%0 Journal Article %C Feinberg School of Medicine, Northwestern University, Chicago, IL, USA %A Listernick, Robert %J Pediatr Ann %D 2006 Dec %N 12 %P 869-73 %T A 3-year-old boy involved in a motor vehicle accident %V 35 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17236433 %0 Journal Article %C Department of Radiation Oncology, Blanchard Valley Regional Cancer Center, Findlay, Ohio %A Lutz, ST %A Chow, EL %A Hartsell, WF %A Konski, AA %J Cancer %D 2007 Mar %T A review of hypofractionated palliative radiotherapy %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17330854 %X Radiotherapy commonly is employed to address symptoms in patients with symptoms caused by cancer. For this article, the authors reviewed data supporting the use of hypofractionated palliative radiotherapy. In addition to single-fraction treatment for painful bony metastasis, the available literature suggested that courses of 2 to 14 external-beam fractions may provide equivalent relief to longer course treatment in patients with a poor prognosis who have primary cancers of the lung, rectum, bladder, prostate, head and neck, spleen, and gynecologic system. Hypofractionated treatment delivers palliation that is time efficient, cost effective, and minimally toxic. Evidence suggests that the reluctance of radiation oncologists to provide single-fraction treatment acts as a barrier to referrals from palliative care professionals. Collaboration in education, research, and patient advocacy will advance the common objectives of the 2 specialties and lead to an appropriate increase in the use of palliative hypofractionated radiotherapy. Cancer 2007. (c) 2007 American Cancer Society %0 Journal Article %C School of Health Information Science, University of Victoria, Victoria, British Columbia %A Lau, Francis %A Yang, Julia %A Pereira, Jose %A Daeninck, Paul %A Aherne, Michael %J J Palliat Care %D 2006 Winter %N 4 %P 267-74 %T A survey of PDA use by palliative medicine practitioners %V 22 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17263053 %X This paper describes the results of a Web survey on the use of personal digital assistants (PDAs) by physicians across Canada involved with the delivery of palliative medicine in different settings. Seventy-two physicians responded to the survey from April to July 2005. The survey revealed 58.3% of respondents currently use PDAs on a daily basis, mostly to organize their practice and to look up medical references. Some use their PDAs to store patient information and to access a central electronic patient record (EPR). In terms of potential PDA use in palliative medicine, six thematic areas are suggested: medical references, EPR, staying connected, personal productivity, clinical research, and issues/concerns. For implications, healthcare organizations should consider mobile technology as part of their information systems strategy. The feasibility of a portable EPR for palliative medicine should be explored, and an information-based approach can help advance palliative medicine research in Canada %0 Journal Article %C Marie Curie Research Wing, Mount Vernon Hospital, Northwood, United Kingdom %A Ng, Quan-Sing %A Goh, Vicky %A Milner, Jessica %A Padhani, Anwar R %A Saunders, Michele I %A Hoskin, Peter J %J Int J Radiat Oncol Biol Phys %D 2007 Feb %N 2 %P 417-24 %T Acute tumor vascular effects following fractionated radiotherapy in human lung cancer: In vivo whole tumor assessment using volumetric perfusion computed tomography %V 67 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17236965 %X PURPOSE: To quantitatively assess the in vivo acute vascular effects of fractionated radiotherapy for human non-small-cell lung cancer using volumetric perfusion computed tomography (CT). METHODS AND MATERIALS: Sixteen patients with advanced non-small-cell lung cancer, undergoing palliative radiotherapy delivering 27 Gy in 6 fractions over 3 weeks, were scanned before treatment, and after the second (9 Gy), fourth (18 Gy), and sixth (27 Gy) radiation fraction. Using 16-detector CT, multiple sequential volumetric acquisitions were acquired after intravenous contrast agent injection. Measurements of vascular blood volume and permeability for the whole tumor volume were obtained. Vascular changes at the tumor periphery and center were also measured. RESULTS: At baseline, lung tumor vascularity was spatially heterogeneous with the tumor rim showing a higher vascular blood volume and permeability than the center. After the second, fourth, and sixth fractions of radiotherapy, vascular blood volume increased by 31.6% (paired t test, p = 0.10), 49.3% (p = 0.034), and 44.6% (p = 0.0012) respectively at the tumor rim, and 16.4% (p = 0.29), 19.9% (p = 0.029), and 4.0% (p = 0.0050) respectively at the center of the tumor. After the second, fourth, and sixth fractions of radiotherapy, vessel permeability increased by 18.4% (p = 0.022), 44.8% (p = 0.0048), and 20.5% (p = 0.25) at the tumor rim. The increase in permeability at the tumor center was not significant after radiotherapy. CONCLUSION: Fractionated radiotherapy increases tumor vascular blood volume and permeability in human non-small-cell lung cancer. We have established the spatial distribution of vascular changes after radiotherapy; greater vascular changes were demonstrated at the tumor rim compared with the center %0 Journal Article %C Department of Ophthalmology and Visual Sciences, The University of Iowa, Iowa City, IA 52240, USA %A Gehrs, Karen M %A Anderson, Don H %A Johnson, Lincoln V %A Hageman, Gregory S %J Ann Med %D 2006 %N 7 %P 450-71 %T Age-related macular degeneration--emerging pathogenetic and therapeutic concepts %V 38 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17101537 %X Today, the average life expectancy in developed nations is over 80 years and climbing. And yet, the quality of life during those additional years is often significantly diminished by the effects of age-related, degenerative diseases, including age-related macular degeneration (AMD), the leading cause of blindness in the elderly worldwide. AMD is characterized by a progressive loss of central vision attributable to degenerative and neovascular changes in the macula, a highly specialized region of the ocular retina responsible for fine visual acuity. Estimates gathered from the most recent World Health Organization (WHO) global eye disease survey conservatively indicate that 14 million persons are blind or severely visually impaired because of AMD. The disease has a tremendous impact on the physical and mental health of the geriatric population and their families and is becoming a major public health burden. Currently, there is neither a cure nor a means to prevent AMD. Palliative treatment options for the less prevalent, late-stage 'wet' form of the disease include anti-neovascular agents, photodynamic therapy and thermal laser. There are no current therapies for the more common 'dry' AMD, except for the use of antioxidants that delay progression in 20%-25% of eyes. New discoveries, however, are beginning to provide a much clearer picture of the relevant cellular events, genetic factors, and biochemical processes associated with early AMD. Recently, compelling evidence has emerged that the innate immune system and, more specifically, uncontrolled regulation of the complement alternative pathway plays a central role in the pathobiology of AMD. The complement Factor H gene--which encodes the major inhibitor of the complement alternative pathway--is the first gene identified in multiple independent studies that confers a significant genetic risk for the development of AMD. The emergence of this new paradigm of AMD pathogenesis should hasten the development of novel diagnostic and therapeutic approaches for this disease that will dramatically improve the quality of our prolonged lifespan %0 Journal Article %C The Parkinson's Disease Research, Education, and Clinical Center, USA. constance.ward@va.gov %A Ward, Constance %J J Neurosci Nurs %D 2006 Dec %N 6 %P 400-2 %T An ethical dilemma involving a Shy-Drager patient: a case study %V 38 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17233508 %X Shy-Drager syndrome, one type of multisystem atrophy, is considered a Parkinson's-plus syndrome. Survival time is less than a decade from the onset of symptoms, and patients usually become physically dependent and wheelchair bound years before death. Ethical dilemmas are very common in health care. In many cases, an ethics consultation is required to resolve complex issues. The ethics committee is guided toward a decision by application of universal ethical principles. Nurses can serve as a patient's advocate, as they are the ones providing direct care and forming relationships with the patient. In many cases, conversations between nurse and patient become pertinent information the ethics team can use to resolve ethical dilemmas %0 Journal Article %A Niederhofer, Helmut %A Damodharan, Senthil Kumar %A Joji, Rekha %A Corfield, Alison %J Autism %D 2006 Nov %N 6 %P 647-9 %T Atomoxetine treating patients with Autistic disorder %V 10 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17088279 %0 Journal Article %C Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel, sprung@cc.huji.ac.il %A Sprung, CL %A Carmel, S %A Baras, M %A Cohen, SL %A Maia, P %A Beishuizen, A %A Nalos, D %A Novak, I %A Svantesson, M %A Benbenishty, J %A Henderson, B %J Intensive Care Med %D 2007 Mar %T Attitudes of European physicians, nurses, patients and families regarding end-of-life decisions: the ETHICATT study. Reply to A.M. Vrakking %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17333115 %0 Journal Article %C Department of Public Health, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands %A Veerbeek, Laetitia %A van Zuylen, Lia %A Gambles, Maureen %A Swart, Siebe J %A van der Heide, Agnes %A van der Rijt, Carin C D %A Ellershaw, John E %J J Palliat Care %D 2006 Winter %N 4 %P 305-8 %T Audit of the Liverpool Care Pathway for the Dying Patient in a Dutch cancer hospital %V 22 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17263060 %0 