%0 Journal Article %C Wellmont Holston Valley Palliative Medicine Service and Eastern Tennessee State University College of Medicine, Johnson City, Tennessee, USA %A Baumrucker, Steven J %J Am J Hosp Palliat Care %D 2007 Feb-Mar %N 1 %P 68-73 %T Durable power of attorney versus the advance directive: who wins, who suffers? %V 24 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17347510 %0 Journal Article %C Sibley Heart Transplant Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia 30322, USA %A Berg, Alexandria M %A Snell, Lecia %A Mahle, William T %J J Heart Lung Transplant %D 2007 May %N 5 %P 453-7 %T Home inotropic therapy in children %V 26 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17449413 %X BACKGROUND: Inotropic therapy is a well-established practice for children with advanced congestive heart failure (CHF). Traditionally, children have been maintained on inotropic therapy in the hospital under close, monitored supervision. Changes to UNOS listing criteria now allow patients awaiting heart transplantation to be discharged to home yet maintain 1B status. In adults, home inotropic therapy has been shown to be a safe and cost-effective bridge to transplantation. To date, there are limited data on the use of home inotropic therapy in children. METHODS: We reviewed the safety and efficacy of continuous ambulatory home inotropic therapy in children. Data were obtained from a single institution from January 2000 to January 2007. RESULTS: There were 14 pediatric patients with end-stage CHF, who received home intravenous inotropic therapy. The indications for home inotropic therapy included palliative care (n = 8) and awaiting heart transplantation (n = 6). Patients ranged in age from 6 to 18 years (median 14.5 years). The majority of subjects (n = 11) received milrinone at a dose of 0.5 to 1.0 mug/kg/min, 2 received dobutamine at 5 mug/kg/min, and 1 received both agents. Duration of therapy ranged from 14 to 476 days (median 68 days). There were 26 hospital re-admissions and 4 suspected catheter infections. No unexpected deaths or pump failures occurred. CONCLUSIONS: Based on this initial review, continuous home inotropic therapy in children with CHF is safe with few complications. Home inotropic therapy may result in substantial cost-savings and improve family dynamics by avoiding prolonged hospitalization %0 Journal Article %C University of Limpopo. South Africa %A Blignaut, E %J AIDS Care %D 2007 Apr %N 4 %P 532-8 %T Oral health needs of HIV/AIDS orphans in Gauteng, South Africa %V 19 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17453594 %X To care for HIV/AIDS orphans will put health and social services in South Africa before a major challenge. Published clinical information on South and Southern African HIV-positive children is limited to hospitalized children. A cross-sectional, prospective study was conducted on a convenience sample of HIV-positive children, living in orphanages in Gauteng, South Africa, in order to determine the oral health needs of the children. Five homes for abandoned/orphaned HIV/AIDS children were visited, 11 caregivers, excluding the nursing sisters (registered nurses), were interviewed to determine their knowledge regarding oral health. An oral examination was performed on 87 children who were not receiving antiretroviral treatment. The caregivers were knowledgeable regarding pseudomembranous candidiasis but all lacked knowledge on oral hygiene procedures and the cariogenic potential of a baby bottle. The mean age of the children ranged between 3.2 and 7 years, with one home having children older than 11 years. Rampant early childhood caries in 19 (21.8%) children was the major finding, with 5 children suffering severe pain from multiple carious teeth. In the hospice section of the homes all 12 children had clinically detectable candidiasis, while in 4 (33.3%) there was an associated bleeding and ulceration of the oral mucosa, impairing their ability to eat. The findings indicate a training need among caregivers regarding the oral health of children and a role for health professionals in preventing oral diseases and reducing suffering %0 Journal Article %C School of Nursing, University of KwaZulu-Natal, Durban 4041, South Africa %A Brysiewicz, P %J Accid Emerg Nurs %D 2007 Apr %T The lived experience of working in a mortuary %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17451956 %X A four year action research study was undertaken in an attempt to foster change in the current management of sudden deaths in the Accident and Emergency Departments in South Africa. During the phase of interviewing bereaved families and health professionals it became apparent that there was a need to involve mortuary staff as victims of sudden deaths have to undergo an autopsy. The researcher chose an interpretive hermeneutic phenomenological research approach to explore the lived experience of working in a mortuary. The mortuary is a place of mystery, sadness, grief or repulsion and we all hope, while we are alive, we will never need to visit. For families who have lost a loved one to a sudden death, this becomes a reality. Working in a mortuary is an extremely stressful experience which is made worse in South Africa due to the large number of people dying sudden violent deaths due to trauma. The themes which emerged from the interviews with mortuary staff were; secondary trauma for families, delays by health professionals and dehumanised mortuary staff. There is a need for a change in the way bereaved families are being managed as well as revision of the environment for the staff working in mortuaries %0 Journal Article %C Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK. andrea.burton@warwick.ac.uk %A Burton, Andrea %A Billingham, Lucinda Jane %A Bryan, Stirling %J Clin Trials %D 2007 %N 2 %P 154-61 %T Cost-effectiveness in clinical trials: using multiple imputation to deal with incomplete cost data %V 4 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17456514 %X BACKGROUND: Cost-effectiveness has become an important outcome in many clinical trials and has resulted in the collection of resource use data and the calculation of costs for individual patients. A specific example is a Cancer Research UK phase III trial comparing chemotherapy (CT) against standard palliative care in patients with advanced non-small cell lung cancer. Resource usage from trial entry until death were collected and costs obtained on a subset of 115 trial patients. For some patients, however, the unavailability of medical notes resulted in some cost components, and hence total cost, being missing. The 82 patients with complete data were not representative of all trial patients in terms of effectiveness and thus it was necessary to address the missing data problem. METHODS: Multiple imputation (MI) was used to impute values for the unobserved individual cost components, allowing total cost to be calculated and cost-effectiveness carried out for all patients in the cost sub-study. The results are compared with those from a complete case analysis. RESULTS: After MI, the results indicated that CT had a high probability of being cost-effective for a societal willingness to pay over pound20 000 per life-year gained. This was in stark contrast with the complete case analysis, which suggested that CT was not a cost-effective use of resources at any reasonable level of willingness to pay for a life-year. LIMITATIONS: Our findings are based on a relatively small retrospective study with all events observed. CONCLUSION: In conclusion, cost-effectiveness analysis of the complete cases only may give biased results, and therefore, in situations where there are missing costs, MI is recommended. Clinical Trials 2007; 4: 154-161. http://ctj.sagepub.com %0 Journal Article %A Canales Ugarte, Susana %A Cassinello Espinosa, Javier %J Clin Transl Oncol %D 2006 Nov %N 11 %P 839-40 %T Cerebral and parotid metachronous metastases from an ovarian carcinoma %V 8 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17134977 %0 Journal Article %A Carelli, Francesco %J Br J Gen Pract %D 2006 Oct %N 531 %P 798 %T Living wills to provide a legal "indication" %V 56 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17007718 %0 Journal Article %C Department of Surgery, University of Minnesota Medical School, Minneapolis, Minnesota %A Chipman, Jeffrey G %A Beilman, Gregory J %A Schmitz, Constance C %A Seatter, Susan C %J J Surg Educ %D 2007 Mar-Apr %N 2 %P 79-87 %T Development and Pilot Testing of an OSCE for Difficult Conversations in Surgical Intensive Care %V 64 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17462207 %X OBJECTIVES: To describe the development and results of an Objective Structured Clinical Exam (OSCE) for leading family conferences in the surgical intensive care unit (SICU). DESIGN: Pilot demonstration and reliability assessment. SETTING: General surgery residency program at a major academic teaching hospital. PARTICIPANTS: PGY-2 and PGY-4 categorical general surgery residents (n = 8). RESULTS: The SICU Family Conference OSCE consists of two 20-minute stations, one requiring residents to lead an end-of-life discussion and the other to disclose an iatrogenic complication. Actual case scenarios and trained actors were used; the examinations were videotaped in a standardized setting. Two professional raters as well as the participating actors assessed each resident performance using rating tools developed for each station and based on guiding principles gleaned from the literature. Resident debriefings and evaluation surveys were also conducted. Resident perception of the OSCE overall was positive. Analysis of the videotapes revealed the need for greater standardization of the actors' roles. The rating tools showed strong internal consistency (0.77-0.85), but inter-rater agreement of scores was generally low (<0.70) within rater groups. Family actors consistently gave residents higher global assessment scores than did the professional raters. Second- and fourth-year residents scored equally well on the examination. CONCLUSIONS: This pilot provided residents with a positive learning experience and valid formative feedback. Case materials developed for each station served their function well. More work in actor and rater training is needed before the examination scores can be reliably used in summative evaluation %0 Journal Article %C Department of Clinical Neurosciences, Brown Medical School, Providence, RI, USA. . Kelvin_Chou@brown.edu %A Chou, K L %A Stacy, M A %J Neurology %D 2007 Mar %N 13 %P 1078-9 %T Skin rash associated with Sinemet does not equal levodopa allergy %V 68 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17389317 %0 Journal Article %C Department of Psychology, Western Carolina University, Cullowhee, NC 28723-9041, USA %A Chovan, William L %J Psychol Rep %D 2007 Feb %N 1 %P 195-8 %T Implementing a pilot program of advanced directives in nursing homes %V 100 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17451025 %X This project focused on employing a comprehensive advance directive, called Five Wishes, that is suited to a process-oriented approach emphasizing a discussion of personal, social, and emotional needs in end-of-life care. With findings of a limited number of advance directives completed, the traditional explanation of the 'onset o f progressive deterioration' a mong the residents is offered. Residents wi th low sense of self-efficacy is suggested as another explanation and one worthy of further research %0 Journal Article %C Zentrum fur Palliativmedizin, Universitat Bonn, Germany. Katri-Elina.Clemens@Malteser.de %A Clemens, Katri Elina %A Klaschik, Eberhard %J Anasthesiol Intensivmed Notfallmed Schmerzther %D 2007 Apr %N 4 %P 280-5 %T [State of the art 2007] %V 42 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17457777 %X The beginning of the modern hospice movement and palliative medicine relates to the recognition of the fact that a cure-oriented health care system often neglects the critically ill and the dying in terms of appropriate treatment and human care. Therefore, the idea was born to offer comprehensive medical, nursing, psychological, social and spiritual care for these patients and their families at a suitable location . This first location was St Christopher's Hospice in London; the starting point of a still ongoing humanly and ethically demanded development %0 Journal Article %C University of Oxford and Cape Town Child Welfare %A Cluver, L %A Gardner, F %J AIDS Care %D 2007 Mar %N 3 %P 318-25 %T Risk and protective factors for psychological well-being of children orphaned by AIDS in Cape Town: a qualitative study of children and caregivers' perspectives %V 19 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17453564 %X By 2020, an estimated 2.3 million South African children will be orphaned by HIV/AIDS (Actuarial Society of South Africa, 2005), but little is known about risk and protective factors for their emotional and behavioural well-being. This qualitative study explores perspectives of affected families. Orphaned children (n = 60), caregivers of orphaned children (n = 42) and social care professionals (n = 20) completed semi-structured interviews and focus groups. Participants were recruited from schools, shelters and welfare services. Findings from multiple sources indicate potential risk and protective factors in a range of dimensions, including bereavement, family functioning, social support, poverty, access to education and perceived stigma. Many factors reflected international literature on children experiencing similar stressors (e.g. non HIV/AIDS-related bereavement). However, this study also identified factors which may be specific to this group, notably stigma, abuse and peer factors. Current research is quantitatively testing associations between these identified factors and psychological outcomes %0 Journal Article %C Montana State University, Bozeman. yoshikoc@montana.edu %A Colclough, Yoshiko Yamashita %A Young, Heather M %J J Fam Nurs %D 2007 May %N 2 %P 201-25 %T Decision making at end of life among Japanese american families %V 13 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17452603 %X This exploratory study describes decision making at end of life among Japanese American families. Using qualitative methods including a one-time, semistructured interview, 16 Japanese American family participants described their experiences with the death of 22 family members. A grounded theory analysis led to the development of a model of a process that reflected the influence of age-cohort generational differences and health care providers' involvement. The model also included four dimensions of family understanding. The four dimensions were awareness of the seriousness of the family members' condition, decision making about life-sustaining treatment, readiness for impending death, and experience of the dying process. Each dimension reflected a continuum from low to high understanding. The results suggest that nurses and other health care providers can impact the level of understanding within each of the dimensions in culturally sensitive ways and contribute to improving the experience with end-of-life decision making for Japanese Americans %0 Journal Article %C Dr. Cruz, Ms. Houck, Dr. Reynolds %A Cruz, Mario %A Scott, John %A Houck, Patricia %A Reynolds, Charles F 3rd %A Frank, Ellen %A Shear, M Katherine %J Psychiatr Serv %D 2007 May %N 5 %P 700-2 %T Clinical presentation and treatment outcome of african americans with complicated grief %V 58 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17463353 %X OBJECTIVE: This study sought to examine whether ethnic differences occur in the presentation of patients with complicated grief or their treatment outcome. METHODS: Analyses of a randomized controlled trial comparing a novel psychotherapy for complicated grief with interpersonal psychotherapy contrasted the clinical presentation, treatment alliance, and rates of treatment completion and response for 19 African Americans