%0 Journal Article
%C Marie Curie Hospice Liverpool, Speke Road, Liverpool L25 8QA, UK
%A Twomey, F
%A McDowell, DK
%A Corcoran, GD
%J Age Ageing
%D 2007 Mar
%T End-of-life care for older patients dying in an acute general hospital--can we do better?
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17389651

%0 Journal Article
%C Department of Internal Medicine, Section of Gastroenterology and Hepatology, Sahlgrenska University Hospital, Gothenburg, Sweden. einar.bjornsson@medic.gu.se
%A Bjornsson, E
%A Abrahamsson, H
%A Simren, M
%A Mattsson, N
%A Jensen, C
%A Agerforz, P
%A Kilander, A
%J Aliment Pharmacol Ther
%D 2006 Sep
%N 6
%P 945-54
%T Discontinuation of proton pump inhibitors in patients on long-term therapy: a double-blind, placebo-controlled trial
%V 24
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=16948806
%X BACKGROUND: The proportion of proton pump inhibitor users on long-term therapy who can discontinue proton pump inhibitor (PPI) medication without developing symptoms is unknown. AIM: To determine the proportion of patients on long-term PPI therapy who are able to discontinue PPIs without developing symptoms. METHODS: Patients on long-term PPIs, without a history of peptic ulcer or esophagitis underwent upper endoscopy. Patients were randomized double-blindly to taper down or continue a constant dosage of omeprazole for three weeks. Thereafter, all patients discontinued PPIs. RESULTS: Of the 97 patients enrolled, had used PPIs for 48 months, 78% had GERD. A total of 27% did not use PPIs during the year after discontinuation, 31% of the patients randomized to tapering discontinued PPIs and 22% of those who did not could discontinue therapy (NS). Gastro-oesophageal reflux disease (GERD) patients were more prone to continue PPIs than non-GERD patients. Only 16 (21%) of GERD patients were off PPIs vs. 48% of patients without GERD (p < 0.05). Serum gastrin was higher at baseline in GERD patients who resumed PPIs versus non-resumers (p < 0.05). GERD and serum gastrin were independent predictors of PPI requirement. CONCLUSIONS: Discontinuation of PPI was successful in 27% of long-term PPI users. GERD patients had more difficulty discontinuing PPIs than non-GERD patients

%0 Journal Article
%C Department of Dermatology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands. m.berends@derma.umcn.nl
%A Berends, M A M
%A Snoek, J
%A de Jong, E M G J
%A van de Kerkhof, P C M
%A van Oijen, M G H
%A van Krieken, J H
%A Drenth, J P H
%J Aliment Pharmacol Ther
%D 2006 Sep
%N 5
%P 805-11
%T Liver injury in long-term methotrexate treatment in psoriasis is relatively infrequent
%V 24
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=16918884
%X BACKGROUND: Methotrexate-induced liver damage in psoriasis has led to dermatologic guidelines that stipulate monitoring of liver injury by means of serial liver biopsies. Recent literature data suggest that methotrexate may be considerably less hepatotoxic than previously assumed. AIM: To evaluate prevalence and development of liver injury in methotrexate treated psoriasis. METHODS: Retrospective chart review (1976-2005). RESULTS: Hundred and twenty-five patients (F58/M67; mean age 45.0, SD 12.7 years) received a median cumulative methotrexate dose of 2,113 mg (range 180-20 235) over a median period of 228 weeks (range 16-1763). Two hundred and seventy eight liver biopsies were analysed and 71% were classified as Roenigk grade I, 14% as Roenigk II, 14% grade IIIa, 2% grade IIIB and 2% grade IV. Liver injury was not associated with cumulative dose, weekly prescribed dose, age or duration of treatment. Obesity and diabetes were significant risk factors for liver injury. A total of 68 patients had multiple biopsies, 3% improved, 72% did not change and in 25% liver histology deteriorated. The majority of cases (84%) that progressed to Roenigk 2 had a cumulative dose of 1,500-6,000 mg. CONCLUSIONS: Methotrexate-related liver injury is less frequent than previously thought and mostly occurred at cumulative dose of <6,000 mg. Diabetes and being overweight are significantly correlated with liver injury

%0 Journal Article
%C Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
%A Katz, Steven C
%A Bowne, Wilbur B
%A Wolchok, Jedd D
%A Busam, Klaus J
%A Jaques, David P
%A Coit, Daniel G
%J Am J Surg
%D 2007 Apr
%N 4
%P 493-7
%T Surgical management of melanoma of the gallbladder: a report of 13 cases and review of the literature
%V 193
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17368297
%X BACKGROUND: Melanoma has the potential to spread to virtually any organ, including the gallbladder. The role of intervention in this rare entity must be based on a thorough appreciation of the underlying disease biology. METHODS: We present a review of all patients treated for gallbladder melanoma at Memorial Sloan-Kettering Cancer Center (MSKCC) between 1991 and 2003. RESULTS: The study group consisted of 13 patients with melanoma metastatic to the gallbladder. The median survival was 12 months following the diagnosis, and only 1 patient survived more than 42 months. Factors associated with improved outcome included symptomatic metastases and metastatic disease confined to the gallbladder (P < .05). Cholecystectomy led to the resolution of right upper quadrant pain in all patients for the duration of their survival. CONCLUSIONS: In patients with melanoma metastatic to the gallbladder, overall survival is determined more by the biology of the disease than treatment. In the presence of symptoms, cholecystectomy is often effective palliation in carefully selected patients

%0 Journal Article
%C Eastbourne District General Hospital Eastbourne BN21 2UD, UK
%A Walton, S
%J Anaesthesia
%D 2007 Apr
%N 4
%P 412-3
%T Advance directives
%V 62
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17381582

%0 Journal Article
%A Spurgeon, Brad
%J BMJ
%D 2007 Mar
%N 7593
%P 555
%T Two thousand health staff sign petition calling for euthanasia to be decriminalised
%V 334
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17363802

%0 Journal Article
%C Johns Hopkins University, Room 609, 624 North Broadway, Baltimore, MD 21205, USA. sdy@jhsph.edu
%A Dy, Sydney
%A Lynn, Joanne
%J BMJ
%D 2007 Mar
%N 7592
%P 511-3
%T Getting services right for those sick enough to die
%V 334
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17347238

%0 Journal Article
%A Workman, Stephen
%J BMJ
%D 2007 Mar
%N 7592
%P 485-6
%T Researching a good death
%V 334
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17347190

%0 Journal Article
%C Cancerkin Centre, Royal Free Hospital, Pond Street, London NW3 2QC, UK
%A Sanitt, Judith S
%J Breast
%D 2006 Dec
%P S31-3
%T Breast reconstruction: a patient's story
%V 15 Suppl 2
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17382860
%X This presentation will aim to show the effect of breast reconstructive surgery on the life of a young woman and her family. Diagnosed at the age of 29 with breast cancer, I was totally petrified at the thought of losing a breast and could not imagine going through life after a mastectomy. A first subcutaneous mastectomy with a simultaneous implant went disastrously wrong and I was left badly scarred. Fortunately, this was followed by a successful latissimus dorsi breast reconstruction, which gave me back some sort of shape and, in time, my confidence. However, this was not an easy passage with emotions on a perpetual roller coaster. Learning to live with both the fact that I had had breast cancer at such an early age, and having to get used to a new body image (when I was quite happy with the old one) took some time. When, 20 years later, another breast cancer diagnosis was made, it was a very different patient who decided straightaway to have a mastectomy and reconstruction. This time the idea of a mastectomy was no longer terrifying although the diagnosis was still a shock. It would have been very simple to have reverted back to the "helpless victim" feeling I had experienced the first time around. The second reconstruction went very well and as the cancer was caught early no other treatment was necessary. Although not so frightening this time, there was still a period of adjustment and grief as I was faced with yet another body image change

%0 Journal Article
%C Department of Internal Medicine, Euroclinic Hospital, 9 Athanasiadou str, 115 21, Athens, Greece. mtektonidou@euroclinic.gr
%A Tektonidou, Maria G
%A Serelis, John
%A Skopouli, Fotini N
%J Clin Rheumatol
%D 2007 Feb
%N 2
%P 258-60
%T Peripheral neuropathy in two patients with rheumatoid arthritis receiving infliximab treatment
%V 26
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=16683176
%X Antitumor necrosis alpha agents have been successfully used for the treatment of rheumatoid and seronegative arthritis, Crohn's disease, psoriasis, and severe cases of vasculitis. Several side effects have been observed in patients receiving these agents including hypersensitivity reactions, infections, drug-induced lupus, or demyelinating syndromes. The presence of peripheral neuropathy has been reported only in isolated cases. We describe two cases of peripheral neuropathy which occurred in patients with rheumatoid arthritis receiving infliximab treatment, one with multifocal motor neuropathy with conduction block and another with axonal sensory polyneuropathy, reversed upon discontinuation of infliximab and intravenous gammaglobulin treatment

%0 Journal Article
%C College of Pharmacy, Ohio State University and Children's Research Institute, Columbus, Ohio 43210, USA
%A Stojanovski, Sasko D
%A Casavant, Marcel J
%A Mousa, Hayat M
%A Baker, Peter
%A Nahata, Milap C
%J Clin Toxicol (Phila)
%D 2007 
%N 1
%P 51-5
%T Atomoxetine-induced hepatitis in a child
%V 45
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17357382
%X OBJECTIVE: To report a case of hepatitis associated with atomoxetine hydrochloride use and to describe the previously-unpublished severe cases of this syndrome. CASE SUMMARY: An eight-year-old female with attention deficient hyperactive disorder (ADHD) was treated with atomoxetine hydrochloride. She complained of increased abdominal pain and occasional emesis; her transaminases and bilirubin were markedly elevated. She was admitted to a tertiary-care pediatric hospital and treated for drug-induced hepatitis. Atomoxetine was discontinued and supportive care was instituted. A liver biopsy showed hepatitis with moderate piecemeal necrosis. Clinical status and liver function tests improved over 13 days of hospitalization. DISCUSSION: To our knowledge this is the first published severe case of atomoxetine-induced hepatitis. The International Organization of Medical Science Diagnostic Scale and the Adverse Drug Reaction Probability Scale by Naranjo et al. were applied to assess causality. Both scales indicated the association of atomoxetine and hepatitis as "probable;" a positive rechallenge would have made this association "definitive." This potential serious adverse reaction should be considered in children receiving atomoxetine therapy

%0 Journal Article
%C Harborview Medical Center, University of Washington School of Medicine, 325 Ninth Avenue, Box 359775, Seattle, WA 98104-2499, USA. tirsch@u.washington.edu
%A Tirschwell, David
%J Crit Care
%D 2006 
%N 6
%P 171
%T Optimizing neurologic prognosis after cardiac arrest
%V 10
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17118215
%X Neurologic disability is a feared outcome of resuscitation from cardiac arrest. The study by Rech and colleagues in the previous issue of Critical Care describes the use of neuron-specific enolase to inform an early prognosis in patients who survived in-hospital cardiac arrest. In their study 'none of the patients had a DNR order and there was no limitation of life support.' As a result, 10% of patients remained in a vegetative state at 6 months, a higher percentage than in other recent studies. The existence of a population of patients in which all are fully supported without withholding care or withdrawal of care may represent an important research opportunity. High neuron-specific enolase levels have been reported in patients that awoke and seem to occur in studies with a higher percentage of patients in a vegetative state at follow-up (more uniform support). If a comprehensive set of clinical, electrophysiological, biochemical and imaging measures could be obtained in a uniform manner in a cohort of patients without limitations in care, a more objective set of comprehensive prognostic indicators could be obtained. A focused international consortium is called for