Journal Article %A Shin, Jae Il %A Lee, Jae Seung %A Jeong, Hyeon Joo %J J Rheumatol %D 2006 Dec %N 12 %P 2551 %T Azathioprine and tubulointerstitial nephritis in HSP %V 33 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17143995 %0 Journal Article %C Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. brazilk@mcmaster.ca %A Brazil, Kevin %A Bedard, Michel %A Krueger, Paul %A Taniguchi, Alan %A Kelley, Mary Lou %A McAiney, Carrie %A Justice, Christopher %J Can Fam Physician %D 2006 Apr %P 472-3 %T Barriers to providing palliative care in long-term care facilities %V 52 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17327890 %X OBJECTIVE: To assess challenges in providing palliative care in long-term care (LTC) facilities from the perspective of medical directors. DESIGN: Cross-sectional mailed survey. A questionnaire was developed, reviewed, pilot-tested, and sent to 450 medical directors representing 531 LTC facilities. Responses were rated on 2 different 5-point scales. Descriptive analyses were conducted on all responses. SETTING: All licensed LTC facilities in Ontario with designated medical directors. PARTICIPANTS: Medical directors in the facilities. MAIN OUTCOME MEASURES: Demographic and practice characteristics of physicians and facilities, importance of potential barriers to providing palliative care, strategies that could be helpful in providing palliative care, and the kind of training in palliative care respondents had received. RESULTS: Two hundred seventy-five medical directors (61%) representing 302 LTC facilities (57%) responded to the survey. Potential barriers to providing palliative care were clustered into 3 groups: facility staff's capacity to provide palliative care, education and support, and the need for external resources. Two thirds of respondents (67.1%) reported that inadequate staffing in their facilities was an important barrier to providing palliative care. Other barriers included inadequate financial reimbursement from the Ontario Health Insurance Program (58.5%), the heavy time commitment required (47.3%), and the lack of equipment in facilities (42.5%). No statistically significant relationship was found between geographic location or profit status of facilities and barriers to providing palliative care. Strategies respondents would use to improve provision of palliative care included continuing medical education (80.0%), protocols for assessing and monitoring pain (77.7%), finding ways to increase financial reimbursement for managing palliative care residents (72.1%), providing educational material for facility staff (70.7%), and providing practice guidelines related to assessing and managing palliative care patients (67.8%). CONCLUSION: Medical directors in our study reported that their LTC facilities were inadequately staffed and lacked equipment. The study also highlighted the specialized role of medical directors, who identified continuing medical education as a key strategy for improving provision of palliative care %0 Journal Article %C Department of Intensive Care, Room H324, Erasmus MC, University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands, a.vrakking@erasmusmc.nl %A Vrakking, AM %A Kompanje, EJ %A Bakker, J %J Intensive Care Med %D 2007 Mar %T Comment on "Attitudes of European physicians, nurses, patients, and families regarding end-of-life decisions: the ETHICATT study" by Sprung et al %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17333116 %0 Journal Article %C Family and Child Nursing, University of Washington, Seattle, Washington, USA %A Swanson, Kristen M %A Connor, Sherri %A Jolley, Sandra N %A Pettinato, Maria %A Wang, Tsae-Jyy %J Res Nurs Health %D 2007 Feb %N 1 %P 2-16 %T Contexts and evolution of women's responses to miscarriage during the first year after loss %V 30 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17243104 %X Descriptions of 85 women's feelings about miscarriage at 1, 6, 16, and 52 weeks were inductively coded, rank-ordered, and clustered into 3 responses: healing, actively grieving, and overwhelmed. Women who were actively grieving or overwhelmed at 1 week experienced significantly less distress from 6 weeks on. Responses at 1 week differed with regards to those who had a history of perinatal loss or went on to experience negative life events or sexual distance after loss. One year responses differed based on who was pregnant or gave birth, miscarried again, lived through a higher number of post-loss negative life events, or experienced interpersonal or sexual distance from their mate. Responses were not influenced by gestational age at loss or having other children %0 Journal Article %C Day Hospital and Out-Patient Clinic, Rehabilitation and Palliative Care Operative Unit, National Cancer Institute of Milano, Milan, Italy %A Ripamonti, C %A Fagnoni, E %A Campa, T %A Giardina, V %A Brunelli, C %A Pigni, A %A De, Conno F %J Support Care Cancer %D 2007 Mar %T Decreases in pain at rest and movement-related pain during zoledronic acid treatment in patients with bone metastases due to breast or prostate cancer: a pilot study %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17333295 %X BACKGROUND: In patients with bone metastases, pain may be absent or moderate at rest, but may be exacerbated by different movements or positions. No study has evaluated separately pain at rest and on movement in patients with bone metastases undergoing treatment with zoledronic acid (ZA). AIM: The aim of this prospective observational study was to evaluate the reduction in intensity of pain at rest and in movement-related pain after treatment with up to six infusions of ZA 4 mg every 28 days in patients with painful bone metastases due to breast or prostate cancer cared for at the Oncological Units and Pain Therapy and Palliative Care Unit of the NCI of Milano. MATERIALS AND METHODS: Pain was assessed by a six-level verbal rating scale (0-5 score) at baseline and on each infusion as well as at follow-up visits (2 weeks after every infusion). The two main endpoints (estimated reduction in pain and movement-related pain) were defined as the difference between the baseline score and the average of all the post-treatment scores for each patient. To allow for the potential confounding effect of analgesic consumption, patients without any increase in analgesic consumption during zoledronic acid treatment were also analyzed as a separate subgroup. RESULTS: Forty-eight patients with breast (34) or prostate cancer (14) were enrolled. At baseline, 100% of the patients had pain on movement, in 65% of them, the intensity ranged from moderate to very severe, in 61% of the patients, the intensity of pain on movement was higher than the intensity of pain at rest (average difference 0.89; 95% CI, 0.5-1.30). The estimated mean intensity reduction of pain at rest and on movement was: (a) 0.62 (95% CI, 0.28-0.98) and 0.79 (95% CI, 0.43-1.14), respectively, during the first 90 days of ZA treatment; (b) 0.59 (95% CI, 0.23-0.96) and 0.86 (95% CI, 0.49-1.23), respectively, during the entire treatment and follow-up period. Analgesic consumption decreased or was stable on average in 31 and 27%, respectively, of available follow-up data. In the 14 patients with decreased or stable analgesic consumption, pain reduction was 0.61 and 1.01, respectively. CONCLUSIONS: In this study, at baseline, all the patients with painful bone metastases experience movement-related pain, and during zoledronic acid treatment, a decrease for both pain at rest and on movement was obtained %0 Journal Article %C Patient-centered Education and Research, Salt Lake City, UT 84103, United States %A Goodlin, SJ %A Trupp, R %A Bernhardt, P %A Grady, KL %A Dracup, K %J Patient Educ Couns %D 2007 Feb %T Development and evaluation of the "Advanced Heart Failure Clinical Competence Survey": A tool to assess knowledge of heart failure care and self-assessed competence %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17331693 %X OBJECTIVE: We developed a tool to identify self-assessment of skills for advanced HF assessment and management and knowledge of HF care. METHODS: A framework for nursing competency in HF care was developed and its face validity confirmed through expert review. An initial instrument was pilot tested and revised. The survey tool was validated via administration to nurses expert in HF care and nurses novice in HF care. Descriptive statistics were used to identify sample characteristics; t-tests and Chi-square analysis were used to compare the novice and expert groups. An Analysis of Variance (ANOVA) was performed to test whether expert scores differed from novice scores. RESULTS: Thirty-six HF "expert" nurses and 85 hospice "novice" nurses completed the survey. The survey took 19.6min on average (mean) with a mode of 15min to complete. Self assessment of competence resulted in generally lower ratings by novice nurses (mean=69.6; S.D.=10.5) than by expert nurses (mean=81.9; S.D.=6.7), t (119)=6.47, p<0.001. HF nurse experts scored themselves less comfortable than did the hospice nurses in the three questions that dealt with coping, bereavement, and communication about dying and prognosis. The mean knowledge scores for experts (30.3; S.D.=2.5) were significantly higher than for novices (22.1; S.D.