with complicated grief and 19 Caucasian Americans with complicated grief matched by sex, age, and baseline grief severity. Participants were randomly assigned to receive 16 sessions of either standard interpersonal psychotherapy or interpersonal psychotherapy enhanced with focused complicated grief components. RESULTS: No differences were found in any clinical or treatment-related measure. CONCLUSIONS: African Americans and Caucasian Americans with complicated grief did not differ significantly in clinical presentation, treatment alliance, treatment completion, and outcome. The results suggest that standard treatment for complicated grief can be provided successfully for different racial and economic groups %0 Journal Article %C Lisa Day is an associate clinical professor in the Department of Physiological Nursing at the University of California, San Francisco, School of Nursing %A Day, Lisa %J Am J Crit Care %D 2007 May %N 3 %P 290-3 %T Lessons from the classics: conflict and tragedy in critical care at the end of life %V 16 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17460323 %0 Journal Article %C MSc, End-of-Life Care Research Group, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium. cindy.de.gendt@vub.ac.be %A De Gendt, Cindy %A Bilsen, Johan %A Van Den Noortgate, Nele %A Lambert, Margareta %A Stichele, Robert Vander %A Deliens, Luc %J J Gerontol A Biol Sci Med Sci %D 2007 Apr %N 4 %P 395-400 %T Prevalence of patients with do-not-resuscitate status on acute geriatric wards in flanders, belgium %V 62 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17452733 %X Background. Elderly hospitalized patients have low survival rates after cardiopulmonary resuscitation, especially in the long term. This study aims to investigate the prevalence of patients with do-not-resuscitate (DNR) status on acute geriatric wards and the characteristics of the preceding decision-making process. Methods. On all 94 geriatric wards in Flanders, Belgium (2002), the geriatrician who performed the bulk of clinical work was asked to fill in a retrospective structured mail questionnaire. Results. The response rate was 72.3%. A DNR status was attributed to 20.3% of patients. A significant higher prevalence of patients with DNR status was found on wards with a geriatrician who had been active in patient care for 15 years or less and on wards with a DNR policy. Mostly, DNR status was attributed when the patient's condition declined (34.0%) or became critical (29.0%). Geriatricians consulted at least one person in 81.0% of the cases: (head) nurses in 72.2%, next of kin in 61.9%, the patient's general practitioner in 22.6%, and the patient him- or herself in 15.7%. Reasons stated to make a DNR decision were the prognosis (68.1%) and the physical condition of the patient (62.2%). Age was mentioned in only 21.1% of the cases, always in combination with other reasons. Conclusions. One fifth of patients on acute geriatric wards in Flanders have DNR status. The decision to attribute DNR status is most often made late in the course of the disease. (Head) nurses and the patient's next of kin are often consulted, the patient and his or her general practitioner rarely %0 Journal Article %C Department of Sociology and Anthropology, College of Charleston, Charleston, SC 29424, USA %A Dickinson, GE %A Clark, D %A Sque, M %J Nurse Educ Today %D 2007 Apr %T Palliative care and end of life issues in UK pre-registration, undergraduate nursing programmes %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17452066 %X Palliative and end of life care topics have traditionally not been in nursing school curricula. Only in recent years have these been included. The aim of this research was to determine the current status of such an emphasis in programmes in the United Kingdom (UK). A mailed survey in 2006 to the 66 undergraduate (pre-registration) nursing programmes in the UK (return rate of 79%) determined that palliative and end of life care play a significant role in these programmes. Forty-five teaching hours on average were devoted to these topics. All of the schools have some provision on palliative and end of life care, and over 95% of students participated in these courses. A nurse was usually the primary instructor, although non-nurses were sometimes used. Attitudes toward dying and death and communicating with terminally-ill patients and family members were emphasised. By highlighting dying and death in the curricula, nursing schools appeared to be giving nursing students an opportunity to face the issue of death, thus helping them to be better prepared to help their patients and their families to do so %0 Journal Article %C Department of Gynecology and Obstetrics, University of Heidelberg Medical School, Heidelberg, Germany. Michael_Eichbaum@med.uni-heidelberg.de %A Eichbaum, Michael H R %A Gast, Anne-Sybil %A Schneeweiss, Andreas %A Bruckner, Thomas %A Sohn, Christof %J Am J Clin Oncol %D 2007 Apr %N 2 %P 139-45 %T Activity and tolerability of a combined palliative chemotherapy with mitomycin C, folinate, and 5-Fluorouracil in patients with advanced breast cancer after intensive pretreatment: a retrospective analysis %V 30 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17414462 %X OBJECTIVES: The aim of this retrospective study was to evaluate the activity and toxicity of a combined chemotherapy containing mitomycin, folinate, and 5-fluorouracil (MiFoFU) in patients with advanced metastatic breast cancer and reduced performance status, ie, elderly patients or heavily pretreated patients. METHODS: We studied the charts of 76 patients with progressive metastatic breast cancer who received MiFoFU chemotherapy at our institution between 1997 and 2003. Primary end points were response and time-to-progression (TTP); secondary end points were overall survival (OAS) and tolerability. RESULTS: Median age was 57 years. Seventeen patients had > or =2 palliative cytostatic treatments before; 19 patients were older 65 years. Patients received a median of 6 cycles. Clinical benefit rate was 58%. After MiFoFU, median TTP and OAS were 8 months and 14 months, respectively. Main nonhematologic toxicity was stomatitis (grade I/II, 21%) and diarrhea (grade I/II, 37%). Grade III/IV hematotoxicity was seen in 18 patients (24%). CONCLUSIONS: A combined MiFoFU chemotherapy is a well-tolerated treatment option in the palliative therapy for patients with metastatic breast cancer. In particular, the favorable efficacy/toxicity ratio in intensively pretreated or elderly patients makes this combination a reasonable alternative within these settings %0 Journal Article %C Department of Dietetics and Nutrition, Florida International University, University Park, Miami, FL, USA. enrionee@fiu.edu %A Enrione, Evelyn B %A Chutkan, Sophia %J J Am Diet Assoc %D 2007 Mar %N 3 %P 416-21 %T Preferences of registered dietitians and nurses recommending artificial nutrition and hydration for elderly patients %V 107 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17324659 %X OBJECTIVE: The study was designed to identify how the beliefs and perceptions of registered dietitians (RDs) affect their decisions to propose artificial nutrition and hydration (ANH) for elderly patients as compared with nurses. DESIGN: A questionnaire consisting of demographic information, 13 belief statements, and eight patient scenarios requiring ANH was mailed to RDs (n=1,500) and nurses (n=1,500) throughout Florida. Thirteen statements, rated on a 5-point Likert scale, addressed beliefs that influence ANH decisions. Eight scenarios of patients, without an advance directive or surrogate decision maker, were created with variations in age, cognition, and emotion. For each scenario, participants selected a treatment, ANH or hydration, and responded: recommend; not recommend; undecided; or recommend a trial period; if no improvement, stop treatment. STATISTICAL ANALYSES PERFORMED: To establish reliability and validity, the instruments were pilot-tested with a group of RDs and nurses. Cross