%0 Journal Article
%C Nottingham City Hospital, GB. vhinton@ncht.trent.nhs.uk
%A Hinton, V
%A Fish, M
%J EDTNA ERCA J
%D 2006 Jul-Sep
%N 3
%P 172-6
%T [In Process Citation]
%V 32
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17393814
%X BACKGROUND: A care pathway for the end-of-life had been implemented onto the two renal wards. An audit was performed to highlight potential issues and areas for development. METHOD: The audit consisted of a base review of documentation from the medical notes of 10 patients who had died an 'expected' death prior to commencing the renal Integrated Care Pathway (ICP) for the end of life and then 10 patients who had died whilst using the ICP documentation. A questionnaire was also given out to nursing staff who had used the ICP documentation. The results were collated and analysed. RESULTS: In the base review 100% of the documentation looked at did not provide a regular documented assessment of symptoms that are common in the terminal phase of life. The ICP provided a documented assessment of all of these main symptoms. The base review indicated a good response by doctors to meet the potential needs of the patient, but the ICP improved on this. This was through the use of a pre-emptive prescription. 80% of all patients were pain free, not agitated, had no nausea or vomiting or respiratory secretions. The 2 patients that had pain received further analgesia and were then pain free at the next assessment. One of the most positive aspects of the audit was that 90% of relatives were aware that the patient was dying and 100% had the plan of care discussed with them. CONCLUSION: Implementing the ICP has generated the opportunity to deliver a hospice model of care to a busy renal unit. It has allowed best practice, and a measurable standard of care, in the final stages of patients' lives. Staff find the documentation easy to use and also see it as enhancing patient care

%0 Journal Article
%C Colorectal Unit, Department of Surgery and Urology, Eskilstuna County Hospital, Eskilstuna, Sweden. george.dafnis@telia.com
%A Dafnis, George
%J Eur J Gastroenterol Hepatol
%D 2007 Jan
%N 1
%P 83-6
%T Repeated coaxial colonic stenting in the palliative management of benign colonic obstruction
%V 19
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17206082
%X In inflammatory bowel disease, strictures of the colon, causing bowel obstruction, is not uncommon. Usually an operative procedure can deal with these strictures. We describe a case of an unfit patient with pulmonary malignancy having a Crohn's stricture of the recto-sigmoid junction in which repeated coaxial placement of self-expanding metallic stents eliminated the need to perform an operation. This is the first report of multiple coaxial colonic stenting. It shows that there is a place for stents in selected cases of inflammatory bowel disease with a limited life expectancy and that repeated colonic stenting makes colonic stenting possible also in patients requiring stents for longer time periods

%0 Journal Article
%C Department of Palliative Care, Policy and Rehabilitation King's College London, UK
%A Higginson, IJ
%A Davies, E
%A Tsouros, AD
%J Eur J Public Health
%D 2007 Mar
%T The end of life: unknown and unplanned?
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17392291

%0 Journal Article
%C Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata, 951-8510, Japan
%A Ikeda, Yoshiyuki
%A Kosugi, Shin-Ichi
%A Nishikura, Ken
%A Ohashi, Manabu
%A Kanda, Tatsuo
%A Kobayashi, Takashi
%A Hatakeyama, Katsuyoshi
%J Gastric Cancer
%D 2007 
%N 1
%P 63-8
%T Gastric carcinosarcoma presenting as a huge epigastric mass
%V 10
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17334721
%X Gastric carcinosarcoma often presents with an elevated lesion or increased thickness of the stomach wall. Histological diagnosis is achieved using conventional hematoxylin and eosin staining to confirm the coexistence of both epithelial and mesenchymal elements. We report a case of gastric carcinosarcoma presenting as a large mass in the epigastric region. Specimens obtained by endoscopic biopsy and surgical excision showed diffuse proliferation of atypical cells in sheet formation. No mucus production or glandular structures were apparent, but immunoreactivity for both epithelial and mesenchymal markers was noted. These findings led to a definitive diagnosis of gastric carcinosarcoma. Immunohistochemical analysis is useful for the early diagnosis and treatment of gastric carcinosarcoma

%0 Journal Article
%C Clinical Neurosciences Division, School of Medicine, University of Southampton, UK. dsbl@soton.ac.uk
%A Baldwin, David S
%A Montgomery, Stuart A
%A Nil, Rico
%A Lader, Malcolm
%J Int J Neuropsychopharmacol
%D 2007 Feb
%N 1
%P 73-84
%T Discontinuation symptoms in depression and anxiety disorders
%V 10
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=16359583
%X The present overview investigates whether different antidepressants have differing discontinuation symptoms upon treatment cessation, if these symptoms vary between depression and anxiety disorders, and with length of treatment. Data came from two comparative studies of escitalopram in major depressive disorder (MDD) (one vs. venlafaxine XR and one vs. paroxetine), two studies in social anxiety disorder (SAD) (one of which used paroxetine as the active reference), and one study in generalized anxiety disorder (GAD), using paroxetine as an active reference [total number of patients: escitalopram (n=1051); paroxetine (n=336); venlafaxine XR (n=124); placebo (n=239)]. All studies included a defined discontinuation period and used the Discontinuation Emergent Signs and Symptoms (DESS) checklist to record the number of discontinuation symptoms. All three antidepressants showed more discontinuation symptoms compared with placebo (p<0.001). Patients reported significantly fewer discontinuation symptoms with escitalopram than with paroxetine and venlafaxine XR in MDD (p<0.05). Escitalopram showed significantly fewer discontinuation symptoms than paroxetine in SAD (p<0.05) and GAD (p<0.001). For each antidepressant, no differences in discontinuation symptoms were observed between the three indications and there was no evidence for increased symptom incidence with increased length of treatment. Thus, discontinuation profiles differ between antidepressants of the same class and are broadly similar in different disorders. No evidence was seen for a higher discontinuation burden with longer treatment

%0 Journal Article
%C Medical Ethics Unit, Shaare Zedek Medical Center, Jerusalem, Israel
%A Steinberg, Avraham
%A Sprung, Charles L
%J Intensive Care Med
%D 2006 Aug
%N 8
%P 1234-7
%T The dying patient: new Israeli legislation
%V 32
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=16718456

%0 Journal Article
%C Division of Mental Health, St George's, University of London, London, UK
%A Tuffrey-Wijne, Irene
%A Bernal, Jane
%A Butler, Gary
%A Hollins, Sheila
%A Curfs, Leopold
%J J Adv Nurs
%D 2007 Apr
%N 1
%P 80-9
%T Using Nominal Group Technique to investigate the views of people with intellectual disabilities on end-of-life care provision
%V 58
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17394619
%X Aim. This paper is a report of a study using the Nominal Group Technique as a method to elicit the views of people with intellectual disabilities on sensitive issues, in this example end-of-life care provision. Background. Establishing consumer views is essential in providing appropriate end-of-life care, yet people with intellectual disabilities have historically been excluded from giving their opinion and participating in research. Methods. Nominal Group Technique was used in three groups, with a total of 14 participants who had mild and moderate intellectual disabilities. This technique involves four steps: (1) silent generation of ideas, (2) round robin recording of ideas; (3) clarification of ideas and (4) ranking of ideas (voting). Participants were presented with an image of a terminally ill woman (Veronica), and were asked: 'What do you think people could do to help Veronica?' Findings. Participants generated a mean of nine individual responses. The highest rankings were given to issues around involvement in one's own care, presence of family and friends, offering activities to the ill person, and physical comfort measures. Conclusion. People with mild and moderate intellectual disabilities are capable of expressing their views on end-of-life care provision, and should be asked to do so. The Nominal Group Technique presents an effective and acceptable methodology in enabling people with intellectual disabilities to generate their views

%0 Journal Article
%C Department of Health Ethics and Philosophy, Maastricht University, Maastricht, The Netherlands
%A van Bruchem-van de Scheur, G G
%A van der Arend, Arie J G
%A Spreeuwenberg, Cor
%A Huijer Abu-Saad, Huda
%A Ter Meulen, Ruud H J
%J J Adv Nurs
%D 2007 Apr
%N 1
%P 44-52
%T Euthanasia and physician-assisted suicide in the Dutch homecare sector: the role of the district nurse
%V 58
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17394615
%X Aim. This paper is a report of the findings of a study into the role of district nurses in euthanasia and physician-assisted suicide in homecare organizations, conducted as part of a study into the role of nurses in medical end-of-life decisions. Background. Issues concerning legislation and regulation with respect to the role of nurses in euthanasia and physician-assisted suicide gave the Minister for Health reason to commission a study into the role of nurses in medical end-of-life decisions in hospitals, nursing homes and homecare organizations. This is the first quantitative study from the perspective of nurses. Previous quantitative studies were conducted under physicians and information on the role of nurses was obtained indirectly. Method. A questionnaire was sent in 2003 to 500 district nurses employed in 55 homecare organizations. The absolute response rate was 86.0% and 81.6% (408) could be used for analysis. Results. In 22.3% of 278 cases, the district nurse was the first with whom patients discussed their request for euthanasia or physician-assisted suicide. In about half (49.8%) of 267 cases nurses were not involved in the general practitioner's decision-making process, and in only 13.3% of 264 cases, did they attend the administration of the lethal drugs. District nurses had provided some degree of aftercare to the surviving relatives in 80.3% of 264 cases. Conclusion. Collaboration between general practitioners and district nurses needs improvement, particularly in relation to decision-making. Our Dutch data could help nurses in other countries to define their (future) role in euthanasia and physician-assisted suicide

%0 Journal Article
%C Division of Geriatrics and Gerontology, Weill Medical College of Cornell University, New York, New York 10021, USA. sdr1031@aol.com
%A Ramsaroop, Sharda D
%A Reid, M C
%A Adelman, Ronald D
%J J Am Geriatr Soc
%D 2007 Feb
%N 2
%P 277-83
%T Completing an advance directive in the primary care setting: what do we need for success?
%V 55
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17302667
%X OBJECTIVES: To systematically review studies designed to increase advance directive completion in the primary care setting and employ meta-analytic techniques to quantify their effects. DESIGN: Extensive bibliographic searches of English-language literature published from January 1991 through July 2005 were conducted. Investigators abstracted prespecified information (e.g., design, study duration, types of interventions employed) and advance directive completion rates for intervention and control arms in each investigation and calculated absolute rate differences (i.e., difference in completion rates between the two groups) for each study. Individual study and pooled-effect sizes were also calculated, along with 95% confidence intervals (CIs). SETTING: Literature review. RESULTS: Eighteen studies were retained in the final sample. Most studies employed multimodal interventions. The most common approach consisted of educational materials directed at patients (through mailing or at visit) coupled with a patient-healthcare provider interaction in a group or individual setting (n=7). Absolute differences in completion rates varied from a high of 44% (favors intervention) to a low of -2% (favors control). Effect sizes could be calculated for 15 of the 18 studies. The pooled effect size was 0.50 (95% CI=0.17-0.83), indicating a moderate overall effect in favor of the intervention. CONCLUSION: The majority of studies demonstrated statistically significant effects associated with the advance directive intervention. The most successful interventions incorporated direct patient-healthcare professional interactions over multiple visits. Passive education of patients using written materials (without direct counseling) was a relatively ineffective method for increasing advance directive completion rates in the primary care setting

%0 Journal Article
%C Department of Radiotherapy and Nuclear Medicine, Plovdiv, Bulgaria. yanevambg@yahoo.co.uk
%A Yaneva, M P
%A Goranova-Marinova, V
%A Goranov, St
%J J BUON
%D 2006 Jan-Mar
%N 1
%P 43-8
%T Palliative radiotherapy in patients with multiple myeloma
%V 11
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17318951
%X PURPOSE: To analyse the therapeutic effect of palliative radiation therapy (RT) in multiple myeloma (MM) patients with bone lesions and soft tissue formations, to compare the therapeutic efficacy of two different RT regimens, the effect of RT on basic disease parameters, and its impact on survival in MM patients. PATIENTS AND METHODS: 162 patients with MM were diagnosed and followed for a 10-year period (1994-2004). Eighty-seven (53.7%) of them with myeloma bone disease (MBD) underwent palliative RT with two different regimens. The effect of RT on MBD and its complications was assessed. Patients with RT were compared in 10 parameters before and after RT. Survival was compared between the irradiated and non irradiated groups and also between patients treated with two different RT regimens, using Kaplan-Meier method and log-rank test. RESULTS: RT was applied in 92.1% of the patients with vertebral fractures, in 90.9% of the patients with non-vertebral fractures, and in 94.1% of the patients with extramedullary tumor formations. In 89.6% of the patients complete or partial pain palliation was achieved and in 58.6% resolution of neurologic symptoms occurred. The levels of hemoglobin (Hb), white blood cell (WBC) and platelet counts (PLT), bone marrow infiltration, serum calcium (Ca), creatinine, albumin, CRP, LDH, beta2-microglobulin did not change significantly before and after RT. Median survival of patients on RT was 32 months (range 30-34) vs. 33 months (range 28-36) for patients without RT (p>0.05). Median survival was 32 months (range 27-37) for patients on 2x8 Gy. vs. 34 months (range 25-39) for those on 5x4 Gy (p>0.05). CONCLUSION: RT is a very effective method in bone pain palliation in vertebral and non-vertebral fractures and reduction of extramedullary formations, but does not influence the survival of patients with MM

