%0 Journal Article
%C Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
%A Thompson, Genevieve N
%A McClement, Susan E
%A Daeninck, Paul J
%J J Palliat Care
%D 2006 Summer
%N 2
%P 91-8
%T "Changing lanes": facilitating the transition from curative to palliative care
%V 22
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17265661
%X Little empirical work has been conducted assessing the perspectives of nurses regarding the barriers, facilitators, and strategies associated with achieving quality patient care at the end of life. A grounded theory study was conducted examining nursing behaviours and social processes inherent in the provision of quality end-of-life care from the perspective of generalist nurses (n = 10) working in an acute care setting. An inductively derived preliminary model, "creating a haven for safe passage", was developed based on the findings from this study and has been published elsewhere (1). This article provides a detailed description of one of the subprocesses of the model regarding the transition from curative to palliative care--the subprocess of "facilitating and maintaining a lane change". The various strategies which nurses used to effect a lane change, as well as the facilitators and barriers they encountered in this process, are presented. The consequences associated with both successful and unsuccessful lane changes are reported

%0 Journal Article
%A Moore, Amanda
%A Tzovarras, Hunter
%J J Leg Med
%D 2006 Dec
%N 4
%P 395-425
%T 2005-2006 National Health Law Moot Court Competition: best brief
%V 27
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17162679

%0 Journal Article
%C Shepard Broad Law Center at Nova Southeastern University, Fort Lauderdale, FL, USA
%A Cerminara, Kathy
%J J Leg Med
%D 2006 Dec
%N 4
%P 377-94
%T 2005-2006 National Health Law Moot Court Competition: problem
%V 27
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17162678

%0 Journal Article
%C Saint-Louis Hospital and Paris 7 University, Assistance Publique-Hopitaux de Paris, France
%A Lautrette, Alexandre
%A Darmon, Michael
%A Megarbane, Bruno
%A Joly, Luc Marie
%A Chevret, Sylvie
%A Adrie, Christophe
%A Barnoud, Didier
%A Bleichner, Gerard
%A Bruel, Cedric
%A Choukroun, Gerald
%A Curtis, J Randall
%A Fieux, Fabienne
%A Galliot, Richard
%A Garrouste-Orgeas, Maite
%A Georges, Hugues
%A Goldgran-Toledano, Dany
%A Jourdain, Merce
%A Loubert, Georges
%A Reignier, Jean
%A Saidi, Faycal
%A Souweine, Bertrand
%A Vincent, Francois
%A Barnes, Nancy Kentish
%A Pochard, Frederic
%A Schlemmer, Benoit
%A Azoulay, Elie
%J N Engl J Med
%D 2007 Feb
%N 5
%P 469-78
%T A communication strategy and brochure for relatives of patients dying in the ICU
%V 356
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17267907
%X BACKGROUND: There is a need for close communication with relatives of patients dying in the intensive care unit (ICU). We evaluated a format that included a proactive end-of-life conference and a brochure to see whether it could lessen the effects of bereavement. METHODS: Family members of 126 patients dying in 22 ICUs in France were randomly assigned to the intervention format or to the customary end-of-life conference. Participants were interviewed by telephone 90 days after the death with the use of the Impact of Event Scale (IES; scores range from 0, indicating no symptoms, to 75, indicating severe symptoms related to post-traumatic stress disorder [PTSD]) and the Hospital Anxiety and Depression Scale (HADS; subscale scores range from 0, indicating no distress, to 21, indicating maximum distress). RESULTS: Participants in the intervention group had longer conferences than those in the control group (median, 30 minutes [interquartile range, 19 to 45] vs. 20 minutes [interquartile range, 15 to 30]; P<0.001) and spent more of the time talking (median, 14 minutes [interquartile range, 8 to 20] vs. 5 minutes [interquartile range, 5 to 10]). On day 90, the 56 participants in the intervention group who responded to the telephone interview had a significantly lower median IES score than the 52 participants in the control group (27 vs. 39, P=0.02) and a lower prevalence of PTSD-related symptoms (45% vs. 69%, P=0.01). The median HADS score was also lower in the intervention group (11, vs. 17 in the control group; P=0.004), and symptoms of both anxiety and depression were less prevalent (anxiety, 45% vs. 67%; P=0.02; depression, 29% vs. 56%; P=0.003). CONCLUSIONS: Providing relatives of patients who are dying in the ICU with a brochure on bereavement and using a proactive communication strategy that includes longer conferences and more time for family members to talk may lessen the burden of bereavement. (ClinicalTrials.gov number, NCT00331877.)

%0 Journal Article
%C School of Nursing, University of Washington, Seattle, WA, USA. doorenbo@u.washington.edu
%A Doorenbos, Ardith Z
%A Wilson, Sarah A
%A Coenen, Amy
%J J Nurs Scholarsh
%D 2006 
%N 4
%P 352-7
%T A cross-cultural analysis of dignified dying
%V 38
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17181083
%X PURPOSE: To describe the characteristics of dignified dying and other terminology nurses used to describe this phenomenon in Ethiopia, India, Kenya, and the United States (US). DESIGN: A cross-sectional descriptive survey with a convenience sample of nurses who cared for dying patients in Ethiopia (n=14), India (n=229), Kenya (n=36), and the US (n=281). Data were collected between 2002 and 2004. METHODS: Nurses were recruited to complete the ICNP Dignified Dying survey, which consists of demographic information, 2 open-ended questions, and 14 questions about characteristics of dignified dying. FINDINGS: The 14 characteristics on the dignified dying scale reliably measured dignified dying, with a Cronbach's alpha coefficient of .91. All characteristics were rated as representative of dignified dying, with content validity scores ranging from .62 to .77. Factor analysis yielded a two-factor solution, which accounted for 53% of the variance. CONCLUSIONS: Findings of this study contribute to the ongoing development of the International Classification of Nursing Practice (ICNP) regarding the nursing phenomenon of dignified dying. The ICNP a unified nursing language system, is used to promote and facilitate scholarly exchange among nurses across countries

%0 Journal Article
%C University of Toronto, Minimally Invasive Surgery Program, Toronto. jscyriac@hotmail.com
%A Cyriac, J
%A Klein, L
%J Surg Endosc
%D 2007 Feb
%N 2
%P 324
%T A laparoscopic duodenojejunostomy for a duodenal obstruction from lymphoma
%V 21
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17195042
%X A patient with lymphoma in one-third of the duodenum causing a duodenal obstruction is described. The patient had a partial response with chemotherapy, but still was obstructed and unable to eat. He was losing weight, and chemotherapy had to be stopped. A gastrostomy tube was inserted for drainage because the stomach was quite distended. A jejunostomy tube was passed through the gastrostomy tube for feeding, but the patient did not tolerate the feeding. A laparoscopic bypass of the duodenumduodenal obstruction (from duodenum to jejunum) for this patient is shown on a video. The patient did very well after this bypass was provided. He was able to tolerate an oral diet on postoperative day 2, and on postoperative day 4, he was discharged home. He has since resumed chemotherapy, and is doing well, at this writing, 2 months after surgery. Electronic supplementary material is available for this article at http://dx.doi.org/10.1007/s00464-005-0874-2

%0 Journal Article
%C Division of Cardiothoracic Surgery, the University of Washington, Seattle, Wash 98195-6310, USA. dewood@u.washington.edu
%A Wood, Douglas E
%A McKenna, Robert J Jr
%A Yusen, Roger D
%A Sterman, Daniel H
%A Ost, David E
%A Springmeyer, Steven C
%A Gonzalez, H Xavier
%A Mulligan, Michael S
%A Gildea, Thomas
%A Houck, Ward V
%A Machuzak, Michael
%A Mehta, Atul C
%J J Thorac Cardiovasc Surg
%D 2007 Jan
%N 1
%P 65-73
%T A multicenter trial of an intrabronchial valve for treatment of severe emphysema
%V 133
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17198782
%X OBJECTIVES: Minimally invasive endoscopic treatment of emphysema could provide palliation with less risk than lung volume reduction surgery and offer therapy to patients currently not considered for lung volume reduction surgery. The Intrabronchial Valve is used to block bronchial airflow in the most emphysematous areas of lung. METHODS: Patients with severe chronic obstructive pulmonary disease and heterogeneous upper lobe-predominant emphysema were eligible. Patients underwent flexible bronchoscopic placement of valves into segmental or subsegmental airways in both upper lobes. Outcomes assessed over a minimum of 6 months of follow-up included the safety, feasibility, tolerance, and success of valve placement; health-related quality of life; exercise capacity; pulmonary function; and gas exchange. RESULTS: Five centers treated 30 patients. Patient follow-up ranged from 1 to 12 months. A mean of 6.1 valves were placed per patient. Valves were positioned by means of flexible bronchoscopy in 99% of desired airways, and the procedure duration ranged from 15 to 125 minutes (mean, 65 minutes). Hospital discharge occurred within 2 days in 27 of 30 patients. There were no deaths or episodes of valve migration, tissue erosion, or significant bleeding. Eighty-three percent of patients had no adverse events judged probably or definitely related to the device. Patients experienced significant improvement in health-related quality of life, although the physiologic and exercise outcomes did not show statistically significant improvements. CONCLUSIONS: These first multicenter results with the Intrabronchial Valve demonstrate significant improvements in health-related quality of life and acceptable safety, ease of use, and procedural complication rates. The valve might be a safer and less-invasive alternative to surgical therapy for patients with severe emphysema

%0 Journal Article
%C Regis University and National Infusion Nurses Society. mmg95@aol.com
%A McCormick-Gendzel, Mary
%A Jurchak, Martha
%J Home Healthc Nurse
%D 2006 Nov-Dec
%N 10
%P 654-61; quiz 670-1
%T A pathway for moral reasoning in home healthcare
%V 24
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17135844
%X Ethical issues arise in the practice of infusing nursing, and when they do, the home care nurse can find guidance in the code of ethics. This article addresses the importance of the code of ethics and introduces a framework for decision-making to assist the home care nurse in determining a course of action in the face of ethical quandaries

%0 Journal Article
%C University of Pittsburgh, School of Nursing, Pittsburgh, PA
%A Mitchell, Ann M
%A Wesner, Sue
%A Garand, Linda
%A Gale, Deborah Dysart
%A Havill, Allyson
%A Brownson, Lynn
%J J Child Adolesc Psychiatr Nurs
%D 2007 Feb
%N 1
%P 3-13
%T A support group intervention for children bereaved by parental suicide
%V 20
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17284234
%X TOPIC: Bereavement is considered by many to be among the most stressful of life events, and it becomes particularly distressing when it concerns the suicide death of a parent. Such an event is especially traumatic for children. PURPOSE AND SOURCES: The purpose of this paper is to present a case for support group interventions designed specifically for child survivors of parental suicide. The authors provide a theoretical framework for supportive group interventions with these children and describe the structure of an 8-week bereavement support group for this special population of suicide survivors. CONCLUSIONS: A case is made for designing and implementing group interventions to meet the mental health needs of this important group of individuals

%0 Journal Article
%A Murray, Scott A
%A Chinn, David J
%A Sheikh, Aziz
%J J R Soc Med
%D 2006 Dec
%N 12
%P 601
%T Access to psychological and psychiatric services needs to be improved for the dying
%V 99
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17139059

%0 Journal Article
%C Section of Palliative Care Medicine, Department of Oncology, MBC-64, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
%A Gray, A
%J Ann Saudi Med
%D 1999 Jul-Aug
%N 4
%P 388-9
%T Book review: Cancer pain relief and palliative care in children WHO Publication, Geneva 1998
%V 19
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17277556

%0 Journal Article
%C Department of Haematology, The Alfred Hospital, Melbourne, Australia
%A Polizzotto, Mark N
%A Martin, Peter
%J J Palliat Care
%D 2006 Summer
%N 2
%P 117-8
%T Buried alive: an unusual problem at the end of life
%V 22
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17265666

