%0 Journal Article %C Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee; Palliative and End-of-Life Care Task Force, St Jude Children's Research Hospital, Memphis, Tennessee %A Baker, JN %A Barfield, R %A Hinds, PS %A Kane, JR %J Biol Blood Marrow Transplant %D 2007 Mar %N 3 %P 245-254 %T A Process to Facilitate Decision Making in Pediatric Stem Cell Transplantation: The Individualized Care Planning and Coordination Model %V 13 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17317576 %X Providers of care for children undergoing stem cell transplantation (SCT) skillfully combine the roles of scientist and clinician. As scientists, they apply scientific methods and disease theory in the creation and testing of new therapies and in the careful observation and exploration of treatment outcomes. As clinicians, they are capable of intuitively delivering care in a patient- and family-centered context of meaning and life values. The specialty of SCT has inherent aspects that make treatment decision making complex and potentially contentious. Having a strategy ready to implement in advance or at the time when treatment decisions need to be made will facilitate and enhance the decision making process for both the health care team and family members. Here we introduce the individualized care planning and coordination (ICPC) model as a practical approach to facilitate ethical and effective decision making in pediatric SCT settings. The ICPC is a 3-step model comprising (1) relationship-understanding the illness experience from the perspective of the patient and family, sharing relevant information, and assessing ongoing needs; (2) negotiation-prognosticating, establishing goals of care, and discussing treatment options; and (3) plan-generating a comprehensive plan of care that includes life and medical plans. Based on a foundation of a care of competence, empathy, compassion, communication, and quality, the ICPC model aims to diminish contentious family-staff interactions that can lead to mistrust and help guide treatment decision making. The ICPC model enhances communication among patients, families, and clinicians by revealing patient and family values and medical and quality-of-life priorities before reaching or even during critical decision points in the transplantation process %0 Journal Article %A Kallel, H %A Dammak, H %A Bahloul, M %A Ben Hamida, C %A Chelly, H %A Rekik, N %A Bouaziz, M %J Intensive Care Med %D 2006 Nov %N 11 %P 1915-6 %T A good death: another break in the wall %V 32 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17019551 %0 Journal Article %A Nolen, R Scott %J J Am Vet Med Assoc %D 2007 Jan %N 2 %P 175-6 %T A legislative look ahead %V 230 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17256212 %0 Journal Article %A Halamandaris, Val J %J Caring %D 2006 Dec %N 12 %P 64 %T A time to celebrate %V 25 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17233267 %0 Journal Article %C Perioperative and Critical Care, Freeman Hospital, Newcastle upon Tyne NE7 7DN, UK %A Sykes, Eliot %A Cosgrove, Joseph F %J Ann R Coll Surg Engl %D 2007 Jan %N 1 %P 22-9 %T Acute renal failure and the critically ill surgical patient %V 89 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17316516 %X Acute renal failure can occur following major surgery. Predisposing factors include massive haemorrhage, sepsis, diabetes, hypertension, cardiac disease, peripheral vascular disease, chronic renal impairment and age. Understanding epidemiology, aetiology and pathophysiology can aid effective diagnosis and management. A consensus definition for acute renal failure has recently been developed. It relates to deteriorating urine output, serum creatinine and glomerular filtration rate. In the surgical patient, precipitants are often pre-renal, although intrinsic damage and obstructed urine flow can occur. Worsening renal function results in distal organ damage. Acute renal failure is a marker of disease severity, carrying a poor prognosis if associated with deteriorating respiratory and cardiovascular function. Acute renal failure in the critically ill surgical patient exerts a massive impact on the evolution of complications and prognosis. Management relates to treating life-threatening problems, maintaining effective ventilation and circulation, removal (or reduction) of nephrotoxins and, where appropriate, establishing either renal replacement therapy or palliative care %0 Journal Article %C Department of Psychiatry, Women's Health Research, and Magnetic Resonance Research Center, Yale University School of Medicine, New Haven, Conn %A Maciejewski, Paul K %A Zhang, Baohui %A Block, Susan D %A Prigerson, Holly G %J JAMA %D 2007 Feb %N 7 %P 716-23 %T An empirical examination of the stage theory of grief %V 297 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17312291 %X CONTEXT: The stage theory of grief remains a widely accepted model of bereavement adjustment still taught in medical schools, espoused by physicians, and applied in diverse contexts. Nevertheless, the stage theory of grief has previously not been tested empirically. OBJECTIVE: To examine the relative magnitudes and patterns of change over time postloss of 5 grief indicators for consistency with the stage theory of grief. DESIGN, SETTING, AND PARTICIPANTS: Longitudinal cohort study (Yale Bereavement Study) of 233 bereaved individuals living in Connecticut, with data collected between January 2000 and January 2003. MAIN OUTCOME MEASURES: Five rater-administered items assessing disbelief, yearning, anger, depression, and acceptance of the death from 1 to 24 months postloss. RESULTS: Counter to stage theory, disbelief was not the initial, dominant grief indicator. Acceptance was the most frequently endorsed item and yearning was the dominant negative grief indicator from 1 to 24 months postloss. In models that take into account the rise and fall of psychological responses, once rescaled, disbelief decreased from an initial high at 1 month postloss, yearning peaked at 4 months postloss, anger peaked at 5 months postloss, and depression peaked at 6 months postloss. Acceptance increased throughout the study observation period. The 5 grief indicators achieved their respective maximum values in the sequence (disbelief, yearning, anger, depression, and acceptance) predicted by the stage theory of grief. CONCLUSIONS: Identification of the normal stages of grief following a death from natural causes enhances understanding of how the average person cognitively and emotionally processes the loss of a family member. Given that the negative grief indicators all peak within approximately 6 months postloss, those who score high on these indicators beyond 6 months postloss might benefit from further evaluation %0 Journal Article %C School of Nursing, University of Nottingham, Nottingham, UK %A Cox, K %A Wilson, E %A Jones, L %A Fyfe, D %J Psychooncology %D 2007 Feb %T An exploratory, interview study of oncology patients' and health-care staff experiences of discussing resuscitation %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17311361 %X There is little research about how patients and their families would like discussions surrounding resuscitation to take place. The purpose of this exploratory study was to investigate the experience of a discussion of resuscitation from the perspective of the participants. In-depth interviews were undertaken with 21 patients, of whom nine were interviewed together with a relative and 14 staff in an oncology setting. Data were analysed using a constant comparative method and coded using NVIVO qualitative data analysis software. Patients appeared to be accepting resuscitation discussions as necessary and important. A minority felt that the timing of the discussion could have been better, particularly if they were newly diagnosed or had recently commenced treatment. Relatives generally found the discussions more difficult and felt that discussions should take place much closer to death. Patients identified that they needed time and privacy during the discussion. Staff identified a need to present a sensitive and individualised discussion which took into account the key elements of timing, place, space, manner and pace. Patients acknowledged that the resuscitation discussion enabled them to begin to address issues relating to dying and end of life. For staff on-going communication skills training and support in this area were seen as important but often overlooked parts of the process. Copyright (c) 2007 John Wiley & Sons, Ltd %0 Journal Article %C Department of Respiratory Medicine, St Vincent's Hospital, Melbourne, Victoria, Australia. conronm@svhm.org.au %A Conron, M %A Phuah, S %A Steinfort, D %A Dabscheck, E %A Wright, G %A Hart, D %J Intern Med J %D 2007 Jan %N 1 %P 18-25 %T Analysis of multidisciplinary lung cancer practice %V 37 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17199840 %X BACKGROUND: The aim of this study was to describe the activity of a lung cancer multidisciplinary clinic (MDC) and examine whether this model of clinical practice results in adherence to best-practice guidelines. METHODS: Prospective analysis of demographic and clinical data in 431 patients referred to a lung cancer MDC for the management of known or suspected thoracic malignancy. Adherence was documented to clinically relevant guideline recommendations concerning timely and evidence-based lung cancer management. RESULTS: Of 431 patients, 257 were diagnosed with primary lung cancer, mean age 68 years, 70% men and 90% current smokers or ex-smokers. Only 21% were referred with known malignancy and 28% were asymptomatic. Overall, 51% had stages I and II non-small-cell lung cancer, with this bias towards early-stage disease greatest in patients from rural areas. Histological confirmation of lung cancer was obtained in 92%. There was a high rate of adherence to international guideline recommendations concerning timely lung cancer diagnosis, staging and treatment implementation. Similarly, there was adherence to selected key evidence based recommendations for lung cancer management contained in national guidelines. CONCLUSION: Within a MDC, patients receive timely diagnosis, staging and treatment according to evidence-based guideline recommendations. The high proportion of patients receiving active treatment has implications for resource allocation. There is a referral bias towards patients with early non-small-cell lung cancer, particularly in rural patients, suggesting that further education about advances in metastatic lung cancer management is required. This study would support the establishment of regional lung cancer services with links to fully resourced MDC %0 Journal Article %C Radiation Therapy Unit, Institute for Cancer Research and Treatment, IRCC, Candiolo, Turin, Italy. pietro.gabriele@ircc.it %A Gabriele, Pietro %A Malinverni, Giuseppe %A