%0 Journal Article %A Abbasi, Kamran %J J R Soc Med %D 2007 May %N 5 %P 205 %T Connections with death %V 100 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17470919 %0 Journal Article %C Oesophagogastric Unit, Department of Surgery Nottingham City Hospital, Hucknall Road, Nottingham, NG5 1PB, United Kingdom, biodunayantunde@yahoo.co.uk %A Ayantunde, AA %A Agrawal, A %A Parsons, SL %A Welch, NT %J World J Surg %D 2007 Jun %T Esophagogastric Cancers Secondary to a Breast Primary Tumor Do Not Require Resection %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17578645 %X BACKGROUND: Breast cancer metastasis to the gastrointestinal tract (GIT) is rare. When it does occur, the upper GIT is more frequently involved, and lobular infiltrating carcinoma apparently has a greater apparent predilection for the GIT than the ductal type does. This study reviewed the clinicopathological features of esophagogastric secondary tumors from breast cancer. PATIENTS AND METHODS: Patients with breast cancer metastases to the upper GIT referred to us for treatment of either esophageal or gastric cancers between November 1997 and November 2004 were identified from our database. The medical records of these patients were then reviewed for clinicopathological data and outcome. RESULTS: Nine patients with mean age of 71 (range: 57-90) years had median time of 6.5 (2.8-32.8) years between primary breast cancer diagnosis and upper GI metastasis. The sites of metastatic lesions included the lower esophagus (2 patients), gastroesophageal junction (1 patient), gastric body (3 patients), and pylorus (3 patients). Histological typing indicated 7 cases of the lobular form and 2 cases of ductal carcinoma. All but one biopsy specimen were estrogen receptor and CK7 positive. Treatment included hormonal therapy and stent in 3 patients, hormonal therapy alone in 1 patient, chemotherapy alone in 1 patient, chemotherapy and gastrojejunostomy in 1 patient, dilatation and stent in 1 patient, and palliative care only in 2 patients. The median survival following treatment of these metastases was 20 (range: 2.1-96.6) months. CONCLUSIONS: The onset of nonspecific GIT symptoms in patients with a history of breast carcinoma should prompt the clinician to rule out the possibility of upper GIT metastasis even many years after the original breast cancer. The use of systemic therapy for breast cancer may result in longer survival %0 Journal Article %C Department of Otorhinolaryngology, University of Duesseldorf, Moorenstrasse 5, 40225 Duesseldorf, Germany %A Bas, Murat %A Bier, Henning %A Schirlau, Kerstin %A Friebe-Hoffmann, Ulrike %A Scheckenbach, Kathrin %A Balz, Vera %A Whiteside, Theresa L %A Hoffmann, Thomas K %J Oral Oncol %D 2006 Aug %N 7 %P 691-7 %T Gamma-delta T-cells in patients with squamous cell carcinoma of the head and neck %V 42 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=16527515 %X In our attempt to characterize a general immune-suppression found in patients with squamous cell carcinoma of the head and neck (SCCHN) we now focused on a subset of CD3 lymphocytes described as gamma/delta-T-cells, a cell type with potential relevance in non-MHC restricted anti-tumor immune responses. Peripheral blood of 33 SCCHN patients and 33 age-matched controls (CON) was evaluated for the frequency of gamma/delta-T-cells among CD3+ T-cells and their onset of apoptosis (Annexin V binding) by multicolor flow cytometry. Results were correlated with clinical parameters. Patients with SCCHN had a significantly higher proportion of gamma/delta-T-cells compared to healthy controls (4.4+/-0.4% for SCCHN vs. 3.0+/-0.3% for CON, p=0.01). However, this increase was not paralleled with a difference in the onset of apoptosis if compared to CON. There was also no correlation between the proportion of gamma/delta-T-cells and tumor stage. However, a significantly higher proportion of gamma/delta-T-cells was found in patients with recurrent or metachronous second primary SCCHN (6.0+/-1.0%) if compared to the other SCCHN (3.8+/-0.4%, p=0.02). In a follow up 3-6 months post-treatment patients showed a decrease of gamma/delta-T-cells among CD3+cells (2.7+/-0.4%, n=4) if they were operated only and an increase if primary radio-chemotherapy (6.7+/-1.7%, n=8) or a combination of operation plus radio-chemotherapy (6.8+/-2.3%, n=3) was applied. Furthermore, patients receiving palliative treatment including radio-chemotherapy had highest values of gamma/delta-T-cells (9.1+/-2.7%, n=4) overall implicating that the treatment modality significantly influences the proportion of gamma/delta-T-cells. Since patients with SCCHN, particularly those with recurrent or second primary disease after treatment, had a higher proportion of gamma/delta-T-cells without signs of a reduced onset of apoptosis this could be due to an increased de novo generation. The current study implies that increased frequencies of gamma/delta-T-cells in patients with SCCHN may not only be the result of tumor-host interactions but the consequence of applied treatment modalities %0 Journal Article %C St. Vincent Mercy Medical Center, Toledo, Ohio %A Bernal, EW %A Marco, CA %A Parkins, S %A Buderer, N %A Thum, D %J Am J Hosp Palliat Care %D 2007 Jun %T End-of-Life Decisions: Family Views on Advance Directives %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17582028 %X A cross-sectional survey was administered to family members of patients who died at 1 of the 5 Catholic institutions comprising Mercy Health Partners, a health care system in Ohio, to determine their opinions about patient and family participation in decisions about end-of-life care. Among 165 respondents, 118 (86%) of 138 agreed that the family was encouraged to join in decisions and 133 (91%) of 146 that their family member's health care choices were followed. Most agreed that nurses answered their questions (93%, 141/151) and that the doctor communicated well with family members (83%, 128/155). Seventy percent (107/152) indicated that their family member had at least 1 advance directive. There were no differences in whether health care choices were followed when patients with formal advance directives (92%, 92/100) were compared with patients without formal advance directives (88%, 35/40). A unique survey instrument can be used to measure family perceptions and opinions of participation in decisions about end-of-life care %0 Journal Article %A Bito, S %A Asai, A %J BMC Med Ethics %D 2007 Jun %N 1 %P 7 %T Attitudes and behaviors of Japanese physicians concerning withholding and withdrawal of life-sustaining treatment for end-of-life patients: Results from an Internet survey %V 8 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17577420 %X ABSTRACT: BACKGROUND: Evidence concerning how Japanese physicians think and behave in specific clinical situations that involve withholding or withdrawal of medical interventions for end-of-life or frail elderly patients is yet insufficient. METHODS: To analyze decisions and actions concerning the withholding/withdrawal of life-support care by Japanese physicians, we conducted cross-sectional web-based internet survey presenting three scenarios involving an elderly comatose patient following a severe stroke. Volunteer physicians were recruited for the survey through mailing lists and medical journals. The respondents answered questions concerning attitudes and behaviors regarding decision-making for the withholding/withdrawal of life-support care, namely, the initiation/withdrawal of tube feeding and respirator attachment. RESULTS: Of the 304 responses analyzed, a majority felt that tube feeding should be initiated in these scenarios. Only 18% felt that a respirator should be attached when the patient had severe pneumonia and respiratory failure. Over half the respondents felt that tube feeding should not be withdrawn when the coma extended beyond 6 months. Only 11% responded that they actually withdrew tube feeding. Half the respondents perceived tube feeding in such a patient as a 'life-sustaining treatment', whereas the other half disagreed. Physicians seeking clinical ethics consultation supported the withdrawal of tube feeding (OR, 6.4; 95% CI, 2.5-16.3; P<0.001). CONCLUSION: Physicians tend to harbor greater negative attitudes toward the withdrawal of life-support care than its withholding. On the other hand, they favor withholding invasive life-sustaining treatments such as the attachment of a respirator over less invasive and long-term treatments such as tube feeding. Discrepancies were demonstrated between attitudes and actual behaviors. Physicians may need systematic support for appropriate decision-making for end-of-life care %0 Journal Article %C King's College, London. julie.bliss@kcl.ac.uk %A Bliss, Julie %A While, Alison %J Br J Community Nurs %D 2007 Jun %N 6 %P 268-72 %T District nursing and social work: palliative and continuing care delivery %V 12 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17577148 %X The growing number of older people has seen a concomitant increase in the number of people with chronic conditions who require continuing and palliative care increasing the need for the relevant professional groups and organizations to work together. This paper reports on a multiple case study which explores the different ways that district nurses and social workers work in delivering palliative and continuing care. Each professional group operationalized their care differently across five themes: assessment, care delivery, focus of care, place of care and funding of care. The balance between care organization and care delivery needs to be addressed within emerging primary care delivery structures as primary care nursing moves towards case management for long term conditions %0 Journal Article %C Rapid Response Radiotherapy Program and Bone Metastases Clinic, Toronto-Sunnybrook Regional Cancer Centre, University of Toronto, Toronto, Ontario %A Bradley, N M E %A Sinclair, E %A Danjoux, C %A Barnes, E A %A Tsao, M N %A Farhadian, M %A Yee, A %A Chow, E %J Curr Oncol %D 2006 Apr %N 2 %P 47-54 %T The do-not-resuscitate order: incidence of documentation in the medical records of cancer patients referred for palliative radiotherapy %V 13 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17576441 %X Patients with symptomatic metastases referred for outpatient palliative radiotherapy for symptom control at the Rapid Response Radiotherapy Program (rrrp) and the Bone Metastases Clinic (bmc) at the Toronto-Sunnybrook Regional Cancer Centre have a limited life expectancy. Relevant medical information is missing from the files of many referred patients when they arrive at the clinics, potentially