%0 Journal Article
%C Clinic for General and Thoracic Surgery, University Clinic of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 7, 24105, Kiel, Germany. schniewind@surgery.uni-kiel.de
%A Schniewind, B
%A Bestmann, B
%A Kurdow, R
%A Tepel, J
%A Henne-Bruns, D
%A Faendrich, F
%A Kremer, B
%A Kuechler, T
%J Ann Surg Oncol
%D 2006 Nov
%N 11
%P 1403-11
%T Bypass surgery versus palliative pancreaticoduodenectomy in patients with advanced ductal adenocarcinoma of the pancreatic head, with an emphasis on quality of life analyses
%V 13
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17009141
%X BACKGROUND: In some centers, palliative resection (PR; partial pancreaticoduodenectomy) is, in selected cases, promoted in preference to double loop bypass (DLB) surgery for advanced pancreatic cancer. This prospective study compares PR with DLB, placing particular focus on patients' quality of life (QoL). METHODS: From 01/1993 to 09/2004, 167 patients were analyzed in a prospective single center study of palliative surgical treatment of advanced ductal adenocarcinoma of the pancreatic head. Thirty-eight underwent PR and 129 underwent palliative DLB. Patients undergoing DLB were divided into: (1) locally advanced disease (LAD-subgroup; n = 61; 47%) and (2) metastasized disease (MD-subgroup; n = 68; 53%). QoL was assessed using the EORTC QLQ-C30 questionnaire supplemented by a pancreatic cancer specific module. QoL data were collected pre-operatively and for up to 12 months after surgery. RESULTS: Median survival was 7.0 months (95% CI 4.09; 9.91) in PR patients and 6.0 months (95% CI 5.39; 6.61) in patients who received DLB. Mortality and morbidity were, respectively, 7.8 and 58% for PR, and 2.6 and 42% for DLB. QoL decreased more after PR than after DLB. The DLB-group recovered quicker, reaching pre-operative QoL levels after 3 months, and were less impaired when discharged. The LAD-subgroup and the MD-subgroup presented with equal levels of QoL. CONCLUSIONS: QoL analysis revealed favorable QoL data after DLB. Additionally, the survival rates of the two groups did not differ significantly, but morbidity and mortality rates in the PR group were elevated. Therefore, the use of PR for advanced pancreatic cancer needs to be carefully evaluated

%0 Journal Article
%C Center for Minority Public Health, Case Western Reserve University, School of Medicine, Department of Epidemiology and Biostatistics, Cleveland, OH 44106-4945, USA. Sana.Loue@cwru.edu
%A Loue, Sana
%A Lowder, Janet L
%A Buzney, Sandra J
%A Buzo, Amanda M
%J Care Manag J
%D 2006 Winter
%N 4
%P 191-8
%T Caring for an adult child with cognitive disabilities: meeting the dual needs of an adult and child
%V 7
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17194055
%X A significant proportion of families in the United States provide care for an adult child who has a cognitive impairment. Significant issues may arise in the context of providing this care, including medical concerns, the nature of the relationship between the adult cognitively impaired child and his or her parents, safety concerns in the home, difficulties that the adult child may face in the community, and employment-related issues. We focus, as well on the need to plan for the future through the execution of powers of attorney, living wills, and accessing government benefits for the individual Caregiver stress is also a concern. We provide various alternatives for the management of these issues

%0 Journal Article
%C Section of Oncology, Department of Medicine, Haukeland University Hospital, University of Bergen, NO-5021, Bergen, Norway
%A Geisler, J
%A Lonning, P E
%A Krag, L E
%A Lokkevik, E
%A Risberg, T
%A Hagen, A I
%A Schlichting, E
%A Lien, E A
%A Ofjord, E S
%A Eide, G E
%A Polli, A
%A di Salle, E
%A Paolini, J
%J Eur J Cancer
%D 2006 Nov
%N 17
%P 2968-75
%T Changes in bone and lipid metabolism in postmenopausal women with early breast cancer after terminating 2-year treatment with exemestane: a randomised, placebo-controlled study
%V 42
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=16963261
%X Aromatase inhibitors improve relapse-free survival in early breast cancer, but there is concern about possible detrimental effects on bone mineral density (BMD) and plasma lipids. This paper presents the results of a 2-year study evaluating the effects of exemestane versus placebo on BMD, bone markers, plasma lipids and coagulation factors, including a 1-year follow-up after termination of treatment in 147 patients. During treatment, the mean annual rate of loss of BMD in the lumbar spine was 2.17% in the exemestane group versus 1.84% in the placebo group (n.s.) and 2.72% versus 1.48%, respectively, in the femoral neck (P=0.024). A loss of BMD above that expected in both arms of this study could be due to low vitamin D status (88% of all patients had vitamin D levels <30 ng/ml). The changes observed with exemestane were partially reversed during a 1-year follow-up, with no significant difference between the two arms. Similarly, the moderate decrease in high-density lipoprotein (HDL)-cholesterol was reversed. The bone marker values decreased, although a difference at 6 months of follow-up was still recorded, in particular for the markers of bone synthesis

%0 Journal Article
%C Department of Agricultural Food & Nutritional Science (J.L.H., V.E.B., W.V.W.), and Department of Oncology (V.E.B.), University of Alberta, Edmonton, Alberta, Canada
%A Hutton, Joanne L
%A Baracos, Vickie E
%A Wismer, Wendy V
%J J Pain Symptom Manage
%D 2007 Feb
%N 2
%P 156-65
%T Chemosensory dysfunction is a primary factor in the evolution of declining nutritional status and quality of life in patients with advanced cancer
%V 33
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17280921
%X Alterations in taste and smell functions have been reported in cancer patients. Although these senses are known to be particularly affected by chemotherapy, many features of chemosensory perception in cancer patients remain obscure. The relative importance of chemosensory changes in the etiology of malnutrition and wasting is not known. To assess this relationship, self-perceived taste and smell function were evaluated using a validated questionnaire in 66 patients with advanced cancer receiving palliative care (median survival 7.4 months). Participants also completed 3-day food records to assess dietary intake, and the Functional Assessment of Anorexia/Cachexia Therapy questionnaire to assess quality of life (QOL). Total chemosensory complaint scores ranged from 0 to 14 on a 16-point scale. Only 14% of the subjects reported no chemosensory complaints of any kind, whereas 86% reported some degree of chemosensory abnormality. The most common complaints were persistent bad taste in the mouth, taste distortion, and heightened sensitivity to odors. Subjects with severe chemosensory complaints showed substantially lower energy intakes (by 900-1,100kcal/day), higher rates of weight loss, and lower QOL scores than subjects with mild or moderate chemosensory complaints. Severe chemosensory dysfunction is persistent well beyond the window of active therapy in patients with advanced cancer and represents a primary factor relating to malnutrition, wasting, and poor QOL. Further research is required to identify appropriate strategies to alleviate this important group of symptoms, to determine whether intervention will improve QOL, and to match foods and diet to the unique chemosensory profile of advanced cancer patients

%0 Journal Article
%C PATRICIA MOYLE WRIGHT is employed as a childbirth educator for the Wyoming Valley Health Care System in Pennsylvania and is pursuing a PhD in Nursing at Loyola University Chicago in Illinois
%A Wright, Patricia Moyle
%J J Perinat Educ
%D 2005 Fall
%N 4
%P 9-15
%T Childbirth education for parents experiencing pregnancy after perinatal loss
%V 14
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17273448
%X Expectant parents who have experienced previous perinatal loss have special concerns, which can be partially addressed by modifying prepared childbirth education courses. This article presents a review of current literature, highlighting the unique needs of expectant parents who have experienced previous pregnancy loss. Modifications to traditional childbirth education courses are suggested, which include addressing parents' grief, managing anxiety, and facilitating communication with health-care providers and others

%0 Journal Article
%C Department of Orthopedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan. maito@med.hokudai.ac.jp
%A Ito, Manabu
%A Abumi, Kuniyoshi
%A Kotani, Yoshihisa
%A Kadoya, Ken
%A Minami, Akio
%J Spine
%D 2007 Jan
%N 2
%P 200-6
%T Clinical outcome of posterolateral endoscopic surgery for pyogenic spondylodiscitis: results of 15 patients with serious comorbid conditions
%V 32
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17224815
%X STUDY DESIGN: Clinical results of posterolateral endoscopic debridement and irrigation followed by percutaneous drainage for pyogenic spondylodiscitis were analyzed. OBJECTIVES: To report clinical results of transforaminal endoscopic surgery for pyogenic spondylodiscitis and to evaluate the effectiveness of this procedure in treatment of pyogenic spinal infections. SUMMARY OF BACKGROUND DATA: Pyogenic spinal infections have been increasing due to the development of medical treatment for patients with comorbid medical problems. Common treatments for spinal infections are administration of antibiotics or surgical debridement with bone grafts. There have been no reports, however, regarding the clinical outcome of posterolateral endoscopic treatment for pyogenic spinal infections. METHODS: Fifteen consecutive patients with pyogenic spondylodiscitis in the thoracic or lumbar spine were enrolled. Preoperative antibiotic treatment had failed in all the patients. The procedures consisted of posterolateral endoscopic debridement and irrigation followed by percutaneous drainage through single portal under the combination of local and intravenous anesthesia. Pain response using visual analog scale (VAS, 0-100 mm), inflammation parameters, and duration of antibiotic therapy were investigated. Radiologic evaluation focused on bony fusion, local kyphosis, disc height reduction, and abscess formation. RESULTS: All patients showed immediate pain reduction after surgery. Averaged VAS for pain was 86 before surgery and 25 at postoperative 1 week. Average of CRP was 4.00 mg/dL before surgery and 1.88 mg/dL at postoperative 1 week. Averaged duration of antibiotics therapy was 3.7 weeks. Spinal fusion was obtained in 13 patients. Two patients with neurologic deficits due to epidural abscess returned to normal. Preoperative psoas abscess in 6 patients disappeared after surgery on MRI. CONCLUSIONS: Posterolateral spinal endoscopic debridement and irrigation brought immediate pain reduction and good clinical results to patients who had comorbid medical problems and had pyogenic spondylodiscitis

%0 Journal Article
%C Department of Biosurgery and Surgical Technology, Imperial College London, St. Mary's Hospital, 10th Floor QEQM Building, Praed Street, London, W2 1NY, UK
%A Tilney, H S
%A Lovegrove, R E
%A Purkayastha, S
%A Sains, P S
%A Weston-Petrides, G K
%A Darzi, A W
%A Tekkis, P P
%A Heriot, A G
%J Surg Endosc
%D 2007 Feb
%N 2
%P 225-33
%T Comparison of colonic stenting and open surgery for malignant large bowel obstruction
%V 21
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17160651
%X BACKGROUND: Colonic stents potentially offer effective palliation for those with bowel obstruction attributable to incurable malignancy, and a "bridge to surgery" for those in whom emergency surgery would necessitate a stoma. The current study compared the outcomes of stents and open surgery in the management of malignant large bowel obstruction. METHODS: A literature search of the Medline, Ovid, Embase and Cochrane databases was performed to identify comparative studies reporting outcomes on colonic stenting and surgery for large bowel obstruction. Random effects meta-analytical techniques were applied to identify differences in outcomes between the two groups. Sensitivity analysis of high quality studies, those reporting on more than 35 patients, those solely concerning colorectal cancer and studies performing intention to treat analysis was undertaken to evaluate the study heterogeneity. RESULTS: A total of 10 studies satisfied the criteria for inclusion, with outcomes reported for 451 patients. Stent insertion was attempted for 244 patients (54.1%), and proved successful for 226 (92.6%). The length of hospital stay was shorter by 7.72 days in the stent group (p < 0.001), which also had lower mortality (p = 0.03) and fewer medical complications (p < 0.001). Stoma formation at any point during management was significantly lower than in the stent group (odds ratio, 0.02; p < 0.001), and "bridging to surgery" did not adversely influence survival. CONCLUSIONS: Colonic stenting offers effective palliation for malignant bowel obstruction, with short lengths of hospital stay and a low rate for stoma formation, but data on quality of life and economic evaluation are limited. There is no evidence of differences in long-term survival between those who have stents followed by subsequent resection and those undergoing emergency bowel resection