%0 Journal Article
%C Department of Visceral and Transplantation Surgery, University Hospital, Zurich, Switzerland
%A Bramkamp, Matthias
%A Dedes, Konstantin J
%A Strobel, Klaus
%A Pahnke, Jens
%A Breitenstein, Stefan
%A Clavien, Pierre-Alain
%J J Clin Oncol
%D 2007 Feb
%N 6
%P 725-6
%T Cholestasis from malignant melanoma
%V 25
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17308277

%0 Journal Article
%C Penn State College of Medicine, Hershey, PA 17033, USA. pkettl@psu.edu
%A Kettl, Paul
%J J Clin Psychiatry
%D 2007 Mar
%N 3
%P 445-50
%T Helping families with end-of-life care in Alzheimer's disease
%V 68
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17388717
%X OBJECTIVE: Alzheimer's disease is a chronic process of gradual deterioration of cognitive ability. While this is clearly a tragedy for the individual and the family, the prolonged nature of the disease allows the clinician an opportunity to plan for progressive stages of the disease including the final stages of care. This article reviews opportunities for assisting families in the care of their ill relatives with Alzheimer's disease. DATA SOURCES: Review articles on end-of-life care and Alzheimer's disease obtained on a search from Ovid on March 2, 2006. Only English-language review articles were included in the search. STUDY SELECTION: Articles were included in the review if they offered clinically relevant material for assisting families in end-of-life care in Alzheimer's disease. Articles between 1998 and 2006 were included. Approximately 10% of the articles listed were included in the review. DATA SYNTHESIS: Clinicians should discuss with family members choices to be made at the end of life in Alzheimer's disease care and work with the family to ensure these wishes are followed. The geriatric psychiatrist plays a central role in these discussions. Other members of the health care team, including nursing care, hospice care, and social work coordinators, all coordinate efforts to deliver optimal end-of-life care. This leads not only to better and more humane care, but also to a cost savings in America's burgeoning health care budget. CONCLUSION: Geriatric psychiatrists can play a central role in assisting families in managing end-of-life care in Alzheimer's disease

%0 Journal Article
%C School of Nursing, The University of Minnesota, 6-150 Weaver-Densford Hall, 1331, 308 Harvard Street S.E., Minneapolis, MN 55455, USA. gaug0015@umn.edu
%A Gaugler, Joseph E
%A Kane, Robert L
%A Newcomer, Robert
%J J Gerontol B Psychol Sci Soc Sci
%D 2007 Jan
%N 1
%P P38-44
%T Resilience and transitions from dementia caregiving
%V 62
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17284556
%X Longitudinal studies have documented how dementia caregivers adapt to their role. Less is known about how resilience (defined as lower or higher perceived burden in the face of frequent care demands) affects key dementia caregiving outcomes. The present study utilized data from 1,979 dementia caregivers over a 3-year period to ascertain whether resilience influences transitions from dementia caregiving, such as institutionalization, care recipient death, or loss to follow-up. Multinomial logistic regression models revealed that high baseline resilience (low burden, high care demands) was associated with less frequent institutionalization and loss to follow-up as well as more frequent care recipient mortality. The findings suggest the need for researchers to capture the heterogeneity of caregiver resilience when examining the longitudinal implications of informal long-term care and delivering clinical interventions

%0 Journal Article
%A Menkin, Elizabeth S
%A Weissman, David E
%J J Hosp Med
%D 2007 Jan
%N 1
%P 49-50; author reply 50-1
%T DNR discussions: right method, wrong message
%V 2
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17295315

%0 Journal Article
%C Department of Family Medicine, Myongji Hospital, Kwandong University College of Medicine, Goyang, Korea
%A Yeom, Chang Hwan
%A Jung, Gyou Chul
%A Song, Keun Jeong
%J J Korean Med Sci
%D 2007 Feb
%N 1
%P 7-11
%T Changes of terminal cancer patients' health-related quality of life after high dose vitamin C administration
%V 22
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17297243
%X Over the years there has been a great deal of controversy on the effect of vitamin C on cancer. To investigate the effects of vitamin C on cancer patients' health-related quality of life, we prospectively studied 39 terminal cancer patients. All patients were given an intravenous administration of 10 g vitamin C twice with a 3-day interval and an oral intake of 4 g vitamin C daily for a week. And then we investigated demographic data and assessed changes in patients' quality of life after administration of vitamin C. Quality of life was assessed with EORTC QLQ-C30. In the global health/quality of life scale, health score improved from 36+/-18 to 55+/-16 after administration of vitamin C (p=0.001). In functional scale, the patients reported significantly higher scores for physical, role, emotional, and cognitive function after administration of vitamin C (p<0.05). In symptom scale, the patients reported significantly lower scores for fatigue, nausea/vomiting, pain, and appetite loss after administration of vitamin C (p<0.005). The other function and symptom scales were not significantly changed after administration of vitamin C. In terminal cancer patients, the quality of life is as important as cure. Although there is still controversy regarding anticancer effects of vitamin C, the use of vitamin C is considered a safe and effective therapy to improve the quality of life of terminal cancer patients

%0 Journal Article
%A Nenner, F
%J J Med Ethics
%D 2006 Sep
%N 9
%P 554-5
%T A patient's choice
%V 32
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=16943340

%0 Journal Article
%C University of Pittsburgh School of Nursing, 3500 Victoria Street, 440 Victoria Building, Pittsburgh, PA 15261, USA. yconley@pitt.edu
%A Conley, Yvette P
%A Tinkle, Mindy B
%J J Nurs Scholarsh
%D 2007 
%N 1
%P 17-24
%T The future of genomic nursing research
%V 39
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17393961
%X PURPOSE: To look toward the future of genomics research and identify genomic-based resources and opportunities for nurse scientists to incorporate genomic concepts into their programs of research. ORGANIZING FRAMEWORK: Five research themes for the future, developed by the National Institute of Nursing Research in collaboration with nurse scientists, are the framework for this article: (a) changing lifestyle behaviors for better health; (b) managing the effects of chronic illness to improve health and quality of life; (c) identifying effective strategies to reduce health disparities; (d) harnessing advanced technologies to serve human needs; and (e) enhancing end-of-life experiences for patients and their families. CONCLUSIONS: Nurse scientists around the world are increasingly integrating genomics into their programs of research. Emerging international genomic initiatives, discoveries, and resources will provide rich opportunities for nurse scientists, as members of interdisciplinary teams, to address important biological, behavioral, social, and ethical questions. This evolving genomic nursing science will be necessary in practice, education, and policy in a time when rapid genomic discoveries are occurring

%0 Journal Article
%C Legacy Health System, 1015 NW 22nd Avenue R200, Portland, OR 97210, USA. kmoneyma@lhs.org
%A Moneymaker, Kathleen A
%A Traeger, Jennifer
%J J Palliat Med
%D 2007 Feb
%N 1
%P 270-1
%T Creating space and ritual for the time of death
%V 10
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17298284

%0 Journal Article
%C University of South Carolina School of Medicine, 1217 Taylor Street, Columbia, SC 29201, USA. hnawaz@gw.med.sc.edu
%A Nawaz, Hamayun Moin
%J J Palliat Med
%D 2007 Feb
%N 1
%P 253-5
%T Seeing patients with new eyes: a medical student's path to palliative medicine through a camera's lens
%V 10
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17298277

%0 Journal Article
%C Community Health and Family Medicine, University of Florida College of Medicine, 655 West 8th Street, Jacksonville, FL 32209, USA. gary.reisfeld@jax.ufl.edu
%A Reisfield, Gary M
%A Wilson, George R
%J J Palliat Med
%D 2007 Feb
%N 1
%P 245-6
%T Prognostication in heart failure #143
%V 10
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17298273

%0 Journal Article
%C University of California-Irvine, 101 The City Drive, Orange, CA 92868, USA. ssliao@uci.edu
%A Liao, Solomon
%A Arnold, Robert M
%J J Palliat Med
%D 2007 Feb
%N 1
%P 184
%T Heart failure and the future of palliative medicine
%V 10
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17298268

%0 Journal Article
%C Division of Gynecologic Oncology, University of Louisville/Brown Cancer Center, 529 South Jackson Street, Louisville, KY 40202, USA. mary.gordiner@louisville.edu
%A Gordinier, Mary E
%A Dizon, Don S
%A Weitzen, Sherry
%A Disilvestro, Paul A
%A Moore, Richard G
%A Granai, C O
%J J Palliat Med
%D 2007 Feb
%N 1
%P 61-6
%T Oral thalidomide as palliative chemotherapy in women with advanced ovarian cancer
%V 10
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17298255
%X OBJECTIVE: We prospectively evaluated thalidomide, an oral agent with antiangiogenic and immunomodulatory properties, in patients with recurrent ovarian cancer, comparing the drug to standard intravenous chemotherapy and treatment holiday in terms of both progression-free interval and quality of life. METHODS: Eligible patients had recurrent ovarian or primary peritoneal cancer and had received a minimum of two prior therapeutic regimens. Patients were offered one of three arms: (Arm A) any standard intravenous single-agent chemotherapy; (Arm B) oral thalidomide 200 mg daily; (Arm C) treatment holiday. Computed tomography (CT) scans were performed every two cycles until disease progression by Response Evaluation Criteria in Solid Tumors (RECIST) criteria. CA-125 was measured monthly as was quality of life using the Functional Assessment of Cancer Therapy (FACT-O) questionnaire. RESULTS: Forty patients participated: 18 on Arm A; 18 on Arm B; and 4 on Arm C. The groups were comparable in terms of number of prior regimens and cycles of chemotherapy. The progression- free intervals were similar in Arm A and Arm B (3.7 versus 3.8 months). The PR/SD rate was 6.7%/60% for Arm A, and 7.7%/53.8% in Arm B. Of those treated with thalidomide, 53% had a drop in CA-125 greater than 50%, compared to 13% receiving intravenous chemotherapy. FACT-O scores at baseline and throughout treatment were equivalent. CONCLUSION: The oral chemotherapeutic agent thalidomide appears to be comparable in response and quality of life, compared to single agent intravenous chemotherapy, in our population of heavily pretreated patients with ovarian cancer

%0 Journal Article
%C Palliative Care Center, Division of Neoplastic Disease and Related Disorders, Medical College of Wisconsin, Froedtert Hospital, 9200 W. Wisconsin Avenue, Milwaukee, WI 53226, USA. dweissma@mcw.edu
%A Weissman, David E
%J J Palliat Med
%D 2007 Feb
%N 1
%P 43-6
%T Risks and rewards
%V 10
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17298252

%0 Journal Article
%C San Diego Hospice & Palliative Care, 4311 Third Avenue, San Diego, CA 92103, USA. fferris@sdhospice.org
%A Ferris, Frank D
%A Al Khateib, Ahmad Abdullah
%A Fromantin, Isabelle
%A Hoplamazian, Linda
%A Hurd, Theresa
%A Krasner, Diane L
%A Maida, Vincent
%A Price, Patricia
%A Rich-Vanderbij, Louanne
%J J Palliat Med
%D 2007 Feb
%N 1
%P 37-9
%T Palliative wound care: managing chronic wounds across life's continuum: a consensus statement from the International Palliative Wound Care Initiative
%V 10
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17298250

%0 Journal Article
%A Billings, J Andrew
%J J Palliat Med
%D 2007 Feb
%N 1
%P 12-6
%T A primer on training slots for graduate medical education
%V 10
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17298245

%0 Journal Article
%A Mogos, Mariana
%A Thangathurai, Duraiyah
%A Roffey, Peter
%J J Palliat Med
%D 2007 Feb
%N 1
%P 6
%T Low incidence of dry mouth in patients with cancer with the use of ketamine
%V 10
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17298243

