%0 Journal Article %J J Clin Ethics %D 2006 Winter %N 4 %P 349-57 %T "Margaret's" children remember. Interview by Christine Mitchell %V 17 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17330729 %0 Journal Article %J J Clin Ethics %D 2006 Winter %N 4 %P 339 %T Care of "Margaret Smith," a letter from the children %V 17 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17330726 %0 Journal Article %C Tehran University of Medical Sciences %A Aramesh, Kiarash %A Shadi, Heydar %J Am J Bioeth %D 2007 Apr %N 4 %P 65-6; discussion W4-6 %T An Islamic perspective on euthanasia %V 7 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17455005 %0 Journal Article %C The Department of Anesthesiology, Family Medicine and Pharmacology, The Rush University Medical College, Rush University Medical Center, Chicago, IL %A Barkin, Robert L %J Am J Ther %D 2007 May-Jun %N 3 %P 299-305 %T Zolpidem extended-release: a single insomnia treatment option for sleep induction and sleep maintenance symptoms %V 14 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17515707 %X It is imperative that primary care clinicians have a thorough understanding of insomnia, because they are often the first point of contact for patients who seek assistance when they have difficulty sleeping. Insomnia may appear with different presentations: sleep onset, sleep maintenances, sleep offset, nonrestorative sleep, or a combination of these symptoms. Untreated symptoms result in clinically significant distress or impairment in social, occupational, or other important areas of following-day functionality. Physicians, pharmacists, and other clinicians should be aware of the conditions that contribute to, are antecedent to, and associated with insomnia. These pathophysiological conditions include advanced age; female gender; respiratory, gastrointestinal, vascular, and rheumatologic pain syndromes; and other conditions such as depression and/or anxiety. Additional health factors contributing to insomnia include chronic pain, stressors, grief reaction, pharmacotherapeutic side effects, lifestyle contributors such as social/recreational drugs, phytopharmaceuticals, and ethanol use. The pharmacotherapy focus in this article is a modified-release formulation of the BZ1 (omega1) receptor agonist zolpidem, zolpidem extended-release. Pharmacokinetic, pharmacodynamic, and safety studies that compare 12.5 mg zolpidem extended-release (Ambien CRtrade markCIV) and 10 mg original zolpidem were initially conducted in healthy volunteers to assess the potential for an improved clinical profile. Zolpidem extended-release (12.5 mg and 6.25 mg extended-release dosage forms) is indicated for the treatment of insomnia characterized by difficulties with sleep onset and/or sleep maintenance. Zolpidem extended-release is devoid of any short-term use limitation and can be prescribed for the duration of medical necessity. The modified-release zolpidem is a two-layer tablet with a biphasic release profile, releasing the first layer immediately, whereas the second layer is released at a slower rate. Plasma concentrations are maintained for a longer period of time versus the immediate-release zolpidem formulation. Pharmacokinetic analysis has also demonstrated that the time to maximum concentration (tmax) and terminal elimination half-life (t1/2) of 12.5 mg zolpidem extended-release are similar to those of 10 mg zolpidem indicating a similar rapid onset of action and an elimination profile that reduced the risk of next-day decrements in performance. Zolpidem's CYP 450 hepatic metabolism uses as a substrate CYP3A4 (major) and 1A2, 2C9, 2C19, and 2D6 as minor pathways. Zolpidem extended-release dosage forms diminish sleep latency, number of awakenings, and wakefulness after sleep onset and augments total time asleep %0 Journal Article %C University of Utah, USA %A Battin, Margaret P %J Am J Bioeth %D 2007 Apr %N 4 %P 58-60; discussion W4-6 %T Right question, but not quite the right answer: whether there is a third alternative in choices about euthanasia in Alzheimer's disease %V 7 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17455001 %0 Journal Article %C Winthrop-University Hospital in Mineola, New York, USA. jberger@winthrop.org %A Berger, Jeffrey T %J J Clin Ethics %D 2006 Winter %N 4 %P 364-6 %T Suffering in advanced dementia: diagnostic and treatment challenges and questions about palliative sedation %V 17 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17330731 %0 Journal Article %C The Hastings Center, Garrison, NY 10524, USA %A Berlinger, Nancy %J Hastings Cent Rep %D 2007 Mar-Apr %N 2 %P inside back cover %T Martin Luther at the bedside %V 37 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17474344 %0 Journal Article %C Smith College School for Social Work, Northampton, MA 01063, USA %A Berzoff, Joan %A Lucas, Georgina %A Deluca, Donna %A Gerbino, Susan %A Browning, David %A Foster, Zelda %A Chatchkes, Esther %J J Soc Work End Life Palliat Care %D 2006 %N 2 %P 45-63 %T Clinical social work education in palliative and end-of-life care: relational approaches for advanced practitioners %V 2 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17513278 %X This paper describes the first post-Master's program in the US in end-of-life care for social workers. Developed at the Smith College School for Social Work, this program used innovative relational methods in student recruitment, curricular design, supervision, and leadership development, based upon input from the faculty, students, and field supervisors. Collaborations emerged with funders, agencies, and programs nationally. The program was based on a pedagogical stance that clinical work with dying people requires the capacity to be fully present- in individual, group, and family work; in interdisciplinary meetings; and in advocating for quality and equity of care-while attending to diverse and at-risk populations. Students deepened their clinical skills and took leadership in the field of end-of-life care %0 Journal Article %C Institut fur Biomedizinische Ethik, Ethik-Zentrum, Universitat Zurich. biller-andorno@ethik.unizh.ch %A Biller-Andorno, Nikola %J Schweiz Rundsch Med Prax %D 2007 Apr %N 17 %P 679-80 %T [Comment on the case: "A request for intensive care in spite of a palliative treatment concept"] %V 96 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17491197 %0 Journal Article %C Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY, US. gab38@columbia.edu %A Bonanno, George A %A Neria, Yuval %A Mancini, Anthony %A Coifman, Karin G %A Litz, Brett %A Insel, Beverly %J J Abnorm Psychol %D 2007 May %N 2 %P 342-51 %T Is there more to complicated grief than depression and posttraumatic stress disorder? A test of incremental validity %V 116 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17516766 %X There is growing interest in complicated grief reactions as a possible new diagnostic category for inclusion in the Diagnostic and Statistical Manual of Mental Disorders. However, no research has yet shown that complicated grief has incremental validity (i.e., predicts unique variance in functioning). The authors addressed this issue in 2 studies by comparing grief, depression, and posttraumatic stress disorder (PTSD) symptoms with different measures of functioning (interviewer ratings, friend ratings, self-report, and autonomic arousal). The 1st study (N = 73) used longitudinal data collected at 4 and 18 months postloss, and the 2nd study (N = 447) used cross-sectional data collected 2.5-3.5 years postloss. With depression and PTSD controlled, grief emerged as a unique predictor of functioning, both cross-sectionally and prospectively. The findings provide convergent support for the incremental validity of complicated grief as an independent marker of bereavement-related psychopathology. ((c) 2007 APA, all rights reserved) %0 Journal Article %C Fondation Bergonie, Bordeaux Cedex, France %A Chauvergne, J %A Hoerni, B %A Hoerni-Simon, G %A Durand, M %J Rev Fr Gynecol Obstet %D 1973 Mar %N 3 %P 159-65 %T [The combination of thio-tepa and 5 fluorouracil as a palliative therapy for breast cancer] %V 68 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17472211 %X Over a six-year period, a total of 177 patients with far-advanced breast carcinoma have been submitted by the authors to 200 chemotherapeutical cycles combining Thio-TEPA and 5 fluorouracile according to a well-defined scheme. The efficiency was but minimally enhanced, as compared with separate use of these