%0 Journal Article
%C Medical History and Ethics, Box 357120, University of Washington, Seattle, WA 98195-7120, USA. dudzin@u.washington.edu
%A Dudzinski, Denise M
%A Shannon, Sarah E
%J Nurs Ethics
%D 2006 Nov
%N 6
%P 608-21
%T Competent patients' refusal of nursing care
%V 13
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17193802
%X Competent patients' refusals of nursing care do not yet have the legal or ethical standing of refusals of life-sustaining medical therapies such as mechanical ventilation or blood products. The case of a woman who refused turning and incontinence management owing to pain prompted us to examine these situations. We noted several special features: lack of paradigm cases, social taboo around unmanaged incontinence, the distinction between ordinary versus extraordinary care, and the moral distress experienced by nurses. We examined this case on the merits and limitations of five well-known ethical positions: pure autonomy, conscientious objection, paternalism, communitarianism, and feminism. We found each lacking and argue for a 'negotiated reliance' response where nurses and others tread as lightly as possible on the patient's autonomy while negotiating a compromise, but are obligated to match the patient's sacrifice by extending themselves beyond their usual professional practice

%0 Journal Article
%C La Trobe University, Bundoora, Victoria, Australia
%A Hordern, AJ
%A Street, AF
%J Soc Sci Med
%D 2007 Jan
%T Constructions of sexuality and intimacy after cancer: Patient and health professional perspectives
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17261346
%X With an increasing emphasis on the provision of psychosocial support for patients in cancer and palliative care, an emerging body of literature has highlighted the importance of providing the opportunity for patients to discuss issues of intimacy and sexuality with their health professionals. Very little is known about why health professionals struggle with this level of communication in clinical practice. The aim of this paper is to discuss constructions of intimacy and sexuality in cancer and palliative care from patient and health professional perspectives. A three stage reflexive inquiry was used to systematically and critically analyse data from semi-structured interviews (n=82), a textual analysis of 33 national and international clinical practice guidelines and participant feedback at 15 forums where preliminary research findings were presented to patients and health professionals in cancer and palliative care. The study was conducted across one public teaching hospital in Australia from 2002 to 2005. Data were further analysed drawing upon the work of Giddens on reflexivity, intimacy and sexuality, to reveal that the majority of health professionals embraced a less reflexive, more medicalised approach about patient issues of intimacy and sexuality after cancer. This was in stark contrast to the expectations of patients. Cancer had interrupted their sense of self, including how they experienced changes to intimate and sexual aspects of their lives, irrespective of their age, gender, culture, type of cancer or partnership status. Key findings from this project reveal incongruence between the way patients and health professionals constructed sexuality and intimacy. Structures which govern cancer and palliative care settings perpetrated the disparity and made it difficult for health professionals to regard patients as people with sexual and intimate needs or to express their own vulnerability when communicating about these issues in the clinical practice setting. A degree of reflexivity about personal and professional constructions of sexuality and intimacy was required for health professionals to confidently challenge these dominant forces and engage in the type of communication patients were seeking

%0 Journal Article
%C Department of Clinical Science and Community Health, University of Edinburgh, Scotland, UK
%A Lakha, Fatim
%A Glasier, Anna F
%J Contraception
%D 2006 Oct
%N 4
%P 287-9
%T Continuation rates of Implanon in the UK: data from an observational study in a clinical setting
%V 74
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=16982226
%X BACKGROUND: Long-acting reversible methods of contraception can potentially reduce unintended pregnancy. There are few data on "real-life" continuation rates of the contraceptive implant Implanon. MATERIALS AND METHODS: Three hundred twenty-four women choosing Implanon in a community family planning clinic in Scotland were followed up by case note review (n=236) or postal questionnaire (n=87) 3 years after insertion of the implant (1 woman chose not to disclose her home address). RESULTS: Data were available for 85% of the women. Continuation rates were 89% (CI 84-91) at 6 months, 75% (CI 69-79) at 1 year, 59% (CI 52-63) at 2 years and 47% (CI 40-52) at 2 years and 9 months. Of the 68 women who discontinued Implanon within 1 year, 62 (91%) did so because of unwanted side effects, the most common being frequent and/or unpredictable bleeding (n=42, 62%). Almost half changed to a less-effective method of contraception; however, one third (n=99, 39%) chose to use a second implant when the first one expired. CONCLUSIONS: Continuation rates of Implanon in this clinic setting in the UK make it a cost-effective method of contraception and justify its widespread provision

%0 Journal Article
%C Nurse Maude Hospice and Brain Injury Rehabilitation Service, Burwood Hospital, Christchurch, New Zealand. ad.macleod@cdhb.govt.nz
%A Macleod, A D
%J Palliat Support Care
%D 2006 Sep
%N 3
%P 305-12
%T Delirium: the clinical concept
%V 4
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17066972
%X Delirium is a common syndrome complicating terminal illness. It is underrecognized partly because it is a difficult clinical concept. Consciousness, awareness, alertness, arousal, awakeness, vigilance, and attention are some of the terms used to describe the deficits occurring in delirium. Though interconnected, they are often loosely defined. Alertness is the primary impairment, and attentional deficits are objective clinical indices of the cognitive impairments of delirium. Simple bedside assessments of delirium are considered. The "deliriant" threshold and the symptomatic fluctuations of delirium are important concepts in the understanding of delirium. Jackson's conceptualization of the nervous system is relevant to delirium. Raising the deliriant threshold by multicomponent interventions is the intent of the palliative management of terminal delirium

%0 Journal Article
%C The Ottawa Hospital Rehabilitation Center (K.G.W.), Ottawa, Ontario; Clinical Epidemiology Program, (K.G.W., M.G.S., J.J.C.), Ottawa Health Research Institute, Ottawa, Ontario; Department of Psychiatry (H.M.C.), University of Manitoba, Winnipeg, Manitoba; Department of Medicine (P.A.), University of Ottawa, Ottawa, Ontario; Department of Family Medicine (S.C.), University of Saskatchewan, Saskatoon, Saskatchewan; Faculty of Pharmacy (P.G.), Universite Laval, Quebec, Quebec; Tertiary Palliative Care Program (K.M.), Grey Nuns Community Hospital, Edmonton, Alberta; Palliative Care Team (M.D.L.), British Columbia Cancer Agency - Center for the Southern Interior, Kelowna, British Columbia; Dr. H. Bliss Murphy Cancer Center (F.O.), St. John's, Newfoundland; Department of Family and Community Medicine (D.K.), University of British Columbia, Vancouver, British Columbia; and Division of Palliative Care Medicine (R.L.F.), Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
%A Wilson, KG
%A Chochinov, HM
%A Graham, Skirko M
%A Allard, P
%A Chary, S
%A Gagnon, PR
%A Macmillan, K
%A De, Luca M
%A O'shea, F
%A Kuhl, D
%A Fainsinger, RL
%A Clinch, JJ
%J J Pain Symptom Manage
%D 2007 Feb
%N 2
%P 118-129
%T Depression and Anxiety Disorders in Palliative Cancer Care
%V 33
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17280918
%X Depression and anxiety disorders are thought to be common in palliative cancer care, but there is inconsistent evidence regarding their relevance for other aspects of quality of life. In the Canadian National Palliative Care Survey, semi-structured interviews assessing depression and anxiety disorders were administered to 381 patients who were receiving palliative care for cancer. There were 212 women and 169 men, with a median survival of 63 days. We found that 93 participants (24.4%, 95% confidence interval=20.2-29.0) fulfilled Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnostic criteria for at least one anxiety or depressive disorder (20.7% prevalence of depressive disorders, 13.9% prevalence of anxiety disorders). The most frequent individual diagnosis was major depression (13.1%, 95% confidence interval=9.9-16.9). Comorbidity was common, with 10.2% of participants meeting criteria for more than one disorder. Those diagnosed with a disorder were significantly younger than other participants (P=0.002). They also had lower performance status (P=0.017), smaller social networks (P=0.008), and less participation in organized religious services (P=0.007). In addition, they reported more severe distress on 14 of 18 physical symptoms, social concerns, and existential issues. Of those with a disorder, 39.8% were being treated with antidepressant medication, and 66.7% had been prescribed a benzodiazepine. In conclusion, it appears that depression and anxiety disorders are indeed common among patients receiving palliative care. These disorders contribute to a greatly diminished quality of life among people who are dying of cancer

%0 Journal Article
%C Portland Veterans Affairs Medical Center and Department of Psychiatry, Oregon Health & Science University, USA
%A Goy, Elizabeth R
%A Carlson, Bryant
%A Simopoulos, Nicole
%A Jackson, Ann
%A Ganzini, Linda
%J J Palliat Care
%D 2006 Summer
%N 2
%P 83-90
%T Determinants of Oregon hospice chaplains' views on physician-assisted suicide
%V 22
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17265660
%X BACKGROUND: Although religiousness is a strong predictor of attitudes towards physician-assisted suicide (PAS), Oregon hospice chaplains express wide variation in their opposition to or support for legalized PAS. We explored factors associated with chaplains' views on PAS. METHODS: A mailed survey to chaplains from 51 Oregon hospices. RESULTS: Fifty of 77 eligible hospice chaplains (65%) returned surveys. Views on PAS were associated with views on suicide in general. Moral and theological beliefs were the most important influences on views on PAS. Chaplains who were opposed to PAS believed that God alone may take life, that life is an absolute good, and that suffering has a divine purpose. Those who supported PAS placed emphasis on the importance of self-determination and sanctity of life as defined by quality of life. CONCLUSIONS: Oregon hospice chaplains' diverse views towards PAS are closely related to their views on suicide in general, and their personal and theological beliefs

%0 Journal Article
%C VA Eastern Colorado Healthcare System, HSR&D TREP for Long-term Care Research, Denver, CO; Division of Health Care Policy & Research, University of Colorado Health Sciences Center, Aurora, CO
%A Radcliff, Tiffany A
%A Dobalian, Aram
%A Levy, Cari
%J J Am Med Dir Assoc
%D 2007 Feb
%N 2
%P 91-7
%T Do orders limiting aggressive treatment impact care for acute myocardial infarction?
%V 8
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17289538
%X OBJECTIVES: Little is known about whether advance directives impact inpatient care for a condition with clear treatment guidelines. The goal of this research was to determine the association between limitation of aggressive treatment (LAT) orders and guideline adherence for acute myocardial infarction (AMI). DESIGN: Secondary examination of data from the national Cooperative Cardiovascular Project (CCP) baseline data. We used seemingly unrelated regression to correct for potential selection bias between patients with and without LAT orders and to determine whether such orders predict guideline adherence for several treatments related to acute myocardial infarction. SETTING: The setting included 4111 short-term non-federal acute care hospitals in the United States. PARTICIPANTS: Participants were 147,475 AMI cases with complete data abstracted from inpatient hospital charts, representing most fee-for-service Medicare patients who were hospitalized with AMI between February 1994 and July 1995. MEASUREMENTS: Adherence to guidelines for treating acute myocardial infarction, including aspirin, Beta blockers, and reperfusion via thrombolytics or PTCA. RESULTS: Patients with LAT orders are less likely to receive care in accordance with guidelines when controlling for other factors that may explain a lower likelihood of guideline adherence. After adjustment for selection effects, we found a lower predicted probability that patients received more invasive treatments. CONCLUSION: Patients with LAT orders appear to receive care that is less aggressive and less congruent with acute myocardial infarction care guidelines compared with patients without such orders. Quality improvement measures will need to take this difference into account and ensure that physicians are not penalized for complying with patient care preferences