tabulations with chi2 tests compared the distribution of responses to the belief statements and scenarios. Statistical significance was P<0.05. RESULTS: Responses to the belief statement, "when in doubt, feed" differed significantly (P<0.001) between RDs and nurses, all other belief statements were not significantly different. In all eight scenarios, significantly more (P<0.001) RDs recommended ANH than did nurses. CONCLUSIONS: RDs clearly endorsed feeding when in doubt; therefore, they recommended ANH more than nurses. Nurses, who hesitated to feed when in doubt, were more diverse with their recommendations, either recommending a trial or not recommending ANH. A philosophical difference related to feeding was apparent between RDs and nurses and may affect consistent and quality care in patients without an advance directive or surrogate decision maker %0 Journal Article %C schmerzambulanz.alteneichen@hamburg.de %A Falckenberg, Maja %J Anasthesiol Intensivmed Notfallmed Schmerzther %D 2007 Apr %N 4 %P 296-301 %T [Multiprofessional cooperation in palliative care] %V 42 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17457779 %X "Nothing is more powerful than an idea whose time has come." (Victor Hugo) Originally referring to the beginning of the enlightenment (reconnaissance) of the French revolution the transcription of this words regarding to German palliative Care structures would mean a tremendous effort. The meaning of the new idea is a holistic kind of care for patients with a chronic disease at the end of their lives, so that they can die as most self determined as possible at a location of their choice. The special aim of palliative care, the need of interdisciplinary cooperation leading to multidisciplinary solutions is pointed out. The meaning of palliative care team as a team with special communication skills in between the team and with further cooperating partners is described. Communication in palliative care means more than telling facts %0 Journal Article %C Reseau de sante Agekanonix, Villeneuve-la-Garenne. aferrari.agk@wanadoo.fr %A Ferrari, Anne %J Soins Gerontol %D 2007 Jan-Feb %N 63 %P 25-7 %T [Moral suffering, a pain too often trivialized] %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17385654 %0 Journal Article %C Department of Medicine, Medical University of South Carolina, United States %A Ford, D %A Flume, PA %J J Cyst Fibros %D 2007 Apr %T Impact of lung transplantation on site of death in cystic fibrosis %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17448734 %X BACKGROUND: Cystic fibrosis (CF) remains a lethal condition where a palliative approach is often taken at the end of life. We wanted to evaluate how lung transplantation impacts end of life care in adult CF patients. METHODS: Data were abstracted using a standardized data collection instrument from all outpatient and inpatient records of adult CF patients with an FEV1 6 months were related to a better prognosis than short duration of symptoms < 2 months. The results from this hospital are in accordance with previous reports from the Western world %0 Journal Article %C Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine. 6655 Travis, Houston, Texas 77030. USA %A Loboprabhu, Sheila M %A Molinari, V %A Pate, J %A Lomax, J %J Aging Ment Health %D 2007 Mar %N 2 %P 192-6 %T The after-death call to family members: A clinical perspective %V 11 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17453552 %X In this paper, we discuss the value of an after-death telephone call made by the treating mental health clinician to family members, after the death of a geriatric patient with a psychiatric disorder. We outline the process of the after-death call including the optimal method, nature, and content. We note the psychotherapeutic value of an after-death telephone call in addressing complex emotions, and helping the family to cope with bereavement. We also discuss institutional, legal, and ethical ramifications. We conclude that an after-death call may be of sufficient benefit to be considered as a 'best practice' approach in the care of every patient %0 Journal Article %C Boston University School of Medicine, MA, USA %A Manuel, Barry M %J Bull Am Coll Surg %D 2002 Dec %N 12 %P 42-3 %T Malpractice verdict against neurosurgeon overturned %V 87 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17387988 %0 Journal Article %C Rutgers University, The State University of New Jersey, School of Social Work. NJ. USA %A McCoyd, Judith L M %J J Psychosom Obstet Gynaecol %D 2007 Mar %N 1 %P 37-48 %T Pregnancy interrupted: loss of a desired pregnancy after diagnosis of fetal anomaly %V 28 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17454512 %X Prenatal diagnostic techniques both enable and force women and couples to make decisions about whether to continue a pregnancy where the fetus has an anomaly. Few studies have explored the decision-making and bereavement processes of women who terminate a desired pregnancy after the discovery of a fetal anomaly. This reports the qualitative results of a study designed to explore these processes while placing them within the context of the societal milieu. Findings are reported as themes that emerged from the 30 intensive interviews conducted with women at varying stages after this experience. These include mythical expectations based on denial that anomaly could occur, misconceptions about the nature of prenatal testing and inaccurate expectations about the experience and duration of grief. Further, the contradictory norms in society are defined as creating additional dilemmas for women as they attempt to gain support and understanding following their loss. Suggestions for how providers may assist women with their grief are incorporated %0 Journal Article %C Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, University Health Network, Canada %A McLean, LM %A Jones, JM %J Psychooncology %D 2007 Apr %T A review of distress and its management in couples facing end-of-life cancer %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17458836 %X The aim of this review paper is to (1) provide an overview of the impact of cancer on the couple, (2) to identify potential outcomes for couple's interventions targeted specifically when one spouse is facing end of life, (3) to review and critique the empirical literature on psychosocial interventions for couple's facing end of life to date, and (4) to provide direction for research in this area. Based on our review, we found that there is clear evidence of significant distress arising from the impact of terminal illness on the marital relationship, which can result in greater suffering in the last months and weeks of life. Currently, there is a very small body of evidence on the effectiveness of couple interventions for those where one is in palliative care. Future randomized controlled trials are needed to examine the impact of couple therapy adapted for couples facing the end of life, and to guide in providing information on the number of sessions and format required for this population. Outcomes, such as more effective communication, reduction in the experience of hopelessness, uncertainty, isolation, depression, anxiety, and more adaptive coping strategies should be considered. Copyright (c) 2007 John Wiley & Sons, Ltd %0 Journal Article %C University of Manitoba, Community Health Sciences, 750 Bannatyne Ave., Winnipeg, Manitoba, R3E 0W3 Canada. menec@cc.umanitoba.ca %A Menec, Verena H %A Lix, Lisa %A Nowicki, Scott %A Ekuma, Okechukwu %J J Gerontol A Biol Sci Med Sci %D 2007 Apr %N 4 %P 400-7 %T Health care use at the end of life among older adults: does it vary by age? %V 62 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17452734 %X Background. Issues around end-of-life health care have attracted increasing attention in the last decade. One question that has arisen is whether very elderly individuals receive overly aggressive treatment at the end of life. The purpose of this study was to address this issue by examining whether