%0 Journal Article
%C LifePath Hospice, 12901 Bruce B. Downs Boulevard, Tampa, FL 33609, USA. schonwer@lifepath-hospice.org
%A Schonwetter, Ronald
%J J Palliat Med
%D 2007 Feb
%N 1
%P 3-5
%T Palliative medicine coming of age
%V 10
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17298242

%0 Journal Article
%C Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
%A Mausbach, Brent T
%A Aschbacher, Kirstin
%A Patterson, Thomas L
%A von Kanel, Roland
%A Dimsdale, Joel E
%A Mills, Paul J
%A Ancoli-Israel, Sonia
%A Grant, Igor
%J J Psychosom Res
%D 2007 Apr
%N 4
%P 439-45
%T Effects of placement and bereavement on psychological well-being and cardiovascular risk in Alzheimer's caregivers: A longitudinal analysis
%V 62
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17383495
%X OBJECTIVE: We examined the impact of Alzheimer caregiver transitions (i.e., placement and bereavement) on psychological outcomes and on plasma D-dimer levels, an end product of the coagulation cascade associated with increased cardiovascular risk. METHODS: This was a prospective study in which 126 spousal caregivers of Alzheimer's patients were assessed each year for 5 years. We used random regression models to evaluate discontinuous change in our outcomes over time, with emphasis on the impact of caregiver transitions on psychological and physical well-being. RESULTS: Caregivers experienced immediate improvement in overload and mastery following transitions, and these improvements were maintained over time. There was also a significant drop in depressive symptoms immediately following placement of spouses. D-dimer rose significantly over time but began to significantly decline at 6-months posttransitions. CONCLUSIONS: Caregiver transitions appear to produce immediate and long-term "normalization" of psychological health in caregivers. This normalization also appears related to "downstream" reductions in D-dimer

%0 Journal Article
%C , College of Community and Public Affairs, PO Box 6000, Binghamton, NY, 13902, lbronst@binghamton.edu
%A Bronstein, Laura R
%A Wright, Kevin
%J J Soc Work End Life Palliat Care
%D 2006 
%N 4
%P 85-102
%T The Impact of Prison Hospice:Collaboration Among Social Workers and Other Professionals in a Criminal Justice Setting that Promotes Care for the Dying
%V 2
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17387096
%X This study reports on a qualitative national telephone survey with coordinators of 14 prison hospice programs in 11 states. The rationale behind the survey was to learn about interdisciplinary collaboration between social work and criminal justice, using prison hospice as an exemplar of this collaboration. In addition to learning that all prison hospices in the study operate using an interdisciplinary team model and that most report high quality collaboration on the hospice team, the following additional five themes emerged: administrators and wardens are very supportive while correctional staff provides mixed support to team and program; greater collaboration with those outside prison hospice is critical; collaboration through prison hospice has a positive impact on dying prisoners; collaboration through prison hospice has a positive impact on prisoner volunteers; and, collaboration through prison hospice has a positive impact on the entire culture of the prison. doi:10.1300/J457v02n04_05

%0 Journal Article
%C , School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157, earnold@wfubmc.edu
%A Mayfield Arnold, Elizabeth
%A Abbott Artin, Katherine
%A Griffith, Devin
%A Lund Person, Judi
%A Graham, Kristina G
%J J Soc Work End Life Palliat Care
%D 2006 
%N 4
%P 61-83
%T Unmet needs at the end of life:perceptions of hospice social workers
%V 2
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17387095
%X Among persons at the end of life, it is important to understand whether the needs of patients are being adequately addressed. In particular, in hospice settings where the emphasis is on comfort care and quality of life, we know little about the presence of unmet needs. The purpose of this study was to examine the experiences of hospice social workers in working with hospice patients who had unmet needs at the end of life. Surveys were mailed to hospice social workers (N = 212) in two Southeastern states with a response rate of 36%. Results revealed that hospice social workers perceived patients to experience a wide variety of unmet needs-more commonly at the time of admission than during subsequent patient interactions. The most common unmet need reported at both times was a decreased ability to participate in activities that make life enjoyable. In situations where unmet needs exist, social workers reported that the most common perceived reasons were patient- related psychosocial issues and family conflict/issues. Additionally, a variety of interventions were used to address unmet needs, but a large number of barriers appear to impact outcomes in the cases. Results suggest that hospice patients experience a number of unmet needs, many of which are potentially treatable problems and concerns. Hospice professionals must continue to seek ways to assess and intervene effectively with patients who have unmet needs. doi:10.1300/J457v02n04_04

%0 Journal Article
%C , 1250 Bellflower Blvd, Long Beach, CA, 90840, stwilson@csulb.edu
%A Wilson, Steve
%J J Soc Work End Life Palliat Care
%D 2006 
%N 4
%P 33-60
%T The validation of the Texas revised inventory of grief on an older latino sample
%V 2
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17387094
%X Purpose: Bereavement is considered to be one of the most profound experiences in older adulthood. However, assessments of emotional reactions to grief and loss have often been based on measures tested on primarily Anglo samples. This study examined the validity and factor structure of a commonly used bereavement measure on an older Latino sample. Design and Methods: Using convergent and discriminant validation procedures, this instrument was tested using a purposive sample of 134 older, recently bereaved Latinos. Results: While the instrument was originally designed to measure two domains of grief: Past Behaviors and Present Feelings, confirmatory and exploratory factor analysis revealed a three-factor solution for this sample which included also Disbelief of the loss. Items within this domain included anger, rejection, and a sense of injustice. Implications: This study underscores the need for improved measures in research on grief and bereavement to capture the intensity and severity of grief in a cross-cultural context. doi:10.1300/J457v02n04_03

%0 Journal Article
%C , 254 Baker Hall, East Lansing, MI, 48824, margie.rodriguezlesage@ssc.msu.edu
%A Rodr, 0237 Guez Le Sage M
%J J Soc Work End Life Palliat Care
%D 2006 
%N 4
%P 3-31
%T Linguistic Competence/Language Access Services (LAS) in End-of-Life and Palliative Care:A Social Work Leadership Imperative
%V 2
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17387093
%X Despite the mandated and moral imperative to advance linguistic competence in all health care contexts, leadership that addresses this area of practice and study in end-of-life and palliative care is not readily obvious. Because social work is ideally suited to lead efforts to advance linguistically-accessible end-of-life and palliative care, social workers are encouraged to assume the challenge. This article focuses on topics that are elementary yet central to discussions on language diversity and leadership initiatives to advance language access in end-of-life and palliative care contexts: importance and function of language, extent of language diversity, inequity related to language diversity, mandates and standards related to language access, and approaches and competencies that contribute positively to language access. doi:10.1300/J457v02n04_02

%0 Journal Article
%C , 1545 Lilac Lane, Lawrence, KS, 66044, hnelson@ku.edu
%A Nelson-Becker, Holly B
%J J Soc Work End Life Palliat Care
%D 2006 
%N 3
%P 87-106
%T Voices of resilience:older adults in hospice care
%V 2
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17387091
%X Terminally ill older adults have the capacity to live well in the context of dying. Having negotiated a lifetime of challenges, they have resources to demonstrate resilience and achieve wholeness in life's final phase, but research has not adequately investigated this process. This qualitative research study considered the paths to resilience used by 30 older adult hospice clients in Kansas and Illinois. Responses were coded using the grounded theory method of Strauss and Corbin (1990) where data drives interpretation and text is coded into categories. Results centered on four themes that included: (1) a redefinition of self; (2) use of religion/ spirituality or openness to uncertainty; (3) maintenance of social investments; and (4) guarding independence even as the scope of life contracted. Results imply that attention should be paid to building environments of wellness. This may be accomplished paradoxically through facilitating continuity of client interests and yet opportunities for creativity and growth as well. Listening with a healing stance and cultivating a habit of being fully present in interactions with clients assist in this process. doi:10.1300/J457v02n03_07

%0 Journal Article
%C , Cecil G Sheps Center for Health Services Research, 725 Martin Luther King, Jr Blvd, Campus Box 7590, Chapel Hill, NC, 27599-7590, munn@email.unc.edu
%A Munn, Jean C
%A Zimmerman, Sheryl
%J J Soc Work End Life Palliat Care
%D 2006 
%N 3
%P 45-59
%T A good death for residents of long-term care:family members speak
%V 2
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17387089
%X Little research has been done on the topic of end-of-life care in long-term care settings to identify important themes regarding end-of-life care structures, processes, and outcomes. This study utilized data gathered in a stratified, random sample of 437 family members of residents who died in 31 nursing homes (NHs) and 199 residential care/ assisted living facilities. Structural components of care including staffing adequacy, training, and consistence as well as facility environment and size were important factors for family members interviewed. "Being there" and manner of care delivery (e.g., staff attitudes/empathy) were major elements in the process of care. These factors were mentioned more than direct care, Hospice, or resident preferences. Family members identified themes of [dying at] home and being comfortable and clean as important outcomes of care. These identified structural components, processes, and outcomes have implications for the role of social workers in these settings despite that social work support is notably absent in these findings. doi:10.1300/J457v02n03_05

%0 Journal Article
%C , 395 South 1500 East, Salt Lake City, UT, 84112, Marilyn.Luptak@socwk.utah.edu
%A Luptak, Marilyn
%J J Soc Work End Life Palliat Care
%D 2006 
%N 3
%P 23-44
%T End-of-Life Care Preferences of Older Adults and Family Members Who Care for Them
%V 2
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17387088
%X Using data from a series of in-depth semi-structured telephone interviews with family caregivers (N = 110), this study explored preferences for end-of-life care and the types of plans made. Caregivers provided rich descriptions of care receivers' perceived preferences for care at six weeks (post-patient discharge due to hip fracture or stroke), as well as their own preferences at one year and at five years. Three general themes characterizing care receivers' preferences for care emerged from the narrative responses: preferred setting for care, expectations for family care, and life-sustaining treatment preferences. A fourth theme, impact of the caregiving experience, also emerged from the caregivers' responses in terms of their own preferences for care. The findings are discussed in terms of the recently proposed national agenda for social work research in palliative and end-of-life care. doi:10.1300/J457v02n03_04

%0 Journal Article
%C , 709 Clark Hall, Columbia, MO, 65211, oliverdr@missouri.edu
%A Parker Oliver, Debra
%A Peck, Marlys
%J J Soc Work End Life Palliat Care
%D 2006 
%N 3
%P 7-21
%T Inside the interdisciplinary team experiences of hospice social workers
%V 2
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17387087
%X Interdisciplinary teamwork is the foundation for the delivery of hospice care. This project interviewed 23 hospice social workers by telephone to explore their experiences with hospice team collaboration. Two research questions were explored: (1) What do social workers perceive as the strengths of interdisciplinary collaboration and (2) What are the challenges for social workers on interdisciplinary hospice teams? Participants identified issues related to team process, administrative processes, and barriers to effective team collaboration. Collaboration was said to be fostered by good communication, trust, roles, joint visitation, respect, team building activities, and administrative interest and support. Challenges to collaboration included large caseloads, a focus on themedicalmodel, limited visits, personality and team conflict. Opportunities for improved collaboration between social workers and hospice team members exist through active evaluation of collaboration and strategic initiatives aimed at improving collaboration. doi:10.1300/J457v02n03_03

%0 Journal Article
%C , 4101 15 Ave. NE, Seattle, WA, 98105-6299, amyai@u.washington.edu
%A Ai, Amy L
%A Hopp, Faith
%A Shearer, Marshall
%J J Soc Work End Life Palliat Care
%D 2005 
%N 1
%P 71-94
%T Getting Affairs in OrderInfluences of Social Support and Religious Coping on End-of-Life Planning Among Open-Heart Surgery Patients
%V 2
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17387083
%X Despite growing interest in end-of-life issues, little research has been done concerning end-of-life plans made by patients with cardiovascular disease (CVD), a disease that constitutes the highest mortality in the United States. Even less information is available on patients who undergo major cardiac surgery, a life-altering procedure with some risk of death, in terms of their engagement in end-of-life planning (EOLP). This prospective study enabled the contributors to explore EOLP among 309 middle-aged and older open-heart surgery patients, using survey data from three sequential interviews. A hierarchical logistic regression model shows that older age, higher education, greater social support, and negative religious coping were positively related to the likelihood of engaging in EOLP. Minority race was inversely related to EOLP. Findings suggest the potential role for social workers in helping cardiac patients to access social spiritual resources, and to consider engagement in EOLP