%0 Journal Article
%C Nursing and Patient Services, Repatriation General Hospital, Daw Park, South Australia. karen.parish@rgh.sa.gov.au
%A Parish, Karen
%A Glaetzer, Karen
%A Grbich, Carol
%A Hammond, Lynette
%A Hegarty, Meg
%A Annie, McHugh
%J Aust J Adv Nurs
%D 2006 Dec-2007
%N 2
%P 21-5
%T Dying for attention: palliative care in the acute setting
%V 24
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17285832
%X BACKGROUND: Palliative care has emerged as a specialist discipline in the past 25 years. However in relation to acute hospitals, a sense exists that patients who are receiving end of life care may not experience support which fully reflects appropriate palliative care management. OBJECTIVE: This study aimed to analyse the end of life care received by patients in the acute wards of a busy teaching hospital. DESIGN: Retrospective analysis using multiple methods including: case note auditing and interviews of key staff was used to determine the quality of end of life support provided to an opportunistic sample of patients who died in acute care wards. SETTING: The research site is a 250 bed teaching hospital in South Australia. SUBJECTS: A medical record audit using an opportunistic sample of 20 recently deceased patients from acute wards was used. For each patient, interviews were also conducted with two nurses (n = 40) selected on the basis of having a major care involvement. MAIN OUTCOME: A range of strategies for enhancing the end of life care for patients in acute wards were determined, including support for application of a Palliative Care Advanced Disease Pathway. RESULTS: The lack of appropriate assessment and documentation indicates that major opportunities for enhanced service provision exist both in relation to physical care and even more significantly in relation to psychosocial and spiritual care. CONCLUSIONS: The end of life care provided for patients reviewed in this study indicates a far from ideal situation in the acute hospital wards of the research setting. An eagerness from the nurse participants in the study for tools and further support in their practice was noted and augurs well for future developments within the research site

%0 Journal Article
%C Nancy Spector is Director of Education, National Council of State Boards of Nursing, 111 E Wacker, Suite 2900, Chicago, IL 60601 (e-mail: nspector@ncsbn.org) Maria A. Connolly is Dean, College of Nursing and Allied Health, University of St Francis, Joliet, Ill. Karen K. Carlson is a Critical Care Clinical Specialist, Carlson Consulting Group, Bellevue, Wash
%A Spector, N
%A Connolly, MA
%A Carlson, KK
%J AACN Adv Crit Care
%D 2007 January/March
%N 1
%P 45-58
%T Dyspnea: Applying Research to Bedside Practice
%V 18
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17284947
%X Dyspnea is a common symptom in patients with acute and chronic critical illness as well as in patients receiving palliative care. While dyspnea can be found in a variety of clinical arenas and across many specialties, the mechanisms that cause dyspnea are similar. Although not often the cause for admission to critical care, it may complicate and extend length of stay. This article defines and describes dyspnea and its pathophysiology. Critical care nurses should strive to implement interventions supported by evidence whenever possible. An evidence-based plan of care for the assessment, planning, intervention, and evaluation of the patient with dyspnea is outlined, using levels of recommendation based on the strength of available evidence. Two case studies are presented to illustrate its application to clinical practice

%0 Journal Article
%C Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
%A Yamao, Kenji
%A Sawaki, Akira
%A Takahashi, Kuniyuki
%A Imaoka, Hiroshi
%A Ashida, Reiko
%A Mizuno, Nobumasa
%J Gastrointest Endosc
%D 2006 Oct
%N 4
%P 663-7
%T EUS-guided choledochoduodenostomy for palliative biliary drainage in case of papillary obstruction: report of 2 cases
%V 64
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=16996372

%0 Journal Article
%C Ministry of Public Health, Nonthaburi, Thailand;
%A Teerawattananon, Yot
%A Mugford, Miranda
%A Tangcharoensathien, Viroj
%J Value Health
%D 2007 Jan-Feb
%N 1
%P 61-72
%T Economic Evaluation of Palliative Management versus Peritoneal Dialysis and Hemodialysis for End-Stage Renal Disease: Evidence for Coverage Decisions in Thailand
%V 10
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17261117
%X Objective: To examine the value for money of including peritoneal dialysis (PD) or hemodialysis (HD) into the universal health insurance scheme of Thailand. Methods: A probabilistic Markov model applied to end-stage renal disease (ESRD) patients aged 20 to 70 years was developed to examine the incremental cost-effectiveness ratio (ICER) of palliative care versus 1) providing PD as an initial treatment followed by HD if complications/switching occur; and 2) providing HD followed by PD if complications/switching occur. Input parameters were extracted from a national cohort, the Thailand Renal Replacement Therapy Registry, and systematic reviews, where possible. The study explored the effects of uncertainty around input parameters, presented as cost-effectiveness acceptability frontier, as well as the value of obtaining further information on chosen parameters, i.e., partial expected value of perfect information. Results: Using a societal perspective, the average ICER of initial treatment with PD and the average ICER of initial treatment with HD were 672,000 and 806,000 Baht per quality-adjusted life-year (QALY) gained (52,000 and 63,000 purchasing power parity [PPP] US$/QALY) compared with palliative care. Providing treatments for younger ESRD patients resulted in a significant improvement of survival and gain of QALYs compared with the older aged group. The cost-effectiveness and cost-utility ratios of both options for the older age group were relatively similar. Conclusions: The results suggest that offering PD as initial treatment was a better choice than offering HD, but it would only be considered a cost-effective strategy if the social willingness-to-pay threshold was at or higher than 700,000 Baht per QALY (54,000 PPP US$/QALY) for the age 20 group and 750,000 Baht per QALY (58,000 PPP US$/QALY) for age 70 years

%0 Journal Article
%C Marie Curie Palliative Care Research Unit, Royal Free and University College Medical School, Department of Mental Health Sciences, Cancer Research UK London Psychosocial Group, Institute of Psychiatry, London, United Kingdom
%A Wilkinson, Susie M
%A Love, Sharon B
%A Westcombe, Alex M
%A Gambles, Maureen A
%A Burgess, Caroline C
%A Cargill, Anna
%A Young, Teresa
%A Maher, E Jane
%A Ramirez, Amanda J
%J J Clin Oncol
%D 2007 Feb
%N 5
%P 532-9
%T Effectiveness of aromatherapy massage in the management of anxiety and depression in patients with cancer: a multicenter randomized controlled trial
%V 25
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17290062
%X PURPOSE: To test the effectiveness of supplementing usual supportive care with aromatherapy massage in the management of anxiety and depression in cancer patients through a pragmatic two-arm randomized controlled trial in four United Kingdom cancer centers and a hospice. PATIENTS AND METHODS: Two hundred eighty-eight cancer patients, referred to complementary therapy services with clinical anxiety and/or depression, were allocated randomly to a course of aromatherapy massage or usual supportive care alone. RESULTS: Patients who received aromatherapy massage had no significant improvement in clinical anxiety and/or depression compared with those receiving usual care at 10 weeks postrandomization (odds ratio [OR], 1.3; 95% CI, 0.9 to 1.7; P = .1), but did at 6 weeks postrandomization (OR, 1.4; 95% CI, 1.1 to 1.9; P = .01). Patients receiving aromatherapy massage also described greater improvement in self-reported anxiety at both 6 and 10 weeks postrandomization (OR, 3.4; 95% CI, 0.2 to 6.7; P = .04 and OR, 3.4; 95% CI, 0.2 to 6.6; P = .04), respectively. CONCLUSION: Aromatherapy massage does not appear to confer benefit on cancer patients' anxiety and/or depression in the long-term, but is associated with clinically important benefit up to 2 weeks after the intervention

%0 Journal Article
%A Miller, Nigel
%J Vet Rec
%D 2006 Dec
%N 24
%P 823
%T Emergency slaughter on farm
%V 159
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17158721

%0 Journal Article
%C School of Health Services Administration, Dalhousie University and Surveillance and Epidemiology Unit, Cancer Care Nova Scotia, 5599 Fenwick Street, Halifax, Nova Scotia, B3H 1R2, Canada, Grace.Johnston@dal.ca
%A O'brien, MB
%A Johnston, GM
%A Gao, J
%A Dewar, R
%J Support Care Cancer
%D 2007 Feb
%T End-of-life care for nursing home residents dying from cancer in Nova Scotia, Canada, 2000-2003
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17277924
%X INTRODUCTION: With our population aging, an increasing proportion of cancer deaths will occur in nursing homes, yet little is known about their end-of-life care. This paper identifies associations between residing in a nursing home and end-of-life palliative cancer care, controlling for demographic factors. METHODS: For this population-based study, a data file was created by linking individual-level data from the Nova Scotia Cancer Centre Oncology Patient Information System, Vital Statistics, and the Halifax and Cape Breton Palliative Care Programs for all persons 65 years and over dying of cancer from 2000 to 2003. Multivariate logistic regression was used to compare nursing home residents to nonresidents. RESULTS: Among the 7,587 subjects, 1,008 (13.3%) were nursing home residents. Nursing home residents were more likely to be female [adjusted odds ratio (OR) 1.4, 95% confidence interval (CI) 1.2-1.7], older (for >/=90 vs 65-69 years OR 5.4, CI 4.1-7.0), rural (OR 1.5, CI 1.2-1.8), have only a death certificate cancer diagnosis (OR 4.2, CI 2.8-6.3), and die out of hospital (OR 8.5, CI 7.2-10.0). Nursing home residents were less likely to receive palliative radiation (OR 0.6, CI 0.4-0.7), medical oncology consultation (OR 0.2, CI 0.1-0.4), and palliative care program enrollment (Halifax OR 0.2, CI 0.2-0.3; Cape Breton OR 0.4, CI 0.3-0.7). CONCLUSION: Demographic characteristics and end-of-life services differ between those residing and those not residing in nursing homes. These inequalities may or may not reflect inequities in access to quality end-of-life care

%0 Journal Article
%A Wagner, Kathryn R
%J Neurology
%D 2007 Jan
%N 2
%P 88-9
%T Enzyme replacement for infantile Pompe disease: the first step toward a cure
%V 68
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17210887

%0 Journal Article
%C Department of Speech Pathology & Audiology, Western Michigan University, Kalamazoo, Michigan, USA
%A Sharp, Helen M
%J Top Stroke Rehabil
%D 2006 Fall
%N 4
%P 18-25
%T Ethical issues in the management of dysphagia after stroke
%V 13
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17082165
%X When patients have severe dysphagia after a stroke, tube feeding may be recommended to reduce the risks associated with malnutrition, dehydration, and/or aspiration. Patients may not be able to participate in decision making, but they may have previously expressed strong preferences related to tube feeding. Clinicians must work together with the family to establish a treatment plan that is respectful of the person's previous wishes, yet mindful of the flaws in advance care planning. Although ethical issues cannot be avoided, clinicians can reduce uncertainty by understanding current ethical and legal views on these challenging issues

%0 Journal Article
%A Clayton, Nick
%J Vet Rec
%D 2006 Dec
%N 23
%P 787
%T FMD and the contiguous cull
%V 159
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17142633

%0 Journal Article
%C Neonatal Service (Ward 35), United Kingdom
%A Ward, Platt MP
%J Arch Dis Child Fetal Neonatal Ed
%D 2007 Feb
%T Fear of death and dying
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17284474
%X It would be possible to respond to Peter Barr's paper "Relation of neonatologists' end-of-life decisions to their personal fear of death" with anger, disbelief or indifference; and it could be misunderstood as suggesting that covert euthanasia is a rampant practice in neonatal units, at least in Australasia. Neither these responses nor such a misreading would do justice to a paper that explores the personal attitudes that mediate the decision-making processes of neonatal consultants when faced with babies in whom the possibility of forgoing continued life support has become an option to be seriously considered

%0 Journal Article
%C Pediatric Palliative Care, Calgary Health Region, Calgary, Alberta, Canada
%A Rallison, Lillian
%A Limacher, Lori Houger
%A Clinton, Michael
%J J Palliat Care
%D 2006 Summer
%N 2
%P 99-104
%T Future echoes in pediatric palliative care: becoming sensitive to language
%V 22
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17265662
%X As the specialty of pediatric palliative care emerges and develops, finding language to describe the complexity of "living while dying" is a challenge. Terms such as "life-limiting" and "life-threatening" are commonly used, but may not be sensitive enough to capture the experience of children and their families due to the restrictions and power at play in the history of the words "limit" and "threat". The search for the right words to use when speaking of children who are living while dying takes us to the language of metaphor and poetry that speaks to us in a different way, a way that encompasses not only the suffering, but also the dreams, hopes, and joys of children and families. Our preferred use of language also provides more than factual statements ever can, by speaking to the hearts and souls of health care providers who share precious moments with these families