health care use at the end life varies by age. Methods. The study included all adults 65 years old or older who died in Manitoba, Canada in 2000 (N = 7678). Measures were derived from administrative data files and included location of death, hospitalizations, intensive care unit (ICU) admission, long-term care (LTC) use, physician visits, and prescription drug use in the last 30 days versus 180 days before death, respectively. Results. Individuals 85 years old or older had increased odds of being in a LTC institution and also dying there than did individuals 65-74 years old. They had, correspondingly, lower odds of being hospitalized and being admitted to an ICU. Although some statistically significant age differences emerged for physician visits, the effects were small. Prescription drug use did not vary by age. Conclusions. These findings indicate that very elderly individuals tended to receive care within LTC settings, with care that might be considered aggressive declining with increasing age. However, health care use among all age groups was substantial. A critical issue that needs to be examined in future research is how to ensure quality end-of-life care in a variety of clinical contexts and care settings for individuals of all ages %0 Journal Article %C Pain Relief & Palliative Care Unit, La Maddalena Cancer Center, Via San Lorenzo 312, 90146 Palermo, Italy. terapiadeldolore@la-maddalena.it %A Mercadante, Sebastiano L %A Berchovich, Michela %A Casuccio, Alessandra %A Fulfaro, Fabio %A Mangione, Salvatore %J Am J Hosp Palliat Care %D 2007 Feb-Mar %N 1 %P 13-9 %T A prospective randomized study of corticosteroids as adjuvant drugs to opioids in advanced cancer patients %V 24 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17347500 %X This randomized controlled study evaluated the role of corticosteroids as adjuvants to opioid therapy in 76 advanced cancer patients with pain who requiring strong opioids. Patients were divided in 2 groups. Group O received conventional opioid treatment. Group OS received dexamethasone (8 mg orally) along with conventional treatment. Pain and symptom intensity, sense of well-being, and opioid escalation index and distress score were recorded at weekly intervals until death. No differences in pain intensity, opioid consumption, and opioid escalation index were found in 66 patients who survived 33 to 37 days. Corticosteroids did not provide significant additional analgesia to opioids, but persistently decreased opioid-related gastrointestinal symptoms for the patients with limited survival and improved the sense of well-being for some weeks. Corticosteroid-related toxicity was minimal. Further studies with an increased sample size are necessary to detect any minimal difference in analgesia between the two groups %0 Journal Article %C Eleanor and Lou Gehrig MDA/ALS Research Center, Neurological Institute, Columbia University, 710 West 168th Street, New York, NY 10032, USA %A Mitsumoto, Hiroshi %J Brain Nerve %D 2007 Apr %N 4 %P 383-91 %T [A strategy to develop effective ALS therapy] %V 59 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17447525 %X In the early 1990s, a number of major events took place in the history of the treatment and science of ALS. A cause of familial ALS, the mutation of superoxide dismutase 1, was discovered and very shortly after, an animal model expressing the human SOD1 mutation for familial ALS was generated. Around the same time, the first medication for the treatment of ALS, riluzole, was approved. Clinical neurologists started to focus more attention on quality of life and standardizing care for patients with ALS, including devising approaches for presenting and discussing the diagnosis, using aggressive symptomatic treatments, and developing a multidisciplinary care system. Since then, nutritional and respiratory care has markedly improved. Respiratory care for those with terminal ALS in Japan has been distinct and perhaps more effective compared to the rest of the world, and this unique experience must be broadly published and shared with others. In 1999, the ALS Treatment Guidelines were published by the American Academy of Neurology and are now under revision. A monitoring system to determine the impact the Guidelines had on actual patient care has taught us that caregivers have only slowly accepted the recommendation to improve quality of care. The team approach, using a multidisciplinary care system from diagnosis to the end of life, is essential to improve care for both the patient and family. Coinciding with the progress in ALS treatment, basic science and translational research also produced dramatic progress in ALS drug discovery. Over the past 15 years, more than 25 potential drugs have been tested in randomized controlled trials. Despite this progress, we have no medications other than riluzole. Although it may be true that ALS research is in its early stages compared to research in other diseases with no cure--it is probably behind cancer research by at least 20 or 30 years--we need to drastically change our approach to drug development. At a national level, we need to create a strong, cohesive team with support from a number of funding agencies, oversight from a regulatory agency, and investigators who all think "outside the box." In addition, we should obtain ideas and suggestions from accomplished experts outside of the field of ALS and put competition aside as we work together to develop strategic plans for the ALS drug development that is essential to beat this devastating disease %0 Journal Article %C Department of Surgical Gastroenterology, Odense University Hospital, Odense C, Denmark. m.bau@dadlnet.dk %A Mortensen, M B %A Edwin, B %A Hunerbein, M %A Liedman, B %A Nielsen, H O %A Hovendal, C %J Surg Endosc %D 2007 Mar %N 3 %P 431-8 %T Impact of endoscopic ultrasonography (EUS) on surgical decision-making in upper gastrointestinal tract cancer: an international multicenter study %V 21 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17180286 %X BACKGROUND: Endoscopic ultrasonography (EUS) is an integrated part of the pretherapeutic evaluation program for patients with upper gastrointestinal (GI) tract cancer. Whether the clinical impact of EUS differs between surgeons from different countries is unknown. The same applies to the potential clinical influence of EUS misinterpretations. The aim of this study was to evaluate the interobserver agreement on predefined treatment strategies between surgeons from four different countries, with and without EUS, and to evaluate the clinical consequences of EUS misinterpretations. METHODS: One hundred patients with upper GI tract cancer were randomly selected from all upper GI tract cancer patients treated at Odense University Hospital between 1997 and 2000. Based on patient records and EUS database results, a case story was created with and without the EUS result for each patient. Four surgeons were asked to select the relevant treatment strategy in each case, at first without knowledge of the EUS and thereafter with the EUS result available. Interobserver agreement and impact of EUS misinterpretations were evaluated using the actual final treatment of each patient as reference. RESULTS: Three of four or all four surgeons agreed on the same treatment strategy for nearly 60% of the patients with and without the EUS results. Treatment decisions were changed in 34% based on the EUS results, and the majority of these changes were toward nonsurgical and palliative treatments (85%). Interobserver agreement was relatively low, but overall EUS increased kappa values from 0.16 ("poor") to 0.33 ("fair"), thus indicating increased overall agreement after the EUS results were available. EUS conclusion regarding stage or resectability was wrong in 17% of the cases, but only one serious event would have been the clinical result of EUS misinterpretations. CONCLUSION: Despite being used in different ways by different surgeons, EUS did change patient management in one third of the cases. The