=4.0), t (119)=11.47, p<0.001. The standardized alpha coefficient of the survey was 0.78 for the questions about knowledge, indicating acceptable reliability of the survey as a tool to discriminate knowledge. Many novice nurses over-estimated their competence in HF assessment and prognostication compared to their performance on the knowledge portion of the survey. CONCLUSION: The Advanced Heart Failure Clinical Competence Survey adequately distinguishes between novice nurses' self-assessment of skills and their demonstrated knowledge of HF assessment and management and those of HF nurse experts. Practice implications The Advanced Heart Failure Clinical Competence Survey can identify hospice nurses' confidence and knowledge or the need for education to enable patient and family education and counseling regarding self-care, medications, distressing symptoms and approaching the end of life %0 Journal Article %A Roy, David J %J J Palliat Care %D 2006 Winter %N 4 %P 259-60 %T During a long night of suffering... take time to remember! %V 22 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17263051 %0 Journal Article %C The Ethox Centre, University of Oxford, Gibson Building/Block 21, Radcliffe Infirmary, Woodstock Road, Oxford OX2 6HE, UK. michael.parker@ethox.ox.ac.uk %A April, Carolyn %A Parker, Michael %J J Med Ethics %D 2007 Mar %N 3 %P 126-7 %T End of life decision-making in neonatal care %V 33 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17329378 %0 Journal Article %C Department of Adult Health Nursing and Program in Ethics, Rush University, Chicago, IL, USA. Marcia_D_Bosek@rush.edu %A DeWolf Bosek, Marcia Sue %A Stammer, Karen %J JONAS Healthc Law Ethics Regul %D 2006 Oct-Dec %N 4 %P 123-8 %T Ethical commitments during desperate times %V 8 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17149041 %0 Journal Article %C Department of GI Medicine and Nutrition, MD Anderson Cancer Center, Houston, Texas 77030, USA %A Ross, William A %A Alkassab, Firas %A Lynch, Patrick M %A Ayers, Gregory D %A Ajani, Jaffer %A Lee, Jeffrey H %A Bismar, Mike %J Gastrointest Endosc %D 2007 Jan %N 1 %P 70-6 %T Evolving role of self-expanding metal stents in the treatment of malignant dysphagia and fistulas %V 65 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17185082 %X BACKGROUND: Self-expanding metal stents (SEMS) are touted as the cornerstone of endoscopic palliation of unresectable esophageal cancer. However, usage at MD Anderson has fallen in recent years, despite a greater volume of patients with esophageal cancer. OBJECTIVE: To compare our more recent experience with that of earlier reported institutional experience and to assess how esophageal stent use has evolved. DESIGN: A retrospective chart review. SETTING: A tertiary referral cancer center. PATIENTS: Ninety-seven patients with malignant dysphagia who had SEMS placed from 2000 to 2003. INTERVENTIONS: Placement of SEMS for malignant disease. MAIN OUTCOMES MEASUREMENTS: Dysphagia scores, overall survival, and complication rates. RESULTS: Dysphagia scores improved in 86%, and tracheoesophageal fistula symptoms improved in 90%. Complications were seen in a majority of the patients and major complications in 37%. Ten patients had hematemesis, migrations occurred in 5, and early unexpected deaths in 2. Adenocarcinoma and female sex were factors associated with increased odds of a major complication. Prior chemoradiation, age, stricture location, and length were not associated with complications. Median survival was 77 days. LIMITATIONS: Noncomparative retrospective single-center study. CONCLUSIONS: SEMS fall short of an ideal palliative method, because complications that require additional intervention are frequent. Usage has declined despite higher numbers of patients with esophageal cancer. However, for patients with tracheoesophageal fistulas, SEMS are the treatment of choice. For patients who are not candidates for chemoradiation or who failed to achieve adequate palliation with such therapy, SEMS offer a viable, albeit imperfect, endoscopic approach %0 Journal Article %C ASIH Langbro Park, Unit for Palliative Medicine and Advanced Medical Home Care, Alvsjo, Sweden. lisa.sand@comhem.se %A Sand, Lisa %A Strang, Peter %J J Palliat Med %D 2006 Dec %N 6 %P 1376-87 %T Existential loneliness in a palliative home care setting %V 9 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17187546 %X BACKGROUND: The diagnosis of an incurable disease implies an existential crisis. This study focused on the emotions, perceptions, and experiences of existential isolation in palliative patients with cancer and their families. MATERIALS AND METHODS: A total of 40 respondents (20 patients and 20 family members) were interviewed in depth. All were Swedes who defined themselves as nonreligious. The patients were enrolled in an advanced hospital-based home care team. The interviews were taped, transcribed, and analyzed with a qualitative, hermeneutic method. RESULTS: The data revealed experiences of existential loneliness with the impending death as a primary source. Experiences of being alone in "a world of one's own" were common. The changes in everyday life and the increasingly restricted social interaction because of the illness meant that the patient partly lost the protection against isolation that the spirit of community normally provides. Other situations that had a triggered the existential isolation were, for example, when a patient in need of support was left alone, when he or she was treated disrespectfully or in a way that made him or her feel invisible, or when people avoided contact because of uneasiness or fear. Changes in one's own body and mood gave rise to feelings of loneliness and unfamiliarity toward oneself. When a staff member touched the patient's body in a nonempathic way, this could induce feelings of being treated like an animal %0 Journal Article %C Department of Psychology, Trent University, 1600 West Bank Drive, Peterborough, Ont., Canada K9J 7B8. rorycoughlan@trentu.ca %A Coughlan, Rory %A Ward, Linda %J Int J Nurs Stud %D 2007 Jan %N 1 %P 47-57 %T Experiences of recently relocated residents of a long-term care facility in Ontario: assessing quality qualitatively %V 44 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=16413555 %X BACKGROUND: Canadians overwhelmingly support universal coverage for health services and seniors' entitlement to high standards of care in long-term care facilities (LTCFs). Government rhetoric reflects these values, but claims of fiscal prudence often means translation into policy and improved care is uneven. Ontario is moving towards standardized "quality of care" measures, but such measures often ignore residents' views and socio-psychological issues. OBJECTIVES AND SETTING: Assessment of residents' experiences in a new "state of the art" LTCF and their understanding of "quality of care" shortly after relocation from two older hospital style facilities. DESIGN AND METHODS: Unobtrusive observations of activities of residents and staff in the LTCF by several researchers generated an analysis of field notes. In addition, one-on-one, in-depth, semi-structured interviews with residents generated qualitative interview data, analyzed utilizing a grounded theory approach. PARTICIPANTS: All residents deemed either moderately cognitively impaired or not impaired were invited to participate. Of these two groups, 18 seniors (five male and 13 female) with a mean age of 84.35yr agreed to be interviewed. Participants were all Caucasian and from a wide variety of social-economic levels. RESULTS: Two meta-themes "Relationships are the foundation of quality care" and "Waiting, activity & grieving loss of personhood" best explained residents' experiences of the LTCF. The two meta-themes were inter-connected and reflected the centrality of socio-psychological "quality of life" issues, especially resident-staff relationships as prominent aspects of seniors' understanding of quality of care. Improvements in facilities and programs were undermined by inattention to staff-patient ratios and continuity in staffing. CONCLUSIONS: Seniors said little regarding the fabulous new facility, but discussed quality of care as a socio-psychological concept intimately connected to staff relations. Government and administrative inattention to issues of sufficient funding for staff, relationship needs and continuity of care for seniors threatened to undermine residents' experiences of meaning, as well as any potential benefits from facilities and program improvements %0 Journal Article %C Ages, Health & Society Department, Institut Universtaire Kurt Bosch/Sion, and Social & Preventive Medicine Institute, Faculty of Medicine, Geneva University, Geneva, Switzerland %A Mpinga, Emmanuel Kabengele %A Pennec, Sophie %A Gomes, Barbara %A Cohen, Joachim %A Higginson, Irene J %A Wilson, Donna %A Rapin, Charles-Henri %J J Palliat Care %D 2006 Winter %N 4 %P 293-6 %T First international symposium on places of death: an agenda for the 21st century %V 22 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17263057 %0 Journal Article %C Purdue University, West Lafayette, Indiana, USA. servaty@perdue.edu %A Mathews, Laura L %A Servaty-Seib, Heather L %J Death Stud %D 2007 Mar %N 3 %P 183-204 %T Hardiness and grief in a sample of bereaved college students %V 31 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17330354 %X The relationship between hardiness and both grief symptoms and personal growth were investigated in a sample of bereaved college students. Hardiness was inversely associated with grief symptoms and offered prediction of grief misery above and beyond that provided by more commonly investigated individual and death-related variables. Hardiness was not linearly associated with personal growth; however, results suggest the need for future research focused on the comprehensive evaluation of the potential non-linear relationship between these constructs. Closeness to the deceased was a significant and linear predictor of personal growth. Directions for future research and implications for practice are discussed %0 Journal Article %C University of California, San Francisco, San Francisco, CA 94110, USA. sdeeks@php.ucsf.edu %A Deeks, Steven G %A Lu, Jing %A Hoh, Rebecca %A Neilands, Torsten B %A Beatty, George %A Huang, Wei %A Liegler, Teri %A Hunt, Peter %A Martin, Jeffrey N %A Kuritzkes, Daniel R %J J Infect Dis %D 2007 Feb %N 3 %P 387-91 %T Interruption of enfuvirtide in HIV-1 infected adults with incomplete viral suppression on an enfuvirtide-based regimen %V 195 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17205477 %X Many antiretroviral drugs continue to exert an anti-human immunodeficiency virus (HIV) benefit in the presence of drug resistance mutations. The degree to which enfuvirtide exerts continued antiviral activity in the presence of incomplete viral suppression has not been defined. To address this