%0 Journal Article
%C Buskerud University College, Institute of Health, Drammen, Norway. ellen.karine.grov@hibu.no
%A Grov, Ellen Karine
%A Dahl, Alv A
%A Fossa, Sophie D
%A Wahl, Astrid K
%A Moum, Torbjorn
%J Support Care Cancer
%D 2006 Sep
%N 9
%P 943-51
%T Global quality of life in primary caregivers of patients with cancer in palliative phase staying at home
%V 14
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=16523266
%X GOAL OF WORK: Research on global quality of life (GQOL) in primary caregivers (PCGs) of cancer patients is limited. This study measured significant domains of GQOL in PCGs and their association with the patients' disease trajectory and the PCGs' background and life situation. This study also explored differences in their GQOL compared to a normative sample from the general population (NORM). PATIENT AND METHODS: In a cross-sectional design, 71 PCGs (aged > or = 50 years) of cancer patients in palliative phase rated their GQOL by the Quality of Life Scale (QOLS) and provided information concerning demography, experienced social support, and caring situation. Associations between the QOLS scores and variables of the patients' medical history were assessed, and comparisons of QOLS scores were made between the PCGs and age- and gender-adjusted NORM. MAIN RESULTS: Long duration of the curative phase for patients and holding a job for PCGs were significantly associated with a favorable GQOL in PCGs. The mean total GQOL score did not differ significantly between the PCGs and NORM groups, though subanalyses revealed significantly more favorable mean score of the relational domain in PCGs compared to NORM. CONCLUSIONS: GQOL in PCGs of cancer patients in palliative phase staying at home was as good as that of the NORM. For PCGs not employed or caring for patients with a short curative phase, getting some recreation could be of importance for improvement of GQOL

%0 Journal Article
%C Department of Health Policy, School of Public Health and Health Services, George Washington University Medical Center, USA
%A Teitelbaum, Joel
%A Rosenbaum, Sara
%J Public Health Rep
%D 2007 Jan-Feb
%N 1
%P 122-4
%T Gonzales v. Oregon: implications for public health policy and practice
%V 122
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17236618

%0 Journal Article
%C Pennsylvania State University
%A Hayes, JA
%A Yeh, YJ
%A Eisenberg, A
%J J Clin Psychol
%D 2007 Feb
%T Good grief and not-so-good grief: Countertransference in bereavement therapy
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17279526
%X This study examined the relationship between therapists' grief related to the death of a loved one and clients' perceptions of the process of bereavement therapy. Mail survey data were obtained from 69 client-therapist dyads. Results indicated that the extent to which therapists missed deceased loved ones was inversely related to client perceptions of therapist empathy, but not to client ratings of the alliance, session depth, or therapist credibility. Therapist acceptance of the death of a loved one was unrelated to any of the dependent measures. Results are discussed in terms of countertransference and its management. (c) 2007 Wiley Periodicals, Inc. J Clin Psychol

%0 Journal Article
%C LOIS TSCHETTER is a faculty member in the College of Nursing at South Dakota State University in Brookings, South Dakota, where she teaches both undergraduate and graduate students
%A Tschetter, Lois
%A Hildreth, Marilyn
%J J Perinat Educ
%D 2005 Fall
%N 4
%P 3-4
%T Grief enriched us: a model of perinatal loss support
%V 14
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17273446
%X This article provides an example of the clinical application of one of the Lamaze International's Institute for Normal Birth evidence-based care practices. The practice of keeping mother and baby together, even in unusual circumstances, enhances family relationships and provides for positive lifetime memories

%0 Journal Article
%C NHMRC Centre of Clinical Research Excellence in Therapeutics, Department of Epidemiology and Preventive Medicine, and Department of Medicine, Monash University, Alfred Hospital, Melbourne, VIC, Australia
%A Krum, Henry
%A Jelinek, Michael V
%A Stewart, Simon
%A Sindone, Andrew
%A Atherton, John J
%A Hawkes, Anna L
%J Med J Aust
%D 2006 Nov
%N 10
%P 549-57
%T Guidelines for the prevention, detection and management of people with chronic heart failure in Australia 2006
%V 185
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17115967
%X Chronic heart failure (CHF) is found in 1.5%-2.0% of Australians. Considered rare in people aged less than 45 years, its prevalence increases to over 10% in people aged >/= 65 years. CHF is one of the most common reasons for hospital admission and general practitioner consultation in the elderly (>/= 70 years). Common causes of CHF are ischaemic heart disease (present in > 50% of new cases), hypertension (about two-thirds of cases) and idiopathic dilated cardiomyopathy (around 5%-10% of cases). Diagnosis is based on clinical features, chest x-ray and objective measurement of ventricular function (eg, echocardiography). Plasma levels of B-type natriuretic peptide (BNP) may have a role in diagnosis, primarily as a test for exclusion. Diagnosis may be strengthened by a beneficial clinical response to treatment(s) directed towards amelioration of symptoms. Management involves prevention, early detection, amelioration of disease progression, relief of symptoms, minimisation of exacerbations, and prolongation of survival

%0 Journal Article
%C Centre for Health Economics Research and Evaluation, University of Technology, Sydney, Australia
%A Zapart, Siggi
%A Kenny, Patricia
%A Hall, Jane
%A Servis, Betty
%A Wiley, Sharon
%J Health Soc Care Community
%D 2007 Mar
%N 2
%P 97-107
%T Home-based palliative care in Sydney, Australia: the carer's perspective on the provision of informal care
%V 15
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17286671
%X The provision of home-based palliative care requires a substantial unpaid contribution from family and friends (i.e. informal care). The present cross-sectional descriptive study, conducted between September 2003 and April 2004, describes this contribution and the impact it has on those providing informal care. The participants were 82 informal carers of patients registered with two community palliative care services in Sydney, Australia (40% of eligible carers). Carers were interviewed to assess the care recipient's care needs, the care provided by the informal carer and the health status of the carer (using the 36-Item Short Form Health Survey). A number of open-ended questions asked about the impact of providing care and the type of support that carers would find helpful. Most carers reported that care recipients required help with household tasks and many needed assistance with personal activities of daily living, taking medications and organisational tasks. In the majority of cases, the principal carer provided all or most of this help. Although, on average, the physical health of carers was similar to that of the Australian population, their mental health scores were lower. Many carers reported effects on social and family relationships, restrictions on their participation in work and leisure activities, and a range of emotional reactions to their caring situation. The support carers said they would like included information and advice, in-home respite, help with household tasks, and financial support. The present study supports the view that effective support for carers must recognise the pre-existing relationship between carer and recipient, and the differing needs of individual carers

%0 Journal Article
%C Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
%A Guiteau, Jacfranz
%A Fanucchi, Michael
%A Folpe, Andrew
%A Staley, Charles A 3rd
%A Kooby, David A
%J Am Surg
%D 2006 Dec
%N 12
%P 1225-30
%T Hypoglycemia in the setting of advanced gastrointestinal stromal tumor
%V 72
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17216825
%X We report a rare case of symptomatic hypoglycemia in a patient with intra-abdominal recurrence of a previously resected gastrointestinal stromal tumor (GIST). The patient is a 65-year-old woman who underwent resection of a large abdominal mass arising from the stomach, histologically diagnosed as a high-grade leiomyosarcoma. She was lost to follow up. Five years later, the mass recurred; core biopsy demonstrated a CD 117-positive, spindle-cell tumor, consistent with a GIST. She was placed on Gleevec, as there was evidence of multifocal disease, but imaging revealed only mild improvement. Subsequently, her clinical status deteriorated, and she was hospitalized for dehydration, vomiting, and mental status changes. Her blood glucose on admission was 22 mg/dL, and a dextrose infusion (50%) was necessary to maintain adequate blood glucose levels. Measurements of insulin, proinsulin, c-peptide, beta-hydroxybutyrate, and thyroid-stimulating hormone were normal, as were cosyntropin stimulation and glucagon response tests. Suspicions arose for tumor-secreted insulin-like factor. She underwent resection of the dominant 44-cm recurrence, with immediate rebound hyperglycemia, followed by complete normalization of her blood glucose levels. She was discharged on postoperative Day 5 without symptoms or insulin, and is alive with disease at 20 months. Paraneoplastic syndromes occur in only 15 per cent of patients with known malignancies (e.g., lung cancer and metastatic carcinoid), and are rarely reported in the setting of GIST. Hypoglycemia is most often observed in presence of insulinoma and only isolated case reports in GIST patients exist. Overexpression of insulin-like growth factor II is thought to be the mechanism of action. Supportive management and palliative resection or debulking is recommended when possible

%0 Journal Article
%A de Lima, Liliana
%J J Palliat Care
%D 2006 Winter
%N 4
%P 300-4
%T IAHPC List of Essential Medicines for Palliative Care: Summary of Process for Editors of Pain and Palliative Care Journals
%V 22
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17263059

%0 Journal Article
%C PALCARE Program, Manila, Philippines
%A Gorospe, Emmanuel C
%A Bausa, Agnes B
%J J Palliat Care
%D 2006 Winter
%N 4
%P 297-9
%T Integrating volunteers in palliative care: the Philippine experience
%V 22
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17263058

%0 Journal Article
%C Duke Institute on Care at the End of Life, Duke University Divinity School, Durham, North Carolina, USA
%A Payne, Richard
%J Pain Med
%D 2007 Jan
%P S1-2
%T Introduction: the scope of breakthrough pain in clinical practice
%V 8 Suppl 1
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17280597

%0 Journal Article
%C University of Hawai'i, USA. siang@hawaii.edu
%A Tan, S Y
%J Hawaii Med J
%D 2006 Sep
%N 9
%P 271
%T Issues in medical malpractice III. General practitioner delayed hospital admission for patient with chest pain
%V 65
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17153674

%0 Journal Article
%J Vet Rec
%D 2006 Dec
%N 26
%P 866-7
%T Joining up approaches on cattle health and welfare
%V 159
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17236258

%0 Journal Article
%C School of Nursing, University of Western Sydney, and Sydney West Area Health Service, Sydney, Australia. patricia_davidson@wsahs.nsw.gov.au
%A Davidson, Patricia M
%A Dracup, Kathleen
%A Phillips, Jane
%A Padilla, Geraldine
%A Daly, John
%J J Cardiovasc Nurs
%D 2007 Jan-Feb
%N 1
%P 58-64
%T Maintaining hope in transition: a theoretical framework to guide interventions for people with heart failure
%V 22
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17224699
%X Theoretical frameworks provide a structure for the planning and delivery of nursing care and for research. Heart failure (HF), a condition of increasing prevalence in communities internationally, is responsible for high rates of morbidity, mortality, and great societal burden. The HF illness trajectory can be unpredictable and uncertain. Markers of transition, such as functional decline and increasing dependence, can signal the need for transition to a more palliative approach. This transition challenges clinicians to deliver information and interventions and to support patients and their families not only in relation to their physical status but also in the social, psychological, and existential dimensions. This article describes a theoretical framework, Maintaining Hope in Transition, informed by transition theory, to assist patients to cope with a diagnosis of HF and to guide development of nursing interventions. Transition theory provides a useful context to assist clinicians, patients, and their families adjust to the challenges inherent in a diagnosis of HF and negotiating the illness trajectory. Key factors acknowledged in the Maintaining Hope in Transition framework that determine its utility in models of care for HF patients are (1) acknowledging the changing of life circumstances, (2) restructuring reality, (3) dealing with vulnerability, (4) achieving normalization, and (5) resolving uncertainty. It is likely that incorporation of these factors in care planning, information, and interventions can facilitate patients' and their families' abilities to negotiate the HF illness trajectory, particularly in the advanced stages