causing delayed treatment and ambiguity in the best management of their needs in situations of worsening condition. Clear documentation of the do-not-resuscitate (dnr) order is imperative to avoid panic and the taking of unnecessarily aggressive measures in situations in which cardiopulmonary resuscitation (cpr) has no benefit or is not desired. Here, we report the current practices of cpr code status documentation for patients referred to the rrrp and the bmc for out-patient palliative radiotherapy.We reviewed referral notes and accompanying medical records for 209 consecutive patients seen in the rrrp and the bmc during May-August 2004 for documentation of cpr-related advance directives. Patient demographics and cancer history were also recorded.Only 13 (6.2%) of the 209 patients had any documented reference to cpr code status. Of these 13 patients, 8 were dnr-coded, and 5 were full code. As compared with patients having no documented cpr code status, patients with documented status were significantly older (median age: 77 years; p = 0.0347), had poorer performance status (median Karnofsky performance status score: 40; p = 0.0001), and were more likely to be referred hospital inpatients (69%, p = 0.0004).Only a small proportion of symptomatic advanced cancer patients had any documentation of cpr code status upon referral for outpatient palliative radiotherapy. In future, our clinics plan to request information about cpr code status on our referral form %0 Journal Article %C School of Nursing, Algonquin College, University of Ottawa, Canada. brajtman@uottawa.ca %A Brajtman, Susan %A Fothergill-Bourbonnais, Frances %A Casey, Alberta %A Alain, Diane %A Fiset, Valerie %J Int J Palliat Nurs %D 2007 May %N 5 %P 213-21 %T Providing direction for change: assessing Canadian nursing students learning needs %V 13 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17577173 %X AIM: To examine the current curriculum content and learning needs of graduating nursing students related to end-of-life care (EOLC). DESIGN: A survey method was employed. SAMPLE: A purposive sample of 58 Anglophone and Francophone students completed the Palliative Care Quiz for Nursing (PCQN) and Frommelt's Attitudes Toward Care of the Dying Scale (FATCOD). Students responded to open-ended questions regarding perceptions of preparedness to care for terminally ill patients, and provided suggestions for changes to the curriculum. Key informant educators identified opportunities to include EOLC content in courses and clinical placements. RESULTS: Results indicated that students held positive attitudes towards caring for dying patients, had modest knowledge levels, and that one third did not feel adequately prepared to care for dying patients. Although EOLC education tends to be threaded throughout the program, the emphasis is dependent upon the commitment of individual professors and clinical instructors with experience and/or expertise in this area. CONCLUSION: Students and educators agreed more emphasis on EOLC was needed. Recommendations include development of teaching strategies and experiential learning in EOLC throughout the curriculum %0 Journal Article %C School of Law, University of Manchester, Manchester, UK. Iain.Brassington@manchester.ac.uk %A Brassington, I %J J Med Ethics %D 2006 Oct %N 10 %P 571-4 %T Killing people: what Kant could have said about suicide and euthanasia but did not %V 32 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17012496 %X An agent who takes his own life acts in violation of the moral law, according to Kant; suicide, and, by extension, assisted suicide are therefore wrong. By a similar argument, and with a few important exceptions, killing is wrong; implicitly, then, voluntary euthanasia is also wrong. Kant's conclusions are uncompelling and his argument in these matters is undermined on considering other areas of his thought. Kant, in forbidding suicide and euthanasia, is conflating respect for persons and respect for people, and assuming that, in killing a person (either oneself or another), we are thereby undermining personhood. But an argument along these lines is faulty according to Kant's own standards. There is no reason why Kantians have to accept that self-killing and euthanasia are contrary to the moral law. Even if some Kantians adhere to this doctrine, others can reject it %0 Journal Article %C School of Nursing, University of Victoria, Victoria, British Columbia, Canada %A Bruce, Anne %J Nurs Philos %D 2007 Jul %N 3 %P 151-7 %T Time(lessness): Buddhist perspectives and end-of-life %V 8 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17581242 %X The perception of time shifts as patients enter hospice care. As a complex, socially determined construct, time plays a significant role in end-of-life care. Drawing on Buddhist and Western perspectives, conceptualizations of linear and cyclical time are discussed alongside notions of time as interplay of embodied experience and concept. Buddhist understandings of self as patterns of relating and the theory of 'dependent origination' are introduced. Implications for understanding death, dying and end-of-life care within these differing perspectives are considered. These explorations contribute to the growing dialogue in nursing between Buddhist and Western traditions %0 Journal Article %C Marie Curie Cancer Care and Thames Valley University, London, UK %A Canning, Deebs %A Rosenberg, John P %A Yates, Patsy %J Int J Palliat Nurs %D 2007 May %N 5 %P 222-9 %T Therapeutic relationships in specialist palliative care nursing practice %V 13 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17577174 %X There has been limited research into the scope or standards of specialist palliative care nursing practice in an Australian context. This study sought to develop a competency framework that described the core domains of specialist palliative care nursing. This article explores one key domain of specialist palliative care nursing practice - therapeutic relationships - that was identified as underpinning other domains of practice. A mixed method was used, involving a literature review, a survey including practice exemplars and an interview of specialist palliative care nurses. Seventy-four registered nurses working in designated specialist palliative care nursing roles from each Australian state and mainland territory were involved. The nurses represented metropolitan, regional, rural and remote communities, various inpatient facilities and community practice settings. Five core domains of specialist palliative care nursing practice were identified: complex supportive care, collaborative practice, leadership, improving practice and therapeutic relationships. Therapeutic relationships were identified as the central domain of specialist palliative care nursing practice to which all other domains were inextricably linked %0 Journal Article %C Rutgers University, USA. carr@ssc.wisc.edu %A Carr, Deborah %A Khodyakov, Dmitry %J J Health Soc Behav %D 2007 Jun %N 2 %P 180-94 %T Health care proxies: whom do young old adults choose and why? %V 48 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17583273 %X Dying persons are encouraged to name as durable power of attorney for health care (DPAHC) someone who will thus be empowered to make end-of-life treatment decisions for them in the event that they become incapacitated. We use data from the Wisconsin Longitudinal Study to investigate whether and whom older adults designate as their DPAHC. DPAHC appointments are affected by recent hospitalizations, personal beliefs (including religion, fear of death, and the belief that doctors rather than patients should control health care decisions), and personal experience with the recent painful death of a loved one. The selections of DPAHC designees are generally consistent with the hierarchical compensatory model: Married persons overwhelmingly name their spouses, while unmarried parents appoint their children. Women are more likely than men to rely on children. Parents of one or two children tend to bypass their children for another relative. Unmarried, childless persons show considerable heterogeneity in their choices. We discuss implications of these findings for health care policy and practice %0 Journal Article %C Pamukkale University, School of Physical Therapy and Rehabilitation, Denizli, Turkey %A Cavlak, Ugur %A Aslan, Ummuhan Bas %A Gurso, Suleyman %A Yagci, Nesrin %A Yeldan, Ipek %J Adv Ther %D 2007 Jan-Feb %N 1 %P 135-45 %T Attitudes of physiotherapists and physiotherapy students toward euthanasia: a comparative study %V 24 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17526470 %X This interventional study was undertaken to assess the impact of physiotherapy education on the knowledge and attitudes of physiotherapists (PTs) and physiotherapy students (PSs) toward euthanasia. The study, which was conducted during the period between 2004 and 2005, included a total of 494 participants (311 PTs; 183 PSs) aged 18 to 52 y from the western and central portions of Turkey, who responded to a self-report questionnaire (response rate, 96.4%) that was based on data from the literature. Results indicated that PTs (48.9%) were more likely to approve of euthanasia than PSs (38.3%) (P<.05). The legalization of euthanasia was favored by 43.7% of PTs, compared with 29.5% of PSs (P<.05). On the other hand, PTs and PSs expressed similar views regarding euthanasia, including reasons for accepting or opposing euthanasia and acceptable conditions for its use (P>.05). Overall results showed that sex and age had no effect on whether euthanasia was accepted (P>.05) religiousness was found to have the greatest effect on attitudes toward euthanasia (P<.05). The findings of the current study suggest that (1) the attitudes of PTs are different from those of PSs, and (2) the Islamic point of view has a negative impact on the attitudes of PTs and PSs toward euthanasia %0 Journal Article %C Department of Gastroenterology and Digestive Endoscopy, Hospital Maresca, Torre del Greco, Naples, Italy %A Cipolletta, L %A Rotondano, G %A Marmo, R %A Bianco, M A %J Dig Liver Dis %D 2007 Apr %N 4 %P 375-88 %T Endoscopic palliation of malignant obstructive jaundice: an evidence-based review %V 39 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17317347 %X Endoscopic stent insertion is considered the method of choice for palliative treatment of malignant biliary obstruction. Nonetheless, relevant studies are often underpowered or outdated and do not compare actual surgical outcomes with latest stent technology. Purpose of this review was to assess, with an evidence-based methodology, the role of