two drugs. According to the authors, however, the principle of multiple chemotherapy should not be questioned. In fact, the problem to be considered is connected with the indications of hormone therapy and chemotherapy, respectively %0 Journal Article %C Department of Geriatrics and Gerontology, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan 10002. jhhchen@ntu.edu.tw or to Susan L. Mitchell, MD, MPH, Department of Medicine, Hebrew SeniorLife, 1200 Centre Street, Boston, MA 02131. E-mail: smitchell@hrca.harvard.edu %A Chen, JH %A Chan, DC %A Kiely, DK %A Morris, JN %A Mitchell, SL %J J Gerontol A Biol Sci Med Sci %D 2007 May %N 5 %P 531-536 %T Terminal Trajectories of Functional Decline in the Long-Term Care Setting %V 62 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17522358 %X Background. Little is known about the terminal trajectories of functional decline among long-term care (LTC) residents dying with different diseases. Methods. A retrospective cohort study was performed on 747 individuals aged 65 or older who died between January 1994 and December 2004 in a 675-bed LTC facility in Massachusetts. Three study groups were created: advanced dementia, n = 314 (42%); terminal cancer, n = 63 (8%); and organ failure (congestive heart failure and chronic obstructive pulmonary disease), n = 370 (50%). Quarterly scores of 7 activities of daily living (ADLs) during the last year of life derived from the Minimum Data Set were compared among the three groups. Each activity was rated from 0 to 4 (higher scores indicate more dependence; total range, 0-28). Results. The mean age of all individuals at death was 91 ± 6 (standard deviation) years. Functional decline was greatest during the last 3 months of life, but this decline was most precipitous in the terminal cancer and organ failure groups compared to the advanced dementia group. The mean change in ADL scores during the last year of life differed among the three groups (p <.001), with the greatest decline in the terminal cancer group (from initial score 13 to final score 25), followed by the organ failure group (13 to 22), and finally, the advanced dementia group (24 to 27). Conclusions. The terminal trajectories of functional decline among LTC residents vary by underlying diseases. An understanding of these trajectories may be useful to clinicians and families caring for LTC residents near the end of life %0 Journal Article %C 1 Department of Science and Research, Centre for Palliative Medicine, University of Bonn %A Clemens, KE %A Klaschik, E %J Jpn J Clin Oncol %D 2007 May %T Clinical Experience with Transdermal and Orally Administered Opioids in Palliative Care Patients--A Retrospective Study %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17519302 %X BACKGROUND: Transdermal fentanyl is a widely used opioid for the treatment of cancer pain. Simplicity of use and high patient compliance are the main advantages of this opioid. However, based on our clinical experience, transdermal fentanyl is often not efficacious in terminally ill palliative care patients. We thus retrospectively examined the pain management and need for opioid switching in cancer patients admitted to our palliative care unit. METHODS: Of 354 patients admitted to our palliative care unit from 2004 through 2005, 81 patients were pre-treated with transdermal fentanyl. Demographic and cancer-related data (diagnosis, symptoms, pain score on a numeric rating scale (NRS)), analgesic dose at admission and discharge were compared. Statistics: mean ± SD, ANOVA, Wilcoxon's test was used for inter-group comparisons, significance P < 0.05, adjusted for multiple testing. Pain scores are given in median (range). RESULTS: Mean transdermal fentanyl dose at admission was 81.0 ± 55.8 microg/h. In 79 patients transdermal fentanyl treatment was discontinued. In two patients, analgesic treatment according to WHO I provided sufficient pain relief. The other 77 patients were switched to other opioids: 33 patients to oral morphine and 44 to oral hydromorphone. In patients switched to morphine the dose at discharge (104.7 ± 89.0 mg) was lower than at admission (165.5 mg morphine equivalence). In patients switched to hydromorphone the dose of 277.8 ± 255.0 mg morphine equivalent was higher at discharge than at admission (218.2 ± 131.4 mg morphine equivalence - considering an equianalgesic conversion ratio morphine: hydromorphone = 7.5: 1). Pain scores decreased significantly after opioid rotation (NRS at rest/on exertion: 4 (0-10)/7 (2-10) versus 1 (0-3)/2 (0-5); P < 0.001). CONCLUSIONS: In the patient group switched to morphine, sufficient pain relief was achieved by lower equianalgesic morphine doses, compared with the doses at admission. In the patient group switched to hydromorphone, higher equianalgesic morphine doses were needed at discharge, considering an equianalgesic conversion ratio of morphine: hydromorphone = 7.5: 1. Patients with far advanced cancer often suffer from sweating and cachexia, which may have negative effects on the absorption of transdermal fentanyl. Opioid switching to oral morphine or hydromorphone was well tolerated and proved to be an efficacious option for cancer pain treatment %0 Journal Article %A Costeloe, Kate %J BMJ %D 2007 May %N 7600 %P 912-3 %T Euthanasia in neonates %V 334 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17478792 %0 Journal Article %C Cleveland-Marshall School of Law, USA %A Davis, Dena %J Am J Bioeth %D 2007 Apr %N 4 %P 60-1; discussion W4-6 %T Help! My body is being invaded by an alien! %V 7 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17455002 %0 Journal Article %C School of Nursing, University of Washington, Seattle, WA %A Doorenbos, Ardith Z %A Given, Barbara %A Given, Charles W %A Wyatt, Gwen %A Gift, Audrey %A Rahbar, Mohammad %A Jeon, Sangchoon %J Res Nurs Health %D 2007 Jun %N 3 %P 270-81 %T The influence of end-of-life cancer care on caregivers %V 30 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17514724 %X The purpose of this secondary analysis was to glean from prospective data whether those caring for elderly family members recently diagnosed with cancer who ultimately died reported different caregiver depressive symptomatology and burden than caregivers of those who survived. Findings from interviews with 618 caregivers revealed that caregiver depressive symptomatology differed based on family members' survival status, and spousal caregivers experienced greater burden when a family member was near death than did non-spousal caregivers. Family member symptoms and limitations in daily living, as well as caregiver health status, age, and employment, were associated with caregiver depressive symptomatology and burden; however, these associations had no interaction with family member survival status. (c) 2007 Wiley Periodicals, Inc. Res Nurs Health 30: 270-281, 2007 %0 Journal Article %C Department of Obstetrics and Gynaecology, Medway Maritime Hospital, Gillingham, Kent, UK. jraduckett@hotmail.com %A Duckett, J R A %A Vella, M %A Kavalakuntla, G %A Basu, M %J BJOG %D 2007 May %N 5 %P 543-7 %T Tolerability and efficacy of duloxetine in a nontrial situation %V 114 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17355360 %X OBJECTIVE: To assess the tolerability and efficacy of duloxetine in a nontrial situation. DESIGN: Prospective observational study. SETTING: Urogynaecology Unit, District General Hospital, UK. POPULATION: Two hundred and twenty-two women with a diagnosis of urodynamic stress incontinence (USI) or mixed USI and detrusor overactivity (DOA) took duloxetine for 4 weeks. METHODS: The results of therapy were assessed with a Patient Global Impression of Improvement (PGI-I) questionnaire. One hundred and forty-eight (67%) women were initially treated with 40 mg twice a day, 67 (30%) women were treated with an escalating dose initially at 20 mg twice a day increasing to 40 mg twice a day after 2 weeks and seven (3%) women were started on a dose of 20 mg twice a day which they continued. MAIN OUTCOME MEASURES: Discontinuation rates and PGI-I scores. RESULTS: Overall 146/222 (66%) women discontinued therapy due to adverse effects or lack of efficacy. Significantly more women starting on the 40 mg twice a day dose stopped due to adverse effects when compared with the escalating dose (P < 0.025). Of the women who tolerated therapy, 80 out of 120 (67%) had a PGI-I score indicating an improvement. However, the overall rate of improvement was 37%. PGI-I scores and discontinuation