%0 Journal Article
%C N ancy A nne S anchez is the Perinatal Education Coordinator at Lucile Packard Children's Hospital at Stanford University Medical Center in Palo Alto, California
%A Sanchez, N A
%J J Perinat Educ
%D 2001 Spring
%N 2
%P 23-30
%T Mothers' perceptions of benefits of perinatal loss support offered at a major university hospital
%V 10
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17273250
%X This qualitative research investigated the perception of mothers regarding hospital support after perinatal loss. Twelve in-depth interviews demonstrated that the mothers recalled the circumstances of the loss. Most identified the hospital's support services and made comments on aspects of hospital support as influential in grief recovery. Most interviewees considered themselves somewhat recovered from the loss

%0 Journal Article
%C Department of Anesthesiology, Koo Foundation Sun Yat-Sen Cancer Center, Republic of China. peng@mail.kfcc.org.tw
%A Peng, Wen Ling
%A Wu, Gong Jhe
%A Sun, Wei Zen
%A Chen, Jeffrey C
%A Huang, Andrew T
%J J Pain Symptom Manage
%D 2006 Nov
%N 5
%P 444-52
%T Multidisciplinary management of cancer pain: a longitudinal retrospective study on a cohort of end-stage cancer patients
%V 32
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17085270
%X The epidemiology of cancer pain and the outcomes associated with pain treatments were investigated through a retrospective survey of 772 patients with advanced cancer. The cumulative prevalence of pain was 87%, including all types of cancer. Mean duration of pain was 6.9+/-8.1 months. The prevalence of pain was 28%, 46%, 67%, 75%, and 79% at 6 months, 3 months, 1 month, 1 week, and 1 day before the time of death, respectively. The so-called "strong" opioids had been used in 85% of the 669 patients with pain. Seventy-nine percent of patients with pain received nonsurgical antineoplastic treatment for pain control. No more than 11% of patients ultimately experienced substantial pain in the last 6 months of life (defined as pain score 5-10 on a 0-10 numeric rating scale). We conclude that the application of a multidisciplinary approach to pain management offers effective pain control for most patients with advanced cancer

%0 Journal Article
%C Virginia Commonwealth University, Department of Surgery, Richmond, Virginia
%A Maluf, D G
%A Stravitz, R T
%A Williams, B
%A Cotterell, A H
%A Mas, V R
%A Heuman, D
%A Luketic, V
%A Shiffman, M L
%A Sterling, R
%A Posner, M P
%A Fisher, R A
%J Transplant Proc
%D 2007 Jan-Feb
%N 1
%P 153-9
%T Multimodality therapy and liver transplantation in patients with cirrhosis and hepatocellular carcinoma: 6 years, single-center experience
%V 39
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17275495
%X The treatment of patients with cirrhosis and hepatocellular carcinoma (HCC) has improved dramatically over the past 10 years. We conducted a 6-year prospective study, using multimodality ablation therapy (MMT) combined with liver transplantation (LTx) for patients with cirrhosis and unresectable HCC. Subjects were classified as: group 1 (n = 35), intention to treat with MMT + LTx; group 2 (n = 16), contemporaneous LTx with "incidental" HCC on explants; group 3 (n = 94), MMT alone; and group 4 (n = 19), palliative care alone. MMT included trans-arterial chemo-embolization (54.4%), trans-arterial chemo-infusion (28.6%), and radio frequency ablation (17%). Group 1, with a mean wait time of 11.6 months pre-MELD era and 5.4 months post-MELD era, had a mean of 2.4 ± 1.2 MMTs and achieved 1- 3-, and 5-year patient survivals of 100, 100, and 76%, respectively, which was not different from group 2 (incidental HCC), namely 93, 93, and 93%, respectively; or to a contemporaneous non-HCC LTx group: namely 84.3, 78.7, and 73.9%, respectively. Despite careful pretransplant HCC staging, 22.8% (8 of 35) group 1 subjects were understaged. Those subjects in group 1 with true T1-2 stage HCC achieved 100% cancer-free survival at 5 years. Only three cases of HCC recurrence occurred in our series, all of whom were understaged. Our data suggest that pretransplant MMT followed by timely LTx provides excellent disease-free survival at 5 years for patients with true T1-2 stage HCC and cirrhosis. Pretransplant HCC understaging contributes to posttransplant HCC recurrence after LTx

%0 Journal Article
%C Department of Physical Medicine and Rehabilitation, Vienna Medical University, Waehringer Guertel 18-20, A-1090, Vienna, Austria. richard.crevenna@meduniwien.ac.at
%A Crevenna, Richard
%A Marosi, Christine
%A Schmidinger, Manuela
%A Fialka-Moser, Veronika
%J Support Care Cancer
%D 2006 Sep
%N 9
%P 970-3
%T Neuromuscular electrical stimulation for a patient with metastatic lung cancer--a case report
%V 14
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=16523264
%X A 47-year-old female patient suffering from advanced lung cancer with metastatic bone and brain disease participated in a passive exercise program, consisting of neuromuscular electrical stimulation (NMES) five times a week, carried out for 4 weeks. After the training period, the results of the 6-min walk (420 m before and 603 m after the training period) have improved by 44%, which demonstrates the increase of physical performance (mobility, endurance capacity). The results of the "Timed up and go" indicate an improvement of mobility and functional health of skeletal muscles. Furthermore, the quality of life (QOL)-scales (assessed by using the SF-36 health survey) "Physical functioning", "Role-physical", "Mental health", "Role-emotional", "Vitality", "Bodily pain", and "General health" showed improvements after the intervention period. Feasibility, safety, and beneficial effects of the NMES program were proven for the patient in this case study. These findings indicate that NMES, initiated and executed with appropriate care, may serve as a useful supportive means of palliative treatment in some patients with advanced cancer and metastatic disease, especially in cases of metastatic involvement of the brain and of the skeletal system with the risk of seizures and pathological fractures where volitional training is not allowed

%0 Journal Article
%C Centre for Bioethics, Karolinska Institutet and Uppsala University, Stockholm, Sweden
%A Lofmark, Rurik
%A Mortier, Freddy
%A Nilstun, Tore
%A Bosshard, Georg
%A Cartwright, Colleen
%A Van Der Heide, Agnes
%A Norup, Michael
%A Simonato, Lorenzo
%A Onwuteaka-Philipsen, Bregje
%J J Palliat Care
%D 2006 Summer
%N 2
%P 105-10
%T Palliative care training: a survey of physicians in Australia and Europe
%V 22
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17265663
%X The purpose of this paper is to present data about the level and background characteristics of physicians' training in palliative care in Australia (AU), Belgium (BE), Denmark (DK), Italy (IT), The Netherlands (NL), Sweden (SE) and Switzerland (CH) (n = 16,486). The response rate to an anonymous questionnaire differed between countries (39%-68%). In most countries approximately half of all responding physicians had any formal training in palliative care (median: 3-10 days). Exceptions were NL (78%) and IT (35%). The most common type of training was a postgraduate course. Physicians in nursing home medicine (only in NL), geriatrics, oncology (not in NL), and general practice had the most training. In all seven countries, physicians with such training discussed options for palliative care and options to forgo life-sustaining treatment more often with their patients than did physicians without. Irrespective of earlier palliative care training, 87%-98% of the physicians wanted extended training

%0 Journal Article
%C Carnegie Mellon University, Pittsburgh, PA 15213, USA. latanya@privacy.cs.cmu.edu
%A Sweeney, Latanya
%A Halpert, Andrew
%A Waranoff, Joan
%J Am J Manag Care
%D 2007 Feb
%N 2
%P 84-92
%T Patient-centered management of complex patients can reduce costs without shortening life
%V 13
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17286528
%X OBJECTIVE: To determine the effect of intensive patient-centered management (PCM) on service utilization and survival. STUDY DESIGN: Prospective cohort study of 756 patients in California who had a life-limiting diagnosis with multiple comorbid conditions (75% were oncology patients) and who were covered by a large commercial health maintenance organization from February 2003 through December 2004. METHODS: Group membership determined assignment to the PCM cohort versus the usual-management cohort after blindly screening for clinical complexity. Both cohorts accessed the same delivery system, utilization management practices, and benefits. Intervention was intensive PCM, involving education, home visits, frequent contact, and goal-oriented care plans. RESULTS: Roughly half (358) of the 756 patients received PCM. Fewer PCM oncology patients elected either chemotherapy or radiation (42% increase over usual-management oncology patients). PCM patients had reductions in inpatient diagnoses indicative of uncoordinated care: nausea (-44%), anemia (-33%), and dehydration (-17%). PCM patients had utilization reductions: -38% inpatient admissions (95% confidence interval [CI] = -37%, -38%), -36% inpatient hospital days (95% CI = -35%, -37%), and -30% emergency department visits (95% CI = -29%, -31%). PCM patients had utilization increases: 22% more home care days (95% CI = 20%, 23%) and 62% more hospice days (95% CI = 56%, 67%). Overall costs were reduced by 26% (95% CI = 25%, 27%). Patients' lives were not shortened (26% of PCM patients died vs 28% of patients who received usual management) (P = .80). CONCLUSION: Comprehensive PCM can sharply reduce utilization and costs over usual management without shortening life

%0 Journal Article
%C Division of Critical Care, Department of Anesthesia, Perioperative and Pain Medicine, Children's Hospital Boston, 300 Longwood Ave, Boston, MA 02115, USA. amy.durall@childrens.harvard.edu
%A Durall, Amy L
%A Laussen, Peter C
%A Randolph, Adrienne G
%J Pediatrics
%D 2007 Jan
%N 1
%P e219-24
%T Potential for donation after cardiac death in a children's hospital
%V 119
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17200246
%X OBJECTIVES: A task force was convened to decide whether a donation after cardiac death policy should be implemented at Children's Hospital Boston. As part of this process, we sought to determine the number of potential kidney donation after cardiac death donors in our PICUs. METHODS: We examined all 254 deaths in the Medical/Surgical ICU and the Cardiac ICU from 2002 to 2004 and identified potential donation after cardiac death donors. Inclusion criteria were age > or = 3 months, mechanical ventilation, and creatinine < or = 1.5 mg/dL. Exclusion criteria were HIV infection, malignancy other than primary brain tumor or nonmelanoma skin cancer, evidence of ongoing infection, death despite resuscitation attempts, and brain death. RESULTS: Twenty-one of the 254 deaths met criteria for brain death, and 233 patients did not. Of the 116 patients > 3 months of age for whom life support was withdrawn, 92 were not suitable for kidney donation after cardiac death. Of the 24 children identified as potentially eligible for donation after cardiac death, 14 died within 1 hour of withdrawal of support and could have proceeded with donation after cardiac death. In the other 10 children, donation would have been aborted because of prolonged time to death. CONCLUSIONS: Of all patients who died in our ICUs, 5.5% would have been potential candidates for donation after cardiac death. Assuming the rates of parental consent are similar to that of our heart-beating organ donors (47%), a donation after cardiac death protocol could have potentially yielded 7 additional organ donors and 14 additional kidneys over this 3-year period

%0 Journal Article
%C Mayo Clinic, 200 First St, Rochester, MN 55905, USA. moynihan.timothy@mayo.edu
%A Moynihan, Timothy J
%A Schapira, Lidia
%J J Clin Oncol
%D 2007 Feb
%N 4
%P 456-7
%T Preparing ourselves, our trainees, and our patients: a commentary on truthtelling
%V 25
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17264346

%0 Journal Article
%C Center to Advance Palliative Care, Mount Sinai School of Medicine, New York, NY, USA
%A Meier, Diane E
%A Beresford, Larry
%J J Palliat Med
%D 2006 Oct
%N 5
%P 1045-8
%T Preventing burnout
%V 9
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17040139

