred for a thrombosis of the superior mesenteric artery, occurring a few weeks after resection of an angiosarcoma of the small intestine, disclosing a primary angiosarcoma of the aortic wall with metastatic disease %0 Journal Article %C Behavioural and Brain Sciences Unit, Institute of Child Health, University College London, London WC1N 1EH, UK %A Boraston, Zillah %A Blakemore, Sarah-Jayne %A Chilvers, Rebecca %A Skuse, David %J Neuropsychologia %D 2007 Apr %N 7 %P 1501-10 %T Impaired sadness recognition is linked to social interaction deficit in autism %V 45 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17196998 %X Can autistic individuals use motion cues to identify simple emotions from 2D abstract animations? We compared emotion recognition ability using a novel test involving computerised animations, and a more conventional emotion recognition test using facial expressions. Adults with autism and normal controls, matched for age and verbal IQ, participated in two experiments. First, participants viewed a series of short (5s) animations. These featured an 'emotional' triangle, interacting with a circle. They were designed to evoke an attribution of emotion to the triangle, which was rated both in terms of anger, happiness, sadness or fear from its pattern of movement, and how animate ("living") it appeared to be. Second, emotion recognition was tested from standardised photographs of facial expressions. In both experiments, adults with autism were significantly impaired relative to comparisons in their perception of sadness. This is the first demonstration that, in autism, individuals can have difficulties both in the interpretation of facial expressions and in the recognition of equivalent emotions based on the movement of abstract stimuli. Poor performance in the animations task was significantly correlated with the degree of impairment in reciprocal social interaction, assessed by the Autism Diagnostic Observation Schedule. Our findings point to a deficit in emotion recognition in autism, extending beyond the recognition of facial expressions, which is associated with a functional impairment in social interaction skills. Our results are discussed in the context of the results of neuroimaging studies that have used animated stimuli and images of faces %0 Journal Article %A Brain, L T A %J Vet Rec %D 2007 Apr %N 15 %P 532 %T Attitudes to badger culling %V 160 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17435105 %0 Journal Article %C Kinderkrankenschwestern PATE-Projekt, Vestische Kinderklinik Universitat Witten/Herdecke, Datteln %A Brun, Sandra %A Menke, Andrea %J Kinderkrankenschwester %D 2002 Jun %N 6 %P 253-4 %T [Palliative medicine in pediatric oncology] %V 21 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17370563 %0 Journal Article %C International Observatory on End of Life Care, Institute for Health Research, Lancaster University, Lancaster, United Kingdom %A Clark, David %A Wright, Michael %A Hunt, Jennifer %A Lynch, Thomas %J J Pain Symptom Manage %D 2007 Jun %N 6 %P 698-710 %T Hospice and palliative care development in Africa: a multi-method review of services and experiences %V 33 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17531910 %X There is a paucity of information on hospice and palliative care provision in Africa and only a weak evidence base upon which to build policy and practice development. We set out to assess the current state of provision across the continent, mapping the existence of services country by country and exploring the perspectives and experiences of those involved. A multi-method review was conducted involving a synthesis of evidence from published and gray literature, ethnographic field visits to seven countries, qualitative interviews with 94 individuals from 14 countries, and the collation of existing public health data. Forty-seven African countries were reviewed, involving the assistance of numerous hospice and palliative care activists, including clinicians, managers, volunteers, policy makers, and staff of donor organizations. The 47 countries of Africa could be grouped into four categories: no identified hospice or palliative care activity (21 countries); capacity building activity is underway to promote hospice and palliative care delivery (11 countries); localized provision of hospice and palliative care is in place, often heavily supported by external donors (11 countries); and hospice and palliative care services are approaching some measure of integration with mainstream service providers and gaining wider policy recognition (four countries). Overall, services remain scattered and piecemeal in most African countries, and coverage is poor. Nongovernmental organizations are the predominant source of provision. Major difficulties relate to opioid availability, workforce development, and achieving sustainable critical mass. Models exist in Uganda, Kenya, South Africa, and Zimbabwe for the development of affordable, sustainable community-based hospice and palliative care services, but sensitivity is required in adopting Western models of hospice and palliative care for implementation in the African cultural context. Overall, interest in the development of hospice and palliative care in Africa has never been greater %0 Journal Article %C Case Western Reserve University, USA %A Clemens, Norman A %J J Psychiatr Pract %D 2007 Mar %N 2 %P 106-8 %T Deconstructing depression %V 13 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17414686 %0 Journal Article %C Capstone College of Nursing in Tuscaloosa, Ala, USA. acollins@bama.ua.edu %A Collins, Angela Smith %A Garner, Marie %J Crit Care Nurse %D 2007 Apr %N 2 %P 53-60 %T Caring for lung cancer patients receiving photodynamic therapy %V 27 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17389413 %0 Journal Article %C City of Hope Medical Center (B.F.), Duarte, California; National Hospice and Palliative Care Organization (S.R.C., P.G.F., J.L.P.), Alexandria, Virginia; American Academy of Hospice and Palliative Medicine (A.C.), Glenview, Illinois; Massachusetts General Hospital (C.M.D.), Boston, Massachusetts; School of Medicine (P.G.F.), University of Utah, Salt Lake City, Utah; Johns Hopkins Children's Center (N.H.), Baltimore, Maryland; Fairview Health Services (M.L.) and Department of Family Medicine and Community Health (M.L.), University of Minnesota Medical School, Minneapolis, Minnesota; Hospice and Palliative Nurses Association (J.L.), Pittsburgh, Pennsylvania; Lilian and Benjamin Hertzberg Palliative Care Institute (D.E.M.), Center to Advance Palliative Care (D.E.M.), and Departments of Geriatrics and Medicine (D.E.M.), Mount Sinai School of Medicine (CAPC), New York, New York; and National Consensus Project (K.Z.), Pittsburgh, Pennsylvania, USA %A Ferrell, B %A Connor, SR %A Cordes, A %A Dahlin, CM %A Fine, PG %A Hutton, N %A Leenay, M %A Lentz, J %A Person, JL %A Meier, DE %A Zuroski, K %J J Pain Symptom Manage %D 2007 Jun %N 6 %P 737-744 %T The National Agenda for Quality Palliative Care: The National Consensus Project and the National Quality Forum %V 33 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17531914 %X The release in 2007 of the National Quality Forum (NQF) preferred practices is a significant advance in the field of palliative care. These NQF preferred practices build on the clinical practice guidelines for palliative care developed by the National Consensus Project (NCP). The NQF is dedicated to improving the quality of American health care, and their focus on palliative care recognizes its growing place within the broader scope of health care. This article reviews the work of both the NCP and NQF and presents the domains and preferred practices that should guide quality improvement efforts in hospice and palliative care %0 Journal Article %C International Observatory on End of Life Care (I.C.F.), Institute of Health Research, Lancaster University, Lancaster, United Kingdom; and Department of Nursing Research and Education (M.G.), City of Hope National Medical Center, Duarte, California; Office of Cancer Survivorship (N.M.A.), Division of Cancer Control & Population Sciences, National Cancer Institute, Bethesda, Maryland; Duke Institute on Care at the End of Life (R.P.), Duke University Divinity School, Durham, North Carolina; Community Health Sciences Department (M.K.-S.), School of Public Health, Asian American Studies Department (M.K.-S.), and Center for Health Disparities (M.K.