question, 25 subjects interrupted enfuvirtide while remaining on a stable background regimen. Enfuvirtide interruption was associated with an immediate but limited increase in plasma HIV-1 RNA levels. Enfuvirtide resistance waned rapidly in the absence of drug pressure and was no longer detectable by week 16 in most individuals. These data indicate that enfuvirtide has measurable antiviral activity in the setting of incomplete viral suppression. Although enfuvirtide resistance mutations are associated with significant fitness defects in vivo, the clinical significance of these mutations remains undefined %0 Journal Article %J Harv Heart Lett %D 2007 Feb %N 6 %P 7 %T Is there an afterlife for pacemakers and defibrillators? %V 17 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17330326 %0 Journal Article %C Primary Palliative Care Research Group, Division of Community Health Sciences: General Practice, University of Edinburgh, Edinburgh, Scotland, UK %A Murray, Scott A %A Mitchell, Geoffrey K %A Burge, Fred %A Barnard, Alan %A Nowels, David %A Charlton, Rodger %J J Palliat Care %D 2006 Summer %N 2 %P 115-6 %T It's time to develop primary care services for the dying %V 22 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17265665 %0 Journal Article %C Primary Palliative Care Research Group, Division of Community Health Sciences: General Practice Section, University of Edinburgh, EH8 9DX %A Kendall, M %A Harris, F %A Boyd, K %A Sheikh, A %A Murray, SA %A Brown, D %A Mallinson, I %A Kearney, N %A Worth, A %J BMJ %D 2007 Feb %T Key challenges and ways forward in researching the "good death": qualitative in-depth interview and focus group study %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17329313 %X OBJECTIVE: To understand key challenges in researching end of life issues and identify ways of overcoming these. DESIGN: Qualitative study involving in-depth interviews with researchers and focus groups with people affected by cancer. PARTICIPANTS: An international sample of 32 researchers; seven patients with experience of cancer; and four carers in south east Scotland. RESULTS: Researchers highlighted the difficulty of defining the end of life, overprotective gatekeeping by ethics committees and clinical staff, the need to factor in high attrition rates associated with deterioration or death, and managing the emotions of participants and research staff. People affected by cancer and researchers suggested that many people nearing the end of life do want to be offered the chance to participate in research, provided it is conducted sensitively. Although such research can be demanding, most researchers believed it to be no more problematic than many other areas of research and that the challenges identified can be overcome. CONCLUSIONS: The continuing taboos around death and dying act as barriers to the commissioning and conduct of end of life research. Some people facing death, however, may want to participate in research and should be allowed to do so. Ethics committees and clinical staff must balance understandable concern about non-maleficence with the right of people with advanced illness to participate in research. Despite the inherent difficulties, end of life research can be conducted with ethical and methodological rigour. Adequate psychological support must be provided for participants, researchers, and transcribers %0 Journal Article %C Department of Obstetrics and Gynecology, University Campus Bio-Medico, Rome, Italy %A Angioli, R %A Palaia, I %A Calcagno, M %A Manci, N %A Zullo, M A %A Bellati, F %A Perniola, G %A de Vivo, A %A Benedetti Panici, P %J Int J Gynecol Cancer %D 2007 Jan-Feb %N 1 %P 88-93 %T Liposome-encapsulated doxorubicin citrate in previously treated recurrent/metastatic gynecological malignancies %V 17 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17291237 %X The aim of this study was to evaluate the safety and efficacy of liposome-encapsulated doxorubicin citrate (LEDC) in patients affected by recurrent/metastatic gynecological malignancies scheduled for palliative chemotherapy. Inclusion criteria were proven recurrent/advanced gynecological neoplasms, measurable/assessable disease, adequate organ function, left ventricular ejection fraction >50% as determined by echocardiography, informed consent. LEDC was administered intravenously over 1 h at the dose of either 75 mg/m(2) or 60 mg/m(2) (every 3 weeks until disease progression or toxicity prohibiting further therapy). From May 2003 to September 2005, 36 patients were enrolled. Primary disease was ovarian, endometrial, and cervical cancers in 15 (42%), 11 (30%), and 10 (28%) patients, respectively. LEDC was employed as third- or fourth-line chemotherapy in 25 (70%) and 11 (30%) patients, respectively. The median number of courses of LEDC received was 3 (range 2-9). Six patients (17%) achieved a partial response to treatment lasting 27 weeks and 10 patients (28%) experienced stable disease lasting 18 weeks. The predominant toxicity was hematological, especially neutropenia. Among patients receiving a dose of 75 mg/m(2), two (11%) suspended therapy for febrile neutropenia, and nine (50%) required a dose reduction of 25%. As a result, the next 18 patients were treated at a reduced dose (60 mg/m(2)) of LEDC. Severe neutropenia (G3-G4) was significantly less common in this group (61% versus 22%; P= 0.04). LEDC has shown antineoplastic activity in previously treated recurrent/metastatic gynecological cancer patients and the toxicity profile could be considered acceptable at a 60 mg/m(2) dosage %0 Journal Article %C Child Health and Illness, Faculty of Nursing, University of Manitoba, Winnipeg, Manitoba, Canada %A Woodgate, Roberta Lynn %J J Palliat Care %D 2006 Summer %N 2 %P 75-82 %T Living in a world without closure: reality for parents who have experienced the death of a child %V 22 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17265659 %X The death of a child has been described as being for parents one of the most traumatic of losses. Nevertheless, information about how parents experience transition through the death trajectory is lacking. This phenomenological study explored parents' lived experienced of transitioning through the death of a child. Twenty-eight bereaved parents (17 mothers, 11 fathers) took part in retrospective, open-ended interviews. Findings showed that, regardless of the time, parents continued to live in a world without closure and, more importantly, did not want to experience closure in their transitioning. To parents, "closure" meant an end to their child in every sense of the word. Their experience of living in a world without closure was supported by four themes: "keeping the memories alive", "being a good parent", "being there at my child's death", and "being there for me after my child dies". Findings yield new insights into how parents live with the death of a child %0 Journal Article %C Department of Internal Medicine, University of Nevada School of Medicine, Reno, USA %A Chau, Diane L %A Mason, M Nathan %J J Opioid Manag %D 2005 Nov-Dec %N 5 %P 244-8 %T Methadone in end-of-life pain management %V 1 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17319557 %0 Journal Article %A Cardona, Andres Felipe %A Garzon, Javier Ricardo %A Burgos, Erick %A Abenoza, Lina Maria %A Cortes, Jorge Alberto %A Ramos, Pedro Luis %J J Palliat Care %D 2006 Winter %N 4 %P 315 %T Mortality and complications associated with percutaneous nephrostomy in patients with ureteral obstruction related to advanced cervical cancer %V 22 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17263063 %0 Journal Article %C National Technical University of Athens, School of Chemical Engineering, Unit of Environmental Science & Technology, 9 Heroon Polytechniou Str., Zografou Campus, 15773 Athens, Greece %A Mergias, I %A Moustakas, K %A Papadopoulos, A %A Loizidou, M %J J Hazard Mater %D 2007 Jan %T Multi-criteria decision aid approach for the selection of the best compromise management scheme for ELVs: The case of Cyprus %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17324504 %X Each alternative scheme for treating a vehicle at its end of life has its own consequences from a social, environmental, economic and technical point of view. Furthermore, the criteria used to determine these consequences are often contradictory and not equally important. In the presence of multiple conflicting criteria, an optimal alternative scheme never exists. A multiple-criteria decision aid (MCDA) method to aid the Decision Maker (DM) in selecting the best compromise scheme for the management of End-of-Life Vehicles (ELVs) is presented in this paper. The constitution of a set of alternatives schemes, the selection of a list of relevant criteria to evaluate these alternative schemes and the choice of an appropriate management system are also analyzed in this framework. The proposed procedure relies on the PROMETHEE method which belongs to the well-known family of multiple criteria outranking methods. For this purpose, level, linear and Gaussian functions are used as preference functions %0 Journal Article %C University Hospital Freiburg, Germany %A Dreher, M %A Storre, JH %A Windisch, W %J Eur Respir J %D 2007 Mar %T Non-invasive ventilation during walking in patients with severe COPD: A randomized cross-over trial %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17331969 %X It was hypothesized that non-invasive positive pressure ventilation (NPPV) applied during walking avoids exercise induced hypoxemia and improves exercise performance in severe COPD patients already receiving long-term NPPV.Twenty COPD patients (65.1+/-8.7 years [mean+/-SD], FEV1 27+/-8 %predicted, TLC 116+/-27 %predicted) reporting dyspnoea even during mild exertion underwent two six minute walking tests with a rollator and supplemental oxygen (2.1+/-0.9 L.min(-1)) in a randomized cross-over design: with and without pressure-limited NPPV as used at home (inspiratory/expiratory pressure 29+/-4/4+/-1 mbar, respiratory rate 20+/-2.min(-1)).PaO2 after walking increased by 10.5+/-10.8 mmHg (95%CI 5.4/15.6 mmHg; P<0.001) with