%0 Journal Article
%C Hopital Notre-Dame, Centre hospitalier, l'Universite de Montreal, Quebec, Canada. serge.daneault.chum@ssss.gouv.qc.ca
%A Daneault, Serge
%A Lussier, Veronique
%A Mongeau, Suzanne
%A Hudon, Eveline
%A Paille, Pierre
%A Dion, Dominique
%A Yelle, Louise
%J Can Fam Physician
%D 2006 Dec
%N 12
%P 1574-5
%T Primum non nocere: could the health care system contribute to suffering? In-depth study from the perspective of terminally ill cancer patients
%V 52
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17279239
%X OBJECTIVE: To explore terminally ill patients' perceptions of their own suffering in order to describe, from these patients' perspective, some elements of health care providers' response to suffering. DESIGN: Qualitative study using content analysis methods suited to a grounded theory approach. SETTING: Teaching and nonteaching hospital oncology clinics, palliative care services (both ambulatory and in-unit), and family practices. PARTICIPANTS: Twenty-six patients diagnosed with terminal cancer. METHODS: Interviews were audiotaped and transcribed verbatim. Data from each interview were coded and categorized to identify and define themes. Themes were discussed and refined until those rating them agreed on them. Data were collected until saturation of emerging issues was reached. MAIN FINDINGS: In our health care system, patients are caught in a pervasive pattern of suffering avoidance, which in turn contributes to increased suffering. Health care services are perceived as a battlefield where physicians and patients are engaged in a losing struggle to ward off illness and death. Both physicians and patients engage in avoiding skepticism and muffling distress. The unavoidable avowal of powerlessness in the face of terminal disease is perceived as capitulation and therapeutic abandonment. Budgetary restraints and understaffing, along with a pervasive culture that implicitly denies death, produce an environment conducive to the avoidance of suffering. To counter this, health care practices that foster increased overlap and continuity between the spheres of oncology, palliative care, and family medicine seem worth developing. CONCLUSION: The suffering of gravely ill patients might be hard to alleviate in the context of modern health care organizations. In some cases, health care delivery directly contributes to increased suffering. Providing support while also helping patients and their families to face upcoming harsh realities is a delicate balancing act that needs to be further explored

%0 Journal Article
%C Institute of Psychiatry, Department of Psychological Medicine, Kings College London, Weston Education Centre, Cutcombe Road, London SE5 9RJ, UK
%A Price, A
%A Hotopf, M
%A Higginson, I J
%A Monroe, B
%A Henderson, M
%J J R Soc Med
%D 2006 Dec
%N 12
%P 637-9
%T Psychological services in hospices in the UK and Republic of Ireland
%V 99
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17139068
%X OBJECTIVE: To evaluate the level of psychological services available to patients and staff in hospices. DESIGN: Questionnaire analysis. SETTING: Hospices in the UK and Republic of Ireland. PARTICIPANTS: 224 hospices. MAIN OUTCOME MEASURES: The availability of professional psychological support for those with advanced disease. RESULTS: Responses were received from 166 hospices (74%). Only 50 hospices (30%) have access to a psychiatrist, whilst 68 (41%) have access to a clinical psychologist and 92 (45%) have neither. Only 21 hospices (12%) have service level agreements with local mental health trusts. Counsellors, complementary therapists and spiritual advisors such as chaplains were more plentiful. CONCLUSIONS: Delivery of the NICE guidelines, especially tier four, may be compromised by limited availability of specialist services. This has implications for the psychological assessment of applicants for voluntary euthanasia under an Assisted Dying Act

%0 Journal Article
%C Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, Unit 1362, 1155 Herman Pressler Boulevard, Houston, TX 77230-1439, USA. ccsun@mdanderson.org
%A Sun, Charlotte C
%A Ramirez, Pedro T
%A Bodurka, Diane C
%J Nat Clin Pract Oncol
%D 2007 Jan
%N 1
%P 18-29
%T Quality of life for patients with epithelial ovarian cancer
%V 4
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17183353
%X Ovarian cancer is the sixth most common cancer worldwide and the seventh most common cause of deaths from cancer in women. Recent annual worldwide figures reflect 204,000 new cases of ovarian cancer and 125,000 deaths. Treatment of advanced ovarian cancer involves a combination of surgery and chemotherapy, both of which may impact a woman's physical, social, and emotional well-being. A woman's quality of life (QOL) is affected by disease site, and treatment-specific and patient-specific factors, but other common QOL issues include changes in physical functioning owing to side effects of treatment, psychological distress caused by fear and anxiety of recurrence, sexual dysfunction associated with anatomic and physiologic changes of treatment, and for younger women, loss of childbearing potential. As new diagnostic and treatment strategies for gynecologic malignancies are developed, research efforts should include QOL consequences. Further studies are needed to develop strategies for identifying women at risk for serious QOL disruption so that effective interventions to assist these women can be designed

%0 Journal Article
%C Palliative Medical Unit, Grantham Hospital, Hong Kong, China
%A Yan, Szeto
%A Kin-Fong, Cheng
%J J Palliat Care
%D 2006 Winter
%N 4
%P 261-6
%T Quality of life of patients with terminal cancer receiving palliative home care
%V 22
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17263052
%X The purpose of this study was to determine the levels of quality of life of patients with terminal cancer who received palliative care in home settings. Data were collected from 85 cancer patients with a life expectancy of less than 12 months using the McGill Quality of Life Questionnaire-Hong Kong version (MQOL-HK). The mean total quality of life score was 6.36 ± 1.37 out of 10. Among the various domains, the physical and existential domains scored relatively low with mean scores of 4.9 ± 1.28 and 6.12 ± 1.6 out of 10, respectively. Conversely, the subscales of sexual functioning and support yielded the highest scores with mean values of 7.45 ± 4 and 6.8 ± 1.9, respectively. There was a significant moderate correlation between age and the mean total quality of life scores (r = 0.53, p < 0.01). In addition, a moderate negative correlation was found between pain intensity and physical subscale (r = -0.57, p < 0.01). In conclusion, patients with terminal cancer receiving palliative home care experienced a moderately high level of quality of life, especially in the sphere of support

%0 Journal Article
%C Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA. gersztenpc@upmc.edu
%A Gerszten, Peter C
%A Burton, Steven A
%A Ozhasoglu, Cihat
%A Welch, William C
%J Spine
%D 2007 Jan
%N 2
%P 193-9
%T Radiosurgery for spinal metastases: clinical experience in 500 cases from a single institution
%V 32
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17224814
%X STUDY DESIGN: A prospective nonrandomized, longitudinal cohort study. OBJECTIVE: To evaluate the clinical outcomes of single-fraction radiosurgery as part of the management of metastatic spine tumors. SUMMARY OF BACKGROUND DATA: The role of stereotactic radiosurgery for the treatment of spinal lesions has previously been limited by the availability of effective target immobilization and target tracking devices. Large clinical experience with spinal radiosurgery to properly assess clinical experience has previously been limited. METHODS: A cohort of 500 cases of spinal metastases underwent radiosurgery. Ages ranged from 18 to 85 years (mean 56). Lesion location included 73 cervical, 212 thoracic, 112 lumbar, and 103 sacral. RESULTS: The maximum intratumoral dose ranged from 12.5 to 25 Gy (mean 20). Tumor volume ranged from 0.20 to 264 mL (mean 46). Long-term pain improvement occurred in 290 of 336 cases (86%). Long-term tumor control was demonstrated in 90% of lesions treated with radiosurgery as a primary treatment modality and in 88% of lesions treated for radiographic tumor progression. Twenty-seven of 32 cases (84%) with a progressive neurologic deficit before treatment experienced at least some clinical improvement. CONCLUSIONS: The results indicate the potential of radiosurgery in the treatment of patients with spinal metastases, especially those with solitary sites of spine involvement, to improve long-term palliation

%0 Journal Article
%A Persaud, Raj
%J J Pain Symptom Manage
%D 2006 Dec
%N 6
%P 516-7; author reply 517-8
%T Re: Caregivers and existential and spiritual distress
%V 32
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17157752

%0 Journal Article
%C Duke Institute on Care at the End of Life, Duke University Divinity School, Durham, North Carolina, USA
%A Payne, Richard
%J Pain Med
%D 2007 Jan
%P S3-7
%T Recognition and diagnosis of breakthrough pain
%V 8 Suppl 1
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17280600
%X Objective. To review major clinical issues related to recognition and diagnosis of breakthrough pain. Issues. Persistent pain and breakthrough pain (BTP) are distinct clinical entities that should be recognized, diagnosed, and treated individually. BTP is common in patients with cancer and a variety of other chronic diseases. Reported incidence of BTP varies widely from 16% to 95% of those with persistent pain syndromes. Such variability is likely due to lack of a clear consensus on the definition of BTP. It is most commonly defined as an abrupt, short-lived, and intense pain that "breaks through" the around-the-clock analgesia that controls persistent pain. The three subtypes of BTP are incident, idiopathic, and end-of-dose failure. BTP also is categorized as somatic, visceral, neuropathic, or mixed. Appropriate assessment of the patient takes into consideration source, severity, pattern, subtype, and cause of pain. Successful treatment is important because BTP has a profound impact on the patient's quality of life, as well as cost of health care. BTP is likely to be underdiagnosed and undertreated because of the lack of consensus on its definition and unwarranted concerns among health care professionals and patients about overmedicating. Additionally, and for reasons not entirely clear, many physicians and other health care providers place a low priority on pain management and underrecognize the occurrence of BTP in patients with persistent pain. Conclusion. Greater knowledge and awareness of BTP in cancer and nonmalignant conditions will lead to improved recognition and diagnosis of BTP and ultimately to more effective treatment and enhanced quality of life for these patients

%0 Journal Article
%C University of Central England, Birmingham
%A Castledine, George
%J Br J Nurs
%D 2006 Nov
%N 21
%P 1203
%T Recognizing problems of loss in patients
%V 15
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17170698

%0 Journal Article
%C Division of Medical Genetics, Department of Pediatrics, Box 3528, Duke University Medical Center, Durham, NC 27710, USA. kishn001@mc.duke.edu
%A Kishnani, P S
%A Corzo, D
%A Nicolino, M
%A Byrne, B
%A Mandel, H
%A Hwu, W L
%A Leslie, N
%A Levine, J
%A Spencer, C
%A McDonald, M
%A Li, J
%A Dumontier, J
%A Halberthal, M
%A Chien, Y H
%A Hopkin, R
%A Vijayaraghavan, S
%A Gruskin, D
%A Bartholomew, D
%A van der Ploeg, A
%A Clancy, J P
%A Parini, R
%A Morin, G
%A Beck, M
%A De la Gastine, G S
%A Jokic, M
%A Thurberg, B
%A Richards, S
%A Bali, D
%A Davison, M
%A Worden, M A
%A Chen, Y T
%A Wraith, J E
%J Neurology
%D 2007 Jan
%N 2
%P 99-109
%T Recombinant human acid [alpha]-glucosidase: major clinical benefits in infantile-onset Pompe disease
%V 68
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17151339
%X BACKGROUND: Pompe disease is a progressive metabolic neuromuscular disorder resulting from deficiency of lysosomal acid alpha-glucosidase (GAA). Infantile-onset Pompe disease is characterized by cardiomyopathy, respiratory and skeletal muscle weakness, and early death. The safety and efficacy of recombinant human (rh) GAA were evaluated in 18 patients with rapidly progressing infantile-onset Pompe disease. METHODS: Patients were diagnosed at 6 months of age and younger and exhibited severe GAA deficiency and cardiomyopathy. Patients received IV infusions of rhGAA at 20 mg/kg (n = 9) or 40 mg/kg (n = 9) every other week. Analyses were performed 52 weeks after the last patient was randomized to treatment. RESULTS: All patients (100%) survived to 18 months of age. A Cox proportional hazards analysis demonstrated that treatment reduced the risk of death by 99%, reduced the risk of death or invasive ventilation by 92%, and reduced the risk of death or any type of ventilation by 88%, as compared to an untreated historical control group. There was no clear advantage of the 40-mg/kg dose with regard to efficacy. Eleven of the 18 patients experienced 164 infusion-associated reactions; all were mild or moderate in intensity. CONCLUSIONS: Recombinant human acid alpha-glucosidase is safe and effective for treatment of infantile-onset Pompe disease. Eleven patients experienced adverse events related to treatment, but none discontinued. The young age at which these patients initiated therapy may have contributed to their improved response compared to previous trials with recombinant human acid alpha-glucosidase in which patients were older