endoscopic versus surgical palliation of patients with malignant obstructive jaundice with special reference to clinical effectiveness, safety aspects and economic outcomes %0 Journal Article %C Royal North Shore Hospital, Sydney, NSW, Australia. jclayton@med.usyd.edu.au %A Clayton, Josephine M %A Hancock, Karen M %A Butow, Phyllis N %A Tattersall, Martin H N %A Currow, David C %J Med J Aust %D 2007 Jun %N 12 %P S77-S108 %T Clinical practice guidelines for communicating prognosis and end-of-life issues with adults in the advanced stages of a life-limiting illness, and their caregivers %V 186 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17576171 %0 Journal Article %A Cooley, Candy %J Int J Palliat Nurs %D 2007 May %N 5 %P 204 %T Equality and choice in palliative care %V 13 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17577171 %0 Journal Article %C Department of Philosophy, Centre for Applied Philosophy and Public Ethics, Old Quad, University of Melbourne, VIC 3010, Australia. sbcurry@unimelb.edu.au %A Curry, S %J J Med Ethics %D 2006 Oct %N 10 %P 606-7; discussion 609-11 %T Living patients in a permanent vegetative state as legitimate research subjects %V 32 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17012504 %0 Journal Article %C Department of Oncological Sciences, Mount Sinai School of Medicine, New York, New York, USA %A Fatone, Anne M %A Moadel, Alyson B %A Foley, Frederick W %A Fleming, Megan %A Jandorf, Lina %J Palliat Support Care %D 2007 Jun %N 2 %P 115-25 %T Urban voices: the quality-of-life experience among women of color with breast cancer %V 5 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17578062 %X OBJECTIVES: Research on the health-related quality of life (HRQL) among women of color (i.e., Hispanics and African Americans) with breast cancer suggests that they may be at elevated risk for a variety of physical and psychosocial sequelae. The context in which these women perceive, experience, and respond to these HRQL challenges can provide important information for planning a culturally appropriate palliative care treatment plan. METHODS: In an effort to understand the quality of life experience after breast cancer among women of color, this study describes the nature and impact of physical, emotional, and menopausal symptoms among African American (n = 8) and Hispanic (n = 12) breast cancer survivors based on qualitative data gathered through semistructured interviews. Themes were identified and categorized into six HRQL domains: physical (e.g., pain, nausea), psychological (e.g., sadness, irritability), cognitive (e.g., memory problems), sexual (e.g., decreased desire), social/functional (e.g., financial strain, social distress), and spiritual/existential (e.g., increased faith, spiritual coping), with high interrater reliability (kappa = .81). RESULTS: For both groups, physical issues had a major impact on HRQL, with psychological issues being additionally salient for Hispanic women. Most (88%) African American women voiced positive changes in their faith after diagnosis whereas 50% of Hispanic women viewed faith as an important way of coping with breast cancer. SIGNIFICANCE OF RESULTS: This research broadens our understanding of the experience of breast cancer among ethnic minority women, and in turn, offers some key directions for guiding the development of culturally tailored HRQL interventions %0 Journal Article %C From the City of Hope National Medical Center, Duarte, Calif (Dr Ferrell and Ms Virani); the Palliative Care Service, Massachusetts General Hospital, Boston, Mass (Ms Dahlin); the Detroit Receiving Hospital and the Wayne State University College of Nursing, Detroit, Mich (Dr Campbell); the Division of Hematology-Oncology, Feinberg School of Medicine, Northwestern University; Chicago, Ill (Dr Paice); and the American Association of Colleges of Nursing, Washington, DC (Ms Malloy) %A Ferrell, BR %A Dahlin, C %A Campbell, ML %A Paice, JA %A Malloy, P %A Virani, R %J Crit Care Nurs Q %D 2007 July/September %N 3 %P 206-212 %T End-of-Life Nursing Education Consortium (ELNEC) Training Program: Improving Palliative Care in Critical Care %V 30 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17579303 %X The integration of palliative care in critical care settings is essential to improve care of the dying, and critical care nurses are leaders in these efforts. However, lack of education in providing end-of-life (EOL) care is an obstacle to nurses and other healthcare professionals as they strive to deliver palliative care. Education regarding pain and symptom management, communication strategies, care at the end of life, ethics, and other aspects of palliative care are urgently needed. Efforts to increase EOL care education in most undergraduate and graduate nursing curricula are beginning; yet, most critical care nurses have not received formal training in palliative care. Moreover, educational resources such as critical care nursing textbooks often contain inadequate information on palliative care. The ELNEC-Critical Care program provides a comprehensive curriculum that concentrates on the requirements of those nurses who are working in areas of critical care. Extensive support materials include CD-ROM, binder, Web sites, newsletters, textbooks, and other supplemental items. The ultimate goal is to improve EOL care for patients in all critical care settings and enhance the experience of family members witnessing the dying process of their loved ones %0 Journal Article %C University of Colorado Health Sciences Center (UCHSC) %A Fischer, SM %A Kutner, JS %A Sauaia, A %A Kramer, A %J Am J Hosp Palliat Care %D 2007 Jun %T Lack of Ethnic Differences in End-of-Life Care in the Veterans Health Administration %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17582027 %X Although existing literature shows pervasive ethnic disparities in end-of-life care, this study sought to determine if there were ethnic differences in the processes of care related to the end of life in a cohort of hospitalized, seriously ill veterans. The medical records of 217 patients (13% African American, 68% white, 9% Hispanic White) were reviewed for documentation of end-of-life care (advance directive discussions, pain, symptom-directed plan, and do-not-resuscitate orders). Logistic regression modeling demonstrated no ethnic differences for the treatment of pain or a symptom-directed plan of care. African American patients were more likely to have a do-not-resuscitate order and advance directive discussion documented compared with white patients. In this equal access system, minority patients were at least as likely or more likely to have important aspects of end-of-life care addressed compared with white patients %0 Journal Article %C Ottawa Regional Cancer Centre, Ottawa, Ontario %A Fitzgibbon, E J %A Samant, R %A Meng, J %A Graham, I D %J Curr Oncol %D 2006 Feb %N 1 %P 27-32 %T Awareness and use of the Rapid Palliative Radiotherapy Program by family physicians in Eastern Ontario: a survey %V 13 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17576438 %X The Ottawa Rapid Palliative Radiotherapy Program (rprp) was established in 1999 with the goal of facilitating access by family physicians to radiotherapy services for patients with advanced symptomatic cancer. Two years later, an audit revealed that of the 148 patients treated by the program, only 19 had been referred by family physicians.We therefore assessed awareness of the rprp and perceptions of the effectiveness of palliative radiotherapy on the part of family physicians by surveying a random sample of family physicians in Eastern Ontario.Response rate was 50%. Only 18% of family physicians were aware of the rprp, although 56% had previously referred patients for palliative radiotherapy. Among responders, 80% regularly provided palliative care, and these physicians were much more likely to be aware of and to refer patients for palliative radiotherapy.Our survey confirms the key role that family physicians play in providing care to patients with advanced cancer. However, significant deficits in family physician awareness of palliative radiotherapy programs and in knowledge of the effectiveness of palliative radiotherapy should be addressed to improve patient care %0 Journal Article %A Forrester, Kim %J Qld Nurse %D 2007 Apr %N 2 %P 10-1 %T Refusal of treatment--an absolute right of the patient or client %V 26 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17508592 %0 Journal Article %C Nursing Law and Politics, Faculty of Health, London South Bank University, UK %A Fullbrook, Suzanne %J Br J Nurs %D 2007 May %N 10 %P 600-1 %T Best interests: a review of issues that affect nurses' decision making %V 16 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17577164 %X 'Best interests' is a term that is often misunderstood and incorrectly applied in practice. This article is the first of three dedicated to an explanation of the legal principles and practical applications of the term when applied to the provision of treatment and care of patients. Elements of the debate are explored that relate to aspects of daily treatment and care and to circumstances where the issue(s) relate to end of life considerations. This first article aims to raise awareness of issues that relate to the idea of acting in a person's best interests. Potential areas of concern and apprehension on the part of healthcare providers are reviewed with the aim of preparing the reader for the more legally concentrated second article, and further to alert the reader to the possibility of uncomfortable reflection to be undertaken in a professional vein %0 Journal Article %C Luther College, University of Regina. mary.hampton@uregina.ca %A Hampton, Mary %A Smith, Fleur MacQueen %J Alta RN %D 2007 May %N 5 %P 18-9 %T Improving end of life care for Aboriginal families %V 63 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17583320 %0 Journal Article %C Office of Applied Studies, SAMHSA, U.S. Department of Health and Human Services, 1 Choke Cherry Road, Rm. 7-1010, Rockville, MD 20587, USA. Beth.Han@samhsa.hhs.gov %A Han, Beth %A Remsburg, Robin E %A McAuley, William J %A Keay, Timothy J %A Travis, Shirley S %J Inquiry %D 2007 Spring %N 1 %P 104-13 %T Length of hospice care among U.S. adults: 1992-2000 %V 44 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17583264 %X This study examined length of service use among U.S. adult hospice patients based on data from the 1992-2000 National Home and Hospice Care Surveys. With the Kaplan-Meier method, we estimated length of service use of current and discharged hospice patients simultaneously. Using a multivariate Cox