NPPV, but decreased by 10.8+/-8.0 mmHg (95%CI -14.5/-7.1 mmHg; P<0.001) without NPPV. dyspnoea as assessed by the Borg dyspnoea Scale decreased from 6 (interquartile range 4.5/10) to 4 (interquartile range 1.5/4.5) (P<0.001) and walking distance increased from 209 (interquartile range 178/279) to 252 (interquartile range 203/314) m (P=0.027) when walking was NPPV-aided.In chronic hypercapnic COPD high intensity NPPV can also be administered during walking with unchanged ventilator settings compared to settings used at rest, thus resulting in improved oxygenation, decreased dyspnoea and increased walking distance. Therefore, NPPV during walking could prevent hypoxia induced complications and could play a future role in palliative care %0 Journal Article %C School of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Level 1, 723 Swanston Street, Carlton, Victoria, Australia 3053. bucknall@unimelb.edu.au %A Bucknall, Tracey %A Manias, Elizabeth %A Botti, Mari %J Clin J Pain %D 2007 Jan %N 1 %P 1-7 %T Nurses' reassessment of postoperative pain after analgesic administration %V 23 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17277638 %X OBJECTIVES: To identify when and how nurses reassess patients' pain after analgesic administration in the postoperative context. METHODS: Fifty-two nurses were observed caring for postoperative patients (N=364) in 2 surgical settings in a major metropolitan hospital. Seventy-four observation periods of 2 hours duration were studied. The research assistant observed nurses' activities in caring for the allocated patients', detailing behavioral and verbal responses onto audiotape. RESULTS: Of the 316 pain activities that occurred in 74 observation periods, 14 (4.4%) were reassessments after analgesic administration. Four themes were evident from the 14 reassessments: opportunistic reassessment, the use of simple questioning, a focus on surgical wound pain not procedural pain, and nurse-initiated reassessment. CONCLUSIONS: Despite the focus on meeting standards of care in the area of pain management, there was an extraordinary lack of patient reassessment by nurses after the administration of analgesics. Given the raised awareness internationally on assessment generally and a lack of evidence focused on reassessment after an intervention, this may explain why research is failing to identify shifts in pain severity scores and indeed patient pain %0 Journal Article %C Faculty of Law, Queensland University of Technology %A Willmott, L %A White, Ben %A Howar, Michelle %J Med Law %D 2006 Dec %N 4 %P 647-61 %T Overriding advance refusals of life-sustaining medical treatment %V 25 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17263032 %X The law recognises the right of a competent adult to make an advance refusal of life-sustaining medical treatment. This right is based on the principle of self-determination which dictates that a competent adult is entitled to make decisions about the kind of treatment he or she wants to receive or not to receive. However, the right to refuse life-sustaining treatment in advance is not unqualified. There are circumstances in which a health professional or a court will be entitled to disregard an advance directive and provide the life-sustaining medical treatment. This intervention is justified on the grounds of the State's interest in preserving life. Although self-determination prevails over the State's interest in life, the courts have held that an adult's wishes need only be respected if the adult has expressed them clearly and there is otherwise no uncertainty. This paper explores in some detail the common law and statutory excuses available to health professionals in Australia who do not wish to comply with directions in an advance directive to refuse life-sustaining medical treatment. At common law, the inquiry revolves around whether the adult intended his or her refusal to apply to the circumstances that have subsequently arisen. The paper considers the different situations in which it might be argued that an adult completed an advance directive but did not intend it to apply, thus permitting a health professional to disregard it. In contrast, the relevant Australian statutes specify a number of excuses that expressly allow a health professional not to follow an advance directive, or prohibit him or her from following it. The paper then compares the common law with those jurisdictions that have enacted legislation and critiques the different excuses available. The paper concludes by asserting that the law generally strikes the correct balance between requiring an advance directive to be followed but not enforcing a direction to refuse life-sustaining medical treatment where there is some doubt about whether it presents the adult's views. However, there are two riders to this proposition. The first is the tendency of the judiciary to err unduly in favour of the sanctity of life when it is called upon to interpret whether an advance directive can be regarded as representing the adult's wishes in the situation that subsequently arose. Secondly, comment is made about the recognition in one statutory jurisdiction of an excuse that permits a health professional to provide treatment contrary to an advance refusal based on good medical practice %0 Journal Article %C Visiting Nurse Association Care Network/Hospice in Worcester, Massachusetts, USA. rryanmms@verizon.net %A Ryan, Rosemary %J J Clin Ethics %D 2006 Winter %N 4 %P 344-8 %T Palliative care for "Margaret" %V 17 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17330728 %0 Journal Article %C Department of Anesthesiology, Yale University School of Medicine, Yale New Haven Children's Hospital, 333 Cedar St, TMP-3, New Haven, CT 06520-8051, USA. brenda.mcclain@yale.edu %A McClain, Brenda C %A Kain, Zeev N %J Pediatrics %D 2007 Mar %N 3 %P 612-4 %T Pediatric palliative care: a novel approach to children with sickle cell disease %V 119 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17332215 %0 Journal Article %C Eijkman-Winkler Center, Department of Virology, University Medical Center Utrecht, Utrecht, The Netherlands %A van Maarseveen, Noortje M %A Wensing, Annemarie M J %A de Jong, Dorien %A Taconis, Maaike %A Borleffs, Jan C C %A Boucher, Charles A B %A Nijhuis, Monique %J J Infect Dis %D 2007 Feb %N 3 %P 399-409 %T Persistence of HIV-1 variants with multiple protease inhibitor (PI)-resistance mutations in the absence of PI therapy can be explained by compensatory fixation %V 195 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17205479 %X OBJECTIVE: To investigate the mechanism explaining the persistence of human immunodeficiency virus (HIV) type 1 variants with multiple protease inhibitor (PI)-resistance mutations in the absence of PI therapy. METHODS: Longitudinal genotypic analyses were performed on sequential samples obtained from 2 HIV-1-infected patients who had stopped PI therapy for 4 years. Replication capacity (RC) was determined using recombinant viruses. Subsequently, the effect that changing individual protease mutations back to wild type has on RC was analyzed. RESULTS: We observed prolonged persistence (up to 4 years) of viruses with multiple protease mutations after PI therapy was stopped, despite the fact that the RC of the viruses was severely reduced. Forcing the virus to evolve toward wild type by changing individual protease mutations to wild type was unsuccessful, because all variants displayed a decreased RC in comparison with that of their predecessors. CONCLUSIONS: We propose compensatory fixation as a mechanism for the in vivo persistence of variants with multiple PI-resistance mutations in the absence of PI therapy. Viruses with multiple PI mutations have (partially) compensated for the initial loss in RC. Therefore, reversion of a single mutation causes a (further) reduction in RC and, as a consequence, the route to wild type is blocked %0 Journal Article %C H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA %A Tanvetyanon, Tawee %A Choudhury, Abdul M %J J Palliat Care %D 2006 Winter %N 4 %P 281-5 %T Physician practice in the discontinuation of statins among patients with advanced lung cancer %V 22 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17263055 %X BACKGROUND: Statins are effective in reducing events from coronary heart disease and can prolong survival. However, this benefit is controversial when other concurrent serious health problems greatly limit the patient's longevity. METHODS: We conducted a retrospective chart review of patients with advanced lung cancer who were receiving statins and had lived for at least one month since diagnosis. FINDINGS: Forty-seven patients with median age of 71 years were included. Discontinuation of statins occurred in 25 patients (53.2%) before the date of death. Median survival was 370 days. Statins were discontinued at a median of 244 days after cancer diagnosis. Discontinuations were more prevalent in patients who received chemotherapy or had a history of cerebrovascular diseases. Lipid monitoring was observed in 25 patients (53.2%). INTERPRETATION: About half of patients with advanced lung cancer who were prescribed statins did not have this drug discontinued until the time of death. Lipid monitoring was suboptimal and, when it occurred, indicated the lipid goal was rarely achieved %0 Journal Article %C Department of Gastroenterology, Belfast City Hospital, Northern Ireland, United Kingdom %A Quinn, Cathy %A Johnston, Simon D %J Gastrointest Endosc %D 2007 Jan %N 1 %P 175-7 %T Portobiliary fistula at ERCP %V 65 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17185103 %0 Journal Article %C Department of Social Policy and Social Work, University of Oxford, Oxford, United Kingdom. don.operario@socres.ox.ac.uk %A Operario, Don %A Pettifor, Audrey %A Cluver, Lucie %A MacPhail, Catherine %A Rees, Helen %J J Acquir Immune Defic Syndr %D 2007 Jan %N 1 %P 93-8 %T Prevalence of parental death among young people in South Africa and risk for HIV infection %V 44 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17075394 %X OBJECTIVES: This