rates were not significantly different between the group with USI and the group with mixed USI and DOA (P > 0.05). CONCLUSION: In a nontrial situation duloxetine is poorly tolerated. Introducing an escalating dose may improve tolerability. A similar number of women with USI and mixed incontinence had a PGI-I score indicating improvement %0 Journal Article %C Palliative Care Medicine, Queen's University, Kingston, Ontario, Canada. dudgeond@kgh.kari.net %A Dudgeon, Deborah J %A Bruera, Eduardo %A Gagnon, Bruno %A Watanabe, Sharon M %A Allan, Sharon J %A Warr, David G %A MacDonald, Susan M %A Savage, Colleen %A Tu, Dongsheng %A Pater, Joseph L %J J Pain Symptom Manage %D 2007 Apr %N 4 %P 365-71 %T A phase III randomized, double-blind, placebo-controlled study evaluating dextromethorphan plus slow-release morphine for chronic cancer pain relief in terminally ill patients %V 33 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17397698 %X This multicenter trial examined the efficacy and safety of dextromethorphan (DM) as an enhancer of analgesia and modulator of opioid tolerance in cancer patients with pain. Eligible patients were randomized to slow-release morphine plus DM or slow-release morphine plus placebo. The initial DM dose was 60 mg four times daily for seven days, with an increase to 120 mg four times daily, if tolerated, for another seven days. During the study, patients recorded medications and scores for pain, nausea, drowsiness, and insomnia. Sixty-five patients were randomized. Although average pain scores (12.6 vs. 15.8), number of breakthrough doses (9 vs. 11.3), and change in total morphine consumption (550.9 mg vs. 597.1mg) were less in the DM group than placebo group, the differences were not statistically significant (P=0.31-0.33). Side-effect scores were not statistically significantly different. Dizziness was greater in the DM (58%) than placebo (36%) group. This study showed a statistically nonsignificant enhancement of analgesia or modulation of opioid tolerance in cancer patients with pain when DM was added to morphine. Participants receiving the DM also had more toxicity, particularly dizziness. This toxicity and the limited evidence of effect do not support the use of DM to enhance opioid analgesia or to modulate opioid tolerance in cancer patients %0 Journal Article %C Department of General Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, Australia %A Dunwoodie, DA %A Auret, K %J Intern Med J %D 2007 May %T Psychological morbidity and burnout in palliative care doctors in Western Australia %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17517081 %X Background: Medicine and particularly palliative care are considered to be stressful professions, with risks of psychological morbidity and burnout. There is little published work quantitatively documenting their prevalence among medical practitioners practising in palliative care. Methods: Three questionnaires, including the General Health Questionnaire (GHQ-12) and the Maslach Burnout Inventory, were sent to palliative care practitioners in Western Australia. Results: Forty-one of 43 (95%) practitioners completed the questionnaires. The mean score on the GHQ-12 was 1.9 (range 0-8), with 11 (27%) scoring 4 or more. On the Maslach Burnout Inventory, mean scores on the emotional exhaustion (EE, mean 17.5, range 1-47) and depersonalization subscales (DP, 4.5, 0-24) fell within the low range, with scores for personal accomplishment (39, 32-46) falling within the average range. Ten respondents (24%) scored high on either the EE subscale or the DP subscale, meeting criteria for burnout. GHQ-12 scores were associated with hours of work per week in palliative care (P = 0.004). The EE (P = 0.024) and DP (P = 0.006) components of burnout were associated with years of work in palliative care. Specialist practitioners were more likely to score in the high category for GHQ-12 (odds ratio = 4.8, P = 0.036) and EE (odds ratio = 8.33, P = 0.031). GHQ (P = 0.038) and DP (P = 0.006) scores were higher in those working in tertiary institutions, with tertiary practitioners more likely to be in the high EE category (odds ratio = 7.5, P = 0.034). Conclusion: Levels of psychiatric morbidity and burnout in palliative medicine are not higher than in other specialties %0 Journal Article %C Kingston University, Kingston upon Thames, Surrey. a.gallagher@hscs.sgul.ac.uk %A Gallagher, A %A Wainwright, P %J Nurs Stand %D 2007 May %N 34 %P 42-6 %T Terminal sedation: promoting ethical nursing practice %V 21 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17518074 %X This article discusses ethical aspects of 'terminal sedation' in relation to end-of-life care. An examination of the literature reveals there are different definitions and explanations of terminal sedation. Some definitions appear compatible with the values of palliative care and nursing, whereas others could arguably be perceived as deserving of the term 'euthanasia in disguise'. The authors suggest that 'palliative sedation' is a more helpful term and argue that, when defined and understood appropriately, it is a defensible and ethical practice. Nurses should be clear about the purpose of their profession, honest about their intentions and respect the autonomy and dignity of the patients for whom they provide care. The doctrine or principle of 'double effect' has been put forward to support the practice of terminal sedation. The authors examine this doctrine and caution that nurses and other professions need to approach it critically in relation to terminal sedation. Vignettes are used to illustrate aspects of the discussion %0 Journal Article %C Stanford Geriatric Education Center, Stanford University School of Medicine, Palo Alto, California, USA. lgerdner@gmail.com %A Gerdner, Linda A %A Cha, Dia %A Yang, Deu %A Tripp-Reimer, Toni %J J Gerontol Nurs %D 2007 May %N 5 %P 20-9; quiz 30-1 %T The circle of life: end-of-life care and death rituals for Hmong-American elders %V 33 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17511332 %X The Hmong are an ethnic minority from Southeast Asia who constitute a growing U.S. population. Gerontological nurses need to understand the cultural meaning and rituals associated with dying, death, and the bereavement process of Hmong Americans. Critical to this is the structure and role of clan and family as a source of support and their involvement in the decision-making process. In this article, we provide an overview of the traditional spiritual beliefs related to life and death with implications for end-of-life and postmortem care. Information was acquired through invited field experiences. Published literature and consultation with Hmong elders were used to clarify, enhance, and validate this understanding %0 Journal Article %C Georgetown University Medical Center, Washington, DC, Veterans Administration Hospital, Baltimore, MD %A Giordano, James %A Gomez, Carlos F %A Harrison, Charles %J Pain Physician %D 2007 May %N 3 %P 395-8 %T On the potential role for interventional pain management in palliative care %V 10 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17525775 %0 Journal Article %A Gridelli, Cesare %A Maione, Paolo %A Galetta, Domenico %A Rossi, Antonio %J J Thorac Oncol %D 2007 Jan %N 1 %P 96-8 %T Safety profile of erlotinib in patients with advanced non-small cell lung cancer with chronic renal failure %V 2 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17410020 %0 Journal Article %C Elisabeth Klinik, Berlin, Germany. horst.gross@mac.com %A Gross, Horst %J Anasthesiol Intensivmed Notfallmed Schmerzther %D 2007 Apr %N 4 %P 274-9 %T ["It is a longer path to death !" On the way with palliative medicine] %V 42 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17457776 %0 Journal Article %C Section of Cardiac Surgery, University of Michigan Health Systems, Ann Arbor, Michigan, USA %A Haft, Jonathan W %A Suzuki, Yoshi %A Aaronson, Keith D %A Dyke, David B %A Wright, Susan %A Poirier, Victor L %A Pagani, Francis D %J ASAIO J %D 2007 May-Jun %N 3 %P 298-303 %T Identification of device malfunction in patients supported with the HeartMate XVE left ventricular assist system %V 53 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17515718 %X Predicting end-of-life for left ventricular assist devices is important to determine timing of device removal. A retrospective analysis was performed on 46 patients undergoing implantation of the latest HeartMate XVE from July 1, 2003, through March 31, 2006. Devices