Bona, Cristina %A Manfredi, Manuela %A Delmastro, Elena %A Gatti, Marco %A Penduzzu, Giovanni %A Baiotto, Barbara %A Stasi, Michele %J Tumori %D 2006 Nov-Dec %N 6 %P 496-502 %T Are quality indicators for radiotherapy useful in the evaluation of service efficacy in a new based radiotherapy institution? %V 92 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17260490 %X AIMS AND BACKGROUND: A number of documents assess the need for quality assurance in radiotherapy, which must be constantly monitored and possibly improved. In this regard, a system that confirms the quality of a department has been suggested and quality indicators have been used to improve the quality of the service. The National Health Service (Istituto Superiore di Sanita) approved a National Research Project to increase the quality of radiotherapy. The aim of the present study was to analyze the practical feasibility and efficacy of the quality indicators elaborated by the National Health Service study group in a radiotherapy unit. PATIENTS AND METHODS: The voluntary accredited program was carried out by the Radiotherapy Department of IRCC in Candiolo from June to August 2002. We analyzed 8 of the 13 indicators according to the National Health Service Project. For this purpose, 133 consecutive patients treated in our Unit were analyzed, and the results are reported according to the appropriate indicator (number of staff related to patients treated, waiting list, case history accuracy, multidisciplinary approach, number of treatment plans performed by CT, number of fields per fraction, number of portal imaging performed per overall treatment, and patient satisfaction). RESULTS: The number of professional staff related to the number of patients treated was easy to calculate and it could be the basis for further evaluation. The overall waiting time was 55.4 days, and it changed for different radiotherapy goals. We obtained 80% conformity in case-history accuracy. The number of multidisciplinary consultations performed ranged between 50% and 100%. The number of CT plans was about 1.6 +/- 0.9 plans per patient. The mean number of fields performed per day and per patient is 3.5 +/- 1.7 and was in agreement with the fact that more than 50% of treatments in our Center were performed with conformal radiotherapy. An average of 16.7 +/- 10.0 portal imaging per case was performed. The percentage of patient satisfaction with the staff obtained a very high compliance. CONCLUSIONS: The self evaluation promoted by the National Health Service Project allows the monitoring of the activities of the service in order to asses critical factors and it can be the starting point to improve the quality of the service and to compare national and international quality assurance results %0 Journal Article %C Department of Adult Nursing/Palliative Care Nursing, School of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan, miyasita-tky@umin.net %A Miyashita, M %A Hirai, K %A Morita, T %A Sanjo, M %A Uchitomi, Y %J Support Care Cancer %D 2007 Feb %T Barriers to referral to inpatient palliative care units in Japan: a qualitative survey with content analysis %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17318594 %X OBJECTIVES: We investigated the barriers to referral to inpatient palliative care units (PCUs) through a qualitative study across various sources of information, including terminal cancer patients, their families, physicians, and nurses. MATERIALS AND METHODS: There were 63 participants, including 13 advanced cancer patients, 10 family members, 20 physicians, and 20 nurses in palliative care and acute care cancer settings from five regional cancer institutes in Japan. Semi-structured interviews were conducted regarding barriers to referral to PCU, and data were analyzed by content analysis method. RESULTS: A total of 21 barriers were identified by content analysis. The leading barriers were (1) a negative image of PCUs by patients and families (n = 39), (2) delay of termination of anti-cancer treatment by physicians in the general wards (n = 24), (3) unwillingness to end anti-cancer treatment and denial of the fatal nature of the disease by patients and families (n = 22), (4) patient's wish to receive care from familiar physicians and nurses (n = 20), and (5) insufficient knowledge of PCUs by medical staff in general wards (n = 17). CONCLUSIONS: To correct these unfavorable images and misconceptions of PCUs, it is important to eliminate the negative image of PCUs from the general population, patients, families, and medical staffs. In addition, early introduction of palliative care options to patients and communication skills training regarding breaking bad news are relevant issues for a smooth transition from anti-cancer treatment to palliative care %0 Journal Article %A Mayor, Susan %J BMJ %D 2007 Feb %N 7588 %P 278 %T Care of dying patients and safety dominate report on NHS complaints %V 334 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17289704 %0 Journal Article %C 1Department of Pediatrics, The University of Utah School of Medicine, Salt Lake City, UT, USA %A Coulter, D M %A Zhou, H %A Rorke-Adams, L B %J J Perinatol %D 2007 Mar %N 3 %P 186-9 %T Catastrophic intrauterine spinal cord injury caused by an arteriovenous malformation %V 27 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17314989 %X We report a baby born with flaccid quadraparesis that was considered possibly attributable to birth injury. Postmortem examination identified an injury that occurred well before delivery caused by hemorrhage from an arteriovenous malformation of the brainstem and spinal cord. We discuss imaging modalities to diagnose neonatal cord injuries, possible treatments, prognosis and end of life decision making for these unfortunate patients. We also emphasize the importance of the autopsy in cases of suspected birth injury.Journal of Perinatology (2007) 27, 186-189. doi:10.1038/sj.jp.7211648 %0 Journal Article %C Home Care Marketing Solutions, Chapel Hill, NC, USA. mike@hcmarketingsolutions.com %A Ferris, Michael T %J Caring %D 2006 Dec %N 12 %P 50-1 %T Celebrating milestones %V 25 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17233261 %0 Journal Article %C Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan. kshimada@ncc.go.jp %A Shimada, Kazuaki %A Sano, Tsuyoshi %A Sakamoto, Yoshihiro %A Kosuge, Tomoo %J Ann Surg Oncol %D 2006 Dec %N 12 %P 1569-78 %T Clinical implications of combined portal vein resection as a palliative procedure in patients undergoing pancreaticoduodenectomy for pancreatic head carcinoma %V 13 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17009145 %X BACKGROUND: The clinical implications of combined portal vein resections are controversial. METHODS: One-hundred and forty-nine consecutive patients underwent macroscopically curative pancreatectomies for pancreatic head carcinoma between January 1, 1996 and December 31, 2004. Portal vein resection was performed in 86 patients (58%). Data on surgical mortality, morbidity, perioperative outcome, pathological factors, initial recurrence site, and survival were retrospectively compared between the patients with and without portal vein resection. RESULTS: The incidence of postoperative pancreatic fistula was lower among patients who underwent portal vein resection. The median survival period was 14 months for the portal vein resection group and 35 months for the non-portal vein resection group, respectively. Combined portal vein resection was a significant predictor of poor survival using a multivariate analysis. Portal vein resection was strongly associated with larger tumor size, the degree of retropancreatic tissue invasion, the presence of extrapancreatic nerve plexus invasion, lymph node metastases, and positive cancer infiltration at the surgical margins. CONCLUSIONS: Portal vein resection at the time of pancreaticoduodenectomy can be safely performed. However, most of patients requiring portal vein resection do not achieve a potentially curative resection or a favorable survival term. As a result, the aggressive application and the strict selection of portal vein resection might reduce the incidence of positive surgical margins, enabling long-term survival in patients who do not require portal vein resection %0 Journal Article %C Pain Relief and Palliative Care Unit, Department of Radiology, Areteion Hospital, University of Athens School of Medicine, Greece %A Mystakidou, Kyriaki %A Katsouda, Emmanuela %A Kouloulias, Vassilios %A Kouvaris, John %A Tsiatas, Marinos %A Vlahos, Lambros %J J Opioid Manag %D 2005 Sep-Oct %N 4 %P 204-10 %T Comparison of transdermal fentanyl with codeine/paracetamol, in combination with radiotherapy, for the management of metastatic bone pain %V 1 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17315548 %X Radiotherapy (R/T) is frequently used for palliative treatment of painful bone metastases; however, complete alleviation of pain is not always achieved. This study was designed to evaluate pain management outcomes and quality of life (QoL) measures in cancer patients with metastatic bone pain receiving a combination of R/T and either transdermal therapeutic fentanyl (TTS-F) patches or codeine/paracetamol. A total of 460 palliative care patients with bone metastases who received R/T were enrolled in this prospective, open-label study. The patients were randomized to initially receive a total dose of 120 mg codeine/paracetamol per day or TTS-F patches releasing 25 microg fentanyl per hour. Pain measures were assessed on the basis of selected questions from the Greek-Brief Pain Inventory. Overall treatment satisfaction (scale, 1 to 4), QoL, and European Collaborative Oncology Group status were also recorded. Among the 460 patients, 422 were eligible for evaluation. Pain measures in the TTS-F group demonstrated statistically significant improvements during the study that were superior to those in the codeine/paracetamol group (p < 0.05). Likewise, there was a significantly greater increase (p < 0.05) in the mean satisfaction score for patients in TTS-F group at every visit between baseline and month two. The vast majority (95.8 percent) of patients in the codeine/paracetamol group increased their medication dosage until the end of the study, whereas in the TTS-F group the respective percentage was only 6.1. Both treatments were generally well tolerated, with constipation as the most common side effect followed by sleep disturbances and nausea. The overall frequencies of side effects were higher in the codeine/paracetamol group. The results therefore indicate that TTS-F offers more effective pain relief than codeine/paracetamol, in combination with R/T, in patients with metastatic bone pain, obtaining complete treatment satisfaction matched by improvements in their QoL %0 Journal Article %C Houston Center for Quality of Care and Utilization Studies, Sections of Geriatrics and