-S.), University of California at Los Angeles, Los Angeles, California; Surgical Palliative Care Task Force (G.P.D.), American College of Surgeons, Erie, Pennsylvania; VITAS Healthcare Corp. (B.M.K.), Miami, Florida; Division of Anesthesiology and Critical Care (G.P.), Department of Symptom Research, University of Texas M. D. Anderson Cancer Center, Houston, Texas; Asian American Network for Cancer Awareness, Research and Training (S.M.S.), Spring Valley, California; Southern Arizona Veterans Affairs Health Care System (R.S.K.), and University of Arizona College of Medicine (R.S.K.), Tucson, Arizona, USA %A Fineberg, IC %A Grant, M %A Aziz, NM %A Payne, R %A Kagawa-Singer, M %A Dunn, GP %A Kinzbrunner, BM %A Palos, G %A Shinagawa, SM %A Krouse, RS %J J Pain Symptom Manage %D 2007 May %T Prospective Integration of Cultural Consideration in Biomedical Research for Patients with Advanced Cancer: Recommendations from an International Conference on Malignant Bowel Obstruction in Palliative Care %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17532174 %X In the setting of an international conference on malignant bowel obstruction as a model for randomized clinical trials (RCTs) in palliative care, we discuss the importance of incorporating prospective cultural considerations in research design. The approach commonly used in biomedical research has traditionally valued the RCT as the ultimate "way of knowing" about how to best treat a medical condition. The foremost limitation of this approach is the lack of recognition of the impact of cultural viewpoints on research outcomes. We propose that interest relevant to cultural viewpoints should be emphasized in conceptualizing and interpreting research questions, designs, and results. In addition to recognizing our cultural biases as individuals and researchers, we recommend two major shifts in designing and implementing RCTs: 1) inclusion of a multidisciplinary team of researchers to inform the diversity of perspectives and expertise brought to the research and 2) use of mixed methods of inquiry, reflecting both deductive and inductive modes of inference %0 Journal Article %A Finlay, Ilora %J Palliat Med %D 2007 Mar %N 2 %P 162-3 %T Clarifying the data on double-effect %V 21 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17443934 %0 Journal Article %C Bridges Palliative Care Program, Children's Memorial Hospital, USA %A Frader, Joel E %J Hastings Cent Rep %D 2007 Jan-Feb %N 1 %P 1 p following 48 %T Discontinuing artificial fluids and nutrition: discussions with children' families %V 37 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17348264 %0 Journal Article %C margit.franz@kitakonzept.de %A Franz, Margit %J Kinderkrankenschwester %D 2007 Mar %N 3 %P 91-5 %T [The death of father or mother leaves a painful void] %V 26 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17427666 %0 Journal Article %A George, Rob %A Regnard, Claud %J Palliat Med %D 2007 Mar %N 2 %P 77-80 %T Lethal opioids or dangerous prescribers? %V 21 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17344254 %0 Journal Article %C Department of Radiation Oncology, Stanford University, Stanford, CA 94305-5847, USA. iris.gibbs@stanford.edu %A Gibbs, Iris C %A Kamnerdsupaphon, Pimkhuan %A Ryu, Mi-Ryeong %A Dodd, Robert %A Kiernan, Michaela %A Chang, Steven D %A Adler, John R Jr %J Radiother Oncol %D 2007 Feb %N 2 %P 185-90 %T Image-guided robotic radiosurgery for spinal metastases %V 82 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17257702 %X BACKGROUND AND PURPOSE: To determine the effectiveness and safety of image-guided robotic radiosurgery for spinal metastases. MATERIALS/METHODS: From 1996 to 2005, 74 patients with 102 spinal metastases were treated using the CyberKnife at Stanford University. Sixty-two (84%) patients were symptomatic. Seventy-four percent (50/68) of previously treated patients had prior radiation. Using the CyberKnife, 16-25 Gy in 1-5 fractions was delivered. Patients were followed clinically and radiographically for at least 3 months or until death. RESULTS: With mean follow-up of 9 months (range 0-33 months), 36 patients were alive and 38 were dead at last follow-up. No death was treatment related. Eighty-four (84%) percent of symptomatic patients experienced improvement or resolution of symptoms after treatment. Three patients developed treatment-related spinal injury. Analysis of dose-volume parameters and clinical parameters failed to identify predictors of spinal cord injury. CONCLUSIONS: Robotic radiosurgery is effective and generally safe for spinal metastases even in previously irradiated patients %0 Journal Article %C Research Unit for General Practice, University of Southern Denmark, JB Winslows Vej 9A, DK-5000 Odense C, Denmark %A Hansen, DG %A Rosholm, JU %A Gichangi, A %A Vach, W %J Age Ageing %D 2007 May %T Increased use of antidepressants at the end of life: population-based study among people aged 65 years and above %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17537746 %X BACKGROUND: the new antidepressants are generally effective and safe for older people, but may have serious side-effects. The use has been rapidly increasing, but focus on upper age groups has been limited. The pattern of antidepressant use as death approaches has never been analysed. OBJECTIVE: to analyse the use of antidepressants among individuals aged 65 years and above with respect to time trends, age and proximity to death. DESIGN: population-based prescription study. SETTING: the County of Funen, Denmark, 1992-2004 ( approximately 470.000 inhabitants). RESULTS: the 1-year prevalence of antidepressants increases steadily over time in all age groups. Among the 65+ year-olds it also increases with age and differs substantially between the youngest and the oldest. Very high prevalences are observed: 26.8% among females 85-89 years old and 17.5% among males 85 years and above in 2004. In all age groups the use of antidepressants increases substantially with proximity to death in the last 3 years of life. In the last phase of life the use is independent of whether the patient dies at age 65 or 90 about 33% of females and 25% of males receive antidepressants in the last 6 months. CONCLUSIONS: the use of antidepressants among 65+ year-olds increases with age and proximity to death to very high levels. Future studies may clarify the problems and diagnoses giving rise to the use of antidepressants for such a large proportion of older people, and especially the problems giving rise to treatment as death approaches %0 Journal Article %C St. Jude Children's Research Hospital, Memphis, Tennessee, pam.hinds@stjude.org %A Hinds, Pamela S %A Burghen, Elizabeth A %A Pritchard, Michele %J West J Nurs Res %D 2007 Jun %N 4 %P 448-65 %T Conducting End-of-Life Studies in Pediatric Oncology %V 29 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17538126 %X Improving our ability to prevent or diminish suffering in dying children and adolescents and their families is dependent on the completion of high-quality pediatric end-of-life studies. The purpose of this article is to provide useful evidence-based strategies that have been used to implement and complete clinically useful pediatric end-of-life studies in oncology. The article describes specific peer-review and methodological challenges and links those to evidence-based solutions. The challenges and solutions described in this article are from eight end-of-life studies involving pediatric oncology patients. It is hoped that the solutions described here will benefit others in their efforts to implement pediatric end-of-life studies so that clinically useful findings will result and will improve the care of dying children and adolescents %0 Journal Article %C Department of Geriatrics, Graduate School of Medicine, Nagoya University %A Hirakawa, Yoshihisa %A Masuda, Yuichiro %A Kuzuya, Masafumi %A Iguchi, Akihisa %A Uemura, Kazumasa %J Nippon Ronen Igakkai Zasshi %D 2007 Mar %N 2 %P 247-50 %T [Effect of end-of-life care teaching on the attitude of medical students to death] %V 44 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17527028 %X AIM: We conducted a national survey to examine how programs to teach end-of-life care to medical students in Japanese medical schools influence their death attitude. METHODS: Sixteen medical schools participated. We conducted a questionnaire survey on fifth- or sixth-year medical students' death attitude at each medical school. Attitude of death was analyzed by the Death Attitude Inventory formed by Hirai et al, which is composed of seven factors: Afterlife belief, Death anxiety, Death relief, Death avoidance, Life purpose, Death concern, and Supernatural belief. We studied how students' attitude to death relates to programs to teach end-of-life care. RESULTS: Overall 1,017 of 1,510 students (67.4%) from the 16 medical schools participated. The students who took a program to teach end-of-life care presented Afterlife belief, Death concern and Supernatural belief score higher than those who did not participate in any program. Multiple logistic regression analysis was conducted and it was found that those trend disappeared, and the students who took a program had greater Death anxiety significantly higher than those who took no program. CONCLUSION: We concluded that the attitude of medical students to death was not related to programs to teach end-of-life care in medical schools. Our survey suggested that improving end-of-life care education is needed to mold the attitude of medical students to death %0 Journal Article %C Klinik fur Mund-, Kiefer- und Gesichtschirurgie, Plastische Operationen, Knappschaftskrankenhaus Recklinghausen, Recklinghausen, Germany. sebastian.hoefert@ruhr-uni-bochum.de %A Hoefert, S %A Bloch, T %A Wierich, W %A Eufinger, H %J Mund Kiefer Gesichtschir %D 2006 Jan %N 1 %P 46-9 %T [Rare entity of a macroscopically visible tumor cone of squamous cell carcinoma in the greater veins of the head and neck] %V 10 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=16362394 %X Cones of malignant tumors are commonly known but only a few descriptions of cones in the head and neck area exist - as seen in a 91-year-old patient under our care. Cones of thymic and thyroid cancers are described in the literature. There are no descriptions of cones of head and neck squamous cell carcinomas. Metastases of squamous cell carcinoma in the head and neck area are very aggressive and have a high potential for vascular neogenesis. A vascular cone might be possible by vascular formation or by mechanical intrusion as described elsewhere %0 Journal Article %C Children's Hospital Boston, USA. ruth.hynes@childrens.hospital.edu %A Hynes, Ruth %J Am J Nurs %D 2007 May %N 5 %P 88 %T Reflections: finding the words %V 107 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17443093 %0 Journal Article %C Department of Companion Animal Clinical Sciences, Norwegian School of Veterinary Science, Oslo, Norway. gry.jaeger@veths.no %A Jaeger, Gry T %A Larsen, Stig %A Soli, Nils %A Moe, Lars %J Acta Vet Scand %D 2007 %N 1 %P 9 %T Two years follow-up study of the pain-relieving effect of gold bead implantation in