%0 Journal Article
%C , North Hall, Neperan Rd, Tarrytown, NY, 10591, gutheil@fordham.edu
%A Gutheil, Irene A
%A Heyman, Janna C
%J J Soc Work End Life Palliat Care
%D 2005 
%N 1
%P 55-70
%T "They Don't Want to Hear Us"Hispanic Elders and Adult Children Speak About End-of-Life Planning
%V 2
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17387082
%X This study used focus groups to understand Hispanic elders' and adult children's concerns about end-of-life planning. Ten older persons participated in the elders group, and ten adult children in a separate group. Themes in both groups included communication, control, burden, spirituality, religious issues, and importance of family relationships. Communication regarding end-of-life planning was of particular importance to both elders and adult children. The most striking indication of the challenges in communication about end-of-life issues is the insistence by both the elders and the adult children that their children/ parents do not want to have these discussions

%0 Journal Article
%C , 2500 E 22nd St, Cleveland, OH, 44115, csteiner@vnacleveland.org
%A Steiner, Carol S
%J J Soc Work End Life Palliat Care
%D 2005 
%N 1
%P 29-53
%T Grief support groups used by few-are bereavement needs being met?
%V 2
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17387081
%X Few adult bereaved attend closed grief support groups, yet many of those who do attend say they are extremely helpful. This research explores factors influencing support group attendance, and the extent to which bereavement support needs are being met. Focus group discussions reveal that a broad scope of sources of support is available to the bereaved. Results show what is seen as unhelpful to them, and what might be more helpful to them. The study indicates many adult bereaved suffer from an overall lack of support and would benefit from more caring overtures from those around them. Findings from this small frontline hospice bereavement study point toward ideas for adjustments in support groups and innovative bereavement education and programming

%0 Journal Article
%C , 1001W Franklin St, Richmond, VA, 23284-2027, pjkovacs@vcu.edu
%A Kovacs, Pamela J
%A Bellin, Melissa Hayden
%A Fauri, David P
%J J Soc Work End Life Palliat Care
%D 2005 
%N 1
%P 13-27
%T Family-Centered CareA Resource for Social Work in End-of-Life and Palliative Care
%V 2
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17387080
%X Recent trends in medicine reflect an attempt to be more patient-centered and while this is progress from the disease- or provider- focused model familiar in healthcare, the experiences and contributions of family as caregivers continue to be overlooked in some settings. The family-centered care model, developed most notably in pediatrics, but emerging in HIV, cancer, and aging, is presented as a resource to increase family involvement at the end of life. In this paper, family-centered care is defined, caregiving trends including support needs of formal and informal caregivers are discussed, and barriers to family-centered services are identified. Reintroducing family into the focus of care at the end of life is the primary goal of this paper. The family- centered model of care offers an appropriate framework for understanding the value of family in end-of-life care and fits well with social work perspectives that understand individuals in the context of their family system and greater environment

%0 Journal Article
%C , School of Social Work, 1255 Amsterdam Ave, New York, NY
%A Christ, Grace
%A Blacker, Susan
%J J Soc Work End Life Palliat Care
%D 2005 
%N 1
%P 5-12
%T Shaping the Future of Social Work in End-of-Life and Palliative Care
%V 2
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17387079
%X The second Social Work Summit on End-of-Life and Palliative Care was held from June 1 to June 3, 2005. Sixty representatives of more than 35 social work and other professional organizations with a commitment to improve care for the terminally ill, dying, and bereaved, attended and formulated key priority directions and initiatives that will further the field

%0 Journal Article
%C , 270 Millet Hall, 3640 Colonel Glenn Hwy
%A Baker, Marjorie
%J J Soc Work End Life Palliat Care
%D 2005 
%N 4
%P 83-95
%T Facilitating Forgiveness and Peaceful ClosureThe Therapeutic Value of Psychosocial Intervention in End-of-Life Care
%V 1
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17387076
%X The importance of addressing psychosocial concerns with dying patients is pivotal to facilitating peaceful closure in endof- life care. The social worker's role in recognizing and providing skilled, psychosocial intervention with patients and families in hospice programs is significant. In this article, the literature in this area is examined and a case example of a hospice patient's need for closure and the responsive social work intervention for the patient in his moment of death is provided. The case offers social work knowledge and skills and demonstrates the therapeutic benefit of addressing psychosocial needs in end-of-life care. The importance of targeted training and continued skill development for social workers in end-of-life treatment settings is emphasized

%0 Journal Article
%C , 1 Washington Square North, New York, NY, 10003, btd1@nyu.edu
%A Dane, Barbara
%A Moore, Robert
%J J Soc Work End Life Palliat Care
%D 2005 
%N 4
%P 63-81
%T Social workers' use of spiritual practices in palliative care
%V 1
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17387075
%X Numerous studies have examined client use of spiritual and/or religious practices to cope with illness and adversity. This study explores social workers' use of spiritual practices as reflected in their work with palliative care clients. Survey results (n = 327) indicated significant relationships of spiritual practices such as yoga, prayer and meditation to working with palliative care clients. The total number of these approaches is predicted by factors such as theoretical orientation and the social workers' own struggles with palliative care and other issues. Our study supports the need for additional investigation of spiritual issues in practice

%0 Journal Article
%C , School of Social Work, 1 University Station Stop D3500, Austin, TX, 78712, barbarajones@mail.utexas.edu
%A Jones, Barbara L
%J J Soc Work End Life Palliat Care
%D 2005 
%N 4
%P 35-61
%T Pediatric Palliative and End-of-Life CareThe Role of Social Work in Pediatric Oncology
%V 1
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17387074
%X Pediatric oncology social workers are often engaged in the psychosocial care of dying children and their families. Despite their participation on the interdisciplinary team, the role for social work in pediatric palliative and end-of-life care has not been clearly defined. This survey of 131 pediatric oncology social workers identified current and best social work practices for care of children and their families at the end of life. Implications for practice, education, and research are discussed

%0 Journal Article
%C , 350 East 17th Street, Baird 12, New York, NY, 10003, taltilio@bethisraelny.org
%A Altilio, Terry
%A Otis-Green, Shirley
%J J Soc Work End Life Palliat Care
%D 2005 
%N 4
%P 3-6
%T "Res Ipsa Loquitur"...It Speaks for Itself...Social WorkValues, Pain, and Palliative Care
%V 1
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17387072

%0 Journal Article
%C , 732 Mott St, Suite 150, Burbank, CA, 91502, sengui@aol.com
%A Enguidanos, Susan Milena
%A Cherin, David
%A Brumley, Richard
%J J Soc Work End Life Palliat Care
%D 2005 
%N 3
%P 37-56
%T Home-Based Palliative Care StudySite of Death, and Costs of Medical Care for Patients with Congestive Heart Failure, Chronic Obstructive Pulmonary Disease, and Cancer
%V 1
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17387068
%X Purpose: To examine differences in site of death and costs of services by primary diagnosis for patients receiving home-based palliative care as compared to usual care at the end of life. Design and Methods: A nonequivalent group design was employed with 298 terminally ill patients diagnosed with cancer, CHF, or COPD enrolled. The treatment group received an interdisciplinary home-based palliative care program and the comparison group received usual Kaiser Permanente services. Data collected included patient demographics, severity of illness, service use, and site of death. Results: Among all diseases, patients enrolled in palliative care were more likely to die at home. Enrollment in palliative care was significant associated with cost reductions for patients with cancer, COPD, and CHF. No significant difference was found between diagnostic groups in terms of magnitude of cost savings. Implications: Provision of interdisciplinary home-based palliative care at end of life can effectively increase the likelihood of dying at home for patients with CHF, COPD, and cancer while realizing significant cost savings

%0 Journal Article
%C , 5700 N Tamiami Drive, Sarasota, FL, 34243, kblack@banshee.sar.usf.edu
%A Black, Kathy
%J J Soc Work End Life Palliat Care
%D 2005 
%N 3
%P 21-35
%T Social workers' personal death attitudes, experiences, and advance directive communication behavior
%V 1
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17387067
%X This research surveyed 29 social workers to examine their personal death attitudes and experiences in relation to their advance directives communication practice behavior. The study measured death attitudes on 5 dimensions: fear, avoidance, neutral, approach, or escape acceptance of death. Participants' personal experiences with terminal illness and death were also assessed. Advance directive communication practices were operationalized as 7 phases: initiation of the topic, disclosure of information, identification of a surrogate decision-maker, discussion of treatment options, elicitation of patient values, interaction with family members, and collaboration with other health care professionals. Findings suggest that social workers' advance directive communication behavior differs by practitioners' death attitudes and experiences. Implications for social work education and professional development are discussed

%0 Journal Article
%C , Hartford Hospital, 1798 Asylum Avenue, West Hartford, CT, 06117, karen.bullock@uconn.edu
%A Bullock, Karen
%A McGraw, Sarah A
%A Blank, Karen
%A Bradley, Elizabeth H
%J J Soc Work End Life Palliat Care
%D 2005 
%N 3
%P 3-19
%T What Matters to Older African Americans Facing End-of-Life DecisionsA Focus Group Study
%V 1
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17387066
%X Background: To better understand what matters to African American elders who are faced with issues of death, dying, and end-of-life care, a qualitative study was conducted to elicit their perspective. Methods: Focus groups were convened across the state of Connecticut. A total of 196 individuals participated in the 90-minute interview sessions. Using an interview guide, a trained moderator conducted the racially homogeneous discussion groups. Transcriptions of the group narratives with 22 older African Americans were coded to identify themes. Data were organized and analyzed using NUD-IST 4 and constant comparative method of qualitative data analysis. Results: Five major themes emerged from the focus group data on older African Americans: (1) spirituality, (2) burden on family, (3) trust, (4) health insurance coverage, and (5) cultural concerns. Conclusion: Recommendations are made for outreach education, involvement of informal helpers, and a level of acceptability in practice for diverse care needs

%0 Journal Article
%C , 354 North Hall, Aging Studies Program, Iowa City, IA, 52242, Mercedes-bern-klug@uiowa.edu
%A Bern-Klug, Mercedes
%A Kramer, Betty J
%A Linder, John F
%J J Soc Work End Life Palliat Care
%D 2005 
%N 2
%P 71-86
%T All AboardAdvancing the Social Work Research Agenda in End-of-Life and Palliative Care
%V 1
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17387064
%X Social workers in all practice areas have the potential to contribute to the National Agenda for Social Work Research in Palliative and End-of-Life Care. The purpose of this article is to invite social work practitioners and researchers to identify research needs and work with others to address them. We offer a conceptualization of the broad scope of social work's involvement in end-of-life issues, and articulate the difference between end-of-life care and end-of-life issues in social work. Suggestions are offered to advance the national research agenda

%0 Journal Article
%C , 3201 Burton SE, Grand Rapids, MI
%A Brandsen, Cheryl K
%J J Soc Work End Life Palliat Care
%D 2005 
%N 2
%P 45-70
%T Social Work and End-of-Life CareReviewing the Past and Moving Forward
%V 1
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17387063
%X This paper reviews the professional literature with respect to the social work profession's involvement in end-of-life care. The search process was conducted by entering key words in various combinations to electronic databases. Eligible articles were required to address one of the following: roles and activities of social workers in providing end-of-life care; core principles valued by social workers in the provision of end-of-life care; and barriers to provision of effective end-of-life care. The literature from 1990 through July 2004 was searched most rigorously. Based on this review, suggestions for where the profession of social work should focus its energies are offered. These key areas include focusing on generating empirically-based knowledge for practice and policy analysis and developing a system of social work education that addresses the unique knowledge and skills needed to participate in end-of-life practice as competent and informed professional practitioners. Current initiatives with regard to critical areas are summarized

%0 Journal Article
%C , PO Box 195, Pomona, NJ, 08240-0195, colonm@stockton.edu
%A Colon, Merydawilda
%J J Soc Work End Life Palliat Care
%D 2005 
%N 2
%P 27-43
%T Hospice and LatinosA Review of the Literature
%V 1
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17387062
%X Research on hospice use by Latinos, although increasing since the late 1990s, remains sparse. This article presents a review of the recent available literature on this topic within the past 15 years. The main aspects discussed are access to hospice care and various factors that researchers suggest affect Latino utilization of hospice care. These factors include beliefs about health care, death and end-of-life care, lack of insurance, lower referral rates by health care professionals and the hospice caregiver requirement. Overall, Latinos underutilize hospice but the reasons remain unclear. No evidence exists to indicate that Latinos are dissatisfied with services once they receive them. Also, no evidence exists to indicate they want services but cannot obtain them. Implications for social work practice and research are discussed