Health Services Research, Michael E DeBakey VA Medical Center, 2002 Holcombe Boulevard, Houston, TX 77030, USA. ubraun@bcm.tmc.edu %A Braun, Ursula K %A Beyth, Rebecca J %A Ford, Marvella E %A McCullough, Laurence B %J BMJ %D 2007 Feb %N 7587 %P 239-41 %T Defining limits in care of terminally ill patients %V 334 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17272566 %0 Journal Article %C Department of Intensive Care, Isala klinieken, Dr van Heesweg 2, 8025 AB, Zwolle, The Netherlands %A Meilink, Mieke %A van de Wetering, Koos %A Klip, Helen %J Resuscitation %D 2006 Dec %N 3 %P 322-6 %T Discussing and documenting (do not attempt) resuscitation orders in a Dutch Hospital: a disappointing reality %V 71 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17064837 %X OBJECTIVE: To determine whether the introduction of a patient information sheet about do not attempt resuscitation (DNAR) orders and personal motivation of the medical staff results in an improvement in the documentation of the DNAR orders in the medical records. DESIGN: Retrospective chart review. METHOD: The medical records for all hospital admissions during February 2005 were checked for age, sex, admission time, admitting specialty, admission type (acute or planned), death, documentation of the DNAR order on the admission form, and if this order was complied with and under whose initiative the order was implemented or not. These data were compared to the medical records from 2 years earlier. RESULTS: In 2005, 119 (9.3%) medical records a DNAR order was found, compared to 10.7% in 2003. In the 43 patients who died DNAR orders were documented more often (18.6%) than in other patients (9%). The DNAR order was written more frequently for patients who were older (46.5 years versus 67.5 years), had a longer hospital admission period (4.2 versus 12.4 days) and for acute admissions. No difference was found for sex. Of the specialties with more than 10 admissions a month, the most frequently written DNAR orders came from internal medicine (36%) and pulmonology (31%); the least from cardiology (2.2%) and thoracic surgery (0%). In 9 of the 119 (7.6%) the DNAR orders were explained, most were initiated by the doctor (7), 1 by the patient an 1 by the family. CONCLUSION: Giving patients more information about DNAR orders and motivating medical staff personally does not influence the documentation of DNAR orders. If documented, it occurred more in the elderly and the deceased patients. Only a few DNAR orders were specified and most were initiated by the doctor %0 Journal Article %C VITAS Innovative Hospice Care, USA %A Policzer, Joel S %J Caring %D 2006 Dec %N 12 %P 26-9 %T Dispelling the myth of intractable pain %V 25 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17233256 %0 Journal Article %A Sheldon, Tony %J BMJ %D 2007 Feb %N 7587 %P 228-9 %T Dutch court acquits suicide counsellor of breaking the law %V 334 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17272547 %0 Journal Article %A Boussarsar, Mohamed %A Bouchoucha, Slaheddine %J Intensive Care Med %D 2006 Nov %N 11 %P 1917-8 %T Dying at home: cultural and religious preferences %V 32 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17019550 %0 Journal Article %A Dyer, Clare %J BMJ %D 2007 Feb %N 7589 %P 329 %T Dying woman seeks backing for dose of morphine to hasten death %V 334 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17303849 %0 Journal Article %C Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA %A Klopp, Ann H %A Eapen, Georgie A %A Komaki, Ritsuko R %J Clin Lung Cancer %D 2006 Nov %N 3 %P 203-7 %T Endobronchial brachytherapy: an effective option for palliation of malignant bronchial obstruction %V 8 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17239296 %X Symptoms resulting from tumors extending to the endobronchial wall are common in patients with lung cancer and significantly impact quality of life. A number of treatment options are available for palliation, including endobronchial brachytherapy, stent placement, laser photoresection, external-beam radiation therapy, and photodynamic therapy. This review will focus on the methodology and role of endobronchial brachytherapy while discussing benefits of other treatment options as additions or alternatives to brachytherapy %0 Journal Article %C University of Chicago, Department of Endoscopy and Therapeutics and the Cancer Research Center, Section of Gastroenterology, 5841 S Maryland Ave, MC4076, Chicago, IL 60637, USA %A Ross, Andrew S %A Semrad, Carol %A Waxman, Irving %A Dye, Charles %J Gastrointest Endosc %D 2006 Nov %N 5 %P 835-7 %T Enteral stent placement by double balloon enteroscopy for palliation of malignant small bowel obstruction %V 64 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17055891 %0 Journal Article %C Senior Lecturer in Adult Nursing, University of the West of England, Gloucester Centre, Hartpury Campus, Gloucester, UK %A Snelling, Paul %J J Adv Nurs %D 2007 Mar %N 5 %P 561-2 %T Ethical Issues in Palliative Care (second edition) %V 57 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17305768 %0 Journal Article %C Intensive Care Unit, Royal Berkshire Hospital, London Road, Reading, RGI 5AN, UK. c.danbury@reading.ac.uk %A Danbury, C M %A Waldmann, C S %J Best Pract Res Clin Anaesthesiol %D 2006 Dec %N 4 %P 589-603 %T Ethics and law in the intensive care unit %V 20 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17219943 %X Intensive Care Medicine epitomises the difficulties inherent in modern medicine. In this chapter we examine some key medicolegal and ethical areas that are evolving. The principles of autonomy and consent are well established, but developments in UK caselaw have shown that the courts may be moving away from their traditional deference of the medical profession. We examine some recent cases and discuss the impact that these cases may have on practice in Intensive Care %0 Journal Article %C RUG, Vakgroep Rechtstheorie, The Netherlands. h.a.m.weyers@rug.nl %A Weyers, Heleen %J Sociol Health Illn %D 2006 Sep %N 6 %P 802-16 %T Explaining the emergence of euthanasia law in the Netherlands: how the sociology of law can help the sociology of bioethics %V 28 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17184419 %X The debate over the legalisation of voluntary euthanasia is most often seen to be the result of three changes in society: individualisation, diminished taboos concerning death and changes in the balance of power in medicine. The fact that these changes occurred in many western countries but led to legalisation in only a few makes this claim problematic. I examine whether socio-legal propositions, with respect to the emergence of laws which focus on social control, offer a better approach to understanding the development of rules allowing and governing euthanasia. After a short sketch of the history of the Dutch law regulating euthanasia, I discuss these three societal changes in the light of shifts in the social control of medical behaviour that shortens life. I show that the Dutch relaxation of the prohibition of euthanasia goes together with new forms of social control: doctors' self control is complemented with second-party control (by patients), professional third-party control and governmental control. My work calls attention to the fact that bioethics is part of larger systems of social control %0 Journal Article %C School of Social Work, School of Medicine, University of Missouri-Columbia, Columbia, Missouri %A Day, Michele %A Demiris, George %A Oliver, Debra Parker %A Courtney, Karen %A Hensel, Brian %J Telemed J E Health %D 2007 Feb %N 1 %P 25-32 %T Exploring underutilization of videophones in hospice settings %V 13 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17309351 %X The aim of this study was to evaluate hospice providers' attitudes and perceptions regarding videophone technology in settings where the technology was introduced but underutilized. Specifically, the project seeks to provide an in-depth understanding of attitudes and perceptions that may lead to failure of a telehealth implementation in the hospice setting in the context of the technology acceptance model. Two hospice agencies were selected as a purposive sample. Both agencies had acquired videophones that were meant to be integrated into care delivery but ultimately were underutilized or never used. Interviews with staff were conducted over the telephone. The interview guide was constructed to capture staff perceptions and attitudes concerning videophone technology. Interviews were audiotaped and transcribed for content analysis. A total of 17 (n = 17) participants (2 hospice administrators, 1 hospice management staff, 10 nurse case managers, and 4 social workers) were interviewed. Participants found videophones to be useful in hospice care but expressed specific practical challenges, such as lack of equipment reliability, lack of human resources, and lack of clarity pertaining to caregiver eligibility criteria. While perceived usefulness of videophones was high among respondents, practical concerns can be interpreted as lack of perceived ease of use. Findings indicate that the Technology Acceptance Model (TAM) provides a good framework for an understanding of telehealth underutilization. Staff perceived that videophones were useful, but they were discouraged by their perception that the videophones were not reliable or easy to use and by their uncertainty about the cases that they were best suited for. Lessons learned are integrated into a randomized clinical trial currently under development %0 Journal Article %C Center for Ethics and Caring, Sioux Valley Hospital, Sioux Falls, SD, USA %A Schellinger, Ellen L %A Harris, Mary Helen %A Eidsness, LuAnn %J S D Med %D 2006 Dec %N 12 %P 523-4 %T Extenuating circumstances: regarding comfort one: new cardiopulmonary resuscitation directives in South Dakota %V 59 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17212184 %X Circa 2001, Aunt Abby had reached her seventh decade when she was diagnosed with advanced ovarian cancer. Chances of cure were slim to nil, and true to her Midwestern upbringing and staunch faith that a better world awaits, Aunt Abby chose to live out her last months at home, "doing" for Uncle Bill, as she had for the last fifty-two years. Uncle Bill and the kids understood and were willing to abide by her wishes to just let her pass, as God would will. But, when the day came that Aunt Abby's heart failed, she was puttering through the local grocery alone, while Uncle Bill slipped around the corner to pick up parts from the hardware store. An alert store clerk called 911. The EMS team arrived quickly, and, as their protocol required, began resuscitation. Aunt Abby's wish for a death with "no fuss" was no match for the emergency medical system's clinical and legal duty to treat until a physician ordered otherwise %0 Journal