were assessed by analysis of motor current waveforms and quantification of the titanium or copper particles within dust localized to the driveline vent filter by optical, polarized light, scanning electron microscopy, and energy dispersive x-ray spectroscopy. Assessments were performed monthly for patients supported > or =330 days or for unexpected device alarms. Thirty-one (67%) patients were supported for <330 days and 15 (33%) were supported for > or =330 days. No malfunctions occurred in patients supported <330 days. For patients supported > or =330 days, five had abnormal current waveforms or copper and titanium dust localized to the vent filter. One underwent urgent transplantation, three underwent device replacement (one death; two ongoing), and one is with ongoing support. Of the remaining 10 patients, seven underwent transplantation; two remain on device; and one died while on left ventricular assist device support. There were no unexpected device failures. Bearing wear of the HeartMate XVE is predictable by analysis of current waveforms or titanium and copper dust within the vent filter %0 Journal Article %C Vermont National Guard, USA %A Hammond, Patricia %J J Christ Nurs %D 2007 Apr-Jun %N 2 %P 94-5 %T The last resort? %V 24 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17432340 %0 Journal Article %C Department of Surgical Oncology, Peter MacCallum Cancer Centre, East Melbourne, Australia. charles.han@svhm.org.au %A Han, Charles C %A Prasetyo, Davin %A Wright, Gavin M %J J Thorac Oncol %D 2007 Jan %N 1 %P 59-64 %T Endobronchial palliation using Nd:YAG laser is associated with improved survival when combined with multimodal adjuvant treatments %V 2 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17410011 %X BACKGROUND: Endobronchial neodymium:yttrium aluminum garnet (Nd:YAG) laser therapy has been shown to be safe and effective in palliating large airway malignancies. The role of multimodal therapy with stenting, brachytherapy, chemotherapy, and radiotherapy together with Nd:YAG laser therapy is unclear. AIM: This study aims to confirm the safety and effectiveness of Nd:YAG laser therapy in the contemporary setting and to investigate the effectiveness of multimodal therapy compared with laser alone. METHODS: One hundred fifty-three Nd:YAG laser treatments on 110 patients between 1999 and 2004 were reviewed retrospectively. Symptom scores for dyspnoea, hemoptysis, and cough before and after the procedure were compared. Survival and time to reintervention were analyzed using the Kaplan-Meier method. Multimodality treatment was compared with Nd:YAG laser therapy alone to determine differences in survival and time to reintervention. p values less than 0.05 were considered significant. RESULTS: There were no operative mortalities directly caused by laser intervention, although 30-day mortality was 6.5%. Deaths were attributable to progression of advanced neoplastic processes rather than laser intervention, and 6.5% of patients had some postoperative morbidity. After Nd:YAG laser intervention, 76% of patients reported improvement to dyspnoea, 94% for hemoptysis, and 75% for cough. Median survival after Nd:YAG laser treatment was 6.64 months; 21% of patients required repeated laser treatment. Compared with Nd:YAG laser treatment alone, multimodality treatments significantly prolonged median time to reintervention by 1.7 months (p = 0.002) and prolonged median survival by 4.9 months (p < 0.001) in patients with NSCLC. CONCLUSION: Nd:YAG laser intervention is safe and effective for palliation of endobronchial malignancies. In most cases, it only needs to be performed once. Compared with Nd:YAG laser therapy alone, multimodal treatment prolonged survival %0 Journal Article %C Redlands Unified School District, CA, USA %A Hone-Warren, Martha %J J Sch Nurs %D 2007 Apr %N 2 %P 98-103 %T Exploration of school administrator attitudes regarding do not resuscitate policies in the school setting %V 23 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17394379 %X Few school districts in the United States have policies relating to do not resuscitate (DNR) orders in the school setting. School administrators are the gatekeepers of policy development. Little is known about administrator attitudes related to DNR orders in the school setting. School nurses need to understand administrator attitudes in order to facilitate DNR policy development. This study explored the attitudes of 15 administrators about DNR orders in the school setting through structured interviews. Administrators were asked their attitudes about DNR orders in the school setting and about DNR policy implementation. The majority of administrators believed that DNR policies should not be developed for the school setting because of the emotions involved and lack of administrator knowledge related to DNR orders. The majority of administrators did agree that having a DNR policy would clarify how staff should respond to DNR orders at school %0 Journal Article %C The Congenital Heart Institute of Florida, All Children's Hospital, University of South Florida, Saint Petersburg, FL 33701, USA. jeffjacobs@msn.com %A Jacobs, Jeffrey Phillip %A Quintessenza, James Anthony %A Chai, Paul J %A Lindberg, Harald L %A Asante-Korang, Alfred %A McCormack, Jorge %A Dadlani, Gul %A Boucek, Robert J %J Cardiol Young %D 2006 Dec %N 6 %P 556-62 %T Rescue cardiac transplantation for failing staged palliation in patients with hypoplastic left heart syndrome %V 16 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17116269 %X OBJECTIVE: Orthotopic heart transplantation is considered a rescue option for children with failing staged palliation or repair of hypoplastic left heart syndrome. We present our strategy for management, and outcomes, for these complex patients. METHODS: We transplanted 68 consecutive children, with diagnoses of hypoplastic left heart syndrome in 31, cardiomyopathy in 20, and post-operative complex congenital heart disease in 17. Of these patients, 9 (13.2%) were neonates, and 46 (67.6%) were infants. Median age was 118.5 days. Operative technique involves bicaval cannulation and anastamoses with continuous low flow bypass, and either short periods of circulatory arrest or continuous low flow antegrade cerebral perfusion for reconstruction of the aortic arch. Initial reperfusion of the donor heart utilizes glutamate and aspartate substrate enriched white blood cell filtered cardioplegia. Immunosuppressive therapy includes induction (pulse steroids, gamma globulin, and polyclonal rabbit antithymocyte globulin) and initial maintenance (calcineurin inhibitor, an anti-proliferative agent, and a weaning steroid protocol). Of the 31 patients with hypoplastic left heart syndrome, 23 underwent primary transplantation, and 8 underwent rescue transplantation from failing staged palliation in seven, or attempted biventricular repair in one. Of the seven patients who had failing staged palliation, three had undergone only the Norwood Stage 1 operation, 2 had undergone a Norwood Stage 1 operation and a Glenn superior cavopulmonary anastomosis and two had undergone a Norwood Stage 1 operation, a Glenn superior cavopulmonary anastomosis, and a completion Fontan operation. RESULTS: The group undergoing primary transplantation was younger (p equals 0.007), weighed less (p equals 0.003), and waited longer for an appropriate donor heart (p equals 0.021) compared to those requiring rescue transplantation. No significant difference exists between the groups with regards to donor heart ischaemic time or post-transplant length of hospital stay. Thirty day survival (p equals 0.156) and overall survival (p equals 0.053) was better in those having primary transplantation, although these differences were not statistically significant when a p value of less than 0.05 is considered to be significant. In those having primary transplantation, no patients had elevated panel reactive antibody greater than 10%. Half of the 8 requiring rescue transplantation had panel reactive antibody greater than 10%, and this subgroup did especially poorly. CONCLUSION: Cardiac transplantation can offer children with failing staged palliation their only chance of survival. Transplantation, however, carries a high risk in this subgroup, especially in the setting of elevated panel reactive antibody %0 Journal Article %C Health Service and Population Research Dept., King's College London, Institute of Psychiatry, London, UK %A Jordanova, V %A Stewart, R %A