proportional hazards model, we examined trends in patients' service use during the 1990s. Findings show that length of service use decreased significantly among adult patients who had Medicare as their only payment source. Although overall length of service use declined significantly in 1996, 1998, and 2000 compared to 1992, it was similar between 1996 and 2000 %0 Journal Article %A Hetland, Jens G %J Tidsskr Nor Laegeforen %D 2007 May %N 11 %P 1536; author reply 1536 %T [Three statements and three questions about life-prolonging treatment] %V 127 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17551564 %0 Journal Article %C Department of Geriatrics, Nagoya University Graduate School of Medicine %A Hirakawa, Yoshihisa %A Masuda, Yuichiro %A Kuzuya, Masafumi %A Iguchi, Akihisa %A Uemura, Kazumasa %J Nippon Ronen Igakkai Zasshi %D 2007 May %N 3 %P 380-3 %T End-of-life care in the curriculum in Japan: a national survey of senior medical students %V 44 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17575444 %X Aim: We conducted a national survey of senior medical students' attitudes about end-of-life care teaching programs for undergraduate students of Japanese medical schools from April 2004 to May 2006. Methods: Our questionnaire survey focused on the students' attitudes towards the following end-of-life areas: 1) end-of-life topics, 2) teaching methods, 3) putting theories into practice, and 4) overall end-of-life issue. Results: Overall, 1,039 students from 16 medical schools responded to our survey. The students who took part in the program appreciated the class on communication techniques with dying patients or family members of dying patients. As for the students who did not participate in the program, they expressed the wish to join a class concerning these issues. These students also expressed an interest in visiting hospices or conducting interviews with dying patients as part of their training. Most of the students formulated good opinions toward end-of-life issues, but not toward end-of-life practices. Regardless of whether they joined the program or not, most of the students had a positive attitude towards end-of-life education programs. Conclusion: The survey highlighted the need to consider wider implementation and improvement of end-of-life care education in the Japanese curriculum %0 Journal Article %C Department of Surgery, Osaka City Sumiyoshi Hospital, 1-2-16 Higashi-Kagaya, Osaka 559-0012, Japan %A Hosono, Shunsuke %A Ohtani, Hiroshi %A Arimoto, Yuichi %A Kanamiya, Yoshitetsu %J J Gastroenterol %D 2007 Apr %N 4 %P 283-90 %T Endoscopic stenting versus surgical gastroenterostomy for palliation of malignant gastroduodenal obstruction: a meta-analysis %V 42 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17464457 %X BACKGROUND: We attempted to elucidate the current status of endoscopic self-expanding metal stents for palliation of malignant gastroduodenal obstruction in comparison with surgical gastroenterostomy. METHODS: Original articles and abstracts published from January 1990 to September 2006 were searched in Medline, EMBASE, and Cochrane Controlled Trials Register databases. Clinical appraisal and data extraction were independently conducted by two reviewers. Statistical analysis was performed by meta-analysis using a random effects model. Weighted mean differences with 95% confidence intervals (CI) were used to analyze continuous variables. Odds ratios with 95% CI were calculated for dichotomous variables. RESULTS: The outcomes of 307 procedures from nine studies were analyzed. Endoscopic stenting was found to be associated with higher clinical success (P = 0.007), a shorter time from the procedure to starting oral intake (P < 0.001), less morbidity (P = 0.02), lower incidence of delayed gastric emptying (P = 0.002), and a shorter hospital stay (P < 0.001) than surgical gastroenterostomy. There was no significant difference between the two groups in the analysis of 30-day mortality. CONCLUSIONS: Endoscopic stenting may be a feasible alternative to surgery for the palliation of inoperable malignant gastroduodenal obstruction, with a high clinical success and low morbidity rate. Additional well-designed randomized controlled trials with larger sample sizes are expected to further reinforce this conclusion %0 Journal Article %A Joyce, Charles %J J R Soc Med %D 2007 May %N 5 %P 210 %T Of saving the elderly %V 100 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17470926 %0 Journal Article %C Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan. hidenori@msic.med.osaka-cu.ac.jp %A Kawashima, Hidenori %A Tanaka, Tomoaki %A Kuratsukuri, Katsuyuki %A Uchida, Junji %A Sugimura, Kazunobu %A Tamada, Satoshi %A Nishisaka, Nobuyasu %A Kumata, Katsuyuki %A Iwai, Yoshihito %A Ikemoto, Shinichi %A Ezaki, Kazuyoshi %A Nakatani, Tatsuya %J Urol Int %D 2007 %N 4 %P 345-50 %T Palliative treatment of bone metastases in hormone-refractory prostate cancer: effects of pamidronate on the carboxyterminal telopeptide of type-I collagen level in patients with increasing prostate-specific antigen levels %V 78 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17495494 %X PURPOSE: Bisphosphonates have been reported to be effective in reducing bone pain and skeletal-related events associated with bone metastases in hormone-refractory prostate cancer (HRPC). However, whether bone resorption is reduced primarily by these particular drugs is difficult to evaluate because patients with HRPC are usually treated with secondary or tertiary hormonal manipulations including second-line antiandrogens, high-dose diethylstilbestrol, or low-dose dexamethasone therapies, some of which may also be effective. Thus, we assessed changes in the level of the carboxyterminal telopeptide of type-I collagen (ICTP), a bone resorption marker, before and after pamidronate administration in HRPC patients with increasing prostate-specific antigen (PSA) levels. PATIENTS AND METHODS: Twenty-one HRPC patients with bone metastases and increasing PSA levels were intravenously treated with pamidronate at a dose of 30 mg either every 2 or every 4 weeks. Pamidronate administration was started immediately after confirmation of three consecutive increases in the PSA level. RESULTS: In 14 patients (67%), the ICTP levels decreased after the administration of pamidronate, despite increasing PSA levels. In 7 of these cases, the ICTP levels were lower than those recorded for 6 months or longer before the start of pamidronate administration. The characteristics of the responders were compared with those of the non-responders. CONCLUSION: In 67% of the HRPC patients with increasing PSA levels, pamidronate reduced the accelerated turnover of bone metabolism caused by metastases of prostate cancer %0 Journal Article %C Division of Cardiology, Kantonsspital Luzern, Switzerland %A Kobza, Richard %A Erne, Paul %J Pacing Clin Electrophysiol %D 2007 Jul %N 7 %P 845-9 %T End-of-life Decisions in ICD Patients with Malignant Tumors %V 30 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17584265 %X Background:The results of multiple implantable cardioverter-defibrillator (ICD) studies have demonstrated a survival benefit in specific high-risk populations, leading to the expansion of ICD implantation rates worldwide. Because the ICD reduces the incidence of sudden cardiac death, patients with these devices more often die of nonarrhythmic causes. For those with a malignancy, little is known about their preferences for disabling ICD therapy. Methods:The objective of the present study was to evaluate whether patients with an ICD and a malignant tumor desire deactivation of their ICD in order to have a death without ICD interventions, which are life-prolonging, bothersome, and prevent a peaceful death. All deceased patients having had an ICD implanted at our institution were retrospectively analyzed with respect to whether the option of disabling ICD therapy had been discussed and whether the ICD had been deactivated. Results:Two hundred and seventy-two patients received an ICD at our institution between January 1, 1994, and January 31, 2007. Thirty-six of the patients have died, and of these eight had a malignant tumor. In six of these eight patients (75%) the option of disabling their ICD therapy was discussed extensively; none wished to abandon the possibility of terminating a malignant arrhythmia by the ICD. Conclusions:With the use of ICDs, patients with heart failure are more frequently protected from arrhythmic death, and consequently treating physicians are increasingly confronted with ICD patients presenting with a malignant tumor or other noncardiac terminal disease. In these situations, dialogue between the treating physician and the patient about the possibility of withdrawing ICD therapy is important to terminal care. The physician must be aware that the patient's attitude may contrast with his/her own, and that the patient may be resolute in maintaining ICD protection from arrhythmic death %0 Journal Article %C Dental and Oral Medical Center, Kurume University School of Medicine %A Koga, Makoto %A Aoki, Masatora %A Anegawa, Emiko %A Tezuka, Makoto %A Iwamoto, Osamu %A Koga, Chihiro %A Kusukawa, Jingo %J Gan To Kagaku Ryoho %D 2007 May %N 5 %P 719-23 %T [Clinical evaluation of palliative chemotherapy with S-1 for oral cancer patients] %V 34 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17496444 %X The purpose of this study was to investigate the effectiveness and safety of palliative chemotherapy using S-1. We treated 19 advanced oral SCC patients including 8 men and 11 women with S-1. Of the 19 patients studied, two patients were classified as UICC Stage II, two patients as Stage III, 14 patients as Stage IV A, and one patient was classified as StageIV C. The ages varied from 54 to 9 1 years (mean ages; 78.3 years-old). The patients received this chemotherapy (80-120 mg/day) consisting of 2 weeks' administration including 5-days' administration and 2-days' termination (named 'Weekday-on/Weekend-off administration schedule' ) following 1 week rest. After this treatment, 7 CR and 4 PR were achieved, but the toxicities were only anorexia, leukopenia, thrombocytopenia, and uritication of NCI-CTC grade 1. The prognosis of 19 cases was 7 terminal by primary disease, 3 terminal by other disease, 7 lives with tumor bearing, and 2 lives without tumor bearing. We concluded that our novel S-1 administration method was extremely effective for oral SCC, including lymph node metastasis, providing high potential without any severe adverse effects for palliative therapy %0 Journal Article %C Division of General Internal Medicine (J.S.K.), Department of