%0 Journal Article
%C , 623 Alden Street, Springfield, MA, 01109, Katherine_Walsh-Burke@spfldcol.edu
%A Walsh-Burke, Katherine
%A Csikai, Ellen L
%J J Soc Work End Life Palliat Care
%D 2005 
%N 2
%P 11-26
%T Professional Social Work Education in End-of-Life CareContributions of the Project on Death in America's Social Work Leadership Development Program
%V 1
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17387061
%X Social work education in both BSW and MSW level courses is missing vital content about end-of-life care, palliative care, and bereavement. End-of-life care training opportunities through continuing education programs have also been limited. This deficit is significant because a vast number of social workers are already confronted with end-of-life issues on a daily basis in a variety of practice settings. Through the Project on Death in America, Social Work Leadership Development Awards initiative, many programs and models for professional social work education and training in end-of-life care have been developed and are presented in this article. These include: end-of-life care courses, symposia, training manuals, certificate programs and fellowships. Although the curricula continue to be refined, many of these programs are available to practitioners to advance their knowledge and skills and their curricular models are available to social work educators for possible replication

%0 Journal Article
%C , 750 First Street NE, Suite 700, Washington, DC
%A Walsh, Karyn
%A Corbett, Becky
%A Whitaker, Tracy
%J J Soc Work End Life Palliat Care
%D 2005 
%N 2
%P 3-9
%T Developing Practice Tools for Social Workers in End-of-Life Care
%V 1
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17387060
%X This article describes the National Association of Social Workers' (NASW) strategies for providing social workers with important practice and policy information about palliative and end-of-life care. With funding from a Soros Foundation's Project on Death in America grant, NASW developed practice standards, a Web-based continuing education course, and drafted a new policy statement to guide social workers in end-of-life care practice. The article provides an in-depth view of the development and scope of these resources for professional social workers

%0 Journal Article
%C , 3600 Duke Univ. Medical Center, Bryan Alzheimer's Disease Center, Durham, NC
%A Gwyther, LP
%A Altilio, T
%A Blacker, S
%A Christ, G
%A Csikai, EL
%A Hooyman, N
%A Kramer, B
%A Linton, J
%A Raymer, M
%A Howe, J
%J J Soc Work End Life Palliat Care
%D 2005 
%N 1
%P 87-120
%T Social Work Competencies in Palliative and End-of-Life Care
%V 1
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17387058
%X Social workers from clinical, academic, and research settings met in 2002 for a national Social Work Leadership Summit on Palliative and End-of-Life Care. Participants placed the highest priority on the development and broad dissemination of a summary document of the state-of-the-art practice of social work in palliative and end-of-life care. Nine Summit participants reviewed the literature and constructed this detailed description of the knowledge, skills, and values that are requisite for the unique, essential, and appropriate role of social work. This comprehensive statement delineates individual, family, group, team, community, and organizational interventions that extend across settings, cultures, and populations and encompasses advocacy, education, training, clinical practice, community organization, administration, supervision, policy, and research. This document is intended to guide preparation and credentialing of professional social workers, to assist interdisciplinary colleagues in their collaboration with social workers, and to provide the background for the testing of quality indicators and &#0147;best practice&#0148; social work interventions

%0 Journal Article
%C , 6638 Villa Sonrisa Dr #623, Boca Raton, FL, 33431-0991, mnkane@aol.com
%A Kane, Michael N
%A Hamlin Ii, Elwood R
%A Hawkins, Wesley E
%J J Soc Work End Life Palliat Care
%D 2005 
%N 1
%P 49-69
%T Perceptions of Preparedness to Assist Elders with End-of-Life Care Preferences
%V 1
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17387056
%X Using a systematic sample of Florida licensed clinical social workers (N = 272), this study found that respondents perceived themselves capable of assisting elders with end-of-life care decisions and considered themselves moderately knowledgeable of resources available to elder clients. Respondents indicated slightly positive attitudes for work with elders and elders with Alzheimer's disease, and most respondents believed that elders should have the right of physician-assisted suicide. Using multivariate analysis, four predictor variables were identified that account for 61.3% of the adjusted variance of the dependent variable of preparedness to assist elders with end-of-life care preferences. These predictor variables were (a) knowledge of resources available to elders, (b) desirability of working with elders, (c) desirability of working with elders with Alzheimer's disease, and (d) attitude toward assisted suicide

%0 Journal Article
%C , 6513 Old Highway 13, Fayetteville, AR, 72701, reese@mail.uark.edu
%A Reese, Dona J
%A Chan, Cecilia L W
%A Perry, David C
%A Wiersgalla, Diane
%A Schlinger, Jennifer M
%J J Soc Work End Life Palliat Care
%D 2005 
%N 1
%P 23-47
%T Beliefs, Death, Anxiety, Denial, and Treatment Preferences in End-of-Life Care:A Comparison of Social Work Students, Community Residents, and Medical Students
%V 1
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17387055
%X This study examined cultural and religious beliefs, death anxiety, denial, and medical treatment preferences in end-of-life care in a sample of social work students, community residents, and medical students in a mid-western city of 49,000. Results indicated that most social work students, community residents, and medical students preferred palliative as opposed to life-prolonging care during terminal illness. The three groups differed in cultural and religious beliefs and all three reported a moderate amount of death anxiety. Students reported less denial of terminality than community residents. Implications for personal and professional preparation to provide end-of-life care are discussed

%0 Journal Article
%C , School of Social Work, 1255 Amsterdam Ave, New York, NY, 10025, ghc1@columbia.edu
%A Christ, Grace H
%A Blacker, Susan
%J J Soc Work End Life Palliat Care
%D 2005 
%N 1
%P 9-22
%T Setting an Agenda for Social Work in End-of-Life and Palliative Care:An Overview of Leadership and Organizational Initiatives
%V 1
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17387054
%X This article describes leadership efforts within social work to promote, enhance, and shape the future of social work practice, education, and research in end-of-life and palliative care. The background and outcomes of the Project on Death in America, Open Society Institute's Social Work Leadership Development Award Program, and the 2002 Social Work Leadership Summit on End-of-Life and Palliative Care are reviewed

%0 Journal Article
%C Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, Yahatanisi-ku, Kitakyusyu, Japan
%A Anan, Ayumi
%A Yamaguchi, Masako
%J J UOEH
%D 2007 Mar
%N 1
%P 73-85
%T [Process of parental acceptance of a child's disability: literature review]
%V 29
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17380731
%X This study used a literature review to examine the process of parental acceptance regarding disability in a child. Our results identify two main theoretical concepts, stages of grief and chronic sorrow, which describe the emotional responses that parents express following the diagnosis of a child's disability. Stages of grief involve a long-term process through which parents struggle to accept their child's condition, eventually leading to acceptance of their child's disability. Alternately, chronic sorrow describes parental life-long sadness throughout their child's lifetime, periodically repeating at critical times in their child's development. Researchers in Japan have developed a disability acceptance model that combines both concepts. This study found that analysis and interpretation of the parental acceptance process varied with each researcher. It is essential for health care professionals who provide support to children with disabilities to understand the process which parents as primary caregivers undergo to accept the conditions of their child's disability. Knowledge of the main theoretical concepts will give them a broader perspective of the parental acceptance experience. Additional systematic studies are recommended to further understand this issue

%0 Journal Article
%C RAND Corporation, Santa Monica, California
%A Shugarman, Lisa R
%A Bird, Chloe E
%A Schuster, Cynthia R
%A Lynn, Joanne
%J J Womens Health (Larchmt)
%D 2007 Mar
%N 2
%P 214-27
%T Age and gender differences in medicare expenditures at the end of life for colorectal cancer decedents
%V 16
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17388738
%X Purpose and Methods: We examined age and gender differences in Medicare expenditures for colorectal cancer decedents in the last year of life (LYOL) through a cross-sectional study of Medicare administrative and claims data. Participants were aged Medicare beneficiaries (68+ years) with colorectal cancer, who were covered by Parts A and B for 36 months before death (1996-1999, n = 6657). We estimated differences in mean Medicare utilization and expenditures in the LYOL overall and by type of service (inpatient, outpatient, physician, skilled nursing facility [SNF], home health, and hospice). Results: Women were more likely than men to use inpatient services, SNF services, home health, and hospice in the LYOL. Average expenditures for women were $1600 higher than for men, which were attributed to higher average expenditures on home health and hospice services. Among decedents aged 68-74 who used inpatient care, inpatient expenditures were higher for women than men. Older cohorts were less likely to use inpatient and outpatient services and more likely to use SNF services. Average Medicare expenditures were significantly lower in older cohorts. Conclusions: Most of the gender differences in average Medicare expenditures were explained by gender differences in age and the lower average expenditures on older decedents with colorectal cancer. Remaining gender differences varied across age cohorts and were largest among those aged 68-74. Higher expenditures for women on each of the social supportive services (SNF, home health, and hospice), even among those who used a particular type of service, may reflect a lack of informal supports for older women compared with men

%0 Journal Article
%A Nelson, Roxanne
%J Lancet Oncol
%D 2007 Jan
%N 1
%P 13
%T Topotecan more effective than supportive care
%V 8
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17348119

%0 Journal Article
%C La Trobe University/Austin Health, Melbourne, VIC, Australia. Amanda.hordern@cancervic.org.au
%A Hordern, Amanda J
%A Street, Annette F
%J Med J Aust
%D 2007 Mar
%N 5
%P 224-7
%T Communicating about patient sexuality and intimacy after cancer: mismatched expectations and unmet needs
%V 186
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17391082
%X OBJECTIVE: To explore the ways that patients and health professionals communicate about intimate and sexual changes in cancer and palliative care settings. DESIGN: A qualitative study using a three-stage reflexive-inquiry approach, with semi-structured, participant interviews (n = 82); textual analysis of national and international cancer and palliative care clinical practice guidelines (n = 33); and participant feedback at 15 educational forums for cancer patients or health professionals. SETTING: A large Australian public teaching hospital between 2002 and 2005. PARTICIPANTS: 50 patients diagnosed with cancer, and 32 health professionals who had worked in cancer and/or palliative care for a minimum of 12 months. MAIN OUTCOME MEASURES: Communication about intimacy and sexuality: patients' needs and experiences and health professionals' attitudes and experiences. RESULTS: There were mismatched expectations between patients and health professionals and unmet patient needs in communication about sexuality and intimacy. Most patients sought information, support and practical strategies about how to live with intimate and sexual changes after treatment for cancer, even if their cancer type did not affect fertility or sexual performance. In contrast, many health professionals assumed that patients shared their professional focus on combating the disease, irrespective of the emotional and physical costs to the patient. Health professionals overwhelmingly limited their understanding of patient sexuality to fertility, contraception, menopausal or erectile status. Many stereotypical assumptions were made about patient sexuality, based on age, sex, diagnosis, culture, and partnership status. There was a relationship between providing patient-centred communication about intimacy and sexuality and health professionals' understanding of their own attitudes and beliefs. CONCLUSION: Resources are needed to help health professionals engage in an exploration of their own definitions of intimacy and sexuality and understand how these affect interactions with patients with cancer

%0 Journal Article
%C Department of Biochemistry and Experimental Medicine, The Children's Memorial Health Institute, Warsaw, Poland
%A Jaworski, M
%A Lorenc, RS
%J Med Sci Monit
%D 2007 Mar
%N 4
%P CR206-210
%T Risk of hip fracture in Poland
%V 13
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17392653
%X Background: Bone fractures generate significant social costs, particularly in highly developed countries. This study was aimed at defining the number of hip fractures in Poland and evaluating absolute risk of fractures of this type within a period of 10 years and to the end of life. Material/Methods: Figures concerning hip fractures in the Mazowsze Province were provided by the Mazowsze Division of the National Health Fund. Data concerning male and female populations divided into age groups and with specified life expectancy were taken from the Central Bureau of Statistics. The number of hip fractures in Poland was estimated based on data for the Mazowsze Province. Lifetime and 10-year risks of hip fracture were calculated based on a model used by J. A. Kanis et al. Results: The estimated number of hip fractures in Poland was 27,434 (7970 in men, 19,464 in women). Lifetime risk of a hip fracture among men was 7.6% (40 years) to 1.6% (90 years) and from 13.6% to 2% among women, respectively. Ten-year risk of a hip fracture was maximal at the age of 80 and was 4.9% among men and 9.2% among women. Conclusions: The study revealed a relatively large number hip fractures in Poland, amounting to approx. 30 thousand fractures per year. The expected increase in life expectancy in Poland, particularly among women, may result in significantly increased numbers of fractures in the nearest future and increased costs of their treatment