Goldberg, D %A Bebbington, PE %A Brugha, T %A Singleton, N %A Lindesay, JE %A Jenkins, R %A Prince, M %A Meltzer, H %J Soc Psychiatry Psychiatr Epidemiol %D 2007 May %T Age variation in life events and their relationship with common mental disorders in a national survey population %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17520161 %X BACKGROUND: Life events (LEs) are recognised to be important risk factors for common mental disorders (CMD). Their prominence may vary across age groups but this issue has received little systematic investigation. METHOD: Data were analysed from the 2000 UK National Survey of Psychiatric Morbidity comprising 8,580 participants aged 16-74 years. A history of recent life events pertaining to health threats, bereavement, interpersonal problems and redundancy was established for the preceding six months. Participants were also asked about earlier lifetime stressors including sexual abuse and expulsion from school. CMD, depression and generalised anxiety disorder were ascertained through the revised Clinical Interview Schedule. RESULTS: The strongest associations between LEs and CMD were for recent threats to health, recent interpersonal problems and lifetime stressors. Recent LEs were more strongly associated with depression than anxiety whereas the associations for lifetime stressors were similar in strength. The strength of association between recent LEs and CMD increased steadily up to the 45-54 years age group and then declined. In the 65-74 year age range, CMD was not significantly associated with any recent LE but instead was associated with the following lifetime stressors: bullying, sexual abuse, running away from home, and institutional care in childhood. CONCLUSIONS: Recent life events were most strongly associated with CMD in mid-rather than early or late adult life. In later life, stronger associations were found with lifetime stressors than recent events %0 Journal Article %A Kai, Yoshinori %J Masui %D 2006 Nov %P S93-9 %T [Legal and ethical aspects of death with dignity and euthanasia] %V 55 Suppl %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17458123 %0 Journal Article %C Palliative Medicine, Surrey and Sussex Healthcare NHS Trust %A Kelly, L %A White, S %A Stone, P %J Ann Oncol %D 2007 May %T The B12/CRP index as a simple prognostic indicator in patients with advanced cancer: a confirmatory study %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17513884 %X BACKGROUND: The vitamin B(12)/C-reactive protein Index (BCI) has been proposed as a prognostic indicator in patients with advanced cancer. The purpose of this study was to confirm the utility of the BCI in palliative care patients. PATIENTS AND METHODS: Patients with advanced cancer provided a blood specimen for analysis. Demographic and disease-related variables were recorded. Patients were followed up for at least 90 days or until death. RESULTS: Patients (n = 329) were divided into three groups according to their BCI score. Patients in group 3 (BCI >40 000; median survival 29 days) had a significantly (P < 0.01) worse survival than patients in group 2 (BCI 10 001-40 000; median survival 43 days) and patients in group 1 (BCI 40 000) predicts poor survival in patients with advanced cancer %0 Journal Article %C Department of Internal Medicine, Pusan National University College of Medicine, 1-10 Ami-dong, Soe-gu, Busan 602-739, Korea %A Kim, Tae Oh %A Kang, Dae Hwan %A Kim, Gwang Ha %A Heo, Jeong %A Song, Geun Am %A Cho, Mong %A Kim, Dong Heon %A Sim, Mun Sup %J World J Gastroenterol %D 2007 Feb %N 6 %P 916-20 %T Self-expandable metallic stents for palliation of patients with malignant gastric outlet obstruction caused by stomach cancer %V 13 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17352023 %X AIM: To ascertain clinical outcome and complications of self-expandable metal stents for endoscopic palliation of patients with malignant obstruction of the gastrointestinal (GI) tract. METHODS: A retrospective review was performed throughout August 2000 to June 2005 of 53 patients with gastric outlet obstruction caused by stomach cancer. All patients had symptomatic obstruction including nausea, vomiting, and decreased oral intake. All received self-expandable metallic stents. RESULTS: Stent implantation was successful in all 53 (100%) patients. Relief of obstructive symptoms was achieved in 43 (81.1%) patients. No immediate stent-related complications were noted. Seventeen patients had recurrent obstruction (tumor ingrowth in 14 patients, tumor overgrowth in 1 patient, and partial distal stent migration in 2 patients). The mean survival was 145 d. Median stent patency time was 187 d. CONCLUSION: Endoscopic placement of self-expandable metallic stents is a safe and effective treatment for the palliation of patients with inoperable malignant gastric outlet obstruction caused by stomach cancer %0 Journal Article %C Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi, Korea %A Kwon, Yong Chol %A Yun, Young Ho %A Lee, Ki Heon %A Son, Ki Young %A Park, Sang Min %A Chang, Yoon Jung %A Wang, Xin Shelley %A Mendoza, Tito R %A Cleeland, Charles S %J Oncology %D 2006 %N 1-2 %P 69-76 %T Symptoms in the lives of terminal cancer patients: which is the most important? %V 71 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17344672 %X OBJECTIVES: Symptoms other than their primary disease can interfere in the lives of terminal cancer patients. We sought to identify which of these symptoms is most important. METHODS: We administered a questionnaire, including the M.D. Anderson Symptom Inventory (MDASI), to 142 terminal cancer patients at the National Cancer Center, Korea. The validity of the MDASI was tested by principal-axis factor analysis and Cronbach's alpha coefficient. Stepwise multiple regression analysis was used to determine the symptoms that interfered most in terminal cancer patients' lives. RESULTS: Factor analysis showed that it was composed of two factors (symptom and interference scales). Cronbach's alpha coefficients of symptom and interference scales were each >0.70. The patients had an average of 11 of 13 symptoms of the MDASI. Pain was the most common and severe, followed by feelings of distress and fatigue. Fatigue was the most highly correlated with interference sum. In stepwise multiple regression analysis, the most interfering symptom was fatigue. CONCLUSIONS: Although pain was the most common and severe symptom, fatigue was the most important symptom interfering in the lives of terminal cancer patients. In treating terminal cancer patients, healthcare providers should actively intervene to reduce both fatigue and pain %0 Journal Article %C Section of Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, MC 19345-C, Houston, TX 77030, USA. malaw@texaschildrenshospital.org %A Law, Mark A %A Grifka, Ronald G %A Mullins, Charles E %A Nihill, Michael R %J Am Heart J %D 2007 May %N 5 %P 779-84 %T Atrial septostomy improves survival in select patients with pulmonary hypertension %V 153 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17452153 %X BACKGROUND: Atrial septostomy is a palliative treatment for patients with pulmonary hypertension (PHTN) refractory to vasodilator therapy. Limited data exist in the pediatric population and in patients with repaired congenital heart defects. METHODS: We performed a retrospective analysis of hemodynamic and symptomatic changes in patients with PHTN who underwent an atrial septostomy at our institution. RESULTS: Forty-six atrial septostomies were performed on 43 patients. Patient ages ranged from 0.3 to 30 years (median 12.5). Of 43 patients, 29 had primary PHTN, 10 had PHTN associated with repaired congenital heart defects, and 4 had other secondary causes of PHTN. Mean baseline pulmonary vascular resistance was 35 ± 17 Wood units, and mean pulmonary artery pressure was 74 ± 19 mm Hg. Patients surviving > or = 30 days had immediate improvement in cardiac index (from 2.3 to 2.9 L x min(-1) x m(-2), P < .0001), right atrial pressure (RAp) (from 9.9 to 8.3 mm Hg, P < .05), and oxygen delivery (from 424 to 491 mL O2 per minute, P < .01), with a decrease in systemic oxygen saturation (from 93% to 86%, P < .001). Pulmonary artery pressure was unchanged (P = .3). New York Heart Association class and symptoms of syncope improved (P < .01). Event-free survival at 1, 2, and 3 years was 84%, 77%, and 69%, respectively. Using the National Institutes of Health Registry model, predicted survival probability significantly