dogs with hip-joint arthritis %V 49 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17381835 %X Seventy-eight dogs with pain from hip dysplasia participated in a six-month placebo-controlled, double-blinded clinical trial of gold bead implantation. In the present, non-blinded study, 73 of these dogs were followed for an additional 18 months to evaluate the long-term pain-relieving effect of gold bead implantation. The recently-published results of the six month period revealed that 30 of the 36 dogs (83%) in the gold implantation group showed significant improvement (p = 0.02), included improved mobility and reduction in the signs of pain, compared to the placebo group (60% improvement).In the long-term two-year follow-up study, 66 of the 73 dogs had gold implantation and seven dogs continued as a control group. The 32 dogs in the original placebo group had gold beads implanted and were followed for a further 18 months. A certified veterinary acupuncturist used the same procedure to insert the gold beads as in the blinded study, and the owners completed the same type of detailed questionnaires. As in the blinded study, one investigator was responsible for all the assessments of each dog. The present study revealed that the pain-relieving effect of gold bead implantation observed in the blinded study continued throughout the two-year follow-up period %0 Journal Article %C Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC. Daryl.Jones@med.monash.edu.au %A Jones, Daryl A %A McIntyre, Tammy %A Baldwin, Ian %A Mercer, Inga %A Kattula, Andrea %A Bellomo, Rinaldo %J Crit Care Resusc %D 2007 Jun %N 2 %P 151-6 %T The medical emergency team and end-of-life care: a pilot study %V 9 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17536983 %X Objectives: To assess the characteristics of patients who died in a teaching hospital and the role of the medical emergency team (MET) in their end-of-life care. Methods: This was a retrospective analysis of 105 deaths over the month of May 2005 by a blinded investigator, who documented patient age, parent hospital unit, comorbidities, presence and timing of not-for-resuscitation (NFR) designation, and presence and timing of first MET review. We analysed differences between medical versus surgical patients, NFR versus non-NFR patients, and MET-reviewed versus non-MET-reviewed patients. Results: Of the 105 patients who died, 80 were medical patients and 25 were surgical patients. Five patients were not designated NFR at the time of death, and three of these had antecedent MET criteria in the 24 hours before death. Of the 100 patients who were designated NFR at the time of death, 35 received a MET call during their admission. Of the 35 MET calls, 10 occurred on the same day as the patient's death, and 12 on the same day as the NFR designation. Documentation of NFR status occurred later in the admission for patients who received a MET call than for those who did not receive a MET call (mean ±SD, 13.3 ±16.1 versus 5.3 ±10.8 days after admission; P = 0.003). Hypotension, hypoxia and tachypnoea were the most common MET triggers, and pulmonary oedema, pneumonia and acute coronary syndromes were the most common reasons for the deterioration in the patient's condition. Following the MET review, patients were admitted to the ICU and newly classified as NFR in 15 and nine of the 35 MET calls, respectively. Conclusions: Most patients who died in our hospital were designated NFR at the time of death. A third of these patients were seen by the MET before death. In about 10% of cases, the MET participated in the decision to designate the patient NFR %0 Journal Article %C Middle Tennessee State University, Murfreesboro, TN, USA %A Judy Campbell, Mary %A Jo Edwards, M %A Ward, Karen S %A Weatherby, Norman %J J Nurs Scholarsh %D 2007 %N 2 %P 165-71 %T Developing a parsimonious model for predicting completion of advance directives %V 39 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17535317 %X Purpose: To develop a theory-based model to assist nurses in promoting self-determination for completion of an advance directive (AD). Design and Methods: This descriptive study included data from a convenience sample of 118 community-dwelling older adults in Tennessee, USA. Multinomial logistic regression was used to estimate the influence of 15 factors and covariates on completion of an AD. Findings: The parsimonious model had three significant factors: receiving AD information; attitude index; and health literacy score. Participants were highly likely to complete ADs if they had positive attitudes toward ADs and had received information on ADs. As health literacy increased, the likelihood that participants completed ADs was reduced. This model explained 25% of the variation in AD completion. Chi-square fit for the parsimonious model was highly significant. Conclusions: Of 15 factors and covariates that could influence completion of an AD, only receiving information about ADs, having positive attitudes toward ADs, and health literacy significantly affected the likelihood of participants completing ADs. More study is needed on this model and how nurses can assist patients with end-of-life decisions %0 Journal Article %C PH Freiburg i.Br./Erziehungswissenschaftliches Institut. dr_peter_kern@yahoo.de %A Kern, P %J Schweiz Rundsch Med Prax %D 2007 Feb %N 8 %P 287-95 %T [Value change and medicine--are there ethical arguments to legalise assisted suicide, even "killing on demand"?] %V 96 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17375653 %X The essay starts quoting general examples of value change in western societies. Medicine is subject to this value change as well. Euthanasie serves to discuss this topic. During the occidental history the mental attitude towards euthanasy has changed fundamentally. The result of this development: "Killing on demand" is forbidden by law and professional ethics of physicians. On the contrary a new theory of philosophical ethics gives reasons even for "killing on demand". The author agrees to these arguments. In rare and well defined situations "killing on demand" is covered by the right to self-determination %0 Journal Article %C Department of Perinatology and Gynaecology, University Medical Centre Utrecht, The Netherlands %A Korenromp, MJ %A Page-Christiaens, GC %A van, den Bout J %A Mulder, EJ %A Hunfeld, JA %A Potters, CM %A Erwich, JJ %A van, Binsbergen CJ %A Brons, JT %A Beekhuis, JR %A Omtzigt, AW %A Visser, GH %J Prenat Diagn %D 2007 May %T A prospective study on parental coping 4 months after termination of pregnancy for fetal anomalies %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17533631 %X OBJECTIVE: To identify short-term factors influencing psychological outcome of termination of pregnancy for fetal anomaly, in order to define those patients most vulnerable to psychopathology. STUDY DESIGN: A prospective cohort of 217 women and 169 men completed standardized questionnaires 4 months after termination. Psychological adjustment was measured by the Inventory of Complicated Grief (ICG), the Impact of Event Scale (IES), the Edinburgh Postnatal Depression Scale (EPDS), and the Symptom Checklist-90 (SCL-90). RESULTS: Women and men showed high levels of posttraumatic stress (PTS) symptoms (44 and 22%, respectively) and symptoms of depression (28 and 16%, respectively). Determinants of adverse psychological outcome were the following: high level of doubt in the decision period, inadequate partner support, low self-efficacy, lower parental age, being religious, and advanced gestational age. Whether the condition was Down syndrome or another disability was irrelevant to the outcome. Termination did not have an important effect on future reproductive intentions. Only 2% of women and less than 1% of men regretted the decision to terminate. CONCLUSION: Termination of pregnancy (TOP) for fetal anomaly affects parents deeply. Four months after termination a considerable part still suffers from posttraumatic stress symptoms and depressive feelings. Patients who are at high risk could benefit from intensified support. Copyright (c) 2007 John Wiley & Sons, Ltd %0 Journal Article %C Pontificia Universidade Catolica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil. lagopatricia@terra.com.br %A Lago, PM %A Devictor, D %A Piva, JP %A Bergounioux, J %J J Pediatr (Rio J) %D 2007 May %N 2 Suppl %P S109-S116 %T End-of-life care in children: the Brazilian and the international perspectives %V 83 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17530135 %X OBJECTIVE: To analyze the medical practices and the end-of-life care provided to children admitted to pediatric intensive care units in different parts of the globe. SOURCES: Articles on end-of-life care published during the last 20 years were selected from the PubMed, MEDLINE and LILACS databases, with emphasis on studies of death in pediatric intensive care units in Brazil, Latin America, Europe and North America, using the following keywords: death, bioethics, pediatric intensive care, cardiopulmonary resuscitation and life support limitation. SUMMARY OF THE FINDINGS: Publications on life support limitation (LSL) are concentrated in North America and Europe. In North American pediatric intensive care units there is a greater incidence of LSL (~ 60%) than in Europe or Latin America (30-40%). These differences appear to be related to cultural, religious, legal and economic factors. Over the last decade, LSL in Brazilian pediatric intensive care units has increased from 6 to 40%, with do not resuscitate orders as the most common method. Also of note is the low level of family participation in the decision-making process. A recent resolution adopted by the Federal Medical Council (Conselho Federal de Medicina) regulated LSL in our country, demystifying a certain