%0 Journal Article
%C Gertrude H. Sergievsky Center, Columbia University, New York, NY, USA. smalbert@pitt.edu
%A Albert, S M
%A Wasner, M
%A Tider, T
%A Drory, V E
%A Borasio, G D
%J Neurology
%D 2007 Mar
%N 13
%P 1058-61
%T Cross-cultural variation in mental health at end of life in patients with ALS
%V 68
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17389312
%X OBJECTIVE: To examine mental health at the end of life among patients with ALS in three countries: Israel, Germany, and the United States. METHODS: Patients met criteria for definite or probable ALS and had forced vital capacity (FVC) <60% of predicted. Patients completed nonsomatic items from the Beck Depression Inventory and visual analogue scale ratings. RESULTS: The three sites contributed a total of 92 patients; 60 died during follow-up. Patients at the three sites did not differ significantly in sociodemographic features or ALS Functional Rating Scale-Revised summary disability score; sites differed in use of nasal ventilation but not percutaneous esophageal gastrostomy (PEG) tube placement. In analyses that adjusted for disability and use of nasal ventilation, patients at the three sites differed in reports of pessimism and suffering; American patients reported the least distress and Israeli patients the most. In analyses limited to people who died, similar patterns emerged, with wish to live greatest in Americans and least among Israelis. These models adjusted for disability and days until death. CONCLUSIONS: Cultural factors may affect mental health at the end of life in patients with ALS

%0 Journal Article
%C St. Giles Hospice, Lichfield, Staffordshire. kay.greene@st-giles-hospice.org.uk
%A Greene, Kay
%J Nurs Stand
%D 2007 Mar
%N 27
%P 40-3
%T Introducing contemporary shift patterns in a hospice setting
%V 21
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17390945
%X For many nurses, quality of life is dependent on the balance of work and home life. Registered, skilled and experienced nurses are necessary to ensure that a high-quality service is provided. The hospice recognised that its main asset in providing such a service is its nursing workforce. This article describes how the hospice introduced new working patterns for nursing staff

%0 Journal Article
%C Memorial Hospital, Santa Rosa, CA, USA
%A Braun, Susan
%J Nursing
%D 2007 Feb
%N 2
%P 44-5
%T Fried eggs and nursing
%V 37
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17273081

%0 Journal Article
%A Fowell, Andrew
%A Johnstone, Ros
%A Russell, Ian
%A Russell, Daphne
%A Finlay, Ilora
%J Palliat Med
%D 2006 Dec
%N 8
%P 845-6
%T Reported symptoms in the last days of life: the need for robust research
%V 20
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17148540

%0 Journal Article
%A Brown, Liz
%A Lawrie, Iain
%A D'Sa, Viv Barros
%A Wilcox, Sarah
%A Bennett, Mike
%J Palliat Med
%D 2006 Oct
%N 7
%P 717-8
%T Constipation: patient perceptions compared to diagnostic tools
%V 20
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17060272

%0 Journal Article
%C Centre for Palliative Care, St Vincent's Hospital and The University of Melbourne, Victoria, Australia. peterh@medstv.unimelb.edu.au
%A Hudson, Peter L
%A Schofield, Penelope
%A Kelly, Brian
%A Hudson, Rosalie
%A O'Connor, Margaret
%A Kristjanson, Linda J
%A Ashby, Michael
%A Aranda, Sanchia
%J Palliat Med
%D 2006 Oct
%N 7
%P 703-10
%T Responding to desire to die statements from patients with advanced disease: recommendations for health professionals
%V 20
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17060269
%X It is not uncommon for patients with advanced incurable disease to express a desire to hasten their death. Health professionals often have difficulty responding to such statements, and find it challenging to ascertain why these statements are made. Health professionals may struggle to determine whether a 'desire to die' statement (DTDS) is about a request for hastened death, a sign of psychosocial distress, or merely a passing comment that is not intended to be heard literally as a death wish. Given the lack of guidelines to assist health professionals with this issue, we have prepared multidisciplinary recommendations for responding to a DTDS, underpinned by key principles of therapeutic communication and a systematic review of empirical literature. Where the relevant literature was lacking, the recommendations were drafted by the authors (clinicians and/ or academics from the following disciplines: nursing, medicine, psychiatry, psychology, sociology, aged care and theology), based on their expert opinion. Multiple drafts of the recommendations were circulated to the authors for refinement until consensus was reached. Strategies for advancing the evidence base for the maturation of guidelines in this area are offered

%0 Journal Article
%C University of Texas Health Science Center at San Antonio School of Nursing, USA. duganb@uthscsa.edu
%A Dugan, Bridget
%J Perspect Psychiatr Care
%D 2007 Feb
%N 1
%P 41-6
%T Loss of identity in disaster: how do you say goodbye to home?
%V 43
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17295857
%X TOPIC: Hurricane Katrina was a disaster that affected the lives of many people from the Gulf Coast area. The hurricane affected their emotional and physical health, and devastated their financial and material status. PURPOSE: This article relates the lived experience of a Hurricane Katrina New Orleans evacuee who relocated to Texas permanently. CONCLUSION: The people who resided in these communities lost not only their homes but their culture and day-to-day life. One's culture and identity are developed and learned over time and cannot be easily replaced. A person may adopt another culture or identity, but the original self (much like the city of New Orleans) has been shattered and torn

%0 Journal Article
%C Nevill Hall Hospital, Abergavenny, South Wales, 15 Llwyn Y Grant Terrace, Penylan, Cardiff CF23 9EW, UK. dgharris@doctors.org.uk
%A Harris, Dylan
%A Davies, Rachel
%J Postgrad Med J
%D 2007 Feb
%N 976
%P 137-40
%T An audit of "do not attempt resuscitation" decisions in two district general hospitals: do current guidelines need changing?
%V 83
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17308220
%X INTRODUCTION: Doctors in all specialties are involved in making "do not attempt resuscitation" (DNAR) decisions; this can be a difficult and challenging process. Guidelines exist to provide an ethical and legal framework for the process and documentation of these decisions. OBJECTIVE: To audit the documentation of resuscitation decisions in a sample of medical inpatients from two district general hospitals. Method: A retrospective case note audit of 50 medical inpatients, in which a DNAR decision had been made (28 from hospital 1, 22 from hospital 2). RESULTS: Average age was 78.9 years (48% male:52% female). In both hospitals DNAR decisions were usually discussed with relatives (84%), documented in nursing notes (100%) and made by senior team members (90%). Although the decision was usually dated and clearly documented (98%), abbreviations were commonly used in hospital 2 (45.5% vs 0% in hospital 1, p<0.05). Decisions regarding other treatment were not consistently documented (78.6% and 72.7%, respectively) and there was little evidence that decisions were reviewed (14.3% and 31.8%). The decision was rarely discussed with the patient (6% of all patients), although 66% of patients were not in a position to have a discussion. CONCLUSIONS: Specific forms for recording DNAR decisions improve the clarity of documentation. Current recommendations to discuss resuscitation with patients are controversial and not followed. However, many patients are not in a position to hold a discussion when the need arises and the guidelines should advocate early discussion during a hospital admission in patients where this is appropriate, prior discussion with family and/or wider use of advanced directives

%0 Journal Article
%C University of California-Los Angeles, School of Medicine, Los Angeles, California 90024, USA. cgrudzen@mednet.ucla.edu
%A Grudzen, Corita
%J Prehospital Disaster Med
%D 2006 Nov-Dec
%N 6
%P 445-50
%T Out-of-hospital resuscitation: have we gone too far?
%V 21
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17334194
%X Americans are living longer and are more likely to be chronically or terminally ill at the time of death. Although surveys indicate that most people prefer to die at home, the majority of people in the United States die in acute care hospitals. Each year, approximately 400,000 persons suffer sudden cardiac arrest in the US, the majority occurring in the out-of-hospital setting. Mortality rates are high and reach almost 100% when prehospital care has failed to restore spontaneous circulation. Nonetheless, patients who receive little benefit or may wish to forgo life-sustaining treatment often are resuscitated. Risk versus harm of resuscitation efforts can be differentiated by various factors, including cardiac rhythm. Emergency medical services policy regarding resuscitation should consider its utility in various clinical scenarios. Patients, family members, emergency medical providers, and physicians all are important stakeholders to consider in decisions about out-of-hospital cardiac arrest. Ideally, future policy will place greater emphasis on patient preferences and quality of life by including all of these viewpoints

%0 Journal Article
%C The University of Chicago, Department of Pediatrics, Comer Children's Hospital, Chicago, IL 60637, USA. seiden@uchicago.edu
%A Seiden, S C
%A Galvan, C
%A Lamm, R
%J Qual Saf Health Care
%D 2006 Aug
%N 4
%P 272-6
%T Role of medical students in preventing patient harm and enhancing patient safety
%V 15
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=16885252
%X BACKGROUND: Substantial efforts are focused on the high prevalence of patient harm due to medical errors and the mechanisms to prevent them. The potential role of the medical student as a valuable member of the team in preventing patient harm has, however, often been overlooked. METHODS: Four cases are presented from two US academic health centers in which medical students prevented or were in a position to prevent patient harm from occurring. The authors directly participated in each case. RESULTS: The types of harm prevented included averting non-sterile conditions, missing medications, mitigating exposure to highly contagious patients, and respecting patients' "do not resuscitate" requests. CONCLUSION: Medical students are often overlooked as valuable participants in ensuring patient safety. These cases show that medical students may be an untapped resource for medical error prevention. Medical students should be trained to recognize errors and to speak up when errors occur. Those supervising students should welcome and encourage students to actively communicate observed errors and near misses and should work to eliminate all intimidation by medical hierarchy that can prevent students from being safety advocates

%0 Journal Article
%C U.O. Pneumologia, Dipartimento Cardio-Toracico, Azienda Ospedaliero-Universitaria Pisana, Via Paradisa 2, Cisanello, 56124 Pisa, Italy
%A Ambrosino, N
%A Simonds, A
%J Respir Med
%D 2007 Mar
%T The clinical management in extremely severe COPD
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17383170
%X Chronic obstructive pulmonary disease (COPD) affects 6% of the general population and is the fourth-leading cause of death in the United States with severe and very severe disease accounting for 15% and 3% of physician diagnoses of COPD. Guidelines make few recommendations regarding providing the provision of care for the most severe stages of disease, namely Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages III and IV with chronic respiratory failure. The effectiveness of inhaled drug therapy in very severe patients has not been assessed yet. Health care systems in many countries include public funding of long-term oxygen therapy for eligible candidates. Currently, there is little evidence for the use of mechanical ventilatory support in the routine management of hypercapnic patients. Pulmonary rehabilitation should be considered as a significant component of therapy, even in the most severe patients. Although Lung Volume Reduction Surgery has been shown to improve mortality, exercise capacity, and quality of life in selected patients, this modality is associated with significant morbidity and an early mortality rate in the most severe patients. Despite significant progress over the past 25 years, both short- and long-term outcomes remain significantly inferior for lung transplantation relative to other "solid" organ recipients. Nutritional assessment and management is an important therapeutic option in patients with chronic respiratory diseases. Morphine may significantly reduce dyspnoea and does not significantly accelerate death. No consistent improvement in dyspnoea over placebo has been shown with anxiolytics. Supplemental oxygen during exercise reduces exertional breathlessness and improves exercise tolerance of the hypoxaemic patient. Non-invasive ventilation has been used as a palliative treatment to reduce dyspnoea. Hypoxaemic COPD patients, on long-term oxygen therapy, may show reduced health-related quality of life, cognitive function, and depression. Only a small proportion of patients with severe COPD discuss end-of-life issues with their physicians