improved (P < .001). Ten patients (22%) died within 30 days of catheterization. Mortality was associated with preceding decompensations in the intensive care unit (6/10, P < .001) and a higher RAp (21.4 vs 9.8 mm Hg, P < .001). CONCLUSIONS: Atrial septostomy provides symptomatic and hemodynamic improvement in cardiac index and RAp. Risk of septostomy is increased in patients with preceding decompensation or a RAp > 18 mm Hg %0 Journal Article %C Service d'Urologie Hopital Saint-Louis, Paris, France. stephane.leroux@gmail.com %A Leroux, Stephane %A Desgrandchamps, Francois %A Ravery, Vincent %A Bochereau, Ghislain %A Menut, Philippe %A Teillac, Pierre %A Ballanger, Philippe %J Prog Urol %D 2007 Feb %N 1 %P 60-4 %T [Prospective study of the quality of life after palliative urinary diversion by subcutaneous pyelovesical bypass (Detour ureteric prosthesis)] %V 17 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17373239 %X OBJECTIVE: To prospectively evaluate the quality of life of cancer patients at the palliative stage after implantation of an extra-anatomical ureteric prosthesis as an alternative to permanent percutaneous nephrostomy (PCN). MATERIAL AND METHODS: A series of 27 prostheses in 19 patients with PCN was prospectively evaluated. The ureteric prosthesis (Detour) consists of two concentric tubes glued to each other. The inner tube is made of silicone and the outer tube is made of polyester. This prosthesis is introduced percutaneously into the renal pelvis as an alternative to nephrostomy. It is tunnelled subcutaneously and is introduced into the bladder via a short incision. Patients were reviewed every three months for 18 months or until death. The EORTC QLQ-C30 self-administered questionnaire was used to evaluate the patients' quality of life. The functioning and position of the prostheses were verified by ultrasound and/or intravenous urography (IVU). RESULTS: There were no failures of prosthesis placement and no intraoperative or early postoperative complications. Injection of the suprapubic incision was observed in 3 cases, in patients with pre-existing bladder disease (radiation cystitis or bladder tumour). The mean follow-up was 7.8 months: 6.6 months for the group of patients who died (15) and 12 months for the 4 patients still alive at the end of the study. Functional scores improved due to elimination of the external nephrostomy tube. In parallel, physical score deteriorated due to disease progression. Overall quality of life and index of satisfaction were improved by elimination of the external diversion. CONCLUSION: Subcutaneous pyelovesical diversion ensures a better quality of life than classical percutaneous nephrostomy in cancer patients at the palliative stage %0 Journal Article %C 1 School of Health, Faculty of Education, Health & Professional Studies, University of New England in Armidale, Australia, 2 School of Professional Development and Leadership, Faculty of Education, Health & Professional Studies, University of New England in Armidale, Australia, 3 Commonwealth/UNESCO Professor of Education in the School of Education at The University of the West Indies in St Augustine, Republic of Trinidad and Tobago %A Maple, M %A Plummer, D %A Edwards, H %A Minichiello, V %J Suicide Life Threat Behav %D 2007 Apr %N 2 %P 127-134 %T The Effects of Preparedness for Suicide Following the Death of a Young Adult Child %V 37 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17521266 %X Suicide deaths are often viewed as sudden and unexpected. Research examining bereavement responses to suicide are generally set within this conceptual framework. Twenty-two parents were interviewed about their bereavement experience following the suicide death of a young adult son or daughter. Data analyzed using narrative methods revealed the concept of preparedness. Three distinct preparedness narratives were identified, termed turbulent-relief, tragedy, and reflective plots. The data presented here highlights the way in which these different situations influence the resultant grief. Understanding preparedness for suicide assists in explaining the variety of grief responses in parents bereaved in this manner %0 Journal Article %C Department of Psychology, University of Missouri-St. Louis, St. Louis, MO, USA %A Marwit, SJ %A Chibnall, JT %A Dougherty, R %A Jenkins, C %A Shawgo, J %J Psychooncology %D 2007 May %T Assessing pre-death grief in cancer caregivers using the Marwit-Meuser Caregiver Grief Inventory (MM-CGI) %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17518412 %X The Marwit-Meuser Caregiver Grief Inventory (MM-CGI) was developed and initially validated with caregivers of persons with Alzheimer's disease, and subsequently evaluated with caregivers of persons with brain injury. The present study examined MM-CGI psychometric and validity properties in 75 caregivers of persons with cancer. As with previous studies, high internal consistency reliability of MM-CGI Total Grief and subscale scores (Personal Sacrifice and Burden, Heartfelt Sadness and Longing, and Worry and Felt Isolation) was demonstrated. Construct validity of the subscale scores was supported by differential associations with other caregiver measures of depression, strain, well-being, and family support. Based on these preliminary results, the MM-CGI appears useful for assessing pre-death grief in caregivers of persons with cancer. Copyright (c) 2007 John Wiley & Sons, Ltd %0 Journal Article %C docmilphd@aol.com %A Miller, Laurence %J Int J Emerg Ment Health %D 2007 Winter %N 1 %P 13-23 %T Line-of-duty death: psychological treatment of traumatic bereavement in law enforcement %V 9 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17523372 %X A line-of-duty death (LODD) strikingly brings home the risk and vulnerability of all law enforcement officers and affects the officer's peers, the entire department, the wider police community, and the officer's family. This article will place LODD in the context of general bereavement psychology, as well as describe some of its unique features. A variety of supportive and psychotherapeutic measures will be offered for helping peer and family survivors cope with this type of tragedy. This is one important area where police psychologists and community mental health clinicians can be of tremendous service in applying their specialized training in trauma therapy and grief counseling to the special needs of law enforcement and emergency services %0 Journal Article %C Graduate School of Social Work, Portland State University, Portland, OR 97207, USA. millerp@pdx.edu %A Miller, Pamela J %A Hedlund, Susan C %A Soule, Ann B %J J Soc Work End Life Palliat Care %D 2006 %N 2 %P 25-43 %T Conversations at the end of life:the challenge to support patients who consider death with dignity in Oregon %V 2 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17513277 %X Oregon's Death with Dignity Act (ODWDA) has been in effect for eight years. The United States Supreme Court recently decided that Oregon's law did not violate the Controlled Substances Act. Other states may consider a law similar to Oregon's through legislative process or ballot measures. Although social work is not mentioned in the law, our profession interfaces with the terminally ill, particularly in hospice. Eighty-seven percent of those who have used the law were enrolled in a hospice program. As a pilot project, this article explores conversations that the authors have had with patients, families, team members and health systems in hospices and oncology settings under Oregon's unique environment. The following four themes emerged from these conversations: (1) mental health, education, choice; (2) team concerns; (3) family issues; and (4) values, ethics, restricted conversations and professional struggles %0 Journal Article %C Office of Ethics at the Boston Children's Hospital, USA. Christine.Mitchell@childrens.harvard.edu %A Mitchell, Christine %J J Clin Ethics %D 2006 Winter %N 4 %P 331-2 %T A mother's death: the story of "Margaret's" children %V 17 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17330724 %0 Journal Article %C Servicio de Medicina de Aparato Digestivo, Hospital Universitario 12 de Octubre, Madrid. tmunoz.hdoc@salud.madrid.org %A Munoz, M T %A Solis Herruzo, J A %J Rev Esp Enferm Dig %D 2007 Feb %N 2 %P 100-11 %T [Chronic intestinal pseudo-obstruction] %V 99 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17417923 %X Chronic intestinal pseudo-obstruction (CIPO) is a syndrome characterized by the presence of recurrent episodes of clinical intestinal obstruction in the absence of obstructive lesions. Although this syndrome is rare, it causes a high morbidity. It is caused by a disturbance of the intestinal motility, that results in a failure of the progression of the intestinal content. Basically, the failure of the intestinal motility is a consequence of muscular disorder, neurological disorder or both. Usually, CIPO is secondary to other systemic disease; however, in the last years, many cases of primary CIPO have been described. The use of new manometric tecniques and specific histological procedures have allowed to clarify the pathogenesis of some of these entities including mitochondrial diseases and paraneoplasic syndromes. Clinical manifestations of CIPO are diverse, depending on the location and extension of the motility disorder. As the diagnosis of this disease is usually not an easy task, patients frecuently undergo unnecesary surgical interventions, are diagnosed of psyquiatric disorders, or the correct diagnosis is delayed several years after the first symptoms arise. The aims of the treatment are to maintain the nutritional condition and to improve symptoms using nutritional measures, drugs or, eventually, endoscopical or surgical procedures %0 Journal Article %C UMDNJ-University Hospital, Newark, NJ, USA %A Murphy, Patricia %A Price, David %J Nurs Manage %D 2007 Mar %N 3 %P 17, 20 %T How to avoid DNR miscommunications %V 38 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17473789 %0 Journal Article %C Department of Neurosurgery, Osaka City General Hospital, Osaka, 534-0021, Japan %A Nakamura, Kazuhito %A Iwai, Yoshiyasu %A Yamanaka, Kazuhiro %A Kawahara, Shinich %A Ikeda, Hidetoshi %A Nagata, Rie %A Uda, Takehiro %A Ichinose, Tsutomu %A Murata, Keiji %A Sakaguchi, Masakazu %A Yasui, Toshihiro %J No Shinkei Geka %D 2007 Apr %N 4 %P 371-5 %T [The surgical treatment of non-functioning pituitary adenomas in the ninth decade] %V 35 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17424969 %X There are no reports of surgical treatment for non-functioning pituitary adenomas in the 9th decade of life, and it is thought that these patients often select conservative treatment and observation, because of their worry about deterioration of their general condition due to invasive surgery and because hypopituitarism and other medical problems are often present. However, it is also true that there is necessity for considering surgical treatment for the pituitary adenomas even in the 9th decade when there is a complaint of visual disturbance. We carried out the palliative surgical removal of three non-functioning pituitary adenomas with visual disturbance in the 9th decade and report these surgical treatments and outcomes. The improvement of visual disturbance was obtained in all three cases. The only perioperative complication was pneumothorax caused by barotrauma. The palliative transsphenoidal surgical removal of non-functioning pituitary adenomas for the purpose of improvement of visual disturbance is a safe procedure in the 9th decade of life %0 Journal Article %A O'Mara, Ann M %J J Clin Oncol %D 2007 May %N 13 %P 1645-6 %T "Will I suffer?" %V 25 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17470855 %0 Journal Article %C Division of Head and Neck Surgery, Department of Surgery, David Geffen School of Medicine-UCLA, 10833 Le Conte Avenue, CHS62-132, P.O. Box 162418, Los Angeles, CA 90095-1624, USA. mpaiva@mednet.ucla.edu %A Paiva, M B %A Sercarz, J A %A Pantuck, A J %A Polyakov, M %A Figlin, R A %A Canalis, R F %A Castro, D J %J Lasers Med Sci %D 2007 Mar %N 1 %P 60-3 %T Combined cytoreductive laser therapy and immunotherapy for palliation of metastatic renal cell carcinoma to the head and neck %V 22 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17219256 %X Interleukin-2 (IL-2) remains the mainstay of treatment for metastatic renal cell carcinoma (RCC), but minimally invasive surgical techniques have provided new options for the combined treatment of RCC. Two patients with metastatic RCC to the head and neck treated by combined laser-induced thermal therapy and IL-2 were described in this case report. Both patients had an extended survival compared to the historical survival of 10 months for metastatic RCC but eventually succumbed to progressive disease. The authors' initial experience with metastatic RCC suggests that laser thermoablation and immunotherapy in selected patients with metastatic RCC is warranted as a palliative treatment, but a larger study with long-term follow-up is necessary to determine the effectiveness of this approach %0 Journal Article %C University of Toronto, Toronto, Canada %A Payne, Greg %A Laporte, Audrey %A Deber, Raisa %A Coyte, Peter C %J Milbank Q %D 2007 %N 2 %P 213-57 %T Counting Backward to Health Care's Future: Using Time-to-Death Modeling to Identify Changes in End-of-Life Morbidity and the Impact of Aging on Health Care Expenditures %V 85 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17517114 %X In most developed countries, as the largest population cohorts approach the age of sixty-five, the impact of population aging on health care expenditures has become a topic of growing interest. This articles examines trends in elderly disability and end-of-life morbidity, estimations of the cost of dying, and models of expenditures as a function of both age and time-to-death and finds broad improvement in mortality and morbidity among the elderly in the developed world. Reduced mortality and low growth in the costs associated with dying could reduce forecasted expenditures, but high growth in expenditures for those not close to death and for nonhospital services could create new economic pressures on health care systems %0 Journal Article %C Neonatal Medicine, Anna Meyer Children's Hospital, Firenze. m.pignotti@meyer.it %A Pignotti, M S %A Toraldo di Francia, M %A Donzelli, G %J Pediatr Med Chir %D 2007 Mar-Apr %N 2 %P 84-93 %T [Intensive care at extremely low gestational age: ethical issues and treatment choices] %V 29 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17461095 %X With the continuing progress of obstetrical and neonatal care, the limit of human viability has continued to shift towards younger gestational ages. The survival rate as well as the survival without disability increases with each additional week of gestation but, for infants born from 22 to 25 w GA, it is still really low, and the threshold of human viability appears to be limited to the physiological development of the lungs, which take place around the 23rd-24th w GA. At present, the care of such infants, born at the threshold of human viability, presents a variety of complex medical, social, and economical decisions assuming the characteristics of ethical decisions in that the limits between benefits and disadvantages is not so clearcut. What is the true infant's best interest is far to be understood and concern about the ethical basis of providing such intensive care is arising in the scientific community. In this paper the authors provide a review of the ethical basis of decisions related to the care of such infants: to treat, not to treat, intensive or compassionate care, withhold or withdraw treatment %0 Journal Article %A Reese, Dona J %A Raymer, Mary %A Orloff, Stacy F %A Gerbino, Susan %A Valade, Rita %A Dawson, Steve %A Butler, Charlotte %A Wise-Wright, Michele %A Huber, Ruth %J J Soc Work End Life Palliat Care %D 2006 %N 2 %P 65-95 %T The Social Work Assessment Tool (SWAT) %V 2 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17513279 %X This paper reports on the last of three National Hospice and Palliative Care Organization initiatives to move hospice and palliative care social workers into the patient/family outcomes arena: the development of the Social Work Assessment Tool. The experience of a team of practitioners and researchers is described, including results of two pilot studies and subsequent SWAT revisions. The major focus is on the current model performance improvement project, in which 19 social workers from 14 hospice and palliative care programs used the SWAT with 101 patients and 81 primary caregivers for a median of 44 days. Quantitative analysis indicated significant improvement in SWAT scores for patients from the first to the second social work visit (t = -2.60, df = 47, p .01). Qualitative interviewing of the social workers indicated some lack of readiness in the field to