Preventive Medicine & Biometrics (L.L.B., D.L.F.), and Colorado Health Outcomes Program (B.L.B., D.L.F.), University of Colorado at Denver and Health Sciences Center, Denver, Colorado, USA %A Kutner, JS %A Bryant, LL %A Beaty, BL %A Fairclough, DL %J J Pain Symptom Manage %D 2007 Jun %T Time Course and Characteristics of Symptom Distress and Quality of Life at the End of Life %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17572055 %X This study sought to describe the characteristics and correlates of symptom distress and quality of life (QOL) among persons receiving hospice/palliative care. English-speaking adults (n=86), their nurses (n=86), and family caregivers (n=49) from 11 hospice/palliative care organizations completed the Memorial Symptom Assessment Scale (MSAS) and McGill Quality of Life Questionnaire (MQOL) at hospice/palliative care enrollment, at one week, two weeks, then monthly until death or discharge. Mixed effects modeling using proxy reports to impute missing patient-reported data were used to describe predictors of symptom distress and QOL. Given study population attrition due to death, analyses are limited to the first 17 days following hospice/palliative care admission. While lack of energy and pain were the most prevalent and distressing symptoms (prevalence 92% and 82%, respectively; mean MSAS scores 3.27 and 2.71, respectively), pain was identified as the most distressing symptom based on its contribution to MSAS summary scores and responses to a single-item "most distressing symptom" question. Pain, nonpain symptom distress, and MQOL scores remained fairly stable throughout the study period. Distress from all other physical symptoms was significantly associated with distress due to pain. There were no significant associations between patient characteristics and distress due to pain. While greater psychological symptom distress had a negative association with QOL, neither pain nor other physical symptom distress was associated with QOL. The persistence of significant symptom distress, particularly due to pain, argues for the need for enhanced evidence to guide care provided in the last days and weeks of life %0 Journal Article %C European Society of Gastroenterology, Munich, Germany. sdladas@hol.gr %A Ladas, S D %A Novis, B %A Triantafyllou, K %A Schoefl, R %A Rokkas, T %A Stanciu, C %A Isaacs, P %A Willich, S N %A Ronn, O %A Dremel, H %A Livadas, G %A Egan, B J %A Boyacioglu, S %A Selimovic, A %A Pulanic, R %A Karagiannis, J A %A Van Vooren, J P %A Kouroumalis, E %A O'Morain, C %A Nowak, A %A Deviere, J %A Malfertheiner, P %A Axon, A %J Endoscopy %D 2007 Jun %N 6 %P 556-65 %T Ethical issues in endoscopy: patient satisfaction, safety in elderly patients, palliation, and relations with industry. Second European Symposium on Ethics in Gastroenterology and Digestive Endoscopy, Kos, Greece, July 2006 %V 39 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17554655 %0 Journal Article %C Dipartimento di Biotecnologie Cellulari ed Ematologia, Universita La Sapienza di Roma, Ematologia, Ospedale S. Giovanni, Roma, Ematologia, Istituto Regina Elena, Roma, Italy. rob.lati@libero.it %A Latagliata, R %A Bongarzoni, V %A Carmosino, I %A Mengarelli, A %A Breccia, M %A Borza, P A %A D'Andrea, M %A D'Elia, G M %A Mecarocci, S %A Morano, S G %A Petti, M C %A Mandelli, F %A Alimena, G %J Ann Oncol %D 2006 Feb %N 2 %P 281-5 %T Acute myelogenous leukemia in elderly patients not eligible for intensive chemotherapy: the dark side of the moon %V 17 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=16373393 %X BACKGROUND: Acute Myelogenous Leukemia (AML) is a common disease in people aged>60 years. About 50% of the patients are not eligible for aggressive chemotherapy (CT) and are only managed with conservative approaches. Results in this subset of patients have not been reported so far. PATIENTS AND METHODS: We retrospectively evaluated 244 consecutive elderly AML patients (M/F 143/101, median age 72 years, range 60-90) diagnosed at our institution from January 1989 to December 1998 and not eligible for intensive CT. Eighty-nine patients (36.5%) had evolved from previous myelodysplasia (sAML). Fifty-three out of 192 (26.4%) patients with available bone marrow (BM) analysis had oligoblastic leukaemia (blasts<40% and WBC<15x10(9)/l). RESULTS: Sixty-seven patients (27.5%) were managed with supportive treatment only. One hundred seventy-seven patients (72.5%), in order to control disease, received conservative CT, consisting of Hydroxyurea (HU) (127 patients, 71.7%), Cytarabine and 6-Thioguanine (39 patients, 22%) or low-dose cytarabine (11 patients, 6.3%). Median overall survival was 179 days (1-3278) with 50 patients (20.5%) surviving>12 months. Older age (>75 years), poor WHO PS (>2), lower PLT levels (<50x10(9)/l) and higher absolute peripheral blast count (>5x10(9)/l) showed a negative prognostic impact on survival in multivariate analysis. CONCLUSIONS: Our data outline the great heterogeneity of elderly AML patients not eligible for intensive CT. A simple scoring system including easily evaluable parameters, which could distinguish subjects with different prognosis, is proposed. Moreover, randomized studies in order to establish best conservative approaches are warranted %0 Journal Article %C CNS Office, LOROS, Groby Road, Leicester, UK. deborahann.lewis@virgin.net %A Lewis, Deborah %A Anthony, Denis %J Int J Palliat Nurs %D 2007 May %N 5 %P 230-6 %T A patient and carer survey in a community clinical nurse specialist service %V 13 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17577175 %X The community clinical nurse specialist (CNS) team provides specialist palliative care to clients with cancer and non-malignant, life-limiting diseases in clients' homes, community hospitals, and residential and nursing homes. CNSs are based in health centres, community hospitals (geographically spread around the county) or at the local hospice. There has been no systematic review of patient and carer levels of satisfaction since the conception of the CNS service in 1984. Accredited as a nursing development unit (Flint and Wright, 2001) by Leeds University, the team has been encouraged to obtain service users' views. National guidelines in the UK (National Institute for Health and Clinical Excellence (NICE), 2004) also recommend that systems be put in place to enable clients to make their voices heard in a variety of ways. The principle aim was to identify the level of patient and carer satisfaction and to highlight aspects of care that warranted alteration or improvement. The CNS team were also keen to identify the aspects of their role most helpful to patients and carers, enabling CNSs to spend their time in a way that is most beneficial to clients %0 Journal Article %C School of Nursing, University of Texas, Austin, TX, USA. michael.limerick@utsouthwestern.edu %A Limerick, Michael H %J Oncol Nurs Forum %D 2007 Mar %N 2 %P 331-9 %T The process used by surrogate decision makers to withhold and withdraw life-sustaining measures in an intensive care environment %V 34 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17573297 %X PURPOSE/OBJECTIVES: To understand the process used by surrogate decision makers who have chosen to withhold and withdraw life-sustaining measures in intensive care units (ICUs). DESIGN: Grounded theory. SETTING: Multihospital system in central Texas. SAMPLE: 17 surrogates who decided to withhold and withdraw life-sustaining measures from patients with a variety of diagnoses, including cancer. METHODS: Surrogates were identified by review of charts of patients in ICUs. Interviews were recorded on audiotape and analyzed using the process of constant comparison. Saturation of data occurred when no new themes emerged. MAIN RESEARCH VARIABLE: The surrogate decision-making process. FINDINGS: Domains and their respective themes included: (a) the personal domain: rallying family support, evaluating the patient's past and present condition, and viewing past and future quality of life; (b) the ICU environment domain: chasing doctors, developing relationships with the healthcare team, and confirming probable medical outcomes; and (c) the decision domain: arriving at a new belief, getting alone to make the decision, and communicating the decision. CONCLUSIONS: Surrogates use a definite process to make decisions regarding withholding and withdrawing life-sustaining measures for patients in ICUs. IMPLICATIONS FOR NURSING: The results reveal opportunities for healthcare providers to improve education and change practice when supporting surrogates. Additional opportunities exist for further research to expand nursing knowledge related to end-of-life issues %0 Journal Article %C Urban Institute, 2100 M St., N.W., Washington, DC 20037, USA. kliu@ui.urban.org %A Liu, Korbin %A Wissoker, Douglas %A Swett, Althea %J Inquiry %D 2007 Spring %N 1 %P 88-103 %T Nursing home use by dual-eligible beneficiaries in the last year of life %V 44 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17583263 %X Research on health care at the end of life has focused on Medicare-financed acute care services. Much less information has been available on nursing home use in the last year of life, particularly for individuals who are dually eligible for Medicare and Medicaid. We used Medicare and Medicaid enrollment and claims data to examine nursing home admissions, odds of dying in nursing homes versus hospitals or the community, and variations in Medicare and Medicaid service use and costs by place of death. We found that, in the last year of life, 75% of dual-eligible people use nursing home care, increasing age is associated with greater likelihood of dying in nursing homes, and dual-eligible people who die in hospitals have notably higher costs than other beneficiaries %0 Journal Article %C College of Nursing, University of South Florida, Tampa, FL, USA. smcmilla@health.usf.edu %A McMillan, Susan C %A Small, Brent J %J Oncol Nurs Forum %D 2007 Mar %N 2 %P 313-21 %T Using the COPE intervention for family caregivers to improve symptoms of hospice homecare patients: a clinical trial %V 34 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17573295 %X PURPOSE/OBJECTIVES: To test an intervention for hospice caregivers designed to help them better manage symptoms experienced by patients with cancer. DESIGN: A three-group comparative design with repeated measures. SETTING: A large nonprofit hospice that primarily provides home care. SAMPLE: 329 hospice homecare patients with cancer and their caregivers were randomized into three groups: a control group (n = 109) receiving standard care, a group (n = 109) receiving standard care