study estimated the prevalence and sociodemographic characteristics of young people in South Africa who have experienced parental death and examined associations between parental death and young people's HIV status and sexual behaviors. DESIGN AND METHODS: Data were from a cross-sectional nationally representative household survey of 11,904 15- to 24-year-old South Africans. Surveys included items on sexual behavior and family composition, and oral fluid samples were collected to test for HIV status. RESULTS: The prevalence of parental death was 27.3% overall: 22.4% reported a father deceased, 7.9% reported a mother deceased, and 3.0% reported both parents deceased. Parental death was disproportionately associated with black ethnicity, impoverished household living conditions, lack of an adult guardian in the home, and not completing compulsory education levels. Controlling for sociodemographic factors, parental death among female participants was significantly associated with HIV-positive status (odds ratio [OR] = 1.25, 95% confidence interval [CI]: 1.08 to 1.44), ever having had oral sex (OR = 1.23, 95% CI: 1.02 to 1.49), ever having had vaginal sex (OR = 1.38, 95% CI: 1.19 to 1.60), and having more than 1 sex partner during the past year (OR = 1.33, 95% CI: 1.07 to 1.64). Among male participants, parental death was significantly associated with ever having had vaginal sex (OR = 1.19, 95% CI: 1.04 to 1.36) and having unprotected sex at the last sexual episode (OR = 1.23, 95% CI: 1.07 to 1.42). CONCLUSIONS: More than one quarter of young South Africans have experienced parental death. Death of a parent is associated with young female South Africans' HIV status and sexual behaviors among young female and male South Africans. HIV prevention interventions are necessary to address the specific needs of young South Africans who have experienced parental death %0 Journal Article %C Department of Public and Occupational Health and EMGO Institute, Vrije Universiteit Medical Centre, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands %A Jansen-van der Weide, Marijke Catharina %A Onwuteaka-Philipsen, Bregje Dorien %A van der Wal, Gerrit %J Health Policy %D 2007 Jan %N 1 %P 97-106 %T Quality of consultation and the project 'Support and Consultation on Euthanasia in the Netherlands' (SCEN) %V 80 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=16621122 %X OBJECTIVE: Consultation of another physician is one of the requirements for prudent practice. The project 'Support and Consultation on Euthanasia in the Netherlands' (SCEN) is aimed at professionalizing consultation. The objective of this study is to assess whether the quality of consultation was improved through SCEN. METHOD: In four districts all general practitioners (GPs) received a pre-test questionnaire approximately six weeks before the start of the project in the period (n=1224, response 71%). In the period from April 2000 to December 2002, all GPs in districts in which SCEN had been implemented received a written post-test questionnaire one and a half years after the start of the project. This post-test questionnaire was returned by 60% of the GPs (n=3614). RESULTS: In SCEN consultations the attending physicians has no specific relation to the attending physician in 85% of consultations, while this is the case for 31% of other consultations. While before the start of SCEN in 71% of consultations six or seven of the seven criteria for good consultation were met, in SCEN consultations 83% of cases six or seven of these requirements were met. GPS who had consulted a SCEN physician generally were more positive about different aspects than those who consulted another consultant, such as considering the consultant to be able to make an independent judgement (totally agree 74% versus 59%). CONCLUSION: Although the quality of consultation appears to be high for both SCEN physicians and other consultants, the SCEN project further contributed to the quality of consultation. Since GPs attach importance to judgement of SCEN physician and have the intention to use it in future, and the quality of consultation stays high over time, this project is expected to maintain its value %0 Journal Article %C City of Hope National Medical Center, Duarte, Calif %A Otis-Green, Shirley %J Am J Crit Care %D 2007 Mar %N 2 %P 106-8 %T Reader sees need for transdisciplinary education model in palliative care %V 16 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17322007 %0 Journal Article %C Endocrine Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York, USA. rjrobbins@tmh.tmc.edu %A Robbins, Richard J %A Driedger, Albert %A Magner, James %J Thyroid %D 2006 Nov %N 11 %P 1121-30 %T Recombinant human thyrotropin-assisted radioiodine therapy for patients with metastatic thyroid cancer who could not elevate endogenous thyrotropin or be withdrawn from thyroxine %V 16 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17123339 %X The value of recombinant human thyrotropin (rhTSH) as preparation for radioiodine therapy was assessed in 115 patients with metastatic thyroid cancer. Patients who were either unable to elevate endogenous TSH during thyroxine withdrawal, or in whom thyroxine withdrawal was contraindicated for medical reasons were eligible. Their physicians requested rhTSH as part of the Thyrogen Compassionate Use Program. This is a retrospective summary of the nonrandomized uncontrolled experience. We assessed the ability of rhTSH to elevate the serum TSH; to avoid the complications of hypothyroidism; to stimulate radioiodine uptake; and to stimulate the serum thyroglobulin. Disease response and adverse events were also assessed. After rhTSH, the serum TSH levels rose to >or=25mU/L in every patient in whom levels were measured (n = 112). Hypothyroid complications were avoided in 22 of 25 patients who had experienced them in the past, and in 47 of 51 patients who were at high risk for hypothyroid complications. Radioiodine uptake was present on whole-body scans (WBS) in 105 of the 115 patients. Serum thyroglobulin levels were lower than baseline in 73% of patients assessed at 12 months. Cancer-related symptoms were improved in approximately 25%. Two patients had serious adverse events that were thought to be related to rhTSH. rhTSH elevates serum TSH and facilitates radioiodine uptake in patients who cannot produce endogenous TSH or who cannot tolerate hypothyroidism %0 Journal Article %C Addiction Recovery Systems, Family Addiction Treatment Centers, Rio Grande and Somers Point, NJ, USA %A Robinson, Carolyn Louise %J Health Prog %D 2007 Jan-Feb %N 1 %P 48-53, 70 %T Relieving pain in the elderly %V 88 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17274579 %X In 2000, people aged 65 and older made up 12.4 percent of the U.S. population. Between now and 2011, when the earliest-born of the baby-boom generation reaches that age, the nation will see a rapid growth in its senior citizen population. It has been estimated that pain occurs in from 45 percent to 85 percent of the geriatric population. Much of it is undertreated. Undertreated pain leads to other problems, including reduced quality of life, decreased socialization, depression, sleep disturbances, cognitive impairment, and malnutrition. For a population already vulnerable because of aging, the costs incurred by more frequent physician visits and hospitalizations can be financially devastating. Health professionals have a moral imperative to help elderly people in pain. The management of pain in geriatric patients can be complicated by the changing physiology that occurs with aging. Older people are also more likely to be living with multiple chronic diseases, necessitating many daily medications, thereby increasing the risk of negative drug-disease and drug-drug interactions. Older patients often show atypical presentations of pain. Depression can also play a role in the assessment and treatment of pain. For a number of reasons, many older people choose not to report their pain. Often they are afraid that they will be involuntarily hospitalized or subjected to invasive procedures if they report pain. Another important barrier to successful pain management is the fact that older people are often misinformed about the aging process, analgesics, pain management, and opioid addiction. Recognition of the problem of undertreatment of pain in older persons prompts the following question: What can be done to solve the problem? Educational in-service sessions improve the quality of patient care, because they improve providers' pain-management skills and attitudes. Patient education is also extremely important. When combined with teaching about self-management and coping strategies, it can improve the patient's pain management %0 Journal Article %A Payne, Sheila %J Nurs Older People %D 2006 Dec %N 11 %P 40 %T Sheila Payne %V 18 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17260600 %0 Journal Article %C Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA %A Sullivan, Mark D %A Mason, Lindsey M %J J Palliat Care %D 2006 Summer %N 2 %P 119-23 %T Slowly dying from sarcoidosis: a patient's story of hanging on and letting go %V 22 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17265667 %0 Journal Article %C Keech Cottage Childrens Hospice, The Pasque Charity. community@pasque.org %A Willis, Eleanor %J Paediatr Nurs %D 2007 Feb %N 1 %P 14-7 %T Symptom care flowcharts: a case study %V 19 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17326551 %X Parents who have a child with a life-limiting condition face the painful prospect of seeing their child's health deteriorate and of becoming involved on a practical level with increasingly complex care. An example of a child with a rare genetic disorder requiring palliative care is used to illustrate how one aspect of the support needs of parents can be met through the use of therapeutic flow charts. The case study shows how a symptom management flowchart was developed to help one family feel more confident in caring for their dying child. It enabled them to focus less on the illness and more on spending quality time as