apprehension of a legal nature. The authors present a proposal for a protocol to be followed in these cases. CONCLUSIONS: The adoption of LSL with children in the final phases of irreversible diseases has ethical, moral and legal support. In Brazil, these measures are still being adopted in a timid manner, demanding a change in behavior, especially in the involvement of families in the decision-making process %0 Journal Article %C Centre for Biostatistics and Genetic Epidemiology, Department of Health Sciences, University of Leicester, UK %A Lambert, PC %A Billingham, LJ %A Cooper, NJ %A Sutton, AJ %A Abrams, KR %J Health Econ %D 2007 May %T Estimating the cost-effectiveness of an intervention in a clinical trial when partial cost information is available: a Bayesian approach %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17533622 %X There is an increasing need to establish whether health-care interventions are cost effective as well as clinically effective. It is becoming increasingly common for cost studies to be incorporated into clinical trials, either on all patients or more usually on a subset of patients. Establishing the total cost per patient is complex, as it requires information on resource use, which may come from a variety of different sources. This complexity may lead to considerable missing data, and can result in some patients only having partial cost information.In this paper we consider a clinical trial consisting of 351 patients with advanced non-small cell lung cancer comparing chemotherapy with standard palliative care. A subset of 115 patients was selected for the cost sub-study. Total cost was split into four components, for which resource use was collected. Complete resource data were available on 82 patients. For the remaining patients at least one of the cost components was missing.The objective of this paper is to develop a Bayesian approach which simultaneously models both the clinical effectiveness data and the cost data, by modelling the individual components. This also provides estimates of the cost-effectiveness in terms of the Incremental Net Monetary Benefit (INMB) and Cost-Effectiveness Acceptability Curves (CEAC). We compare a number of different models of increasing complexity. The models estimate the interrelationships between the four cost components and survival, and thus enable a predictive distribution for each missing cost item to be obtained. Copyright (c) 2007 John Wiley & Sons, Ltd %0 Journal Article %C Academic Palliative and Supportive Care Studies Group (M.L.-W., V.K.), Division of Primary Care (A.S.), School of Population, Community and Behavioural Sciences, University of Liverpool, Liverpool; and Division of Psychology and Social Change (J.S.), Manchester Metropolitan University, Manchester, United Kingdom %A Lloyd-Williams, M %A Kennedy, V %A Sixsmith, A %A Sixsmith, J %J J Pain Symptom Manage %D 2007 May %T The End of Life: A Qualitative Study of the Perceptions of People Over the Age of 80 on Issues Surrounding Death and Dying %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17531435 %X This study explored how elderly people living in the community perceive issues around death, dying, and the end of life using a qualitative grounded theory approach. Forty individuals aged between 80 and 89 years who were living alone in the community were interviewed and were identified through purposive and random sampling. The results revealed that issues associated with end of life included fear of how they would die, fear of becoming a burden to others, wanting to prepare for and have a choice with regard to where and when they die, and issues relating to assisted dying. The study demonstrated that issues relating to the end of life are a major concern for older people, but are seldom addressed by professionals. Listening to and understanding the views and experiences of the older age group regarding end-of-life care is needed if adequate person-centered care is to be delivered to this ever-growing population group %0 Journal Article %A Luce, John M %J Crit Care Med %D 2007 May %N 5 %P 1419-20 %T A legally sanctioned process for resolving conflicts about treatment considered medically inappropriate %V 35 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17446736 %0 Journal Article %A Luthi, Urs %J Krankenpfl Soins Infirm %D 2007 %N 3 %P 24-6 %T [Creating dignity anew in every process] %V 100 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17427854 %0 Journal Article %C Medicin geriatre, Hopital Sainte-Perine, Paris %A Mahamdia, Rachid %A Galiano, Odile %A Cudennec, Tristan %J Soins Gerontol %D 2007 Mar-Apr %N 64 %P 10-3 %T [Urinary incontinence in elderly persons] %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17474228 %0 Journal Article %C E.U.E. de la Comunidad de Madrid %A Martinez Ortega, J C %A Martinez Ortega, R M %A Quintana Oter, C %A Rubiales Paredes, D %J Rev Enferm %D 2007 Mar %N 3 %P 32-9 %T [Last will and testament: decision-making at the end of one's life] %V 30 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17474370 %X Current medical practice has made great progress over the past century which permits people to live longer and better than before. But this improvement has not been transferred to the field of death. To die with dignity today is a privilege only a few have. Those close to death claim their right to a death with dignity. Their petition usually goes unheard by the medical profession. The patients' autonomous law, which regulates last will and testaments or anticipated final wishes, is a step in this direction. The objective of this article is to publicize the current legal regulations related to last wills and testaments or last wishes by means of a critical review of the existing legislation %0 Journal Article %C Department of Gerontological Nursing, Nagasaki University Graduate School of Biomedical Sciences, Japan %A Matsui, Miho %J J Nurs Scholarsh %D 2007 %N 2 %P 172-6 %T Perspectives of elderly people on advance directives in Japan %V 39 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17535318 %X Purpose: To examine perspectives of Japanese elderly people on advance directives (ADs) and factors related to positive attitudes toward ADs. Method: The data were collected by a structured questionnaire from 313 of 565 older adult members of senior citizens' centers in two cities in Japan. Survey items pertained to demographic characteristics, terminal care preferences, and personal values, including autonomy, family function, and religious piety. Findings: Of the 313 elderly people who completed questionnaires, 72.9% had positive preferences for executing living wills. With regard to durable power of attorney for health care, 62.2% approved of it. The supporters of ADs were more likely to have had discussions about terminal care with family members or physicians, experience of a family member hospitalized for terminal illness or injury, preferences for life-sustaining treatments that were self-determined, and personal values such as religious piety. The relationship between positive preferences toward durable power of attorney for health care and sex, marital status, and living arrangements were significant. Conclusions: Most Japanese older adults in this study approved of ADs, and family structure was important to the acceptance of designating a proxy. Discussion about end-of-life care and respect for life-sustaining treatment preferences are important decisions, about the end of life %0 Journal Article %C Department of Palliative Care, Saitama Cancer Center, Saitama, Japan %A Matsuo, Naoki %A Morita, Tatsuya %J J Pain Symptom Manage %D 2007 Jun %N 6 %P 655-6 %T Physician-reported practice of the use of methylphenidate in Japanese palliative care units %V 33 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17531905 %0 Journal Article %A Meyers, Susan %J Trustee %D 2007 May %N 5 %P 20-4, 1 %T Care with compassion. The case for palliative care %V 60 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17539573 %X As the population ages, and complex, chronic conditions become more prevalent in the patient mix, hospitals need to take a sharper look at the advantages--and common sense--of palliative care %0 Journal Article %C Division of Medical Ethics, Department of Public Health and Primary Health Care, University of Bergen, Norway %A Miljeteig, Ingrid %A Markestad, Trond %A Norheim, Ole Frithjof %J Acta Paediatr %D 2007 Jun %N 6 %P 825-9 %T Physicians' use of guidelines and attitudes to withholding and withdrawing treatment for extremely premature neonates in Norway %V 96 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17537010 %X Objectives: To examine if explicit written guidelines for withholding and withdrawing treatment for extremely premature infants exist and are used in obstetric and paediatric units in Norway, and to explore changes in attitudes and which factors are considered important when making decisions regarding life support. Methods: Cross-sectional postal survey addressed to the medical directors of all the 46 obstetric and the 28 paediatric units in Norway. Results: The response rate was 84%. Half the units had guidelines for withholding and one quarter for withdrawing life support. Most of them were non-written informal guidelines. The most important factors for withholding treatment were gestational age and vitality while risk of severe disability and future quality of life were the major concerns for withdrawing treatment. The mean reported gestational age threshold for resuscitating infants decreased from 23.6 weeks (SD ± 0.6) in a study from 1998 to 23.0 weeks (SD ± 0.8) in 2005 (p = 0.001). Physicians did not perceive this change in threshold, but 1/3 felt that decisions regarding provision of life support had become more difficult. Almost half