Article %A Cook, J G %A Cawley, G D %A Richards, I M %J Vet Rec %D 2007 Jan %N 2 %P 64 %T FMD and the contiguous cull %V 160 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17220528 %0 Journal Article %A Nolen, R Scott %J J Am Vet Med Assoc %D 2007 Jan %N 2 %P 168-70 %T Getting beyond surgical contraception %V 230 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17223746 %0 Journal Article %C Department of Educational Psychology, Kuwait University, Kuwait City, Kuwait %A Hadi, Fawzyiah %A Llabre, Maria Magdalena %A Spitzer, Susan %J J Trauma Stress %D 2006 Oct %N 5 %P 653-62 %T Gulf War-related trauma and psychological distress of Kuwaiti children and their mothers %V 19 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17075916 %X The participants were 111 Kuwaiti boys and girls and 59 mothers assessed in 1993 and 2003 to determine exposure to war-related trauma during the Iraqi occupation and subsequent psychological distress. Children were classified into four groups based on what happened to their fathers during the occupation: killed, missing, arrested, or unharmed. The results indicate that the group whose fathers were arrested had the highest level of posttraumatic stress symptoms and the highest level of depression and anxiety in 2003. In 1993, the highest levels of depression for children and their mothers were observed in those whose fathers-husbands were killed or missing relative to controls. Long-term effects of war-related trauma in children may be influenced by the war experience of their fathers %0 Journal Article %C Federation d'hematologie et Centre d'Investigation Clinique, Hopital Saint-Louis, Paris, France %A Rousselot, Philippe %A Huguet, Francoise %A Rea, Delphine %A Legros, Laurence %A Cayuela, Jean Michel %A Maarek, Odile %A Blanchet, Odile %A Marit, Gerald %A Gluckman, Eliane %A Reiffers, Josy %A Gardembas, Martine %A Mahon, Francois-Xavier %J Blood %D 2007 Jan %N 1 %P 58-60 %T Imatinib mesylate discontinuation in patients with chronic myelogenous leukemia in complete molecular remission for more than 2 years %V 109 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=16973963 %X In the present study, we address the issue of the discontinuation of imatinib mesylate (Gleevec) in chronic myelogenous leukemia with undetectable residual disease for more than 2 years. Twelve patients were included. The median duration of real-time quantitative-polymerase chain reaction (RTQ-PCR) negativity and imatinib therapy were, respectively, 32 months (range, 24-46 months) and 45 months (range, 32-56 months) before imatinib interruption. Six patients displayed a molecular relapse with a detectable BCR-ABL transcript at 1, 1, 2, 3, 4, and 5 months. Imatinib was then reintroduced and led to a novel molecular response in most patients. Six other patients (50%) still have an undetectable level of BCR-ABL transcript after a median follow-up of 18 months (range, 9-24 months). We hypothesize that relapses observed within 6 months reflect the kinetics of undetectable dividing chronic myelogenous leukemia (CML) cells. Those cells may be eradicated or controlled in long-term nonrelapsing patients, as described in our study %0 Journal Article %C King's College London, United Kingdom %A Selman, LE %A Harding, R %A Beynon, T %A Hodson, F %A Coady, E %A Hazeldine, C %A Walton, M %A Gibbs, LM %A Higginson, IJ %J Heart %D 2007 Mar %T Improving end of life care for chronic heart failure patients - "Let's hope it'll get better, when I know in my heart of hearts it won't" %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17309905 %X Objective Although chronic heart failure (CHF) has a high mortality rate and symptom burden, and clinical guidance stipulates palliative care intervention, there is a lack of evidence to guide clinical practice for patients approaching the end of life. This study aimed to formulate guidance and recommendations for improving end of life care in CHF. The objectives were to generate data on patients and carers? preferences regarding future treatment modalities, and to investigate communication between staff, patient and carer on end of life issues. Design Semi-structured qualitative interviews were conducted with 20 CHF patients (New York Heart Association functional classification III-IV); 11 family carers; 6 palliative care clinicians and 6 cardiology clinicians. Setting A tertiary hospital in London, UK. Results Patients and families reported a wide range of end of life care preferences. None had discussed these with their clinicians, and none were aware of choices or alternatives in future care modalities, such as adopting a palliative approach. Patients and carers live with fear and anxiety, and are uninformed about the implications of their diagnosis. Cardiac staff confirmed that they rarely raise such issues with patients. Disease specific and specialism-specific barriers to improving end of life care were identified. Conclusions This novel, integrated data provides three recommendations for improving care in line with policy directives: sensitive provision of information and discussion of end of life issues with patients and families; mutual education of cardiology and palliative care staff; and mutually agreed palliative care referral criteria and care pathways for CHF patients %0 Journal Article %C Department of Psychiatry, University of California, San Diego, CA, USA %A Zisook, S %A Kendler, KS %J Psychol Med %D 2007 Feb %P 1-31 %T Is bereavement-related depression different than non-bereavement-related depression? %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17306046 %X Background. This review tackles the question: 'Is bereavement related depression (BRD) the same or different from standard (non-bereavement-related) major depression (SMD)?' To answer this question, we examined published data on key characteristics that define and characterize SMD to assess whether they also characterize BRD.Method. We searched all English-language reports in Medline up to November 2006 to identify relevant studies. Bibliographies of located articles were searched for additional studies.Results. Consistent with the position that BRD is distinct from SMD, some, but not all, studies report that men are as likely as women to have BRD and that past or family histories of SMD do not predict BRD. With greater consistency, studies suggest that, like SMD, BRD is: more common in younger than in older adults, predicated by poor health or low social support, followed by recurrent episodes of major depressive episode (MDE), and associated with impaired immunological responses, altered sleep architecture, and responsivity to antidepressant treatment.Conclusions. Overall, the prevailing evidence more strongly supports similarities than differences between BRD and SMD. Because so few studies focus on BRD occurring within the first 2 months of bereavement, the period identified by the DSM to exclude the diagnosis of MDE, more research is needed specifically on this group to help us evaluate the validity of this important diagnostic convention %0 Journal Article %C Regional Centre for Disease Control of South-Eastern France %A Bendiane, Marc K %A Peretti-Watel, Patrick %A Pegliasco, Herve %A Favre, Roger %A Galinier, Anne %A Lapiana, Jean-Marc %A Obadia, Yolande %J J Opioid Manag %D 2005 Mar-Apr %N 1 %P 25-30 %T Morphine prescription to terminally ill patients with lung cancer and dyspnea: French physicians' attitudes %V 1 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17315408 %X This study aimed to investigate factors associated with analgesic use of morphine in end-of-life care. French general practitioners (GPs) and oncologists (N = 719) were asked whether they would prescribe morphine as first-line therapy to patients with terminal lung cancer suffering from dyspnea associated with cough and great anxiety. Overall, 54 percent of oncologists and 40 percent of GPs stated that they would prescribe morphine in the presented case. This prescriptive attitude correlated with physicians' age, professional background, communication skills, and attitude toward terminally ill patients. The findings of this study indicate that improving analgesic use of opioids in end-of-life care is not only a matter of enhancing technical skills acquired through training or experience but also a matter of improving communication and empathy between physicians and patients %0 Journal Article %J NIH Consens State Sci Statements %D 2004 Dec %N 3 %P 1-26 %T NIH State-of-the-Science Conference Statement on Improving End-of-Life Care %V 21 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17308546 %X OBJECTIVE: To provide health care providers, patients, and the general public with a responsible assessment of currently available data on improving end-of-life care. PARTICIPANTS: A non-DHHS, nonadvocate ten-member panel representing the fields of geriatrics, psychiatry, economics, health policy, nursing, philosophy, epidemiology, and oncology. In addition, 19 experts from fields related to the subject matter of the conference presented data to the panel and to the conference audience. EVIDENCE: Presentations by experts and a systematic review of the medical literature prepared by the Southern California Evidence-based Practice Center, through the Agency for Healthcare Research and Quality's Evidence-based Practice Centers Program. Scientific evidence was given precedence over clinical anecdotal experience. CONFERENCE PROCESS: Answering pre-determined questions, the panel drafted its statement based on scientific evidence presented in open forum and on the published scientific literature. The draft statement was read in its entirety on the final day of the conference and circulated to the audience for comment. The panel then met in executive session to consider the comments received, and released a revised statement later that day at http://www.consensus.nih.gov. This statement is an independent report of the panel and is not a policy statement of the NIH or the Federal Government. A final copy of this statement is available, along with other recent conference statements, at the same web address of http://www.consensus.nih.gov. CONCLUSIONS: (1) Circumstances surrounding end of life are poorly understood, leaving many Americans to struggle through this life event. (2) The dramatic increase in the number of older adults facing the need for end-of-life care warrants development of a research infrastructure and resources to enhance that care for patients and their families. (3) Ambiguity surrounding the definition of end-of-life hinders the development of science, delivery of care, and communications between patients and providers. (4) Current end-of-life care includes some untested interventions that need to be validated. (5) Subgroups of race, ethnicity, culture, gender, age, and disease states experience end-of-life care differently, and these