%0 Journal Article
%C Department of Anaesthesia and Intensive Care, Haukeland University Hospital, N-5021 Bergen, Norway
%A Elshove-Bolk, J
%A Guttormsen, AB
%A Austlid, I
%J Resuscitation
%D 2007 Mar
%T In-hospital resuscitation of the elderly: Characteristics and outcome
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17383791
%X OBJECTIVES: To determine the characteristics of the geriatric patient population subjected to resuscitation attempts at a 1000-bed university hospital and to determine factors associated with mortality and outcome after in-hospital CPR. METHODS: Retrospective chart review. The hospital records from all patients >75 years subjected to in-hospital resuscitation attempts during 2000-2001 were reviewed. Data regarding patient characteristics, mode of arrest and outcome details were extracted. RESULTS: During the study period 151 resuscitation attempts were registered, and 53 (35%) of the patients were >/=75 years of age. The average age was 81 years; 29/53 (55%) patients were female. The admission diagnosis was "cardiac ischaemia" (angina pectoris, myocardial infarction) in 18/53 (34%) of the patients. PEA (pulseless electric activity) was the most common primary arrhythmia (17/53, 32%), and cardiac aetiology was the most common cause of arrest (41/53, 77%). The time of arrest was spread equally over the day. Most resuscitation attempts were performed at the general wards (28 patients, 53%). More then half-part of the patients died immediately (32/53, 60%); initially ROSC (return of spontaneous circulation) was established in 21/53 (40%) patients. A total of 9/53 (17%) patients were discharged home. 'Do not attempt resuscitation' (DNAR) orders or a statement that DNAR orders had been discussed with the patient was not documented in any of the patients resuscitated. CONCLUSION: Selected patients among the geriatric hospitalised patients may benefit a from a short resuscitation attempt. This includes especially those admitted for cardiac ischemia suffering a cardiac arrest with VT or VF as a primary arrhythmia or patients suffering a primary respiratory/hypoxic arrest. Patients who are unlikely to benefit from CPR should be identified on or during hospital admission and the possibility of DNAR orders should be discussed to avoid inappropriate treatment and potential patient suffering. There is a need for implementing routines for discussing the existence of advance-directives or DNAR orders upon admission

%0 Journal Article
%A Foppa, Carlo
%J Rev Med Suisse
%D 2006 Oct
%N 84
%P 2439; author reply 2439-40
%T [Why not kill one's mother-in-law?]
%V 2
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17121252

%0 Journal Article
%C Espace Ethique, AP-HP, Departement de Recherche en Ethique, Paris-Sud 11. marc.guerrier@sls.ap-hop-paris.fr
%A Guerrier, M
%J Rev Neurol (Paris)
%D 2006 Jun
%P 4S334-4S359
%T [Ethical issues and supportive tools and their reversibility in amyotrophic lateral sclerosis]
%V 162 Spec No 2
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17128135

%0 Journal Article
%C Centre Referent pour la SLA de Bordeaux, CHU Haut Leveque, Pessac. emmanuelle.salort@chu-bordeaux.fr
%A Campana-Salort, E
%J Rev Neurol (Paris)
%D 2006 Jun
%P 4S113-4S121
%T [How should the diagnosis of amyotrophic lateral sclerosis be announced?]
%V 162 Spec No 2
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17128098
%X In amyotrophic lateral sclerosis (ALS) announcement of the diagnosis is an important step in the process of comprehensive care. The patterns of psychological reactions following bad news must be considered with precaution. The neurologist must take into consideration the specific aspects of announcing familial ALS. This paper reviews the modalities of announcement of the diagnosis and course in ALS patients

%0 Journal Article
%C Division of Medical Oncology and Haematology, University of Toronto and Department of Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, University Health Network, Canada
%A Zimmermann, Camilla
%J Sociol Health Illn
%D 2007 Mar
%N 2
%P 297-314
%T Death denial: obstacle or instrument for palliative care? An analysis of clinical literature
%V 29
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17381818
%X As a society and as individuals, we have come to recognize ourselves as 'death-denying', a self-characterisation particularly prominent in palliative care discourse and practice. As part of a larger project examining death attitudes in the palliative care setting, a Medline search (1971 to 2001) was performed combining the text words 'deny' and 'denial' with the subject headings 'terminal care', 'palliative care' and 'hospice care'. The 30 articles were analysed using a constant comparison technique and emerging themes regarding the meaning and usage of the words deny and denial were identified. This paper examines the theme of denial as an obstacle to palliative care. In the articles, denial was described as an impediment to open discussion of dying, dying at home, stopping 'futile' treatments, advance care planning and control of symptoms. I suggest that these components of care together constitute what has come to be perceived as a correct 'way to die'. Indeed, the very conceptualisation of denial as an obstacle to these components of care has been integral to building and sustaining the 'way to die' itself. The personal struggle with mortality has become an important instrument in the public problem of managing the dying process

%0 Journal Article
%C Florida State University College of Law, USA
%A Shepherd, Lois
%J Spec Law Dig Health Care Law
%D 2006 Jul
%N 327
%P 9-29
%T Shattering the neutral surrogate myth in end-of-life decisionmaking: Terri Schiavo and her family
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17388125

%0 Journal Article
%C Department of Palliative Care and Rehabilitation Medicine, The University of Texas M.D. Anderson Cancer Center, Unit 008, 1515 Holcombe Blvd., Houston, TX, 77030, USA, ebruera@mdanderson.org
%A Fadul, N
%A Kaur, G
%A Zhang, T
%A Palmer, JL
%A Bruera, E
%J Support Care Cancer
%D 2007 Mar
%T Evaluation of the memorial delirium assessment scale (MDAS) for the screening of delirium by means of simulated cases by palliative care health professionals
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17387520
%X BACKGROUND: Delirium is among the most common neuropsychiatric complications of advanced cancer. The Memorial Delirium Assessment Scale (MDAS) is a widely used and validated screening tool for delirium in cancer patients. OBJECTIVE: The purpose of this study was to assess the use of the MDAS by different palliative care health professionals after receiving formal training and a guiding manual for administration and scoring. MATERIALS AND METHODS: Thirty-one palliative care health professionals received a training session on the MDAS, including description of the tool, validation, and scoring. Participants also received copies of a proposed standardized manual for completion of the MDAS. Two of the investigators presented three simulated cases to the participants, who independently completed a scoring sheet for each case. The data were then analyzed according to the cases and the profession of the operators. RESULTS: Thirty-one scoring sheets were analyzed (11 physicians, 12 nurses, and 8 others). A correct diagnosis was achieved by 30 (96.8%) of the 31 participants in case 1 (nondelirious, true score = 5, median = 5, range = 2-15), 28 of 31 (90.3%) in case 2 (severe mixed delirium, true score = 20, median = 18, range = 10-26), and 31 of 31 in case 3 (mild hypoactive delirium, true score = 14, median = 19, range = 13-25). Overall percentage of error was 31% for items 2, 3, and 4 (cognitive) and 45% for all other items (observational) (p < 0.001). The percentage of error did not differ between physicians and nurses and other palliative care professionals (p > 0.99). CONCLUSIONS: Our preliminary results suggest that adequate training and a guiding manual can enhance the application of MDAS by palliative care health professionals in the teaching settings. Clinical studies to assess the utility of the MDAS as a screening tool are justified to further confirm these findings

%0 Journal Article
%C Dipartimento di Endocrinologia e Oncologia Molecolare e Clinica, Universita degli Studi di Napoli Federico II, Napoli, Italy. giuseppedilorenzoncol@hotmail.com
%A Di Lorenzo, Giuseppe
%A Autorino, Riccardo
%A Giuliano, Mario
%A Morelli, Emilio
%A Giordano, Antonio
%A Napodano, Giorgio
%A Russo, Aniello
%A Benincasa, Giuseppe
%A D'Armiento, Massimino
%A Altieri, Vincenzo
%A De Placido, Sabino
%J Urology
%D 2007 Feb
%N 2
%P 347-51
%T Phase II trial of gemcitabine, prednisone, and zoledronic acid in pretreated patients with hormone refractory prostate cancer
%V 69
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17320676
%X OBJECTIVES: To investigate the impact on biochemical and objective response and on pain improvement of gemcitabine, prednisone, and zoledronic acid in patients with hormone-refractory prostate cancer (HRPC), previously treated with docetaxel-based regimens. METHODS: The patients were treated with gemcitabine 1000 mg/m2 every 14 days, prednisone 10 mg orally on days 1 to 7 and 14 to 21, and zoledronic acid every 4 weeks. Changes in prostate-specific antigen levels, tumor response, and toxicity were evaluated every month. The pain response, based on pain reduction and analgesic drug reduction, was assessed during therapy. RESULTS: A total of 22 men (median age 65 years) were treated. Overall, 5 patients (23%) achieved a 50% or greater reduction in prostate-specific antigen level after two cycles; a partial response was observed in 1 (14%) of 7 patients with measurable disease, and 3 (43%) of 7 had stable disease. Of the 22 men, 23% had pain improvement. The most important hematologic toxicity was neutropenia (grade 3 in 18%). CONCLUSIONS: The combination of gemcitabine, prednisone, and zoledronic acid appears to be associated with biochemical response, pain improvement, and good safety in pretreated patients with HRPC

%0 Journal Article
%A Arsen'ev, A I
%A Barchuk, A S
%A Kanaev, S V
%A Vedenin, Ia O
%A Klimenko, V N
%J Vopr Onkol
%D 2006 
%N 6
%P 701-7
%T [Role of endobronchial methods in combined palliative treatment of lung cancer]
%V 52
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17338254

%0 Journal Article
%A Kaprin, A D
%A Kostin, A A
%J Vopr Onkol
%D 2006 
%N 6
%P 673-4
%T [Use of radiofrequency ablation in palliative therapy of renal cancer]
%V 52
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17338247
%X New methods in management of renal cancer promising better quality-of-life outcomes have been introduced for the past 10-15 years. They offer more opportunity of early detection of cancer, differential diagnosis and more accurate staging. Yet, there is a sizeable percentage of patients who cannot undergo surgery for general health reasons, multiple tumor involving both kidneys or involvement of a single kidney. Such patients may be given radio frequency ablation which causes a.c.-charged intracellular structures to vibrate leading to coagulation of tumor. Being unable of complete cure, the procedure is well tolerated. It gives the feeling of comfort, improves quality of life and is often followed by survival times comparable to postoperative ones

%0 Journal Article
%A Kostin, A A
%A Kaprin, A D
%J Vopr Onkol
%D 2006 
%N 6
%P 670-2
%T [Potential of modern urology in palliation of cancer]
%V 52
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17338246
%X The paper deals with certain issues in present-day oncology and introduction of the most efficient endourological procedures to improve quality of life. Most cancer patients suffer urological cancer-related and postoperative complications. Oncologists are often confronted with such problems as disturbed passage of urine in colorectal and gynecological cancers, radiation injury and surgery-induced impairment of the urinary tract and urolithiasis in cancer patients. Diagnostic and therapeutic potential of modern urology and novel approaches intended to improve quality of life in cancer patients with urological complications are discussed

%0 Journal Article
%C dr.martinklein@t-online.de
%A Klein, Martin
%J Wurzbg Medizinhist Mitt
%D 2005 
%P 51-62
%T [Euthanasia and the doctrine of double effect]
%V 24
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17153292
%X Direct active euthanasia is prohibited in most countries while passive and indirect is not. However, many arguments against the legalization of voluntary active euthanasia are flawed. Ethical differences between active and passive or indirect euthanasia are difficult to maintain especially when the passivity of the actor causes death. The crucial point is not activity or passivity but respect for the autonomy of individual human beings. In particular there appears to be little ethical difference between active and indirect euthanasia. Indirect euthanasia has often been justified by the principle of double effect, which traces back to Thomas Aquinas. But resorting to this rule contains a logical fallacy. The principle of double effect does not allow foreseen and unwanted adverse effects of an action to occur when they are avoidable. In terminal sedation, an example for indirect euthanasia, hypoxemia and dehydration can easily be prevented by respirator therapy and fluid administration. Therefore the rule of double effect is not applicable. Indirect and direct active euthanasia cannot be ethically distinguished by resorting to the principle of double effect