plus friendly visits, and a group (n = 111) receiving standard care plus the COPE intervention. METHODS: Caregivers received experimental training in the COPE intervention (creativity, optimism, planning, expert information) over nine days to assist with symptom management. MAIN RESEARCH VARIABLES: Intensity of pain, dyspnea, and constipation, overall symptom distress, and quality of life (QOL). Data were collected on admission and days 16 and 30. FINDINGS: Although symptom intensity for three target symptoms did not decrease, symptom distress was significantly improved (p = 0.009) in the COPE intervention group. QOL was not significantly different. CONCLUSIONS: Symptom distress, a measure that encompasses patient suffering along with intensity, was significantly decreased in the group in which caregivers were trained to better manage patient symptoms. IMPLICATIONS FOR NURSING: The COPE intervention is effective and immediately translatable to the bedside for hospice homecare patients with advanced cancer %0 Journal Article %C CHASE Hospice Care for Children, Surrey, UK. toni.menezes@chasecare.org.uk %A Menezes, Antoinette %A Esplen, Polly %A Bartlett, Paul %A Turner, Bridget %A Keel, Mike %A Etherington, Veronica %A Conisbee, Elaine %A Plant, Antonia %A Haslam, Val %A England, Julie %J Int J Palliat Nurs %D 2007 May %N 5 %P 237-42 %T A system of electronic records developed by a children's hospice %V 13 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17577176 %X This paper describes the development, implementation and dissemination of an electronic data collection system for children's hospices in the UK. In 1999, CHASE Hospice Care for Children (CHASE) began providing support for life-limited children and their families in their own homes across south-west London, Surrey and West Sussex. CHASE community team is multidisciplinary and original members of the team had to create all of the necessary administrative systems for collecting and storing information about referrals and care provided to children and their families. The community team had the foresight to record activity statistics from day one of the service. The team worked together to identify information routinely collected that could usefully be stored on a computer database and a simple solution was created for this purpose using Microsoft Access version 2. CHASE was in a privileged position because the commitment to use information technology came from people providing care to children and their families %0 Journal Article %A Miller, Pamela %J Soc Work %D 2007 Apr %N 2 %P 190-1 %T End-of-life decisions in Oregon %V 52 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17582830 %0 Journal Article %C Motor Neurone Disease Care and Research Centre, Royal Preston Hospital, Fulwood, Preston PR2 9HT, UK. Douglas.Mitchell@lthtr.nhs.uk %A Mitchell, J D %A Borasio, G D %J Lancet %D 2007 Jun %N 9578 %P 2031-41 %T Amyotrophic lateral sclerosis %V 369 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17574095 %X Amyotrophic lateral sclerosis (known in the UK as motor neuron disease) is a devastating illness with uncertain pathogenesis. In this Seminar, we review its natural history, clinical features, diagnostic criteria, variant and mimic syndromes, genetic forms, and epidemiology. Several hypotheses about causes of the disorder are discussed, such as excitotoxicity and oxidant stress, and we review past and present putative disease-modifying treatments. Disease-management strategies, from telling the patient about their illness to end-of-life decisions and palliative care, are presented. We review options for control of the main symptoms of amyotrophic lateral sclerosis--including dysphagia, dysarthria, respiratory distress, pain, and psychological disorders--and care in the terminal phase. The need for good psychosocial and spiritual care of patients and families is emphasised. We conclude with an overview of some current major issues and future prospects, ranging from the search for disease markers to challenging developments such as stem-cell and gene therapy %0 Journal Article %C Centre for Primary Health Care Studies, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK. d.munday@warwick.ac.uk %A Munday, Daniel %A Dale, Jeremy %A Murray, Scott %J J R Soc Med %D 2007 May %N 5 %P 211-5 %T Choice and place of death: individual preferences, uncertainty, and the availability of care %V 100 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17470927 %0 Journal Article %C Hospice Association of America, USA. jen@nahc.org %A Neigh, Janet E %J Caring %D 2007 May %N 5 %P 56 %T NAHC's Hospice QAPI Collaborative Project: seeking additional hospices to test draft Patient & Family Satisfaction Surveys %V 26 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17578224 %0 Journal Article %C School of Narsing, Faculty of Medicine, University of Miyazaki %A Oku, Shoko %J Nippon Ronen Igakkai Zasshi %D 2007 May %N 3 %P 351-8 %T The effect of care of terminally ill patients' families on care of families attending patients' deathbeds in a general ward %V 44 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17575440 %X Aim: Care of families attending patients' deathbeds is important, leading to care of the bereaved. However, we have no knowledge of a causal relationship between factors of care of terminally ill patients' families and care of families attending patients' deathbeds. The aim of this survey was to find out which factors of care nurses provide to terminally ill patients' families affect care of families attending patients' deathbeds in a general ward where many terminally ill elderly patients spend their time. Methods: Questionnaire survey of 978 general ward chief nurses working for hospitals with over 100 beds in the Kyushu district. Data were processed through factor analysis and covariance structured analysis. Results: 236 valid responses were analyzed. Four factors regarding chief nurses providing for families of terminally ill patients were identified. These factors were interpreted as first, mediating communication between families and patients; second, providing information; third, promoting cooperation and understanding among families; and fourth alleviating restrictions. The first factor correlates with the third factor. Especially, the first factor strongly affects the provision of care to families attending patients' deathbeds. The relationships of the second and fourth factors with care of families attending patients' deathbeds were not proved. Conclusion: Care of terminally ill patients' families in a general ward consists of four factors: mediating communication between families and patients, providing information, promoting cooperation and understanding among families, and alleviating restrictions. It was revealed that the more nurses promote cooperation and understanding among families, the more they can mediate communication between families and patients and provide care to families attending patients' deathbeds. It suggests that nurses are able to have a positive effect on the grief process of the bereaved by intervening between patients and families %0 Journal Article %C AP-HP, Hopital Albert Chenevier and Hopital Henri-Mondor, Department of Internal and Geriatric Medicine, University Paris 12, Creteil, France. Elena.Paillaud@ach.ap-hop-paris.fr %A Paillaud, Elena %A Ferrand, Edouard %A Lejonc, Jean-Louis %A Henry, Olivier %A Bouillanne, Olivier %A Montagne, Olivier %J Age Ageing %D 2007 May %N 3 %P 274-9 %T Medical information and surrogate designation: results of a prospective study in elderly hospitalised patients %V 36 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17261528 %X OBJECTIVES: To determine the preferences of French elderly inpatients concerning medical information and surrogate designation in life-threatening situations. METHODS: Intention-to-act questionnaire was completed by two geriatricians during a patient interview in the week following admission in three geriatric units in France. The participants were elderly patients (> or =70 years) with adequate cognitive performance for decision making as assessed by the Mini Mental State Examination. The impact of socio-demographic factors, level of confidence in medical care, cognitive or physical disability on surrogate designation and amount of medical information expected were measured. MEASUREMENTS: Impact of socio-demographic factors, level of confidence in medical care, cognitive or physical disability on surrogate designation and amount of medical information expected. RESULTS: 426 consecutive elderly patients were recruited. 32.6% wanted to receive complete information about their care and 77% declared they would want to be informed if they were in a life-threatening situation. 4.5% reported they would not want any medical information. A family member was designated as surrogate by 73% of the patients. In 28%, a second surrogate was also designated, usually the family physician (22%) or a member of the hospital medical staff (10%). Polytomous logistic regression analysis was used to assess determinants of the amount of information expected and social and medical parameters. MMSE score, the presence of physical disability, a low level of confidence in medicine and the presence of children were identified as independent determinants of a high level of information expectation. CONCLUSION: Elderly hospitalised patients expressed a strong desire to receive extensive information and were willing to designate a surrogate in a life-threatening situation. The surrogate was usually a family member alone or with another person, usually a practitioner %0 Journal Article %C The Institute for the Study and Treatment of Psychosocial Stress, Toronto, Ontario, Canada. arokach@yorku.ca %A Rokach, Ami %A Matalon, Raan %A Safarov, Artem %A Bercovitch, Michaela %J Palliat Support Care %D 2007 Jun %N 2 %P 153-9 %T The loneliness experience of the dying and of those who care for them %V 5 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17578066 %X OBJECTIVE: The study compared the qualitative aspects of the loneliness experience of the dying, their caregivers, and the general population. METHOD: The patients were recruited in an oncological hospice in Israel, and, despite being on their deathbed, agreed to participate in the study. Thirty-seven cancer-stricken patients, 78 caregivers, and 128 participants from the general population volunteered to partake in the study. They answered, anonymously, a 30-item questionnaire and were asked to endorse those items that described their experience of loneliness. RESULTS: Results suggested that the three populations did, indeed, differ in their experience of loneliness. More specifically, dying patients and their caregivers had significantly higher subscale scores on the Growth and Discovery and the Self-alienation subscales than the general population did. It was also found that the number of hospitalization days was significantly negatively correlated to the Emotional Distress and Self-alienation subscales. SIGNIFICANCE OF RESULTS: The present results indicate that loneliness is experienced differently in or out of the hospice and by the dying patient, his or her caregiver, and the general population. This may be the first study to examine the qualitative aspects of the loneliness experienced by the dying and by their caregivers. More research is needed to replicate the present study, using larger samples %0 Journal Article %C Veterans Affairs Medical Center, University of Minnesota, Department of Medicine, Section of General Medicine (1110), One Veterans Drive, Minneapolis, MN 55417, USA %A Roth, Craig S %J Patient Educ Couns %D 2007 May %N 2 %P 138-9 %T A trip to the nursing home %V 66 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17339092 %0 Journal Article %C Service d'Hepato-gastroenterologie, Hopital Ambroise Pare, 92100 Boulogne, France. philippe.rougier@apr.ap-hop-paris.fr %A Rougier, Philippe %A Mitry, Emmanuel %A Barbare, Jean-Claude %A Taieb, Julien %J Semin Oncol %D 2007 Apr %N 2 Suppl 1 %P S12-20 %T Hepatocellular carcinoma (HCC): an update %V 34 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17449346 %X In the absence of large randomized trials, the current treatment strategy for hepatocellular carcinoma (HCC) remains a matter of choice depending mostly on retrospective studies, experience of centers, and the technical therapeutic possibilities. In fact, treatment decisions must be based on HCC extension and liver function, which is dependent on underlying liver disease. Cirrhosis limits therapeutic choices, life expectancy, and tolerance to therapy. Surgical resection and/or local destruction are the most common curative treatments. Orthotopic liver transplantation is probably the best treatment for small HCC developed in cirrhosis because it treats tumor, cirrhosis, and preneoplastic lesions at the same time. However, this treatment method is feasible in fewer than 5% of cases. Adjuvant treatments include transarterial chemoembolization, chemotherapy, polyprenoic acid, interferon, adoptive immunotherapy, and intra-arterial radioactive lipiodol. Results from trials warrant confirmation in larger randomized trials to show a clear survival benefit on recurrence rate, secondary prevention, and overall survival. Chemoembolization is the only palliative treatment that has been proven to be active, unlike systemic chemotherapy, immunotherapy, and hormone therapy, whose activity is largely questionable and must all be restricted to clinical trials. Possible future therapeutic strategies include epidermal growth factor receptor inhibitors, antivascular endothelial growth factor therapies, cyclin D inhibitors, and HMG-CoA reductase inhibitors %0 Journal Article %C Faculty of Health and Social Care, London South Bank University. sanderkl@lsbu.ac.uk %A Sanders, K %A Chaloner, C %J Nurs Stand %D 2007 May %N 35 %P 41-4 %T Voluntary euthanasia: ethical concepts and definitions %V 21 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17515151 %X Euthanasia is a highly emotive and contentious subject, giving rise to a great deal of debate. However, despite its frequent exposure in public and professional media, there appears to be a lack of clarity about the concepts and definitions used in the euthanasia debate. This suggests that discussions on this subject are inadequately informed and ineffectual. The ethical focus of the euthanasia debate concerns the moral legitimacy of 'voluntary euthanasia'. This article provides an overview and clarification of some of the key ethical issues at the centre of that debate %0 Journal Article %A Santaeugenia Gonzalez, S %A Altimir Losada, S %A Santesmases Jarque, J %A Urrutia de Diego, A %J Rev Clin Esp %D 2007 Mar %N 3 %P 147; author reply 147-8 %T [Assessment of terminal disease in Internal Medicine] %V 207 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17397640 %0 Journal Article %C Department of Surgery, Otto-von-Guericke-University Magdeburg, Leipziger Str. 44, D-39120 Magdeburg, Germany. scheidbach@t-online.de %A Scheidbach, Hubert %A Schubert, Daniel %A Hugel, Omar %A van den Hoogen, Alexandra %A Rose, Jorg %A Pross, Matthias %A Kose, Daniela %A Kockerling, Ferdinand %A Lippert, Hans %J Surg Laparosc Endosc Percutan Tech %D 2007 Apr %N 2 %P 79-82 %T Results of laparoscopic surgery for colorectal cancer in palliative intent: short-term end points in 331 patients in comparison with procedures in benign indications %V 17 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17450084 %X BACKGROUND AND AIMS: Colorectal surgery performed in palliative intent is a relatively common intervention. The present study investigates the question whether such interventions are suitable for laparoscopic procedure. PATIENTS AND METHODS: The data presented herein were collected from 4834 patients within the framework of a multicenter study initiated by the "Laparoscopic Colorectal Surgery Study Group (LCSSG)." In a subgroup analysis of 331 operated palliative-intent patients, the short-term outcomes were evaluated and compared with those obtained in patients undergoing surgery for benign indications. RESULTS: Overall, the morbidity and mortality rates were significantly higher in the cancer patients than in patients with a benign indication, with no significant differences between the 2 groups in terms of intraoperative complications, conversion, and reoperation rates. The analysis of the individual complications revealed that the significant differences were due exclusively to the more frequent presence of general medical complications, and thus were unrelated to the laparoscopic procedure. CONCLUSIONS: The laparoscopic approach to the palliation of incurable colorectal carcinomas was associated with comparable results with regard to intraoperative complications, conversion, reoperation rates, and postoperative surgical complications in comparison with surgical procedures for benign indications, with significantly higher morbidity and mortality rates related solely to general-medical complications %0 Journal Article %C Herlev Hospital, Onkologisk Afdeling, Herlev. lisa.sengelov@dadlnet.dk %A Sengelov, Lisa %A Klarskov, Ole Peter %A Karlsson, Stellan %J Ugeskr Laeger %D 2007 May %N 20 %P 1905-7 %T [Treatment of hormonal refractory metastatic prostate cancer] %V 169 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17553368 %X Hormonal refractory metastatic prostate cancer is a fatal disease with a poor prognosis. Treatment options are palliative with second line anti-hormonal, estrogens and prednisolon. When palliation is the goal, the side effects have to be carefully considered. Local radiotherapy has an effective pain relieving effect, and can be repeated. Chemotherapy with docetaxel and prednisolon is indicated in patients with symptomatic metastatic disease. Newer options with immunotherapy and designed molecules have not yet proven effective. Pain and anemia are significant symptoms and should be treated in a multidisciplinary setting %0 Journal Article %C Department of Neurology, Pain and Palliative Care, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA %A Shaiova, Lauren %A Rim, Faye %A Friedman, Deborah %A Jahdi, Maryam %J Palliat Support Care %D 2007 Jun %N 2 %P 161-6 %T A review of methylnaltrexone, a peripheral opioid receptor antagonist, and its role in opioid-induced constipation %V 5 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17578067 %X OBJECTIVES: Opioid medications are frequently used in pain and palliative care patients with malignancy to manage symptoms such as pain and dyspnea. However, opiates are associated with various side effects. Constipation is a particularly problematic and common side effect of opioid pharmacology. Opioid antagonists have been studied in the management of opioid-induced constipation. Methylnaltrexone (MNTX) is a peripheral opioid antagonist currently under clinical investigation. It offers the potential to reverse undesirable side effects without reversing analgesia. METHODS: This article attempts to review existing clinical data, focusing on antagonism of opioid-induced adverse effects on the gastrointestinal system. RESULTS: MNTX seems to be well tolerated with limited or transient side effects. MNTX has been shown to improve oral-cecal transit times in opioid treated patients, induce laxation in chronic opioid users, and neither reverses the analgesic effects of morphine nor cause withdrawal symptoms. SIGNIFICANCE OF RESULTS: Larger clinical trials of MNTX are still necessary to support its use as a standard for treatment of opioid-induced constipation %0 Journal Article %C 464 Riverside Drive, #101 New York, NY 10027 E-mail: csilver@brooklyn.cuny.edu %A Silver, Catherine B %J Psychoanal Rev %D 2007 Jun %N 3 %P 409-30 %T Womb envy: loss and grief of the maternal body %V 94 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17581094 %0 Journal Article %C Department of Hepatology, Postgraduate Institute of Medical Education & Research, Chandigarh, India. virendrasingh100@hotmail.com %A Singh, Virendra %A Kapoor, Rakesh %A Solanki, Kuldip Kumar %A Singh, Gurpreet %A Verma, Ganga Ram %A Sharma, Suresh C %J Liver Int %D 2007 Apr %N 3 %P 347-52 %T Endoscopic intraluminal brachytherapy and metal stent in malignant hilar biliary obstruction: a pilot study %V 27 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17355456 %X BACKGROUND/AIMS: Malignant hilar biliary obstruction carries a poor prognosis, as the disease is often unresectable at the time of diagnosis. Various palliative measures as surgical/radiological/ endoscopic drainage with or without radiotherapy/chemotherapy have been tried with dismal outcome. We prospectively studied the effect of unilateral metal stent with intraluminal high dose rate (HDR) brachytherapy in patients with type II malignant hilar biliary obstruction. METHODS: Eight patients with type II malignant hilar biliary obstruction were treated with contrast-free unilateral metal stenting followed by endoscopic intraluminal brachytherapy (ILBT). A retrospectively analyzed group of 10 patients treated only with contrast-free unilateral metal stenting served as historical controls. RESULTS: A successful drainage was achieved in all, cholangitis occurred in none and no patient died within 30 days in both groups. The