impact of EUS misinterpretations seemed very low, and this study confirmed one of the strongest clinical possibilities of EUS, i.e., the ability to detect nonresectable cases. EUS is an important imaging modality for oncosurgeons from different countries %0 Journal Article %A Nau, Jean-Yves %J Rev Med Suisse %D 2006 Nov %N 86 %P 2577 %T [The veterinarian and euthanasia during epizootic outbreaks] %V 2 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17168050 %0 Journal Article %C Escola Superior de Saude de Beja %A Nobre, Cidalia de Fatima Carvoeiras %J Servir %D 2006 Sep-Oct %N 5 %P 238-42 %T [Experience with a terminal situation in oncologic disease] %V 54 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17195544 %0 Journal Article %C From the School of Nursing (SN), Center for Ethics, Humanities, and Palliative Care (LH, RH, MB, TQ), and the Departments of Community and Preventive Medicine (RH, HTG) and Neurology (RH), University of Rochester Medical Center, Rochester, NY %A Norton, SA %A Hogan, LA %A Holloway, RG %A Temkin-Greener, H %A Buckley, MJ %A Quill, TE %J Crit Care Med %D 2007 Apr %T Proactive palliative care in the medical intensive care unit: Effects on length of stay for selected high-risk patients* %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17452930 %X OBJECTIVE:: The purpose of this study was to examine the effect of proactive palliative care consultation on length of stay for high-risk patients in the medical intensive care unit (MICU). DESIGN:: A prospective pre/post nonequivalent control group design was used for this performance improvement study. SETTING:: Seventeen-bed adult MICU. PATIENTS:: Of admissions to the MICU, 191 patients were identified as having a serious illness and at high risk of dying: 65 patients in the usual care phase and 126 patients in the proactive palliative care phase. To be included in the sample, a patient had to meet one of the following criteria: a) intensive care admission following a current hospital stay of >/=10 days; b) age >80 yrs in the presence of two or more life-threatening comorbidities (e.g., end-stage renal disease, severe congestive heart failure); c) diagnosis of an active stage IV malignancy; d) status post cardiac arrest; or e) diagnosis of an intracerebral hemorrhage requiring mechanical ventilation. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: Primary measures were patient lengths of stay a) for the entire hospitalization; b) in the MICU; and c) from MICU admission to hospital discharge. Secondary measures included mortality rates and discharge disposition. There were no significant differences between the usual care and proactive palliative care intervention groups in respect to age, gender, race, screening criteria, discharge disposition, or mortality. Patients in the proactive palliative care group had significantly shorter lengths of stay in the MICU (8.96 vs. 16.28 days, p = .0001). There were no differences between the two groups on total length of stay in the hospital or length of stay from MICU admission to hospital discharge. CONCLUSIONS:: Proactive palliative care consultation was associated with a significantly shorter MICU length of stay in this high-risk group without any significant differences in mortality rates or discharge disposition %0 Journal Article %C Emergency Department, Royal Bolton Hospital, Bolton NHS Trust, Bolton, UK %A Parris, R J %A Schlosenberg, J %A Stanley, C %A Maurice, S %A Clarke, S F J %J Emerg Med J %D 2007 May %N 5 %P 339-42 %T Emergency department follow-up of bereaved relatives: an audit of one particular service %V 24 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17452701 %X BACKGROUND: Although much has been written about the treatment of bereaved relatives in emergency departments, very little has been published about their follow-up after they have left the department. METHODS: One model of follow-up is described, in which relatives are invited to a meeting in the department 4-6 weeks after their loss. In this model, it is emphasised that the follow-up is not a counselling session but an opportunity to ask questions, and an audit of the service is presented. RESULTS AND CONCLUSION: It is suggested that the provision of information is theoretically beneficial to the bereavement process %0 Journal Article %C Faculty of Nursing, University of Calgary, Calgary, AB. bpaton@ucalgary.ca %A Paton, Brenda %A Backlund, Judy %A Barnes, Monica %A Thirsk, Lorraine %J Can J Cardiovasc Nurs %D 2007 %N 1 %P 7-14 %T Recalibrating time and space: women's challenges of living with heart failure %V 17 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17378518 %X The progressive and demanding nature of heart failure has a significant impact on the daily life of all individuals. Gender-related differences exist in diagnosis, management and home-based support, whereby women's needs have been either managed less aggressively or overlooked. Minimal research has been conducted on the everyday challenges for women who are living in the community with heart failure. The researchers of this interpretive research encouraged the seven women who volunteered for this study to talk about their day-to-day challenges. The interviews were interpreted through a process informed by Heideggerian hermeneutics, whereby the three themes of recalibrating time and space, balancing pathways of wishing and hoping and practicality, and acknowledging loss in persevering through uncertainty were uncovered. The findings of this research may be utilized in assisting and preparing women to think and plan ahead by considering some decisions others make while taking on a new path in responding to the symptoms associated with heart failure %0 Journal Article %C MSPH, UAB Center for Aging and UAB Center for Palliative Care, UAB School of Medicine, 1530 3rd Ave. South, CH-19, Rm. 219, Birmingham, AL 35294. critchie@uab.edu %A Ritchie, Christine S %A Wieland, G Darryl %J J Gerontol A Biol Sci Med Sci %D 2007 Apr %N 4 %P 393-4 %T Improving End-of-Life Care for Older Adults: An International Challenge %V 62 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17452732 %0 Journal Article %C Department of Internal Medicine and Geriatrics, Poliambulanza Hospital, Brescia and Geriatric Research Group, Brescia, Italy %A Rozzini, R %A Sabatini, T %A Ranhoff, A %A Trabucchi, M %J Age Ageing %D 2007 Apr %T Do we really need palliative care for severe dementia patients? %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17459916 %0 Journal Article %C Department of Social and Welfare Studies, Faculty of Health Sciences, Campus Norrkoping, Linkoping University, Norrkoping, Sweden. kerry@isv.liu.se %A Ryde, Kerstin %A Friedrichsen, Maria %A Strang, Peter %J Palliat Support Care %D 2007 Mar %N 1 %P 51-9 %T Crying: a force to balance emotions among cancer patients in palliative home care %V 5 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17461371 %X OBJECTIVE: Crying is a common but seldom studied phenomenon in palliative care. The aim of this study was to explore the significance of patients crying in a palliative care context. METHODS: Tape-recorded interviews with 14 cancer patients in palliative home care were carried out. To gain deeper understanding, a hermeneutic analysis and interpretation was used. RESULTS: Crying was described in different dimensions: (1) intense and despondent crying as a way of ventilating urgent needs, (2) gentle, sorrowful crying as a conscious release of emotions, and (3) quiet, tearless crying as a protection strategy. Crying seems to be an expression for an inner emotional force, provoked by different factors, which cause changes in the present balance. To cry openly but also to cry on the inside meant being able to achieve or maintain balance. Crying may be something useful, which could create release and help reduce tension, but it may also have a negative impact as it consumes energy and creates feelings of shame. SIGNIFICANCE OF RESULTS: Professionals need to understand the different levels