differences remain poorly understood. (6) Valid measures exist for some aspects of end of life; however, measures have not been used consistently or validated in diverse settings or with diverse groups. (7) End-of-life care is often fragmented among providers and provider settings, leading to a lack of continuity of care and impeding the ability to provide high-quality, interdisciplinary care. (8) Enhanced communication among patients, families, and providers is crucial to high-quality end-of-life care. (9) The design of the current Medicare hospice benefit limits the availability of the full range of interventions needed by many persons at the end of life %0 Journal Article %C Alzheimer's Society %A Hunt, Neil %J Nurs Times %D 2006 Dec %N 50 %P 23-4 %T New clinical guidance to support patients with dementia %V 102 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17212292 %X NICE and the Social Care Institute for Excellence have issued guidance to help health and social care professionals support the 750,000 people in the UK who have dementia and their carers. The guidance addresses the full range of treatments and services for people. This article outlines how professionals can work to ensure the recommendations are successfully implemented %0 Journal Article %C Research Centre on Aging, Faculty of Physical Education and Sports, University of Sherbrooke, Sherbrooke, Quebec, Canada %A Aubertin-Leheudre, Mylene %A Melancon, Michel O %A Chaput, Jean-Philippe %A Dionne, Isabelle J %J J Women Aging %D 2006 %N 4 %P 19-29 %T Past-users of HRT are osteopenic four months after discontinuation:an observational and cross-sectional study %V 18 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17200061 %X Hormonal replacement therapy (HRT) helps to prevent osteoporosis. The effect of short-term discontinuation of a long-term HRT on bone mineral density (BMD) in healthy post-menopausal women is unknown. Fifteen women on HRT (HRT users), 17 who never used HRT (non-users) and 8 former HRT users (past-HRT users) were recruited. BMD was measured by DXA. Our results allow to hypothesize that BMD may decline after short-term HRT discontinuation, which would increase the fracture risks. Indeed, our results show that past-HRT users are osteopenic just as non-users. However, these results should be re-examined using a prospective trial and a larger sample size %0 Journal Article %C Department of Small Animal Surgery and Anaesthesiology, Lyon National Veterinary School, 1 Avenue Bourgelat, 69 280 Marcy l'Etoile, France %A Beraud, R %A Carozzo, C %J J Small Anim Pract %D 2007 Jan %N 1 %P 43-5 %T Perirenal expanding haematoma in a cat %V 48 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17212749 %X A four-year-old, entire male domestic cat was referred for assessment of a large abdominal mass of three-weeks duration. Diagnostic imaging suggested the presence of either splenic neoplasia, an abdominal abscess or haematoma. A coeliotomy was performed and an enlarged, irregular mass, including the left kidney and adrenal gland, was identified. The mass was removed, requiring a left adrenalo-uretero-nephrectomy. The aorta was accidentally punctured during the procedure, resulting in paraplegia. Given a poor prognosis, the owners decided to have the cat euthanased. Histological examination of the mass was characteristic of a chronic expanding haematoma %0 Journal Article %C cfoster348@aol.com %A Foster, Claudia %J Caring %D 2006 Dec %N 12 %P 16-8, 20 %T Personal journey. Sarah's story %V 25 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17233254 %0 Journal Article %C Neurosciences Laboratory, Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge CB3 0ES %A Palmer, A C %J J Small Anim Pract %D 2007 Jan %N 1 %P 49-52 %T Pontine infarction in a dog with unilateral involvement of the trigeminal motor nucleus and pyramidal tract %V 48 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17212751 %X An unusual case of unilateral trigeminal neuronopathy in a dog is reported, in which the motor nucleus of the trigeminal nerve and the ipsilateral corticospinal tract were destroyed, apparently by a cerebrovascular accident (stroke). Hemiplegia did not occur. Neuropathological changes are described, including remyelination by Schwann cells in the central nervous system. The case illustrates the importance of central nervous system post-mortem examination when establishing causes of cranial nerve paralysis %0 Journal Article %C Department of Psychology, The Chinese University of Hong Kong, Shatin NT, Hong Kong, People's Republic of China. ctang@cuhk.edu.hk %A Tang, Catherine So-kum %J J Psychosom Res %D 2006 Nov %N 5 %P 699-705 %T Positive and negative postdisaster psychological adjustment among adult survivors of the Southeast Asian earthquake-tsunami %V 61 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17084149 %X OBJECTIVE: This study explored psychosocial factors associated with psychological adjustment among survivors of a severe natural disaster. METHODS: Two hundred sixty-seven adult Thai survivors of the 2004 Southeast Asian earthquake-tsunami were surveyed. RESULTS: At 6 months following the disaster, percentages of survivors who reported positive and negative adjustment were 34% and 40%, respectively. For positive adjustment, best predictors were predisaster employment, increased arousal, and frequent support seeking. Support seeking also partially mediated the association between arousal and positive adjustment. For negative adjustment, infrequent support seeking and increased intrusion and arousal were the best predictors. Arousal was a partial mediator between intrusion and negative adjustment, and support seeking also partially mediated the influence of intrusion and arousal on negative adjustment. CONCLUSION: Mental health programs for survivors of natural disasters should focus on promoting active coping strategies such as support seeking, strengthening of support networks, and management of posttraumatic stress symptoms to facilitate adjustment %0 Journal Article %C Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA %A Kirkpatrick, JN %A Ghani, SN %A Burke, MC %A Knight, BP %J J Cardiovasc Electrophysiol %D 2007 Feb %T Postmortem Interrogation and Retrieval of Implantable Pacemakers and Defibrillators: A Survey of Morticians and Patients %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17313530 %X Device Retrieval Survey of Morticians and Patients. Introduction: Recent recalls of pacemakers and defibrillators cast a spotlight on product reliability. Universal postmortem device analysis could yield valuable information, but little data exist on the rate and feasibility of device examinations following death. This study investigated how morticians manage pacemakers and defibrillators and surveyed morticians and device patients regarding routine postmortem device interrogation and explantation. Methods and Results: Seventy-one morticians were surveyed on device interrogation and explantation practices. One hundred fifty patients presenting for routine device interrogation were interviewed regarding preferences for what should be done with devices postmortem and willingness to execute "device advance directives" authorizing analysis and retrieval. The average number of devices annually explanted per mortician was 7 +/- 10 (range = 1 to 50). The most common methods of disposal were placement in medical waste (44%) and donation for human reimplantation in developing nations (18%). Only 4% of morticians reported ever returning devices to manufacturers, but 87% agreed that routine explantation and return of devices to manufacturers would be feasible. Eighty-seven percent of device patients had no understanding of how their device would be handled after death. However, a majority (82%) indicated a willingness to have their device interrogated after death, and most (79%) were willing to have it returned to manufacturers. Willingness was not associated with age, sex, time since device implantation, or device type. Conclusions: Implantable pacemakers and defibrillators are rarely analyzed after patients die. Systematic postmortem device retrieval appears feasible and acceptable to morticians and patients. Further efforts are needed to implement universal postmortem device evaluation. (J Cardiovasc Electrophysiol, Vol. 18, pp. 1-5, May 2007) %0 Journal Article %C Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong %A Lok, IH %A Neugebauer, R %J Best Pract Res Clin Obstet Gynaecol %D 2007 Feb %T Psychological morbidity following miscarriage %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17317322 %X Emerging evidence has suggested that miscarriage could be associated with significant and possibly enduring psychological consequences. As many as 50% of miscarrying women suffer some form of psychological morbidity in the weeks and months after loss. About 40% of miscarrying women were found to be suffering from symptoms of grief shortly after miscarriage, and pathological grief can follow. Elevated anxiety and depressive symptoms are common, and major depressive disorder has been reported in 10-50% after miscarriage. Psychological symptoms could persist for 6 months to 1 year after miscarriage. The underlying risk factors predisposing a miscarrying woman to psychological morbidity include a history of psychiatric illness, childlessness, lack of social support or poor marital adjustment, prior pregnancy loss, and ambivalence toward the fetus. In addition, care-givers should be aware of the possible moderating effect of clinical practices such as surgical treatment and ultrasound findings on the psychological impact on a miscarrying woman. Unlike in postpartum depression, simple and effective screening measures of psychological morbidity in the context of miscarriage have not been well established. While studies have highlighted that psychological follow-up was highly desired by miscarrying women, and that psychological intervention was potentially beneficial, there is a substantial lack of randomized controlled intervention studies in this area %0 Journal Article %C Department of Clinical and Cognitive Neuroscience, University of Heidelberg, Central Institute of Mental Health, J5, 68169 Mannheim, Germany. thiemek@u.washington.edu %A Thieme, Kati %A Flor, Herta %A Turk, Dennis C %J Arthritis Res Ther %D 2006 %N 4 %P R121 %T Psychological pain treatment in fibromyalgia syndrome: efficacy of operant behavioural and cognitive behavioural treatments %V 8 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=16859516 %X The present study focused on the evaluation of the effects of operant behavioural (OBT) and cognitive behavioural (CBT) treatments for fibromyalgia syndrome (FMS). One hundred and twenty-five patients who fulfilled the American College of Rheumatology criteria for FMS were randomly assigned to OBT (n = 43), CBT (n = 42), or an attention-placebo (AP) treatment (n = 40) that consisted of discussions of FMS-related problems. Assessments of physical functioning, pain, affective distress, and cognitive and behavioural variables were performed pre-treatment and post-treatment as well as 6 and 12 months post-treatment. Patients receiving the OBT or CBT reported a significant reduction in pain intensity post-treatment (all Fs > 3.89, all Ps < 0.01). In addition, the CBT group reported statistically significant improvements in cognitive (all Fs > 7.95, all P < 0.01) and affective variables (all Fs > 2.99, all Ps < 0.02), and the OBT group demonstrated statistically significant improvements in physical functioning and behavioural variables (all Fs > 5.99, all Ps < 0.001) compared with AP. The AP group reported no significant improvement but actually deterioration in the outcome variables. The post-treatment effects for the OBT and CBT groups were maintained at both the 6- and 12-month follow-ups. These results suggest that both OBT and CBT are effective in treating patients with FMS with some differences in the outcome measures specifically targeted by the individual treatments compared with an unstructured discussion group. The AP group showed that unstructured discussion of FMS-related problems may be detrimental %0 Journal Article %C Department of Clinical and Health Psychology, University of Florida Health Science Center, Gainesville, Florida 32610, USA. ssears@phhp.ufl.edu %A Sears, Samuel F %A Sowell, Lauren Vazquez %A Kuhl, Emily A %A Handberg, Eileen M %A Kron, Jordana %A Aranda, Juan M Jr %A Conti, Jamie B %J Pacing Clin Electrophysiol %D 2006 Jun %N 6 %P 637-42 %T Quality of death: implantable cardioverter defibrillators and proactive care %V 29 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=16784431 %X OBJECTIVES: The purpose of this paper is to discuss quality of death (QOD) among patients with congestive heart failure (CHF) and implantable cardioverter defibrillators. We outline recommendations that enhance QOD from the device patient and specialty cardiology perspectives. BACKGROUND: Contemporary treatment of CHF patients routinely includes both pharmacologic therapy and the use of cardiac devices. The implantable cardioverter defibrillator prevents premature death in heart failure patients, though not death itself. CONCLUSIONS: Active discussion and consideration of patient's QOD is indicated in implantable cardioverter defibrillator patients to prevent unnecessary treatment and to increase control over perceived quality of life by patients and family %0 Journal Article %C Medical Psychology Research Unit, Department of Medicine and School of Psychology, and the School of Public Health, University of Sydney, New South Wales, Australia. jclayton@med.usyd.edu.au %A Clayton, Josephine M %A Butow, Phyllis N %A Tattersall, Martin H N %A Devine, Rhonda J %A Simpson, Judy M %A Aggarwal, Ghauri %A Clark, Katherine J %A Currow, David C %A Elliott, Louise M %A Lacey, Judith %A Lee, Philip G %A Noel, Michael A %J J Clin Oncol %D 2007 Feb %N 6 %P 715-23 %T Randomized controlled trial of a prompt list to help advanced cancer patients and their caregivers to ask questions about prognosis and end-of-life care %V 25 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17308275 %X PURPOSE: To determine whether provision of a question prompt list (QPL) influences advanced cancer patients'/caregivers' questions and discussion of topics relevant to end-of-life care during consultations with a palliative care (PC) physician. PATIENTS AND METHODS: This randomized controlled trial included patients randomly assigned to standard consultation or provision of QPL before consultation, with endorsement of the QPL by the physician during the consultation. Consecutive eligible patients with advanced cancer referred to 15 PC physicians from nine Australian PC services were invited to participate. Consultations were audiotaped, transcribed, and analyzed by blinded coders; patients completed questionnaires before, within 24 hours, and 3 weeks after the consultation. RESULTS: A total of 174 patients participated (92 QPL, 82 control). Compared with controls, QPL patients and caregivers asked twice as many questions (for patients, ratio, 2.3; 95% CI, 1.7 to 3.2; P < .0001), and patients discussed 23% more issues covered by the QPL (95% CI, 11% to 37%; P < .0001). QPL patients asked more prognostic questions (ratio, 2.3; 95% CI, 1.3 to 4.0; P = .004) and discussed more prognostic (ratio, 1.43; 95% CI, 1.1 to 1.8, P = .003) and end-of-life issues (30% v 10%; P = .001). Fewer QPL patients had unmet information needs about the future (21 = 4.14; P = .04), which was the area of greatest unmet information need. QPL consultations (average, 38 minutes) were longer (P = .002) than controls (average, 31 minutes). No differences between groups were observed in anxiety or patient/physician satisfaction. CONCLUSION: Providing a QPL and physician endorsement of its use assists terminally ill cancer patients and their caregivers to ask questions and promotes discussion about prognosis and end-of-life issues, without creating patient anxiety or impairing satisfaction %0 Journal Article %C Maternidade Alfredo da Costa, Lisboa, Portugal %A Serrano, Fatima %A Lima, Maria Luisa %J Psychol Psychother %D 2006 Dec %N Pt 4 %P 585-94 %T Recurrent miscarriage: psychological and relational consequences for couples %V 79 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17312873 %X Recurrent miscarriage is a rare condition that has been described as a traumatic event for couples. Although symptoms of depression, anxiety and lowered self-esteem have been related after recurrent miscarriage, little is known about its impact on couple sexuality and on gender differences in attitude and the grief that follow. The objectives of this study are to describe the consequences of recurrent pregnancy loss for the couple's relationship, and explore gender differences in attitudes and grief intensity toward this kind of reproductive failure. Each member of 30 couples with at least 3 recurrent miscarriages answered a set of questionnaires, including the Impact of Events Scale (Horowitz, Wilnwe, & Alvarez, 1979), the Perinatal Grief Scale (Toedter, Lasker, & Qlhadeff, 1988), the Partnership Questionnaire (Hahlweg, 1979) and the Intimate Relationship Scale (Hetherington & Soeken, 1990). Results showed that men do grieve, but less intensely than their partners. Although the couple's relationship seemed to not be adversely affected by recurrent miscarriage, couples described sexual changes after those events. Grief was related to the quality of communication in the couple for women, and to the quality of sex life for men %0 Journal Article %C Department of Surgery, Bellevue Hospital/New York University School of Medicine, New York, New York 10016, USA %A Lim, Suhsien %A Muhs, Bart E %A Marcus, Stuart G %A Newman, Elliot %A Berman, Russel S %A Hiotis, Spiros P %J J Surg Oncol %D 2007 Feb %N 2 %P 118-22 %T Results following resection for stage IV gastric cancer; are better outcomes observed in selected patient subgroups? %V 95 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17262741 %X BACKGROUND: Patients who present with stage IV gastric cancer are not commonly managed with surgical resection as effective palliation can usually be accomplished with systemic chemotherapy, endoscopic stenting, or surgical bypass procedures. Given the inherent morbidity and mortality associated with gastrectomy, palliative resection for stage IV gastric cancer should be reserved for ideal surgical candidates who are most likely to benefit from the procedure. The purpose of this study is to review outcomes following resection for stage IV gastric cancer, and to identify criteria predictive of improved outcomes following gastrectomy in this setting. METHODS: A retrospective review of a prospective GI oncology database was conducted. Sixty-three patients with stage IV gastric cancer managed with surgical resection between 1989 and 2001 were identified. Variables including demographic data, patterns of distant spread (ex: peritoneal, lymphatic, hematogenous), location of tumor, and type of gastrectomy were utilized to conduct survival analyses. RESULTS: Actuarial survival for all patients at one and 3-year intervals was 52% and 12%, respectively. Improved survival was observed for patients of East Asian race (median survival 20 vs. 12 months, P < 0.05, students t-test) and age less than 60 years (median survival 15 vs. 12 months, P < 0.05). This trend was also illustrated by Kaplan-Meier survival analysis. Other variables including pattern of distant spread, location of tumor, and type of gastrectomy were not associated with a significant difference in survival. Both East Asian race and age less than 60 years were statistically significant predictors of improved survival when assessed by univariate regression analysis. When variables were analyzed in a multivariate regression analysis, Asian race and age <60 both lost their statistical significance as independent predictors of improved survival. CONCLUSIONS: Long-term survival for patients with stage IV gastric cancer who are managed with surgical resection is achievable. Patient specific variables including East Asian race and age less than 60 years appear to be associated with prolonged survival when assessed by comparison of means, Kaplan-Meier analysis, and univariate regression analysis. However, multivariate regression analysis failed to demonstrate these factors as independent predictors of improved outcome. In conclusion, highly selected acceptable risk surgical candidates with stage IV gastric cancer should be considered for management with surgical resection in clinically appropriate scenarios %0 Journal Article %C School of Public and Environmental Affairs, Indiana University-Purdue University, Fort Wayne, IN 46805-1499, USA. zieglers@ipfw.edu %A Ziegler, Stephen J %A Bosshard, Georg %J BMJ %D 2007 Feb %N 7588 %P 295-8 %T Role of non-governmental organisations in physician assisted suicide %V 334 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17289733 %0 Journal Article %A Bush, Andrew %J Intensive Care Med %D 2006 Nov %N 11 %P 1691-3 %T Spinal muscular atrophy with respiratory disease (SMARD): an ethical dilemma %V 32 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=16964484 %0 Journal Article %J Hosp Case Manag %D 2007 Feb %N 2 %P 19-20 %T Take stock of successes, avoid compassion fatigue %V 15 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17249278 %0 Journal Article %A Machado, Calixto %J Neurology %D 2007 Jan %N 4 %P 312; author reply 312-3 %T Terminating artificial nutrition and hydration in persistent vegetative state patients: current and proposed state laws %V 68 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17242347 %0 Journal Article %A Thompson, Belinda S %J J Am