a family. The development of symptom care flowcharts enabled the professional team and parents to think through problems before they arose and to make joint decisions. They boosted the confidence of family and carers by providing them with clear information and advice. Flowcharts of this kind can help support parents and carers in ongoing situations where multiple carers are involved and the child's care needs change over time %0 Journal Article %C Division of Thoracic Surgery, Department of General Surgery and Surgical Specialities, University of Modena and Reggio Emilia, Italy %A Stefani, Alessandro %A Natali, Pamela %A Casali, Christian %A Morandi, Uliano %J Eur J Cardiothorac Surg %D 2006 Dec %N 6 %P 827-32 %T Talc poudrage versus talc slurry in the treatment of malignant pleural effusion. A prospective comparative study %V 30 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17113008 %X OBJECTIVE: The aim of this study was to investigate the effectiveness, safety and appropriate mode of administration of intrapleural talc for pleurodesis, in the treatment of malignant pleural effusion (MPE). METHODS: Prospective not randomized trial was conducted to compare thoracoscopic talc poudrage (TP) with tube thoracostomy and talc slurry (TS) for the local control of malignant pleural effusion. Both procedures were previously standardized; 6g of talc was administered for each procedure. Only the patients with lung re-expansion after drainage entered the study. Patients at high risk for general anaesthesia, poor general conditions and short life-expectancy received talc slurry through a chest tube, at the bedside. All the other patients underwent videothoracoscopic talc poudrage, with a pneumatic atomizer, under general anaesthesia. Morbidity, 30-day freedom from recurrence and long-term results were assessed and the two groups were compared. RESULTS: One hundred and nine patients entered the study (72 TP, 37 TS). Sixty-three patients in the TP group (87.5%) and 27 in the TS group (73%) had an immediate successful pleurodesis (p = 0.049); 53 patients (88.3%) and 16 patients (69.6%) had a successful pleurodesis 90 days after the procedure; 59 patients (81.9%) and 23 patients (62.2%), respectively, had a life-long pleural symphysis (p = 0.023). Adverse effects were generally mild: chest pain (36.1% in TP patients, 48.6% in TS patients) and fever (38.8% and 35.1%, respectively) were the more common but the difference was not significant between the two groups. We observed neither acute respiratory failure nor mortality due to the procedure. CONCLUSIONS: Our study confirms that intrapleural talc carries good results in the treatment of malignant pleural effusion. TP was significantly more effective than TS; both methods were safe but TS had a higher incidence of thoracic pain during the procedure. Talc pleurodesis should be offered to every patient with MPE, apart from terminally ill ones, provided that a satisfying lung re-expansion has been achieved. TP should be performed whenever possible; otherwise, a slurry bedside procedure will be worthwhile, even in patients with low performance status (PS), though poorer results have to be expected. A careful selection is essential to define the proper technique %0 Journal Article %C University of Pennsylvania Law School, USA %A Ruger, Theodore W %J J Law Med Ethics %D 2006 Winter %N 4 %P 817-20 %T The United States Supreme Court and health law: the year in review %V 34 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17199824 %0 Journal Article %C Department of Anaesthesia, Yong Loo Lin School of Medicine, National University of Singapore, Singapore %A Li, L L M %A Cheong, K Y P %A Yaw, L K %A Liu, E H C %J Anaesth Intensive Care %D 2007 Feb %N 1 %P 46-51 %T The accuracy of surrogate decisions in intensive care scenarios %V 35 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17323665 %X Critically ill patients are often unable to make decisions about life-sustaining treatments and surrogate decision-makers are relied upon. However, it is unclear how accurately the surrogates' decisions reflect patients' intentions and expectations. We interviewed 36 pairs of patients and their appointed surrogate decision-makers about their decisions regarding nine treatments in each of three scenarios. The scenarios were persistent vegetative state, coma with likely neurological damage and chronic disease with dementia. The patients were interviewed 24 hours after they had undergone elective surgery under general anaesthesia. The surrogates were interviewed separately by the same interviewer. There was poor agreement between decisions made by the patients and their surrogates. The patients' and surrogates' summary scores (median (interquartile range) [range]) for treatments were 0 (0-4) [0-9] vs 8 (0-9) [0-9] for the vegetative state scenario, 3 (0-9) [0-9] vs 9 (0-9) [0-9] for the coma scenario and 3 (0-9) [0-9] vs 9 (4-9) [0-9] for the chronic disease scenario. The significantly higher surrogate scores suggest that the surrogates' decisions would have resulted in the patients having far more treatment than the patients would have wanted. In our participants, there was poor agreement between the decisions made by surrogates and patients. Further study is needed on measures such as facilitated discussions, advance directives and the difficulties that surrogates face, in order to improve the accuracy of surrogates' decisions and respect of patients' autonomy %0 Journal Article %C Massachusetts General Hospital, USA. jholman@partners.org %A Holman, Julieta Bleichmar %A Brendel, David H %J J Clin Ethics %D 2006 Winter %N 4 %P 333-8 %T The ethics of palliative care in psychiatry %V 17 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17330725 %0 Journal Article %C John Jay College of Criminal Justice (CUNY) in New York, NY 10019, USA. jkaplow@jjay.cuny.edu %A Kaplow, Julie B %A Saxe, Glenn N %A Putnam, Frank W %A Pynoos, Robert S %A Lieberman, Alicia F %J Psychiatry %D 2006 Winter %N 4 %P 362-75 %T The long-term consequences of early childhood trauma: a case study and discussion %V 69 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17326730 %X There is a great need to better understand the impact of traumatic events very early in life on the course of children's future development. This report focuses on the intriguing case of a girl who witnessed the murder of her mother by her father at the age of 19 months and seemed to have no recollection of this incident until the age of 11, when she began to exhibit severe symptoms of posttraumatic stress disorder (PTSD) in response to a traumatic reminder. The case presentation serves as the basis for a discussion regarding pertinent issues involved in early childhood trauma. This case and accompanying discussion were originally presented at the 19th Annual Meeting of the International Society for Traumatic Stress Studies and were transcribed and revised for use in this article. Specific topics include early childhood memory and trauma, learning and the appraisal of danger, and PTSD and traumatic grief in early childhood. Clinical and public health implications are also discussed. This case illustrates the dramatic impact that "preverbal" traumatic memories can have on children's later functioning and speaks to the importance of assisting very young children in the immediate aftermath of traumatic events %0 Journal Article %C Department of Radiation Oncology, The Cancer Institute, National University Hospital, Singapore. Jeremy_Tey@mail.nhg.com.sg %A Tey, Jeremy %A Back, Michael F %A Shakespeare, Thomas P %A Mukherjee, Rahul K %A Lu, Jiade J %A Lee, Khai Mun %A Wong, Lea Choung %A Leong, Cheng Nang %A Zhu, Ming %J Int J Radiat Oncol Biol Phys %D 2007 Feb %N 2 %P 385-8 %T The role of palliative radiation therapy in symptomatic locally advanced gastric cancer %V 67 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17118569 %X PURPOSE: To review the outcome of palliative radiotherapy (RT) alone in patients with symptomatic locally advanced or recurrent gastric cancer. METHODS AND MATERIALS: Patients with symptomatic locally advanced or recurrent gastric cancer who were managed palliatively with RT at The Cancer Institute, Singapore were retrospectively reviewed. Study end points included symptom response, median survival, and treatment toxicity (retrospectively scored using the Common Toxicity Criteria v3.0 [CTC]). RESULTS: Between November 1999 and December 2004, 33 patients with locally advanced or recurrent gastric cancer were managed with palliative intent using RT alone. Median age was 76 years (range, 38-90 years). Twenty-one (64%) patients had known distant metastatic disease at time of treatment. Key index symptoms were bleeding (24 patients), obstruction (8 patients), and pain (8 patients). The majority of patients received 30 Gy/10 fractions (17 patients). Dose fractionation regimen ranged from an 8-Gy single fraction to 40 Gy in 16 fractions. Median survival was 145 days, actuarial 12-month survival 8%. A total of 54.3% of patients (13/24) with bleeding responded (median duration of response of 140 days), 25% of patients (2/8) with obstruction responded (median duration of response of 102 days), and 25% of patients (2/8) with pain responded (median duration of response of 105 days). No obvious dose-response was evident. One Grade 3 CTC equivalent toxicity was recorded. CONCLUSION: External beam RT alone is an effective and well tolerated modality in the local palliation of gastric cancer, with palliation lasting the majority of patients' lives %0 Journal Article %A Syrett, Michel %J Ment Health Today %D 2007 Feb %P 24 %T This life. Articulating the pain and grief is such an important part of the recovery process %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17328314 %0 Journal Article %C Department of Otolaryngology-Head and Neck Surgery, Edith Wolfson Medical Center, Holon, Israel %A Cinamon, Udi %A Levy, Dalia %A Sokolov, Maxim %A Hayat, Henri %A Roth, Yehudah %J J Palliat Care %D 2006 Winter %N 4 %P 309-11 %T Total laryngectomy as a palliative procedure for a patient with