conduct quantitative outcomes measurement. Additional measures are needed in addition to the SWAT, including qualitative measures, and measures of mezzo and macro practice. Participants indicated that the SWAT was appropriate for use with economically and culturally diverse clients %0 Journal Article %C Division of Primary Care, University of Liverpool, Whelan Building, Brownlow Hill, Liverpool L69 3GB, UK %A Reeve, J %A Lloyd-Williams, M %A Dowrick, C %J Fam Pract %D 2007 May %T Depression in terminal illness: the need for primary care-specific research %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17515443 %X BACKGROUND: Palliative care research highlights depression as a common, treatable condition in patients with terminal cancer. Guidance from the European Association for Palliative Care calls for proactive screening and treatment of the disease. However, prevalence of depression among primary care patients with advanced cancer is unknown and it remains uncertain whether existing guidance is appropriate for use by GPs. OBJECTIVE: To estimate the prevalence of depression in a primary care population with terminal cancer. METHODS: A two-stage community prevalence survey conducted in primary care practices in Merseyside, UK. Adult patients with advanced metastatic cancer were invited to join the study. In phase 1, a depression screening tool (the Edinburgh Depression Scale [EDS]) was used to categorize patients as being high or low risk of depression. In phase 2, samples from each group underwent a diagnostic assessment using the revised Clinical Interview Schedule. Weighted prevalence estimates were calculated. RESULTS: In a final sample of 70 (response rate 47.9%), the prevalence of depression was 4.1% (95% confidence interval 0-8.8%). The sensitivity and specificity of the EDS were poorer than predicted. CONCLUSION: The prevalence of depression in our sample was lower than expected given findings from previous studies. Screening tools also performed differently in this population. The limitations in our study are discussed; however, our findings raise questions about whether depression guidance from palliative care studies can be directly applied to a primary care setting. We propose the need for development of a primary palliative care evidence base to underpin appropriate clinical care %0 Journal Article %C Hospice of North Shore, USA. coleenreid@hotmail.com %A Reid, Coleen %J J Clin Ethics %D 2006 Winter %N 4 %P 340-3 %T Medicating "Margaret" %V 17 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17330727 %0 Journal Article %C Law School, University of Adelaide, Australia %A Richards, Bernadette %J Health Expect %D 2007 Jun %N 2 %P 206-7 %T Patient-centred ethics and communication at the end of life %V 10 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17524014 %0 Journal Article %C Memorial Sloan-Kettering Cancer Center, New York, NY, USA. Roses@mskcc.org %A Rose, Susannah L %A Shelton, Wayne %J J Soc Work End Life Palliat Care %D 2006 %N 2 %P 3-23 %T The role of social work in the ICU: reducing family distress and facilitating end-of-life decision-making %V 2 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17513276 %X The costs associated with Intensive Care Units (ICUs) are high and at times invasive ICU care may not be beneficial, particularly for those patients admitted to ICUs who have little hope of recovery. The process of clarifying medical goals for these patients is often facilitated by addressing psychosocial factors. Social workers in the ICU are uniquely qualified to assess and address many of the complex psychosocial circumstances and can clarify potential misperceptions, enhancing communication among patients (if capacitated), their families, and the medical team members. This can not only help improve quality of life for very sick and dying patients in the ICU and their families, but may also reduce the likelihood of decision-making conflicts from arising. Further studies need to be done to investigate the effectiveness of social work interventions in reducing family distress, avoiding care that is unwanted by patients, and demonstrating cost-saving benefits %0 Journal Article %C Klinik fur Anasthesiologie und Operative Intensivmedizin, Christian-Albrechts-Universitat, Kiel, Germany. scholz@anaesthesie.uni-kiel.de %A Scholz, Jens %J Anasthesiol Intensivmed Notfallmed Schmerzther %D 2007 Apr %N 4 %P 272-3 %T [Palliative medicine. Self determination and care at life's end] %V 42 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17457775 %0 Journal Article %A Shimoda, Motomu %J Masui %D 2006 Nov %P S84-92 %T [Euthanasia and death with dignity: logical analysis of the problems] %V 55 Suppl %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17458122 %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 Assistant Professor in the Department of Obstetrics and Gynecology at the University of Colorado at Denver and Health Sciences Center %A Spillman, Monique A %A Sade, Robert M %J J Law Med Ethics %D 2007 Summer %N 2 %P 265-72 %T Clinical trials of xenotransplantation: waiver of the right to withdraw from a clinical trial should be required %V 35 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17518852 %X Xenotransplantation pits clinical research ethics against public health needs because recipients must undergo long-term, perhaps life-long, surveillance for infectious diseases. This surveillance requirement is effectively an abrogation of the right to withdraw from a clinical trial. Ulysses contracts, which are advance directives for future care, may be an ethical mechanism by which to balance public health needs against limitation of individual rights %0 Journal Article %C Department of Radiology, Peter MacCallum Cancer Centre, Victoria, Australia. amy.teh@petermac.org %A Teh, Amy Yuen Meei %A Ball, David %A Cassumbhoy, Robin %A Guglani, Sam %J J Thorac Oncol %D 2007 Jan %N 1 %P 79-80 %T Bilateral patellar metastases from non-small cell lung cancer %V 2 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17410015 %0 Journal Article %C Faculty of Health and Social Care, The University of Hull, Hull, UK %A Wilson, Benita %J J Clin Nurs %D 2007 Jun %N 6 %P 1012-20 %T Nurses' knowledge of pain %V 16 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17518877 %X Aim. The aim of this study was to establish if postregistration education and clinical experience influence nurses' knowledge of pain. Background. Inadequacies in the pain management process may not be tied to myth and bias originating from general attitudes and beliefs, but reflect inadequate pain knowledge. Design. A pain knowledge survey of 20 true/false statements was used to measure the knowledge base of two groups of nurses. This was incorporated in a self-administered questionnaire that also addressed lifestyle factors of patients in pain, inferences of physical pain, general attitudes and beliefs about pain management. Method. One hundred questionnaires were distributed; 86 nurses returned the questionnaire giving a response rate of 86%. Following selection of the sample, 72 nurses participated in the study: 35 hospice/oncology nurses (specialist) and 37 district nurses (general). Data were analysed using SPSS. Results. The specialist nurses had a more comprehensive knowledge base than the general nurses; however, their knowledge scores did not appear to be related to their experience in terms of years within the nursing profession. Conclusion. Whilst educational programmes contribute to an increase in knowledge, it would appear that the working environment has an influence on the development and use of this knowledge. It is suggested that the clinical environment in which the specialist nurse works can induce feelings of reduced self-efficacy and low personal control. To ease tension, strategies are used that can result in nurses refusing to endorse their knowledge, which can increase patients' pain. Relevance to clinical practice. Clinical supervision will serve to increase the nurses' self-awareness; however, without power and autonomy to make decisions and affect change, feelings of helplessness, reduced self-efficacy and cognitive dissonance can increase. This may explain why, despite educational efforts to increase knowledge, a concomitant change in practice has not occurred %0 Journal Article %A de Beaufort, Inez %J Am J Bioeth %D 2007 Apr %N 4 %P 57-8; discussion W4-6 %T The view from before %V 7 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17455000