Vet Med Assoc %D 2007 Jan %N 2 %P 187-8 %T The Horse Slaughter Act revisited %V 230 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17260421 %0 Journal Article %A Ward, Gerald M %J J Am Vet Med Assoc %D 2007 Jan %N 2 %P 187 %T The Horse Slaughter Act revisited %V 230 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17256220 %0 Journal Article %A Burke, William J %A Pullicino, Patrick %A Coverdale, John F %J Neurology %D 2007 Jan %N 5 %P 391-2; author reply 392 %T The controversy over artificial hydration and nutrition %V 68 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17265563 %0 Journal Article %A Cochrane, Thomas %A Truog, Robert D %J Neurology %D 2007 Jan %N 5 %P 391; author reply 392 %T The controversy over artificial hydration and nutrition %V 68 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17261691 %0 Journal Article %A Lilly, Craig M %A Daly, Barbara J %J N Engl J Med %D 2007 Feb %N 5 %P 513-5 %T The healing power of listening in the ICU %V 356 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17267913 %0 Journal Article %C Clinical Education and Research, Saint Alphonsus Regional Medical Center, Boise, Idaho, USA. jillande@sarmc.org %A Anderson, Jill H %J J Cardiovasc Nurs %D 2007 Mar-Apr %N 2 %P 89-94; quiz 95-6; discussion 97-8 %T The impact of using nursing presence in a community heart failure program %V 22 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17318031 %X Nursing presence is the foundation of a long-term nurse-patient relationship that improves clinical decision making and ultimately patient outcomes. A home-based, advanced practice nurse-directed program uses presence at the heart of service delivery in an outpatient heart failure program that addresses complex healthcare needs of this patient population. The Community Case Management program has the following goals: (1) to improve access to appropriate cost-effective healthcare, (2) to prevent hospitalizations, and (3) to improve quality of life. An advanced practice cardiac nurse conducts home visits providing skilled nursing assessments, targeted education, emotional support, and advanced care planning to a vulnerable group of heart failure patients. Common nursing interventions are patient and caregiver education, therapeutic presence, supervision of adherence, and advocacy. The Community Case Management program provides a full continuum of care including disease management, case management, and palliative care serving patients and loved ones over the duration of their illness until death. Community Case Management results in fewer emergency room visits, unplanned hospitalizations, cost avoidance, as well as high patient satisfaction and improved quality of life. It is the contention of this author that the success of the program, while resting on expert multidisciplinary care, is also influenced by the spirit of a long-term therapeutic relationship that develops between the nurse, patient, and the patient's loved ones %0 Journal Article %C Department of Chemical Pathology and metabolic bone clinic, St Thomas' Hospital campus, Kings College London, London, UK. andrew.deane@kcl.ac.uk %A Deane, Andrew %A Constancio, Leonor %A Fogelman, Ignac %A Hampson, Geeta %J BMC Musculoskelet Disord %D 2007 %P 3 %T The impact of vitamin D status on changes in bone mineral density during treatment with bisphosphonates and after discontinuation following long-term use in post-menopausal osteoporosis %V 8 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17214897 %X BACKGROUND: It is still unclear whether addition of calcium/vitamin D supplements leads to an incremental benefit in patients taking bisphosphonates and whether achievement of serum level of 25 (OH) vitamin D of at least 70 nmol/L has an impact on the skeletal response to bisphosphonates. Moreover the maintenance of BMD after bisphosphonates withdrawal with the continuation of calcium/vitamin D supplements only, remains uncertain. The aims were to assess the impact of vitamin D status on changes in bone mineral density (BMD) in firstly patients with post-menopausal osteoporosis on bisphosphonates and secondly following discontinuation of bisphosphonates after long-term use. METHODS: Two patient groups were recruited. The first study population comprised of 112 women treated with a bisphosphonate. The second study population consisted of 35 women who had been on bisphosphonates for > 5 years in whom the treatment agent was discontinued. Baseline BMD, changes in BMD following treatment, duration of treatment, serum 25 (OH) vitamin D, parathyroid hormone (PTH), urine C-terminal telopeptides of type 1 collagen (CTX) were obtained on the study participants. RESULTS: In the first study group, subjects with serum vitamin D concentrations (> 70 nmol/L) had a significantly lower serum PTH level (mean [SEM] 41 2 ng/L). PTH concentrations of 41 ng/L or less was associated with a significantly higher increase in BMD at the hip following treatment with bisphosphonates compared to patients with PTH > 41 ng/L (2.5% [0.9] v/s -0.2% [0.9], P = 0.04). In the second study group, discontinuation of bisphosphonate for 15 months after long-term treatment did not result in significant bone loss at the lumbar spine and total hip, although a trend towards gradual decline in BMD at the femoral neck was observed. CONCLUSION: the data suggest that optimal serum 25 (OH) vitamin D concentration may lead to further reduction in bone loss at the hip in patients on bisphosphonates. A prospective controlled trial is needed to evaluate whether the response to bisphosphonates is influenced by vitamin D status. BMD is preserved at the lumbar spine and total hip following discontinuation of bisphosphonate for a short period following long-term treatment, although a gradual loss occurs at the femoral neck %0 Journal Article %C Office of Clinical Practice Evaluation, Strong Memorial Hospital, NY, USA. Robert_Holloway@urmc.rochester.edu %A Holloway, Robert G %A Tuttle, Deborah %A Baird, Tracy %A Skelton, W Keith %J Neurology %D 2007 Feb %N 8 %P 550-5 %T The safety of hospital stroke care %V 68 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17310024 %X OBJECTIVES: To analyze medical errors and adverse events occurring in stroke patients and to provide insights into system or stroke-specific processes that can be modified to reduce the likelihood of error and patient harm. METHODS: We analyzed spontaneously reported errors and adverse events reported within a voluntary and mandatory event reporting system in stroke patients admitted to a 750-bed academic medical center over a 3.5-year period between July 1, 2001, and December 31, 2004. We determined the frequency of near misses and preventable adverse events by event type (medication, adverse clinical, and falls). We performed a central event analysis to determine the most likely cause of preventable adverse events. RESULTS: Of the 1,440 stroke patients admitted during the study period, 173 patients (12.0%) experienced an adverse event that was reported within an event-reporting system. Of the 176 events in 148 patients reported in the voluntary event reporting system, 72 were falls, 62 were medication events, and 42 were adverse clinical events. Of the 28 events in 25 patients reported in the mandatory event-reporting system, all were adverse clinical events and involved patient harm. Of the total 201 unique events (3 events were reported in both systems), 18 were near misses and 183 were adverse events. Of the 183 adverse events, 86 were preventable, 37 were not preventable, and 60 were indeterminate. Preventable adverse events involved drugs and situations commonly seen in the stroke population and occurred in all aspects of care delivery from thrombolytic management to end-of-life care. Of the 86 preventable adverse events, 37% (32/86) were transcription/documentation errors, 23% (20/86) were failure to perform a clinical task, 10% (9/86) were communication/handoff errors between providers, and 10% (9/86) were failed independent checks/calculations. CONCLUSIONS: Adverse events and errors occur frequently in stroke patients. A disease-specific approach to analyzing spontaneously reported events may help close the feedback loop on patient safety and improve the quality of care %0 Journal Article %A Clarfield, A M %A Jotkowitz, A %A Glick, S %J Isr Med Assoc J %D 2006 Dec %N 12 %P 893-4; author reply 894-5 %T Tube feeding of the terminally demented patient %V 8 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17214119 %0 Journal Article %C Renal Section, Boston University School of Medicine, Boston, MA, USA %A Chen, Joline L T %A Sosnov, Jonathan %A Lessard, Darleen %A Yarzebski, Jorge %A Gore, Joel %A Goldberg, Robert %J Am J Kidney Dis %D 2007 Jan %N 1 %P 83-90 %T Use of do-not-resuscitate orders in patients with kidney disease hospitalized with acute myocardial infarction %V 49 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17185148 %X BACKGROUND: Patients with kidney disease are at increased risk for adverse health outcomes in comparison to patients without kidney disease. Therefore, patients with kidney disease may have greater use of do-not-resuscitate (DNR) orders than patients without kidney disease in the setting of an acute illness. We examined the association between advanced kidney disease and use of DNR orders in patients admitted with an acute myocardial infarction (AMI) to all greater Worcester, MA, hospitals as part of an epidemiological study. METHODS: Use of DNR orders in 4,033 Worcester residents hospitalized with AMI at 11 greater Worcester medical centers during 1997, 1999, 2001, and 2003 was examined. Advanced kidney disease was defined on the basis of serum creatinine level at the time of hospital admission. RESULTS: Forty-nine percent of patients with kidney disease and AMI had a DNR order in their medical records compared with 21% of patients without kidney disease. After controlling for a variety of potentially confounding factors, patients with kidney disease were more likely to have a DNR order than patients without kidney disease (adjusted odds ratio, 1.55; 95% confidence interval, 1.21 to 1.98). Patients with advanced kidney disease who received DNR orders were older, had more comorbid conditions, and were at greater risk for dying than patients with kidney disease without a DNR order. CONCLUSION: Advanced kidney disease is associated with greater rates of DNR orders in patients hospitalized with AMI. Awareness of kidney disease may be an important consideration for patients and health care providers in discussing the use of DNR measures %0 Journal Article %C Clatterbridge Centre for Oncology, Bebington, Wirral, UK %A Ramani, V S %A Gollins, S W %A Wong, H %J Clin Oncol (R Coll Radiol) %D 2006 Nov %N 9 %P 649-57 %T Weekly fluorouracil at 425 mg/m(2) plus low-dose folinic acid for 24 weeks as adjuvant treatment for colorectal cancer: assessment of toxicity and delivery %V 18 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17100149 %X AIMS: To assess the toxicity and dose delivery of weekly bolus 5-fluorouracil (5-FU) at 425 mg/m(2) plus low-dose folinic acid (FA) for 24 weeks as adjuvant treatment for colorectal cancer. MATERIALS AND METHODS: Data were collected on toxicity and dose reductions, stoppages, delays and intensity from 100 consecutive patients receiving this adjuvant regimen after curative surgery. RESULTS: There were 53 men and 47 women (median age: 64 and 65 years, respectively); 77 patients with colon cancer and 23 with cancer of the rectum; 34 patients with Dukes' stage B and 66 with Dukes' stage C. Thirty-seven patients experienced at least one grade 3 or 4 toxicity, mainly diarrhoea (20 patients) or fatigue (14 patients). Only one grade 4 toxicity was noted (diarrhoea). In multivariate analysis, increased grade 3 and 4 toxicity was significantly associated with female gender (P = 0.001) and age >65 years (P = 0.046). Forty patients completed the 24 cycles without dose reduction or delay. Forty-one patients required at least one dose reduction. The median 'conventional' dose intensity (DI), calculated from the first cycle to the last, was 408 mg/m(2)/week (96%). The median DI over 24 weeks was 387 mg/m(2)/week (91%). A higher median 24-week DI was delivered to men (407 mg/m(2)/week, 96%) than women (361 mg/m(2)/ week, 85%; P = 0.009). Women older than 65 years showed a significantly reduced median DI over 24 weeks (347 mg/ m(2)/week, 82%) compared with men aged 65 years or younger (407 mg/m(2)/week, 96%; P = 0.049) and men older than 65 years (425 mg/m(2)/week, 100%; P = 0.001), although the difference against women aged 65 years or younger (377 mg/ m(2)/week, 89%) was not statistically significant (P = 0.09). CONCLUSION: This regimen has shown what might be considered high rates of grade 3 and 4 toxicity for an adjuvant treatment, although the delivered DI was acceptable. Caution is urged in the treatment of elderly female patients who have statistically higher rates of grade 3 and 4 toxicity and lower DI %0 Journal Article %C Diagnostic Imaging, Royal Veterinary and Agricultural University, 1870 Frederiksberg, Denmark %A Arnbjerg, J %A Jensen, A L %A Olesen, A B %J J Small Anim Pract %D 2007 Jan %N 1 %P 36-8 %T X-linked spondylo-epiphyseal dysplasia tarda in the Danish-Swedish farm hound %V 48 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17212747 %X In two litters from the same parents, three out of four males had an abnormally short leg and body length. Affected dogs showed signs of pain when moving, which could be eliminated by analgesia. On radiography, these animals had widened, radiolucent, irregularly bordered intervertebral disc spaces. When examined at seven months of age, the epiphyses appeared widened and irregular in shape and outline. General bone opacity in the vertebral column was lower in the affected male dogs than in the normal littermate. The affected dogs developed spondylosis and arthrosis of the larger limb joints. All affected dogs were euthanased on humane grounds, the eldest at the age of two years nine months. Based on the clinical and radiographic evidence, the condition seen in the male dogs described here resembles X-linked spondylo-epiphyseal dysplasia tarda caused by a collagenopathy due to malformation of COL2A1 as seen in human beings %0 Journal Article %C Institutionen for neurobiologi, vardvetenskap och samhalle, Karolinska institutet; geriatriska kliniken, Karolinska Universitetssjukhuset Huddinge, Stockholm. johan.lokk@karolinska.se %A Lokk, Johan %J Lakartidningen %D 2007 Jan %N 3 %P 124-7 %T ["Bamse" helps patients with Parkinson disease during the palliative phase. Alleviation of symptoms and respect for both the patient and the relatives are crucial] %V 104 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17302116 %0 Journal Article %C Istituto Giano, Roma. gianorom@tin.it %A Spinsanti, Sandro %J Recenti Prog Med %D 2006 Oct %N 10 %P 580-6 %T [Bioethics: emerging problems and perspectives] %V 97 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17263050 %X Bioethics was born in an environment of rules that have traditionally governed relationships between health care providers and patients, as an innovation based on two strong points: the ability to transcend the paternalism of doctors and the acceptance of a plurality of ethics that characterize our societies. The new relationships that were born from bioethics require recognition and respect for the autonomy of the individual, even when they are sick. Instead of sincerely resolving a request for an agreement, the actual practice of informed consent, if any information is actually consented to at all, is more of a guarantee for the health care provider. With respect to pluralism, the polarization between secular bioethics and religious bioethics (Catholic), prevalent in Italy, tends to solidify the positions. Bioethics without dialogue is reduced to BioLaw %0 Journal Article %C Unfallchirurgische Klinik, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstr. 430, 60389 Frankfurt am Main. uschweigkofler@arcor.de %A Schweigkofler, U %A Schmidt, K W %A Rotharmel, S %A Hoffmann, R %J Unfallchirurg %D 2006 Sep %N 9 %P 770-6 %T [Care of polytrauma and the conflict between "acting and omitting". Medical, ethical and legal aspects in the current debate on the legal validity of patient directives] %V 109 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=16897029 %X When treating the seriously injured, physicians are called upon to take into account not only what is medically possible, but also what is ethically and legally viable. This results in an area of conflict between 'acting and omitting', in which medical actions have to be weighed up and justified with regard to the individual diagnosis, prognosis and will of the patient. In this paper the medical, ethical and legal aspects of this problematic area are illustrated using a case example, and placed in the context of the current debate on the legal validity of the extent and liability of advance patient directives %0 Journal Article %C Oddzial Ortopedyczno-Urazowy Katedry i Kliniki Chirurgii Pediatrycznej, Uniwersytecki Szpital Dzeciecy, Wydzial Lekarski Uniwersytetu Jagiellonskiego %A Sulko, Jerzy %A Radlo, Wojciech %J Chir Narzadow Ruchu Ortop Pol %D 2006 %N 1 %P 29-32 %T [Femoral head resection in dislocated hip in cerebral palsy children] %V 71 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17128770 %X The purpose of this study is to assess the outcome of proximal femoral resection in dislocated hip in cerebral palsy patients. Between 1993-2003 we treated 5 nonambulatory patients with quadriplegic form of cerebral palsy. We performed 6 resection of the proximal part of the femur. The average age at the surgery was 15.8 years (9-19.5 years) and average follow-up was 69 months (12-144 months). The indication to surgery was persistent hip pain. The results were good--the pain relieved, the movement in ,,the hip" was better and hygiene improved. Femoral head resection is radical, invasive method but we recommended it for selected group of severly spastic nonambulatory cerebral palsy patients with painful hip dislocation %0 Journal Article %A Martin, C %J Ann Fr Anesth Reanim %D 2006 Nov-Dec %N 11-12 %P e2-3 %T [From end-of-life management to euthanasia] %V 25 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17318982 %0 Journal Article %C Consultation de medecine legale, CHU Nord-Amiens, place Victor-Pauchet, 80054 Amiens cedex 01, France %A Manaouil, C %A Strunski, V %J Ann Otolaryngol Chir Cervicofac %D 2007 Feb %T [Informations to patients in otorhinolaryngology: legislation, jurisprudence, and incidences on pratices.] %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17313937 %X The law of March 4, 2002 is the pedestal of legal responsibility in medicine in France. This law resumed data stemming from the jurisprudence but innovated also by establishing for example the "confidant" person and the direct access of the patient to his medical file. This law established or strengthened the rights of the patients: respect for dignity, respect for refusal of care, right to end-of-life care, right to adequate analgesia, right to the respect for professional confidentiality but also right to the information. The obligation of information is justified by the respect for the autonomy of the patient and by the necessity of obtaining a free and lit assent. Information is not only a preliminary to the medical act; it has to be done before, during and after. In case of complication, it will be reinforced. The information has to deal with the necessity of the medical act, the expected benefits, the possible urgency, the consequences, the normally predictable frequent or severe complications, the alternatives and the predictable consequences in case of refusal. The oto-laryngologist can refuse to perform an act prescribed by a colleague that he considers useless or too dangerous as compared to the benefit expected. The surgical oto-laryngologist in private practice has to prove that he informed his patient and it is his (compulsory) malpractice insurance that financially compensates the patient in case insufficient information leads the patient to lose his or her chance to refuse treatment. If the surgical oto-laryngologist practices in a public hospital, the establishment has to bring this proof of sufficient information, and in case of litigation, the hospital must provide compensation. One will note that the more difficult it is to justify the medical act, the less the judges tend to tolerate insufficient patient information. If the indication of the act is indisputable from a medical standpoint, then legally there is usually no ground for litigation due to insufficient information except possibly emotional damage %0 Journal Article %C Centre Hospitalier de Versailles. sghez@ch-versailles.fr %A Ghez, Stephanie %J Soins %D 2006 Nov %N 710 %P 48-50 %T [Palliative management of the patient with respiratory insufficiency] %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17225767 %0 Journal Article %A Lemaitre, Annelyse %J Soins %D 2006 Nov %N 710 %P 39 %T [Support care and chronic obstructive lung disease, how to care in other ways?] %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17225761 %0 Journal Article %C Service d'accompagnement et de soins palliatifs, CHU Dupuytren, 87042 Limoges, France %A Terrier, G %A Grouille, D %A Bourzeix, JV %J Ann Fr Anesth Reanim %D 2007 Feb %T [Use of locoregional anaesthesia in a palliative care unit.] %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17317085 %0 Journal Article %A Nau, Jean-Yves %J Rev Med Suisse %D 2006 Sep %N 79 %P 2140 %T [Why not kill abnormal children?] %V 2 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17073185