of crying. In such situations sometimes comforting the patient may not be the best solution, as some may need privacy %0 Journal Article %C Department of Oncology and Radiotherapy, Turku University Hospital, P.O. Box 52, Savitehtaankatu 1, 20521, Turku, Finland, eeva.salminen@tyks.fi %A Salminen, E %A Clemens, KE %A Syrjanen, K %A Salmenoja, H %J Support Care Cancer %D 2007 Apr %T Needs of developing the skills of palliative care at the oncology ward : An audit of symptoms among 203 consecutive cancer patients in Finland %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17458565 %X BACKGROUND: To clarify the prevalence and severity of the symptoms, 203 consecutive patients with breast, prostate and other cancers treated mainly for palliation were surveyed. MATERIALS AND METHODS: The series includes 116 men and 87 women with the mean age of 65 years (range 27-86 years). The patients filled-up the Edmonton Symptom Assessment System (ESAS) questionnaire with 11 items describing cancer-related symptoms in the visual analogue scale (VAS). RESULTS: Altogether, 98% of the patients reported at least 1 of the 10 symptoms. There was a significant difference in the score frequencies between the 10 symptoms (p = 0.0001), fatigue receiving the highest frequency (50.8%) of the high scores. Fatigue was also the single most frequent symptom reported by 86.3% of the patients, followed by pain at effort (71.5%), sleeplessness (71.1%) and depression (59.0%). The most disturbing syndrome was pain (n = 48, 23.9%), followed by fatigue (n = 28, 13.9%), depression (9.5%) and dyspnoea (6.0%). Altogether, 75% had more than 5 symptoms and 10% reported all 10 symptoms. The total number of symptoms was not significantly associated with sex (p = 0.781) or age (p = 0.062), but it was associated with the diagnostic group; patients with breast cancer (n = 41) and those with prostate cancer (n = 44) reported fewer symptoms than the patients with other cancers (n = 116)(p = 0.023, Kruskal-Wallis). CONCLUSIONS: Symptoms related to cancer are common among patients treated with palliative indication, but if not specifically surveyed, may remain un-detected and un-treated. ESAS as a clinical tool brings more symptoms to the attention of the physicians and helps in getting a comprehensive insight into the patient's problems %0 Journal Article %A Savary, Claire %J Soins %D 2007 Jan-Feb %N 712 Suppl %P S13 %T [Respecting the wishes of Mister B.] %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17441297 %0 Journal Article %C Institute for Biomedical Ethics, Zurich University Centre for Ethics, Zurich, Switzerland %A Schulz-Baldes, A %A Huseman, D %A Loui, A %A Dudenhausen, Jw %A Obladen, M %J Acta Paediatr %D 2007 May %N 5 %P 681-7 %T Neonatal end-of-life practice in a German perinatal centre %V 96 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17462059 %X Aim: To investigate the end-of-life practice in a large perinatal centre in Germany. Methods: Retrospective chart review was performed in all neonates deceased in the delivery room (n = 31) and the neonatal intensive care unit (n = 47) between 2002 and 2004. Results: Neonatal death was preceded by an end-of-life decision (EOLD) in 81% of cases in the delivery room and 83% in the neonatal intensive care unit. The majority of deceased neonates were born prematurely or with congenital malformation. Life-sustaining treatment was not initiated in 74% of the infants deceased in the delivery room. In the unit, 52% died after withdrawal of therapy. Mechanical ventilation was withdrawn most frequently (79% of cases). Futility and immediate death were common considerations in EOLD, but the infant's suffering and future quality of life also played a role. Parents were involved in EOLD-making in all but emergency cases. No active termination of life was performed. Conclusion: In our perinatal centre, the majority of neonatal deaths occurred after limitation of therapy. Treatment was actively withdrawn in half of the infants in the neonatal intensive care unit. Actual end-of-life practice in a large perinatal centre differs from the restrictive attitude towards EOLD reported for German neonatologists in previous surveys %0 Journal Article %C Psychiatry Division, National Cancer Center Hospital, Chuou-ku, Tokyo, Japan %A Shimizu, Ken %A Akechi, Tatsuo %A Shimamoto, Masaya %A Okamura, Masako %A Nakano, Tomohito %A Murakami, Tadashi %A Ito, Tatsuhiko %A Oba, Akira %A Fujimori, Maiko %A Akizuki, Nobuya %A Inagaki, Masatoshi %A Uchitomi, Yosuke %J Palliat Support Care %D 2007 Mar %N 1 %P 3-9 %T Can psychiatric intervention improve major depression in very near end-of-life cancer patients? %V 5 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17461366 %X OBJECTIVE: Although depression is a prevalent and burdensome psychiatric problem in end-of-life cancer patients, little is known about its susceptibility to treatment, especially when patients reach very close to the end of life. This study was conducted to evaluate response rate of that end-of-life depression to psychiatric intervention and to assess the feasibility of conventional evidence-based pharmacological therapy for depression. METHODS: The medical records of 20 patients who were referred to the psychiatry division for major depressive disorder and died within 3 months after the referral were reviewed. The Clinical Global Impression-Improvement (CGI-I) Scale was used for each case, and responders were defined as patients whose scores were much or very much improved. All pharmacological treatments were extracted, and the doses of the antidepressant prescribed were compared to their evidence-based-defined therapeutic doses. RESULTS: Of the 20 patients, seven were responders, but no response was achieved when the survival time was less than 3 weeks. Most patients were treated with antidepressants, but the doses prescribed were far less than the defined doses, especially the doses of the tricyclic antidepreSsants (TCAs). SIGNIFICANCE OF RESULTS: These results suggested that patients' survival time largely determines susceptibility to psychiatric treatment, and it is hard to achieve response in patients whose survival time was less than about 1 month. Implementation of conventional evidence-based pharmacological treatment is difficult, especially with TCAs, and various antidepressants, which can be administrated by other routes, are needed when oral intake is impossible %0 Journal Article %A Stone, Susan %J Acad Emerg Med %D 2007 May %N 5 Suppl 1 %P S132 %T Treatment preferences of patients at the end of life %V 14 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17463568 %0 Journal Article %A Stone, Susan %A Abbott, Jean %A Lowenstein, Steven %J Acad Emerg Med %D 2007 May %N 5 Suppl 1 %P S132-3 %T Paramedics knowledge skills and attitude on end of life care %V 14 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17463566 %0 Journal Article %C Klinika za grudnu hirurgiju, Institut za plucne bolesti KC Srbije %A Subotic, D %A Mandaric, D %J Acta Chir Iugosl %D 2006 %N 3 %P 59-65 %T [Palliative operations for lung cancer] %V 53 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17338202 %X The goal of the palliative resection can be threefold: relief of symptoms without expected survival benefit, obviation of an urgent situation and maintenance or restoration of a good quality survival. Clear distinction should be made between this type of operation and incomplete resection: in spite of a curative intent, the latter type of operation is characterized either by residual disease or positive most distal lymph node station. Classification of palliative operations for lung cancer based on the underlying pathology seems to be most suitable for clinical use: 1) tumours without extrapulmonary extension; 2) tumours with direct involvement of adjacent organs; 3) metastatic involvement of intrathoracic or distant organs; 4) lung tumours associated with nonmalignant pathology (lung suppuration, pleural empyema). Although palliative operations for lung