of the responding physicians agreed with the statement that Norway is too liberal in its provision of life support to extremely premature infants. Conclusion: The criteria for whom to provide life support or not are imprecise and may be subject to unperceived changes. Explicit local guidelines for the decision-making process may secure legitimacy and fair treatment options %0 Journal Article %A Miura, Hisayuki %A Ota, Toshiki %J Nippon Ronen Igakkai Zasshi %D 2007 Mar %N 2 %P 162-4 %T [End-of-life care in the elderly patients--resolving ethical dilemmas in Japan] %V 44 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17527007 %0 Journal Article %C Department of Neurology, Nishimaruyama Hospital %A Miyagishi, Ryuji %A Higashi, Takuya %A Akaishi, Yasuhiro %A Arai, Masayoshi %A Minemawari, Yoshimori %J Nippon Ronen Igakkai Zasshi %D 2007 Mar %N 2 %P 219-23 %T [Clinical features and prognosis of terminally ill patients in a geriatric long-term care hospital with particular regard to the implications of artificial nutrition] %V 44 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17527024 %X AIM: To clarify the clinical features of terminally ill patients in our hospital and elucidate the implications of administering artificial nutrition. METHODS: Between April 2004 and March 2005, we assessed 155 patients who died in Nishimaruyama Hospital--a geriatric long-term care facility in Sapporo. We analyzed their clinical backgrounds on admission, the clinical course up to the terminal stage of the illness, and the outcome of patients who received artificial nutrition. RESULTS: In 95 patients, the main cause of the terminal illness was infection. The symptoms of these patients, such as cerebral infarction and cognitive dysfunction, deteriorated progressively, and eventually, eating became difficult. At this point, alternative methods for providing nutrition were discussed. For 60 patients (41 died of acute disease and 19, of advanced cancers), artificial nutrition was not considered. Artificial nutrition was administered to 63 patients; tube feeding was carried out in 30 patients. Because of repeated aspiration pneumonia, 14 of these 30 patients eventually underwent intravenous hyperalimentation (IVH). Thirty-three patients directly underwent IVH. Thirty-two patients did not undergo any feeding course. The mean survival times of the tube feeding and non-artificial nutrition groups were 827 and 60 days, respectively. The difference in the survival times was statistically significant. CONCLUSION: The outcome of patients who were placed on tube feeding was good. This may be because we selected those patients considered most suitable for tube feeding or IVH. The criteria that were used to select an appropriate method for providing nutrition varied, although the patients in our hospital requested palliative care %0 Journal Article %C Department of Healthcare Quality Assessment, Graduate School of Medicine, University of Tokyo, Japan %A Miyata, Hiroaki %A Aita, Kaoruko %A Shiraishi, Hiromi %A Kai, Ichiro %J Nippon Koshu Eisei Zasshi %D 2007 Apr %N 4 %P 254-61 %T Understanding treatment attitudes toward dementia: differences among community residents and health care professionals %V 54 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17533961 %X To examine how the severity of dementia affects attitudes to treatment preferences in a lay group of community residents and a group of medical care professionals who provide direct care to dementia affected patients. The participants were 259 community residents aged between 40 and 65, and 217 care professionals working at nursing homes or group homes. Respondents were randomly assigned to one of two scenarios involving moderate or severe dementia and each was asked questions about their preferences and attitudes to the employment of eight types of active treatments (ATs) to deal with a newly acquired illness as well as eight types of life-sustaining treatment (LST). Among the community residents, there were no significant differences in preferences toward any treatment items between the moderate dementia and severe dementia scenarios. Similarly, care professionals showed no significant differences in attitudes toward 15 of the 16 treatment items. The community residents had more negative attitudes than care professionals in attitudes to all types of LST, including four variations of AT that have a good chance of success. After dementia deprives an individual of decision-making capacity, progress of the disease has little effect on both community residents and care professionals' preferences. When discussing about end-of-life decision-making, care professionals need to be careful about the gaps in perception of good chance treatments with patients %0 Journal Article %C Division of Psychological Medicine, Institute of Psychiatry, London, UK. spjucrm@iop.kcl.ac.uk %A Morgan, Craig %A Kirkbride, James %A Leff, Julian %A Craig, Tom %A Hutchinson, Gerard %A McKenzie, Kwame %A Morgan, Kevin %A Dazzan, Paola %A Doody, Gillian A %A Jones, Peter %A Murray, Robin %A Fearon, Paul %J Psychol Med %D 2007 Apr %N 4 %P 495-503 %T Parental separation, loss and psychosis in different ethnic groups: a case-control study %V 37 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17094816 %X BACKGROUND: Numerous studies have reported high rates of psychosis in the Black Caribbean and Black African populations in the UK. However, few studies have investigated the role of specific risk factors in different ethnic groups. We sought to investigate the relationship between long-term separation from, and death of, a parent before the age of 16 and risk of adult psychosis in different ethnic groups. METHOD: All patients with a first episode of psychosis who made contact with psychiatric services in defined catchment areas in London and Nottingham, UK and a series of community controls were included in the AESOP (Aetiology and Ethnicity in Schizophrenia and Other Psychoses) study. Data relating to clinical and social variables, including parental separation and loss, were collected from patients and controls. RESULTS: Separation from, and death of, a parent before the age of 16 were both strongly associated with a two- to threefold increased risk of psychosis. The strength of these associations were similar for White British and Black Caribbean (but not Black African) subjects. Separation from (but not death of) a parent was more common among Black Caribbean controls than White British controls. CONCLUSIONS: Early separation may have a greater impact in the Black Caribbean population, because it is more common, and may contribute to the excess of psychosis in this population %0 Journal Article %C Kaiser Permanente Center for Health Research (R.M.), Oregon Health & Science University (R.M.), and Northwest Permanente PC-Kaiser Sunnyside Medical Center (R.M.), Portland, Oregon; Veterans Integrated Palliative Program (K.R.), Veterans Administration Greater Los Angeles Healthcare System, and University of California at Los Angeles David Geffen School of Medicine (K.R.), Los Angeles, California; Behavioral Measurement Shared Service (S.J.C.), University of Arizona Colleges of Pharmacy and Public Health, and Arizona Cancer Center (S.J.C.), Tucson, Arizona; Mayo Clinic-Rochester (A.D., J.A.S.), Rochester, Minnesota; Center on Outcomes, Research and Education (D.C.), Evanston Northwestern Healthcare, Evanston, and Northwestern University Feinberg School of Medicine (D.C.), Chicago, Illinois; Barts and the London Palliative Care Team (D.J.F.), St. Bartholomew's Hospital, Barts and the London National Health Service Trust, London, United Kingdom; Rollins School of Public Health (J.L.), Emory University, Atlanta, Georgia; Division of Surgical Oncology (M.S.K.), University Hospital at Stony Brook, State University of New York at Stony Brook, Stony Brook, New York; American Cancer Society (T.M.); Southern Arizona Veterans Affairs Health Care System (R.S.K.), and University of Arizona College of Medicine (R.S.K.), Tucson, Arizona, USA %A Mularski, RA %A Rosenfeld, K %A Joel, Coons S %A Dueck, A %A Cella, D %A Feuer, DJ %A Lipscomb, J %A Karpeh, MS Jr %A Mosich, T %A Sloan, JA %A Krouse, RS %J J Pain Symptom Manage %D 2007 May %T Measuring Outcomes in Randomized Prospective Trials in Palliative Care %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17532180 %X Palliative care aims to improve the quality of life of patients and their families and reduce suffering from life-threatening illness. In assessing palliative care efficacy, researchers must consider a broad range of potential outcomes, including those experienced by the patient's family/caregivers, clinicians, and the health care system. The purpose of this article was to summarize the discussions and recommendations of an Outcomes Working Group convened to advance the palliative care research agenda, particularly in the context of randomized controlled trials. These recommendations address the conceptualization of palliative care outcomes, sources of outcomes data, application of outcome measures in clinical trials, and the methodological challenges to outcome measurement in palliative care populations. As other fields have developed and refined methodological approaches that address their particular research needs, palliative care researchers must do the same to answer important clinical questions in rigorous and credible ways %0 Journal Article %A Murphy, BM %A Elliott, PC %A Worcester, MU %A Higgins, RO %A R, M %A Roberts, SB %A Goble, AJ %J Br J Health Psychol %D 2007 Jan %T Trajectories and predictors of anxiety and depression in women during the 12 months following an acute cardiac event %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17535492 %X ObjectivesMany previous investigations of the recovery of emotional