mean (+/-SD) patency of metal stent was 305 (+/-183.96) days and 143.9(+/-115.11) days in patients with and without intraluminal brachytherapy, respectively (P=0.03). Mean (+/-SD) survival of these patients was 310 (+/-192.68) days and 154.9 (+/-122.51) days in patients with and without intraluminal brachytherapy, respectively (P=0.05). Kaplan-Meier analysis showed estimated median survival of 225 (95% CI; 169.5, 280.4) days in brachytherapy and 100 (95%CI; 94.1, 105.8) days in control group (P=0.025). No major complications related to metal stent or ILBT were observed. CONCLUSIONS: Contrast-free unilateral metal stenting with HDR ILBT in type II malignant hilar biliary obstruction is a safe and effective method of palliation and appears to prolong patient survival as well as patency of stent in these patients, however, a larger, randomized trial is required to validate the same %0 Journal Article %A Smith, Alison P %A Lichtveld, Maureen Y %J Nurs Econ %D 2007 Mar-Apr %N 2 %P 110-8 %T A competency-based approach to expanding the cancer care workforce %V 25 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17500497 %0 Journal Article %C Department of Pulmonary and Mediastinal Pathology, Armed Forces Institute of Pathology, 6825 16th St NW, Washington, DC 20306, USA %A Tavora, Fabio %A Rassaei, Negar %A Shilo, Konstantin %A Foss, Robert D %A Galvin, Jeffrey R %A Travis, William D %A Franks, Teri J %J Arch Pathol Lab Med %D 2007 Jun %N 6 %P 970-3 %T Occult primary parotid gland acinic cell adenocarcinoma presenting with extensive lung metastasis %V 131 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17550329 %X Acinic cell adenocarcinoma is a malignant salivary gland neoplasm with a relatively low rate of lymphangitic spread to regional lymph nodes. Distant metastases are rare and their occurrence typically indicates an unfavorable outcome. We encountered an unusual example of acinic cell adenocarcinoma that initially presented in the lung, whereas the primary parotid carcinoma, despite extensive clinical evaluation, only became apparent 1 year after initial diagnosis. The histologic, immunohistochemical, and ultrastructural features of the tumor in the parotid gland and lung were similar. The tumor displayed an aggressive behavior resulting in death within 2 years of the initial presentation. This presentation is unique, showing that peripheral lung tumors of salivary gland type are likely to be metastatic, and careful clinical evaluation is warranted in establishing their primary site of origin %0 Journal Article %C The Warren Alpert Medical School of Medicine at Brown University (J.M.T., J.E.S., R.R.), Providence, Rhode Island; Home & Hospice Care of Rhode Island (J.M.T., R.R.), Pawtucket, Rhode Island; University of Pennsylvania School of Medicine (D.C.), Philadelphia, Pennsylvania; National Hospice and Palliative Care Organization (C.S., S.C.), Alexandria, Virginia; and Rhode Island Hospital (R.R.), Providence, Rhode Island, USA %A Teno, JM %A Shu, JE %A Casarett, D %A Spence, C %A Rhodes, R %A Connor, S %J J Pain Symptom Manage %D 2007 Jun %T Timing of Referral to Hospice and Quality of Care: Length of Stay and Bereaved Family Members' Perceptions of the Timing of Hospice Referral %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17583469 %X Previous research has noted that many persons are referred to hospice in the last days of life. The National Hospice and Palliative Care Organization collaborated with Brown Medical School to create the Family Evaluation of Hospice Care (FEHC) data repository. In 2005, 106,514 surveys from 631 hospices were submitted with complete data on the hospice length of stay and bereaved family member perceptions of the timing of hospice care. Of these surveys, 11.4% of family members believed that they were referred "too late" to hospice. This varied from 0 to 28.1% among the participating hospice programs with 30 or more surveys. Among those with hospice lengths of stay of less than a month, only 16.2% reported they were referred "too late." Although the bereaved family member perceptions of the quality of end-of-life care did not vary by length of stay for each of the FEHC domains, the perception of being referred "too late" was associated with more unmet needs, higher reported concerns, and lower satisfaction. Our results suggest that family members' perception of the timing of hospice referral-not the length of stay-is associated with the quality of hospice care. This perception varies substantially among the participating hospice programs. Future research is needed to understand this variation and how hospice programs are delivering high quality of care despite short length of stay %0 Journal Article %C The Pain Treatment Center of the Bluegrass, Lexington, Kentucky, USA %A Thornberry, Thomas %A Schaeffer, Jennifer %A Wright, Peter D %A Haley, Mindi C %A Kirsh, Kenneth L %J Palliat Support Care %D 2007 Jun %N 2 %P 147-52 %T An exploration of the utility of hypnosis in pain management among rural pain patients %V 5 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17578065 %X OBJECTIVE: Hypnosis is an adjunctive, noninvasive treatment with few side effects that can be useful in the management of chronic pain. However, it has fallen into disfavor in recent years and is often perceived by physicians as simple charlatanism. We evaluated the efficacy of this treatment as used clinically in a large, mostly rural, pain management center. METHODS: We conducted a chart review of 300 pain patients from the Pain Treatment Center of the Bluegrass who had undergone hypnosis for their pain concerns. A chart audit tool was developed consisting of basic demographics, pre- and posthypnosis pain ratings, a rating of relaxation achieved posthypnosis, and scores on the Beck Depression Inventory, Perceived Disability Scale, and the Pain Anxiety Symptom Scale. RESULTS: The sample consisted of 79 men (26.3%) and 221 women (73.7%) with a mean age of 46.3 years (SD = 9.9, range = 19-78). Pain levels recorded pre- and posthypnosis revealed significant improvement as a result of the intervention (mean difference = 2.5, t (1,298) = 25.9, p < .001). Patients reported an average of 49.8% improvement in relaxation level posthypnosis (SD = 24.2%) and had a mean score of 19.0 on the Beck Depression Inventory (SD = 9.9), indicating moderate levels of depression. Also, patients saw themselves as severely disabled regarding their ability to engage in physical (8.3/10) or job-related (7.7/10) activities. Attempts to identify predictors of hypnosis success were not fruitful with one exception. "Poor" responders to hypnosis reported greater levels of perceived dysfunction in their sexual functioning compared to the "good" responders, F(1,187) = 7.2, p < .01. SIGNIFICANCE OF RESULTS: Hypnosis appears to be a viable adjunct for pain management patients, including those from rural and relatively disadvantaged backgrounds. Prospective trials are needed to examine the utility of this modality in end-of-life and palliative care patients %0 Journal Article %A Trueman, Carol Ann %J Caring %D 2007 May %N 5 %P 40-3 %T Emergency preparedness for home care and hospice: the New Jersey experience %V 26 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17578218 %0 Journal Article %C Escola de Medicina e Cirurgia, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brasil %A Vasconcellos-Silva, PR %A Rivera, FJ %A Siebeneichler, FB %J Cad Saude Publica %D 2007 Jul %N 7 %P 1529-1538 %T Healthcare organizations, linguistic communities, and the emblematic model of palliative care %V 23 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17572801 %X The linguistic-communicative paradigm offers some interesting perspectives in a context where the perception of patient needs is considered a critical step in high-quality care. This study describes healthcare organizations as linguistic communities based on the conceptual framework of Habermas' communicative action theory. Four communicative models are present in healthcare settings: objectifying-instrumental (hegemonic model), where elements of interaction are objectified for clinical purposes; dialogic model with strategic perspectives, in which conversations are used unilaterally as tools to access subjective states; non-dialogic-transmissional model, in which linguistic exchanges are replaced with artifacts to transmit information; and full communicative model (present in palliative care based in homecare and informal caregivers, emphasizing health team/family interactions). Based on these premises, we considered palliative care an emblematic communicative model based on multidisciplinary teams devoted to transdisciplinary collaboration. In these settings, linguistic interaction with patients and their families could provide a solid basis for organization of healthcare networks %0 Journal Article %C UCLA School of Law, USA. volokh@law.ucla.edu %A Volokh, Eugene %J Harv Law Rev %D 2007 May %N 7 %P 1813-46 %T Medical self-defense, prohibited experimental therapies, and payment for organs %V 120 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17546805 %0 Journal Article %C Veterinary Laboratories Agency - Preston, Barton Hall, Garstang Road, Preston, Lancashire PR3 5HE %A Wessels, M E %A Greenwood, J %J Vet Rec %D 2007 May %N 19 %P 666-7 %T Gastrocnemius myopathy in yearling beef cattle %V 160 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17496277 %0 Journal Article %C Palliative Care Unit, Haradoi Hospital %A Yamashita, Kazumi %A Nabeshima, Atsuko %A Hara, Yuichi %A Okochi, Jiro %J Nippon Ronen Igakkai Zasshi %D 2007 May %N 3 %P 345-50 %T Influence of body weight, age, and primary tumor site on opioid dose in advanced cancer pain patients %V 44 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17575439 %X Aim: The aim of this study was to evaluate the relationship between maximum opioid dose and body weight, age, and primary site in terminal cancer patients in a palliative care unit. Methods: Medical records of 152 terminal cancer patients were reviewed retrospectively. Body weight, primary tumor site, age, and analgesic state were used as independent variables, and the maximum opioid dose was used as a dependent variable. Results: There was no correlation between body weight and maximum opioid requirement. Selected independent variables were age and location of the primary lesion in the lower gastrointestinal tract. Maximum opioid dose was negatively correlated with age (P /=75 was 116.9mg/day. Conclusion: Elderly cancer patients required a lower amount of opioid analgesia than younger adults. The ratio for age <65, 65-74, and >/=75 was about 1 : 1/2 : 1/3