cancer can be considered in carefully selected patients, they should always be avoided if other, less aggressive non-surgical procedures offer the same quality of palliation %0 Journal Article %C Institut fur Diagnostische und Interventionelle Radiologie, J. W. Goethe-Universitat Frankfurt. T.vogl@em.uni-frankfurt.de %A Vogl, T J %A Herzog, C %A Zangos, S %A Lindemayr, S %J Rofo %D 2007 Mar %N 3 %P 300-7 %T [Palliative treatment of primary lung tumors with transpulmonary chemoembolization (TPCE)] %V 179 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17325997 %X PURPOSE: To evaluate transpulmonary chemoembolization (TPCE) as a symptomatic palliative method for treating inoperable primary lung tumors. MATERIALS AND METHOD: From 2002 to 2005, 17 patients (17 males, 3 females; average age: 64.5 years) suffering from primary lung tumors were treated in 3.6 sessions (range: 2 to 8) using TPCE. The patients had the following primary tumors: adenocarcinoma (n = 6), pleural mesothelioma (n = 2), squamous cell carcinoma (n = 1), small cell carcinoma (n = 1), and non-small cell carcinoma (n = 7). After femoral vein puncture, tumor-supplying pulmonary arteries were selectively explored, and 5 - 10 mg mitomycin C and 5 - 10 mL lipiodol and microsphere particles (Spherex) (20 - 70 microm in diameter) were applied with balloon protection. Diagnosis and follow-up were performed in 4-week intervals with unenhanced and contrast-enhanced computed tomography (CT). The mean follow-up was 11.3 months. RESULTS: Treatment was well tolerated by all patients with no major side effects or complications. The laboratory parameters were not significantly influenced. 11.8 % of the patients (n = 2) showed high or moderate lipiodol uptake, and 76.5 % (n = 13) showed low lipiodol uptake. After evaluation of morphologic criteria, a mean volume regression of 12.1 ml (40.4 %) of the embolized areas was achieved in four patients (23.5 %), while a constant value was identified during follow-up for seven patients (41.2 %). In six patients (35.3 %), progression of the treated lung tumors was recorded. The tumor increased by a mean of 38.37 ml (165.38 %). CONCLUSION: TPCE is a well-tolerated palliative treatment option for patients with primary lung tumors %0 Journal Article %C Deparment of Hospice Care, Second Affiliated Hospital of China Medical University, Shenyang, China %A Wang, Yu-Mei %A Feng, Guo-He %A Xiao, Shi-Qi %A Sun, Jian-Chun %J Zhongguo Dang Dai Er Ke Za Zhi %D 2007 Apr %N 2 %P 179-82 %T [Research progress on hospice care for pediatric patients] %V 9 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17448321 %0 Journal Article %C Arizona State University, USA %A Woien, Sandra %J Am J Bioeth %D 2007 Apr %N 4 %P 64-5; discussion W4-6 %T Conflicting preferences and advance directives %V 7 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17455004 %0 Journal Article %C Vanderbilt University Medical Center, Nashville, Tennessee, USA. rzaner@houston.rr.com %A Zaner, Richard M %J J Med Philos %D 2006 Dec %N 6 %P 655-66 %T On evoking clinical meaning %V 31 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17162733 %X It was in the course of one particular clinical encounter that I came to realize the power of narrative, especially for expressing clinically presented ethical matters. In Husserlian terms, the mode of evidence proper to the unique and the singular is the very indirection that is the genius of story-telling. Moreover, the clinical consultant is unavoidably changed by his or her clinical involvement. The individuals whose situation is at issue have their own stories that need telling. Clinical ethics is in this sense a way of helping patients, families, and, yes, health providers to discover and give voice to those stories. In this way, clinical ethics is an evoking of meaning. Kierkegaard understood this well: Indirect communication is the language for the unique and the otherwise inexpressible %0 Journal Article %C Department of Social Psychiatry, University of Groningen, PO Box 30.001, 9700 RB Groningen, Netherlands %A de, Groot M %A de, Keijser J %A Neeleman, J %A Kerkhof, A %A Nolen, W %A Burger, H %J BMJ %D 2007 Apr %T Cognitive behaviour therapy to prevent complicated grief among relatives and spouses bereaved by suicide: cluster randomised controlled trial %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17449505 %X OBJECTIVE: To examine the effectiveness of a family based grief counselling programme to prevent complicated grief among first degree relatives and spouses of someone who had committed suicide. DESIGN: Cluster randomised controlled trial with follow-up at 13 months after the suicide. SETTING: General practices in the Netherlands. PARTICIPANTS: 122 first degree relatives and spouses of 70 people who committed suicide; 39 families (68 participants) were allocated to intervention, 31 families (54 participants) to control. INTERVENTION: A family based, cognitive behaviour counselling programme of four sessions with a trained psychiatric nurse counsellor between three to six months after the suicide. Control participants received usual care. MAIN OUTCOME MEASURES: Self report complicated grief. Secondary outcomes were the presence of maladaptive grief reactions, depression, suicidal ideation, and perceptions of being to blame for the suicide. RESULTS: The intervention was not associated with a reduction in complicated grief (mean difference -0.61, 95% confidence interval -6.05 to 4.83; P=0.82). Secondary outcomes were not affected either. When adjusted for baseline inequalities, the intervention reduced the risk of perceptions of being to blame (odds ratio 0.18, 0.05 to 0.67; P=0.01) and maladaptive grief reactions (0.39, 0.15 to 1.01; P=0.06). CONCLUSIONS: A cognitive behaviour grief counselling programme for families bereaved by suicide did not reduce the risk of complicated grief or suicidal ideation or the level of depression. The programme may help to prevent maladaptive grief reactions and perceptions of blame among first degree relatives and spouses. Trial registration Current Controlled Trials ISRCTN66473618 %0 Journal Article %C Department of Clinical Psychology, Universiteit van Amsterdam, Roetersstraat 15, 1018 WB, Amsterdam, The Netherlands. F.J.vanZuuren@uva.nl %A van Zuuren, Florence J %A van Manen, Eeke %J Med Health Care Philos %D 2006 %N 3 %P 339-47 %T Moral dilemmas in neonatology as experienced by health care practitioners: a qualitative approach %V 9 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17082871 %X During the last two decades there has been an enormous development in treatment possibilities in the field of neonatology, particularly for (extremely) premature infants. Although there are cross-cultural differences in treatment strategy, an overview of the literature suggests that every country is confronted with moral dilemmas in this area. These concern decisions to initiate or withhold treatment directly at birth and, later on, decisions to withdraw treatment with the possible consequence that the child will die. Given that the neonate cannot express his or her own will, who will decide? And on the basis of what information, values and norms? We explored some of these issues in daily practice by interviewing a small sample of health care practitioners in a Dutch university Neonatal Intensive Care Unit (NICU). It turned out that experiencing moral dilemmas is part of their daily functioning. Nurses underline the suffering of the newborn, whereas physicians stress uncertainty in treatment outcome. To make the best of it, nurses focus on their caring task, whereas physicians hope that future follow-up research will lead to more predictable outcomes. As for their own offspring, part of these professionals would hesitate to bring their own extremely premature newborn to a NICU. For the most oppressing dilemma reported - terminating an already initiated treatment - we propose the concept of 'evidence shift' to clarify the ambiguous position of uncertainty in decision making