well-being, particularly the resolution of depression, following an acute cardiac event assume that all patients follow a similar, linear trajectory. However, it is possible that there are different groups of patients who follow different trajectories. This study tested for multiple trajectories of anxiety and depression and identified the characteristics of patients most at risk for persistent or worsening anxiety and depression in the 12 months following their cardiac event.MethodA consecutive sample of 226 women was interviewed following either acute myocardial infarction (AMI) or coronary artery bypass graft surgery (CABGS). The Hospital Anxiety and Depression Scale were administered on four occasions over 12 months. Growth curve and growth mixture modelling were used to identify trajectories of change and univariate tests were employed to establish predictors of each trajectory.ResultsMost women began with relatively low levels of anxiety and/or depression that improved over the 12 month period (84% women showed this trajectory for anxiety, 89% for depression). A smaller group began with relatively high levels of anxiety and/or depression that worsened over time (16% for anxiety, 11% for depression). Patients in the latter group were more likely to report high levels of loneliness, have a first language other than English, perceive their cardiac disease as more severe (anxiety group only) and have diabetes (depression group only). Trajectories were non-linear, with most change occurring in the initial 2-month period.ConclusionGrowth modelling techniques highlight that change in anxiety and depression following an acute event follows neither a single nor linear trajectory. Most women showed early resolution of anxiety and depression following their event, indicative of a normal bereavement or adjustment response. A minority of women reported worsening anxiety and/or depression in the year following their cardiac event, particularly those who lacked social support or were from non-English speaking backgrounds. Intervention studies to explore support options for these women are warranted, both prior to and following their event %0 Journal Article %C Duke Institute on Care at the End of Life, Duke University Divinity School, Durham, North Carolina, USA %A Payne, Richard %J Pain Med %D 2007 Jan %P S3-7 %T Recognition and diagnosis of breakthrough pain %V 8 Suppl 1 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17280600 %X Objective. To review major clinical issues related to recognition and diagnosis of breakthrough pain. Issues. Persistent pain and breakthrough pain (BTP) are distinct clinical entities that should be recognized, diagnosed, and treated individually. BTP is common in patients with cancer and a variety of other chronic diseases. Reported incidence of BTP varies widely from 16% to 95% of those with persistent pain syndromes. Such variability is likely due to lack of a clear consensus on the definition of BTP. It is most commonly defined as an abrupt, short-lived, and intense pain that "breaks through" the around-the-clock analgesia that controls persistent pain. The three subtypes of BTP are incident, idiopathic, and end-of-dose failure. BTP also is categorized as somatic, visceral, neuropathic, or mixed. Appropriate assessment of the patient takes into consideration source, severity, pattern, subtype, and cause of pain. Successful treatment is important because BTP has a profound impact on the patient's quality of life, as well as cost of health care. BTP is likely to be underdiagnosed and undertreated because of the lack of consensus on its definition and unwarranted concerns among health care professionals and patients about overmedicating. Additionally, and for reasons not entirely clear, many physicians and other health care providers place a low priority on pain management and underrecognize the occurrence of BTP in patients with persistent pain. Conclusion. Greater knowledge and awareness of BTP in cancer and nonmalignant conditions will lead to improved recognition and diagnosis of BTP and ultimately to more effective treatment and enhanced quality of life for these patients %0 Journal Article %C Harvard Medical School, Boston, MA, USA %A Penson, Richard T %A Wenzel, Lari B %A Vergote, Ignace %A Cella, David %J Int J Gynaecol Obstet %D 2006 Nov %P S247-57 %T Quality of life considerations in gynecologic cancer. FIGO 6th Annual Report on the Results of Treatment in Gynecological Cancer %V 95 Suppl 1 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17161164 %X Quality of life (QOL) is a fundamental consideration for patients with life threatening diseases. Major evolving paradigms are discussed: improved QOL with laparoscopic surgery, the impact on QOL of intraperitoneal chemotherapy for optimally cytoreduced ovarian cancer, combination therapy, sexuality, and survivorship. The goals of treatment for many patients with gynecologic tumors remain largely palliative, and patient reported QOL is the primary outcome determining the utility of treatment. Particularly in this area, QOL endpoints are increasingly important in clinical trials. The QOL issues facing gynecologic cancer patients, the use of validated QOL instruments, recent advances in the evaluation of interventions, and changes in concepts related to QOL are reviewed %0 Journal Article %C Department of Psychiatry, Weill Medical College of Cornell University, New York, 10605 USA. cpfeffer@med.cornell.edu %A Pfeffer, Cynthia R %A Altemus, Margaret %A Heo, Moonseong %A Jiang, Hong %J Biol Psychiatry %D 2007 Apr %N 8 %P 957-65 %T Salivary cortisol and psychopathology in children bereaved by the september 11, 2001 terror attacks %V 61 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17137565 %X BACKGROUND: Studies suggest that stressful events increase risk for childhood anxiety and depression and hypothalamic-pituitary-adrenal (HPA) axis dysregulation. This prospective longitudinal study evaluated relationships among severe psychosocial stress, psychiatric morbidity, and HPA axis function in children. METHODS: Forty-five children (mean age: 8.9 ± 2.9 years) suffering parent death from September 11, 2001 terror attacks and 34 nonbereaved children (mean age: 9.3 ± 2.5 years) were evaluated prospectively at 6-month intervals in this 2-year study. Assessments involved diagnostic interviews (Child Schedule for Affective Disorders and Schizophrenia [K-SADS]) for psychopathology and 3 days of baseline salivary cortisol and a salivary dexamethasone suppression test for HPA axis function. RESULTS: Bereaved children, but not nonbereaved children, had significantly increased rates of psychiatric disorders involving anxiety disorders, especially posttraumatic stress disorder (PTSD), after September 11, 2001 compared with retrospective assessments before September 11, 2001. Morning (AM) and 4:00 pm baseline cortisol were significantly and persistently higher for bereaved than nonbereaved children. Compared with bereaved children without psychopathology, bereaved children with PTSD had significantly lower 4:00 pm baseline cortisol and significantly greater 4:00 pm cortisol suppression. Children with generalized anxiety disorder had significantly less AM cortisol suppression than children without psychopathology. CONCLUSIONS: Children bereaved by sudden, unexpected parent death had persistent psychological dysfunction and HPA axis dysregulation in this study %0 Journal Article %C University of Pittsburgh, Department of Dermatology, Pittsburgh, PA 15213, USA %A Prevost, Noel M %A English, Joseph C 3rd %J J Drugs Dermatol %D 2007 Feb %N 2 %P 202-4 %T Palliative treatment of fingernail lichen planus %V 6 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17373179 %X Lichen planus of the nails is a destructive inflammatory onychodystrophy that is often difficult to treat. We report a case of treatment with combined topical therapy of tazarotene gel and clobetasol gel. This modality may be effective for patients with nail lichen planus without the potential adverse affects of systemic treatments %0 Journal Article %C Family Center, New York, NY 10007, USA. wreich@thefamilycenter.org %A Reich, Warren A %A Rubin, Rachel M %J AIDS Educ Prev %D 2007 Feb %N 1 %P 82-94 %T Prototypical images in condom scripts among AIDS-bereaved adolescents %V 19 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17411391 %X Twenty-five HIV-negative late adolescents (13 women and 12 men) who had lost a parent to AIDS generated vignettes in which the characters were deciding whether to use a condom (condom scripts). Two clinically trained judges rated the interpersonal tone of the condom scripts on 17 semantic differential scales. Three other clinically trained raters described script characters' attributes by selecting from a list of 36 terms. Multidimensional scaling (MDS) and individual differences hierarchical classes analyses (INDCLAS) were used to inductively derive a typology of condom scripts. Two dimensions emerged from MDS analysis: incompatibility and inequality. Condom scripts culminating in unprotected sex depicted situations in which partners held unequal influence. INDCLAS results suggested a prototype for equal-influence condom scripts - excited male and assertive, powerful female - and for unequal-influence (unprotected sex) condom scripts - powerful, disengaged male and permissive female. These results inform the development of theoretical models and HIV prevention program materials %0 Journal Article %C Cadre de sante, unite de soins palliatifs et Equipe mobile, Hopital Bretonneau, AP-HP, Paris. isa.remy@brt.aphp.fr %A Remy, Isabelle %J Soins Gerontol %D 2007 Mar-Apr %N 64 %P 35-8 %T [Bretonneau mobile team, a bridge between the hospital and the community] %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17474237 %0 Journal Article %C Departments of Psychosocial Oncology and Palliative Care (G.R., C.Z., J.J, L.G.) and Medical Oncology (F.A.S., M.M., M.F.), Princess Margaret Hospital, University Health Network, Toronto; Behavioral Sciences and Health Research Division (G.R., C.Z., A.R., J.J., L.G.), Toronto General Research Institute, University Health Network, Toronto; Faculty of Medicine (G.R., C.Z., J.J., F.A.S., M.M., M.F., L.G.), University of Toronto, Toronto; Department of Epidemiology and Biostatistics (A.D.), University of Western Ontario, London, Ontario; and Department of Kinesiology and Health Science (L.G.), York University, Toronto, Ontario, Canada %A Rodin, G %A Zimmermann, C %A Rydall, A %A Jones, J %A Shepherd, FA %A Moore, M %A Fruh, M %A Donner, A %A Gagliese, L %J J Pain Symptom Manage %D 2007 Jun %N 6 %P 661-675 %T The Desire for Hastened Death in Patients with Metastatic Cancer %V 33 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17531909 %X A substantial minority of patients in palliative care settings report a high desire for hastened death (DHD), in association with physical and emotional distress, low social support, and impaired spiritual well being. To clarify to what extent DHD emerges in association with suffering prior to the end of life, we determined its prevalence and correlates in ambulatory patients with metastatic cancer, the majority of whom had an expected survival of >6 months. We hypothesized that DHD in this sample would be directly linked to physical and psychological distress, and inversely related to perceived social support, self-esteem, and spiritual well being. Three hundred twenty-six outpatients completed the Schedule of Attitudes Toward Hastened Death (SAHD), Brief Pain Inventory, Memorial Symptom Assessment Scale, Beck Depression Inventory-II (BDI-II), Beck Hopelessness Scale (BHS), Medical Outcomes Study Social Support Survey, FACIT-Spiritual Well-Being Scale, Rosenberg Self-Esteem Scale, and Karnofsky Performance Status. Over 50% of participants reported pain, >20% reported elevated levels of depression (BDI-II>/=15) and hopelessness (BHS>/=8), but <2% had a high DHD (SAHD>/=10). DHD was correlated positively with hopelessness, depression, and physical distress, and negatively with physical functioning, spiritual well being, social support, and self-esteem; it was not associated with treatment status or proximity to death. Over 34% of the variance in predicting SAHD scores was accounted for by hopelessness, depression, and functional status. The relative absence of a strong DHD in this sample suggests that the will to live tends to be preserved in cancer patients prior to the end of life, in spite of significant emotional and physical suffering %0 Journal Article %A Rosemann, T %A Hermann, K %A Miksch, A %A Engeser, P %A Szecsenyi, J %J BMC Palliat Care %D 2007 May %N 1 %P 5 %T The PAMINO-project: evaluating a primary care based educational program to improve the quality of life of palliative patients [ISRCTN78021852] %V 6 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17535418 %X ABSTRACT: BACKGROUND: The care of palliative patients challenges the health care system in both quantity and quality. Especially the role of primary care givers needs to be strengthened to provide them with the knowledge and the confidence of applying an appropriate end-of-life care to palliative patients. To improve health care services for palliative patients in primary care, interested physicians in and around Heidelberg, Germany, are enabled to participate in the community-based program 'Palliative Medical Initiative North Baden (PAMINO)' to improve their knowledge in dealing with palliative patients. The impact of this program on patients' health and quality of life remains to be evaluated. METHODS: The evaluation of PAMINO is a non-randomized, controlled study. Out of the group of primary care physicians who took part in the PAMINO program, a sample of 45 physicians and their palliative patients will be compared to a sample of palliative patients of 45 physicians who did not take part in the program. Every four weeks for 6 months or until death, patients, physicians, and the patients' family caregivers in both groups answer questions to therapy strategies, quality of life (QLQ-C15-PAL, POS), pain (VAS), and burden for family caregivers (BSFC). The inclusion of physicians and patients in the study starts in March 2007. DISCUSSION: Although participating physicians value the increase in knowledge they receive from PAMINO, the effects on patients remain unclear. If the evaluation reveals a clear benefit for patients' quality of life, a larger-scale implementation of the program is considered. Trial registration The study was registered at 'current controlled trials (CCT)', registration number: ISRCTN78021852 %0 Journal Article %C Klinik und Poliklinik fur Padiatrische Hamatologie und Onkologie, Universitatsklinikum Hamburg-Eppendorf, Hamburg %A Schnahs, Thomas %J Kinderkrankenschwester %D 2007 Mar %N 3 %P 96-7 %T [The art of holistic care in pediatric oncology] %V 26 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17427667 %0 Journal Article %C Department of Preventive and Societal Medicine, University of Nebraska Medical Center, USA %A Schonfeld, Toby L %A Romberger, Debra J %A Hester, D Micah %A Shannon, Sarah E %J Hastings Cent Rep %D 2007 Jan-Feb %N 1 %P 14; discussion 14-6 %T Resuscitating a bad patient %V 37 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17348256 %0 Journal Article %C marianneschwill@gmx.ch %A Schwill-Bubendorf, Marianne %J Krankenpfl Soins Infirm %D 2007 %N 3 %P 16-7 %T [Like a feather drifting away] %V 100 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17427851 %0 Journal Article %A Scriver, Mary Strachan %J J Pastoral Care Counsel %D 2006 %N 5 Suppl %P 445-54 %T Reflections on CPE experiences after two decades %V 60 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17472208 %0 Journal Article %C General Intensive Care Unit, Department of Anesthesiology and Critical Care Medicine, Medical Center, Hadassah Hebrew University, P.O. Box 12000, 91120, Jerusalem, Israel, sprung@cc.huji.ac.il %A Sprung, CL %A Maia, P %A Bulow, HH %A Ricou, B %A Armaganidis, A %A Baras, M %A Wennberg, E %A Reinhart, K %A Cohen, SL %A Fries, DR %A Nakos, G %A Thijs, LG %J Intensive Care Med %D 2007 Jun %T The importance of religious affiliation and culture on end-of-life decisions in European intensive care units %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17541550 %X OBJECTIVE: To determine the influence of religious affiliation and culture on end-of-life decisions in European intensive care units (ICUs). DESIGN AND SETTING: A prospective, observational study of European ICUs was performed on consecutive patients with any limitation of therapy. Prospectively defined end-of-life practices in 37 ICUs in 17 European countries studied from 1 January 1999 to 30 June 2000 were compared for frequencies, patterns, timing, and communication by religious affiliation of physicians and patients and regions. RESULTS: Of the 31,417 patients 3,086 had limitations. Withholding occurred more often than withdrawing if the physician was Jewish (81%), Greek Orthodox (78%), or Moslem (63%). Withdrawing occurred more often for physicians who were Catholic (53%), Protestant (49%), or had no religious affiliation (47%). End-of-life decisions differed for physicians between regions and who had any religious affiliation vs. no religious affiliation in all three geographical regions. Median time from ICU admission to first limitation of therapy was 3.2 days but varied by religious affiliation; from 1.6 days for Protestant to 7.6 days for Greek Orthodox physicians. Median times from limitations to death also varied by physician's religious affiliation. Decisions were discussed with the families more often if the physician was Protestant (80%), Catholic (70%), had no religious affiliation (66%) or was Jewish (63%). CONCLUSIONS: Significant differences associated with religious affiliation and culture were observed for the type of end of life decision, the times to therapy limitation and death, and discussion of decisions with patient families %0 Journal Article %C Division of Palliative Care, Department of Family Medicine, Kaohsiung Veterans General Hospital, and School of Nursing, I-shou University, Kaohsiung, Taiwan %A Tu, MS %A Chiou, CP %J Int J Clin Pract %D 2007 May %T Perceptual consistency of pain and quality of life between hospice cancer patients and family caregivers: a pilot study %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17537189 %X Aims: Clinicians usually adjust medical management based on caregivers' observation when caring for seriously ill or cognitive-impaired patients. The purpose of this study is to research the differences in perceptual congruence of patients and caregivers when assessing patients' global pain (GP) and quality of life (QOL) in a hospice ward. Methods: From July 2002 to June 2004, hospice inpatients and their family caregivers were invited to participate in this study at a medical centre in Southern Taiwan. The survey was cross-sectional, incorporating patients' bio-psycho-social factors so as to understand their impacts on patients' pain perception and QOL. The bio-psycho-social factors included biological pain, physical dependence, financial difficulty, anxiety over family, existential meaning of life, uncontrolled outcome of disease and insufficient emotional support. Results: Fifty-eight patient/caregiver dyads were recruited in the study. The mean of patients' self-reported GP was higher than caregivers' rating (5.9 ± 1.7 vs. 5.1 ± 1.9, p < 0.05); however, the score of patients' QOL was lower in the patients than in the caregivers (6.9 ± 1.6 vs. 7.9 ± 1.4, p < 0.001). The result of