advanced laryngeal and colon cancers: dilemmas %V 22 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17263061 %0 Journal Article %C *Department of Palliative Care, Policy and Rehabilitation, King's College London School of Medicine, Weston Education Centre, London, United Kingdom, daggerUniversity of Cape Town, Cape Town, South Africa, double daggerAfrican Palliative Care Association, Uganda %A Harding, R %A Gwyther, L %A Powell, FM %J J Acquir Immune Defic Syndr %D 2007 Mar %N 3 %P 364 %T Treating HIV/AIDS Patients Until the End of Life %V 44 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17327759 %0 Journal Article %C St Oswald's Hospice, Newcastle City Hospitals NHS Trust and Northgate and Prudhoe NHS Trust, Newcastle Upon Tyne, UK %A Regnard, C %A Reynolds, J %A Watson, B %A Matthews, D %A Gibson, L %A Clarke, C %J J Intellect Disabil Res %D 2007 Apr %N 4 %P 277-292 %T Understanding distress in people with severe communication difficulties: developing and assessing the Disability Distress Assessment Tool (DisDAT) %V 51 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17326809 %X Background Meaningful communication with people with profound communication difficulties depends on the ability of carers to recognize and translate many different verbal cues. Carers appear to be intuitively skilled at identifying distress cues, but have little confidence in their observations. To help in this process, a number of pain tools have been developed, but this sits uncomfortably with the lack of evidence that pain has any specific signs or behaviours. A palliative care team working with people with intellectual disabilities developed the Disability Distress Assessment Tool (DisDAT) to document a wide range of signs and behaviours of distress and when an individual is content. Method The tool was piloted with 16 carers and 8 patients. It was then assessed using quantitative and qualitative methods, employing 56 carers in routine clinical situations with 25 patients, most with severe communication difficulties. Carers of 10 patients participated in semi-structured interviews exploring the signs and behaviours demonstrated by patients when distressed and when content. These same 10 patients were observed for distress cues during different activities. Results It became clear that distress did not have a common meaning among carers, but there was a clear understanding that distress did not just cover physical pain. The range of distress cues was wide, with no evidence that any cues were specific to particular causes. Although some distress cues were common between patients, each patient had a distinct pattern of distress cues. In addition, different carers identified a different range of distress cues, while the length of the relationship did not influence the number of cues identified. Most distress cues were a change from the norm, but some patients demonstrated distress as an absence of content cues. Carers found the DisDAT simple to use and useful, and several felt that DisDAT would have helped advocate for the patients in previous conflicts with clinical teams. Conclusions There was no evidence that pain has any specific signs or behaviours. The preliminary and assessment phases showed that distress was a useful clinical construct in providing care. The DisDAT reflected patients' distress communication identified by a range of carers, and provided carers with evidence for their intuitive observations of distress %0 Journal Article %C VA New Jersey Health Care System, PDIA Faculty Scholar, East Orange, New Jersey 07018, USA. Victor.chang@med.va.gov %A Chang, Victor T %A Janjan, Nora %A Jain, Subash %A Chau, Chi %J J Palliat Med %D 2006 Dec %N 6 %P 1414-34 %T Update in cancer pain syndromes %V 9 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17187550 %X Cancer pain assessment and management are integral to palliative medicine. This paper reviews recent publications in the period 1999-2004 in the broad categories of epidemiology, pain assessment, nonpharmacologic approaches to cancer pain (radiation therapy, anesthetic blocks, palliative surgery and chemotherapy, complementary and alternative medicine), and in nociceptive pain, neuropathic pain, visceral pain, and bone pain %0 Journal Article %C Department of Public Health, Erasmus MC, P.O. Box 2040, 3000CA Rotterdam, The Netherlands, j.rietjens@erasmusmc.nl %A Rietjens, Judith A C %A Bilsen, Johan %A Fischer, Susanne %A Van Der Heide, Agnes %A Van Der Maas, Paul J %A Miccinessi, Guido %A Norup, Michael %A Onwuteaka-Philipsen, Bregje D %A Vrakking, Astrid M %A Van Der Wal, Gerrit %J Death Stud %D 2007 Mar %N 3 %P 205-21 %T Using drugs to end life without an explicit request of the patient %V 31 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17330359 %X A small proportion of deaths result from the use of drugs with the intention to hasten death without an explicit request of the patient. Additional insight into its characteristics is needed for evaluating this practice. In the Netherlands in 2001, questionnaires were mailed to physicians that addressed the decision making that preceded their patient's death. Cases of ending life without an explicit request of the patient were compared with similar cases from 1995 and with cases from Belgium, Denmark, and Switzerland. In the Netherlands in 2001, patients receiving life-ending drugs without their explicit request were most often 80+ years old and had cancer. Most of them were incompetent patients nearing death. Characteristics of this practice in 1995 were quite comparable, as were characteristics of this practice in Belgium, Denmark, and Switzerland. The use of drugs with the intention to hasten death without an explicit request of the patient is part of medical end-of-life practice in the studied countries, regardless of their legal framework, and it occurs in similar fashion %0 Journal Article %C brigitte.longerich@sbk-asi.ch %A Bardet, Francoise %J Krankenpfl Soins Infirm %D 2006 %N 12 %P 61 %T [A convivial repast] %V 99 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17212267 %0 Journal Article %A Ferhi, K %A Ferhi, A %A Oussedik, K %A Bensallah, K %A Sibert, L %J J Chir (Paris) %D 2006 Sep-Oct %N 5 %P 328-9 %T [A penile metastasis as the first manifestation of colon cancer] %V 143 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17185963 %0 Journal Article %A Oberli, Franziska %J Krankenpfl Soins Infirm %D 2006 %N 12 %P 27 %T [Cat tears] %V 99 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17212261 %0 Journal Article %C Equipe mobile de soins palliatifs %A Ciais, JF %A Pradier, C %A Ciais, C %A Berthier, F %A Vallageas, M %A Raucoules-Aime, M %J Presse Med %D 2007 Mar %N 3P1 %P 404-409 %T [Impact of a hospice home visit team on unwanted hospitalization of terminally-ill patients at home in acute medical emergencies.] %V 36 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17321361 %X OBJECTIVES: This study was undertaken to evaluate the impact of paramedical hospice specialists on hospitalization of terminally-ill patients in acute medical emergencies. METHOD: In this intervention, the SAMU (French medical emergency call center) responded to requests for emergency aid at the homes of terminally-ill patients by sending to the patient's home, together with a physician and the emergency ambulance team, a team composed of a nurse and a volunteer, both trained in hospice (terminal) care . When the patient wished to stay at home, the hospice team remained to support the patient and family and to provide comfort care until the crisis situation stabilized. This before-and-after study compares SAMU calls during the first year of the intervention to those in the preceding year. RESULTS: During the intervention period, 14% of patients were hospitalized compared with 48% during the reference year (p<0.0001), for a relative risk of hospitalization of 0.29. The emergency hospice team was considered to be not only complementary but also essential in emergency medical situations for patients receiving palliative care at home. Interaction with existing services did not present problems. Families benefited from considerable assistance in particularly difficult situations. CONCLUSION: A team of paramedical hospice specialists, acting on request of the SAMU, provides a concrete and useful response to problems of unwanted hospitalization in acute emergencies for home-based terminally ill patients. This type of organization is consistent with respect for the patient's choice to remain at home until the end of life. Prevention of unwanted hospitalization and heroic measures should undoubtedly result in cost savings more than sufficient to fund this program %0 Journal Article %A Gravgaard, Anne-Marie Boeck %A Safsten, Bengt %J Lakartidningen %D 2007 Jan %N 1-2 %P 57 %T [Increased rights to euthanasia discussed in Belgium] %V 104 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17323747 %0 Journal Article %A Fernandez Herraez, Elias %A Martinez Lopez, Maria Jesus %J Med Clin (Barc) %D 2006 Nov %N 18 %P 719 %T [Living wills. It is necessary to close the information circuit between clients and register] %V 127 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17169307 %0 Journal Article %A Bach, Sandra %A Blaser, Bea %J Krankenpfl Soins Infirm %D 2006 %N 12 %P 13-5, 46-9 %T [Luciano was able to live and die at home] %V 99 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17212256 %0 Journal Article %A Nau, Jean-Yves %J Rev Med Suisse %D 2006 Nov %N 88 %P 2706 %T [The veterinarian and euthanasia during times of animal epidemics (2)] %V 2 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17265816 %0 Journal Article %C Servicio de Dermatologia, Hospital Virgen Salud, Toledo, Espana. icervigon@sescam.jccm.es %A Cervigon, Ivan %A Perez, Cristina %A Bahillo, Constanza %A Martinez-Amo, Jose Luis %A Gargallo, Ana Belen %A Lopez-Barrantes, Olivia %A Schoendorff, Cristina %A Garcia, Carmen %A Garcia-Almagro, Domingo %J Actas Dermosifiliogr %D 2006 Oct %N 8 %P 546-8 %T [Umbilical nodule] %V 97 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17067538