regression analyses showed that 'biological pain', 'religion' and 'gender' were independent variables for patients' GP; however, 'biological pain' and 'gender' were factors for patients' QOL. No psychosocial factor was revealed as a factor in patient's perception of GP or QOL in this survey. Conclusion: This study indicates that caregivers have the propensity to under-rate patients' pain and overvalue QOL; moreover, 'religion' and 'gender' influence patients' perception near the end-of-life. Therefore, reassessment and proper holistic approach are important in hospice care %0 Journal Article %A Verheijde, Joseph L %A Rady, Mohamed Y %A McGregor, Joan %J Crit Care Med %D 2007 May %N 5 %P 1439-40; author reply 1440-1 %T Recovery of transplantable organs after cardiac or circulatory death: the end justifying the means %V 35 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17446749 %0 Journal Article %C Department of Public Health, Erasmus MC, University Medical Center Rotterdam, The Netherlands %A Vrakking, Astrid M %A van der Heide, Agnes %A Provoost, Veerle %A Bilsen, Johan %A van der Wal, Gerrit %A Deliens, Luc %J Acta Paediatr %D 2007 Jun %N 6 %P 820-4 %T End-of-life decision making in neonates and infants: comparison of the Netherlands and Belgium (Flanders) %V 96 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17537009 %X Aim: We compared the results of two recent studies on end-of-life decisions (ELDs) for neonates and infants in Belgium (Flanders) and the Netherlands. Methods: Questionnaires were sent to physicians who reported the death of a child under the age of 1 (Belgium: n = 292, response 87%; Netherlands: n = 249, response 84%). The questionnaires included structured questions about whether death had been preceded by ELDs, and about the decision-making process. Results: In both countries, in about 25% of all deaths a life-sustaining treatment was withheld, and in about 40% pain or other symptoms were alleviated taking into account that death might be hastened. In Belgium, a life-sustaining treatment was less often withdrawn than in the Netherlands (32% vs. 50%, respectively). Drugs were administered with the explicit intention of hastening death in similar percentages of all deaths (Belgium: 7%; Netherlands: 9%). Dutch physicians more often than Belgian physicians discussed ELDs with parents (96% vs. 81%, respectively), and with colleague physicians (94% vs. 80%, respectively). Conclusions: End-of-life decision making in severely ill neonates seems to be rather similar in Belgium and the Netherlands. Differences are that Dutch physicians more often withdraw life-sustaining treatment. Furthermore, parents and colleague physicians are more often involved in the decision making in the Netherlands %0 Journal Article %C Department of General Surgery, University of Heidelberg, Heidelberg, Germany %A Welsch, Thilo %A Kleeff, Jorg %A Seitz, Helmut K %A Buchler, Peter %A Friess, Helmut %A Buchler, Markus W %J J Gastroenterol Hepatol %D 2006 Oct %P S69-75 %T Update on pancreatic cancer and alcohol-associated risk %V 21 Suppl 3 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=16958677 %X Ductal adenocarcinoma of the pancreas is characterized by extremely aggressive behavior, with an overall 5-year survival of <4%. Because conventional and specifically tailored therapeutic regimens have little impact on patient survival, epidemiological and molecular research aims at identifying and reducing risk factors. Cigarette smoking, obesity, diabetes mellitus, and chronic pancreatitis are amenable to medical prevention or therapy. Heavy alcohol consumption is an inconsistent single risk factor for pancreatic cancer but may promote carcinogenesis by increasing the risk of diabetes mellitus or chronic pancreatitis. For various agents, the key carcinogenic effect is probably an inflammatory response in the pancreatic tissue. On the molecular level, mutations of oncogenes and tumor suppressor genes, as well as various epigenetic alterations, such as overexpression of growth factors and their receptors, are important in tumorigenesis. Complete and safe surgical resection, together with adjuvant therapy, offers prolonged survival, with 5-year survival rates of approximately 25%. However, for unresectable or disseminated disease, which constitutes the vast majority of cases, treatment is palliative. Despite increasing knowledge about the molecular pathology of pancreatic cancer and despite advances in treatment, the overall course of the disease is dismal, and reinforced efforts to reduce incidence and improve outcome are needed desperately %0 Journal Article %A Wu, L %A Bonanno, G %A Duhamel, K %A Redd, WH %A Rini, C %A Austin, J %A Nereo, N %A Ostroff, J %A Parsons, S %A Martini, R %A Williams, S %A Mee, L %A Sexson, S %A Manne, S %J Br J Health Psychol %D 2007 Apr %T Pre-bereavement meaning and post-bereavement distress in mothers of children who underwent haematopoietic stem cell transplantation %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17535504 %X ObjectivesThe purpose of this study was to explore the association of meaning-making with psychological adjustment to bereavement among mothers of children who had undergone haematopoietic stem cell transplantation (HSCT).DesignA prospective research design was used. Regression analyses were conducted to determine the relations between pre-bereavement variables (distress, searching for meaning, and finding meaning) and distress post-bereavement.MethodsThirty-five mothers of children who had undergone HSCT were interviewed at the time of their child's HSCT and 3 months post-bereavement.ResultsMothers who reported searching for meaning at HSCT reported greater post-bereavement distress, and mothers who reported finding meaning at HSCT reported less post-bereavement distress. Distress at HSCT and the number of days between the time of death and the post-bereavement time point were also found to be significant predictors of post-bereavement distress.ConclusionsThis study provides partial support for the role of meaning in adjustment to loss %0 Journal Article %C University College London, London, UK %A Wyatt, John %J Acta Paediatr %D 2007 Jun %N 6 %P 790-1 %T End-of-life decisions, quality of life and the newborn %V 96 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17537002 %0 Journal Article %C Laboratory of Veterinary Pathology, Life and Environmental Sciences, Osaka Prefecture University, Sakai.Osaka, Japan %A Yamate, Jyoji %A Tomita, Akitada %A Kuwamura, Mitsuru %A Mitsunaga, Fusako %A Nakamura, Shin %J Exp Anim %D 2007 Apr %N 2 %P 155-9 %T Spontaneous peritoneal malignant mesothelioma in a geriatric japanese macaque (Macaca fuscata) %V 56 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17460361 %X A 28.5-year-old female Japanese macaque (Macaca fuscata) was euthanatized because of abdominal distension due to severe ascites. Nodular lesions of varying sizes up to 5 mm in diameter were distributed diffusely on the surface of the omentum, mesentery and parietal peritoneum. No neoplastic masses were detected in any visceral organ. The nodules were composed of proliferation of mono- or multi-layered epithelial-like cells occasionally showing papillary growth and sheets of small round or polygonal cells. Signet ring-like cells and tubular structures were occasionally present. Neoplastic cells were strongly positive to cytokeratin, and occasionally to vimentin. Based on gross and histopathological findings, this tumor was diagnosed as an epithelial type of peritoneal malignant mesothelioma, the first reported case in the non-human primates %0 Journal Article %C Department of Anaesthesia and Intensive Care, John Hunter Hospital, Newcastle, NSW. mzib@bigpond.com %A Zib, Martina %A Saul, Peter %J Crit Care Resusc %D 2007 Jun %N 2 %P 213-8 %T A pilot audit of the process of end-of-life decision-making in the intensive care unit %V 9 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17536994 %X Background: Withdrawal of potentially life-prolonging treatments is a common procedure in most intensive care units. Until recently, quality improvement activities have been hampered by the absence of a clear sense of "best practice" in this complex area. Objective: This pilot audit addresses the feasibility of developing an end-of-life (EOL) decision-making audit and quality improvement tool and applying it in the intensive care setting. Methods: Between November 2005 and April 2006, treatment was withdrawn from 47 patients in our ICU. Their charts were audited, and a structured interview was conducted with the intensivist who documented the decision. We defined treatment withdrawal as the cessation of mechanical ventilation and all other forms of life support in the anticipation of the patient's death. Results: 55% of ICU deaths were the result of treatment withdrawal. Overwhelmingly, treatment failure or futility was the reason cited for withdrawal. There were no cases of conflict between the medical team and the patient's family. The level of confidence among intensivists about EOL decision-making was high. Consultation with ICU colleagues was rated as the most helpful factor in decisionmaking. Intensivists wished for earlier and more active support from the admitting medical officers in decisionmaking. Strong support for advance planning and for audit of EOL decision-making was highlighted. Conclusions: A current ICU quality improvement review lists EOL management as a possible audit item (Curtis et al. Crit Care Med 2006; 34: 211). Our study demonstrated the feasibility of developing a quality improvement tool for EOL decision-making and applying it in the intensive care setting. As evidence about the process of EOL decisionmaking accumulates, that process should become a component of quality assurance audit in intensive care