%0 Journal Article
%C Department of Mental Health Sciences, University College London, London NW3 2PF, UK. m.king@medsch.ucl.ac.uk
%A Walsh, Kiri
%A Jones, Louise
%A Tookman, Adrian
%A Mason, Christina
%A McLoughlin, Joanne
%A Blizard, Robert
%A King, Michael
%J Br J Psychiatry
%D 2007 Feb
%P 142-7
%T Reducing emotional distress in people caring for patients receiving specialist palliative care: Randomised trial
%V 190
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17267931
%X BACKGROUND: Caring for relatives with advanced cancer may cause psychological and physical ill health. AIMS: To evaluate the effectiveness of increased support for distressed, informal carers of patients receiving palliative care. METHOD: The sample was composed of 271 informal carers who scored over 5 on the 28-item General Health Questionnaire (GHQ-28). The intervention comprised six weekly visits by a trained advisor. Primary outcome was carer distress (GHQ-28) at 4-week, 9-week and 12-week follow-up. Secondary outcomes were carer strain and quality of life, satisfaction with care, and bereavement outcome. RESULTS: Scores on the GHQ-28 fell below the threshold of 5/6 in a third of participants in each trial arm at any follow-up point. Mean scores in the intervention group were lower at all time points but these differences were not significant. No difference was observed in secondary outcomes. Carers receiving the intervention reported qualitative benefit. CONCLUSIONS: The intervention might have been too brief, and ongoing help might have had accruing benefits. Alternatively, informal carers of patients with cancer may already receive considerable input and the advisor's help gave little additional advantage; or caring for a dying relative is extremely stressful and no amount of support is going to make it much better

%0 Journal Article
%C Children's Hospital at Westmead, Australia
%A Barr, P
%J Arch Dis Child Fetal Neonatal Ed
%D 2007 Feb
%T Relation of neonatologists' end-of-life decisions to their personal fear of death
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17284476
%X OBJECTIVE: To study the relationship of Australian and New Zealand (ANZ) neonatologists' personal fear of death to their forgoing life sustaining treatment and hastening death in newborns destined for severe disability and newborns for whom further treatment is considered non-beneficial or overly burdensome. DESIGN: A self-report questionnaire survey of ANZ neonatologists. SETTING: Neonatologists registered in the 2004 ANZ Directory of Neonatal Intensive Care Units. Participants The 78 (56%) of 138 neonatologists who responded to the study questionnaire. MAIN OUTCOME MEASURES: Between group differences in the Multidimensional Fear of Death Scale. RESULTS: In newborns for whom further treatment was deemed futile, 73 neonatologists reported their attitude to hastening death as follows: 23 preferred to hasten death by withdrawing minimal treatment, 35 preferred to hasten death with analgesia-sedation, and 15 reported hastening death was unacceptable. Analysis of variance showed a statistically significant difference between the three groups concerning Fear of the Dying Process (F = 3.78, P = .028), Fear of Premature Death (F = 3.28, P = .044) and Fear of Being Destroyed (F = 3.20, P = .047). Post-hoc comparisons showed that neonatologists who reported hastening death was unacceptable compared with neonatologists who preferred to hasten death with analgesia-sedation had significantly less Fear of the Dying Process and Fear of Premature Death and significantly more Fear of Being Destroyed. CONCLUSIONS: ANZ neonatologists' personal fear of death and their attitude to hastening death when further treatment is considered futile are significantly related. Neonatologists' fear of death may influence their end-of-life decisions

%0 Journal Article
%C Department of Epidemiology and Public Health, Yale School of Medicine, New Haven, Connecticut, USA
%A Fenix, J B
%A Cherlin, Emily J
%A Prigerson, Holly G
%A Johnson-Hurzeler, Rosemary
%A Kasl, Stanislav V
%A Bradley, Elizabeth H
%J J Palliat Care
%D 2006 Winter
%N 4
%P 286-92
%T Religiousness and major depression among bereaved family caregivers: a 13-month follow-up study
%V 22
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17263056
%X OBJECTIVE: To examine the association between a multi-item measure of religiousness and major depressive disorder (MDD) in bereaved family caregivers of patients with cancer. DESIGN: A prospective longitudinal study of primary caregivers of consecutive patients (n = 175) with cancer enrolled in the largest hospice in Connecticut. RESULTS: Caregivers with a high religiousness summary score were significantly less likely to have MDD at the 13-month follow-up interview (OR = 0.79, 95% CI: 0.68-0.91). This finding remained significant (OR = 0.74, 95% CI: 0.59-0.91) after adjustment for caregiver MDD at baseline, caregiver age, caregiver burden, and number of activities restricted due to caregiving roles. CONCLUSIONS: Family caregivers who reported greater religiousness at baseline had lower rates of depression in the 13-month follow up after their loss. Collaboration with religious support groups or community groups during bereavement could offer an effective mechanism for speeding the process of recovery for some caregivers

%0 Journal Article
%C Harvard Radiation Oncology Program, Dana-Farber Cancer Institute, Boston, MA, USA. tbalboni@partners.org
%A Balboni, Tracy A
%A Vanderwerker, Lauren C
%A Block, Susan D
%A Paulk, M Elizabeth
%A Lathan, Christopher S
%A Peteet, John R
%A Prigerson, Holly G
%J J Clin Oncol
%D 2007 Feb
%N 5
%P 555-60
%T Religiousness and spiritual support among advanced cancer patients and associations with end-of-life treatment preferences and quality of life
%V 25
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17290065
%X PURPOSE: Religion and spirituality play a role in coping with illness for many cancer patients. This study examined religiousness and spiritual support in advanced cancer patients of diverse racial/ethnic backgrounds and associations with quality of life (QOL), treatment preferences, and advance care planning. METHODS: The Coping With Cancer study is a federally funded, multi-institutional investigation examining factors associated with advanced cancer patient and caregiver well-being. Patients with an advanced cancer diagnosis and failure of first-line chemotherapy were interviewed at baseline regarding religiousness, spiritual support, QOL, treatment preferences, and advance care planning. RESULTS: Most (88%) of the study population (N = 230) considered religion to be at least somewhat important. Nearly half (47%) reported that their spiritual needs were minimally or not at all supported by a religious community, and 72% reported that their spiritual needs were supported minimally or not at all by the medical system. Spiritual support by religious communities or the medical system was significantly associated with patient QOL (P = .0003). Religiousness was significantly associated with wanting all measures to extend life (odds ratio, 1.96; 95% CI, 1.08 to 3.57). CONCLUSION: Many advanced cancer patients' spiritual needs are not supported by religious communities or the medical system, and spiritual support is associated with better QOL. Religious individuals more frequently want aggressive measures to extend life

%0 Journal Article
%A Dean, Mervyn
%J Can Fam Physician
%D 2006 Aug
%P 951
%T Resources for palliative care
%V 52
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17273492

%0 Journal Article
%C Department of Medical Gastroenterology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico
%A Garcia-Leiva, Jorge
%A Gamboa-Dominguez, Armando
%A Ceron-Lizarraga, Tania
%A Morales-Espinosa, Daniela
%A Meza-Junco, Judith
%A Arrieta, Oscar
%J Ann Hepatol
%D 2006 Oct-Dec
%N 4
%P 263-7
%T Response of negative estrogen-receptor hepatocarcinoma to tamoxifen, and survival of non-resectable patients
%V 5
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17151578
%X Hepatocellular carcinoma is the fifth most common malignant neoplasm worldwide. Most patients are not candidates to surgical treatment. The prognosis of this neoplasm is poor, with an overall survival rate of 8 weeks in unresectable tumors. Estrogen receptors have been found in up to 33% of this tumors, reason why treatment with tamoxifen or progesterone compounds have been tried to diminish this neoplasm's progression but its use remains controversial. In our institution, thirteen patients were treated with tamoxifen (20- 40 mg/day) and 26 received supportive measures only. The clinical and tumoral characteristics were similar in both groups. Survival in the Tamoxifen group was of 5.5 ± 1.7 months while in the supportive measures group was of 2.1 ± 0.5 months (p = 0.018). Other factors related to an increased survival were: female gender and the Okuda score; age, TNM and alphaFP were not related to survival. The multivariate analysis showed that treatment with tamoxifen duplicates survival independently of the tumoral stage and functional hepatic reserve. It seems that the benefit of treatment with tamoxifen is limited and is not associated to the presence of estrogen receptors. In our study a 69 year-old man with diagnosis of non-resectable hepatocellular carcinoma and negative estrogen receptors, was treated with tamoxifen with a partial response and an overall survival of 4 years until November 2005. Despite some case reports that have shown tumoral regression, while other studies do not report any survival benefits. It is important to identify patients that would benefit from treatment with tamoxifen

%0 Journal Article
%C Division of Hematology and Oncology, Texas Tech University Health Sciences Center, Texas, TX, USA
%A Rohrer, James E
%A Esler, W Vance
%A Saeed, Qaiser
%A Saeed, Samreen
%A Periman, Phillip
%A Beggs, David
%A Hancock, Paul
%A Lim, Seah H
%J Support Care Cancer
%D 2006 Aug
%N 8
%P 871-3
%T Risk of mistaken DNR orders
%V 14
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=16468031
%X A questionnaire study was carried out among attendants at a community cancer center to determine the subjects' preferences and understanding of the meaning of do-not-resuscitate (DNR). Only 34% correctly understood the meaning of DNR, and 66% thought that DNR was administered only to prolong life without realizing that a DNR decision would result in not being resuscitated even if the cause of the sudden death was potentially reversible. We then determined the subjects' preferences if they had developed a treatment complication needing resuscitation and be put on the ventilator machine temporarily. When the subject was not expected to be alive in 6 months, the preference for resuscitation was not related to correct understanding. However, when the chance of cure was 30%, a preference for resuscitation was related to an incorrect understanding of the meaning of DNR. About 70% of respondents who would accept ventilator care had an incorrect understanding of DNR. The adjusted odds for the correct understanding of DNR were less for respondents who preferred resuscitation. The adjusted odds ratio (AOR) was 0.58 (CI: 0.35-0.93) (p=0.02) after adjusting for age and 0.53 (CI: 0.32-0.86) (p=0.01) after adjusting for both age and treatment group. These results suggest that physicians should be open to the possibility that patients may not always understand what DNR means, and they may be placed on DNR by mistake

%0 Journal Article
%C Academic Hospitalist, Waterbury Hospital, Waterbury, Connecticut, USA. shivenchabria@yahoo.com
%A Chabria, Shiven
%J J Hosp Med
%D 2006 Nov
%N 6
%P 378-9
%T Rites of passage
%V 1
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17219532

%0 Journal Article
%C Division of Hematology & Oncology, Vanderbilt University School of Medicine, Nashville, Tennessee 37232, USA
%A Stinnett, Shannon
%A Williams, Laura
%A Johnson, David H
%J J Support Oncol
%D 2007 Jan
%N 1
%P 19-24
%T Role of chemotherapy for palliation in the lung cancer patient
%V 5
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17265782
%X Lung cancer is the leading cause of cancer-related deaths in the United States and presents with a constellation of common, often persistent, and severe symptoms. Chemotherapy is well known to impart a survival benefit; however, the benefit of chemotherapy for relief of lung cancer symptoms has been slow to gain recognition. Tumor-related symptoms such as pain, cough, and dyspnea are improved, along with constitutional symptoms such as fatigue and overall quality of life, sometimes even after failure of previous regimens. The efficacy of chemotherapy for the relief of symptoms and improvement in quality of life makes these drugs a fundamental part of palliative care

%0 Journal Article
%A Denny, Lynette
%A Ngan, Hextan Y S
%J Int J Gynaecol Obstet
%D 2006 Nov
%P S50-5
%T Section B: Malignant manifestations of HPV infection Carcinoma of the cervix, vulva, vagina, anus, and penis
%V 94 Suppl 1
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17276165
%X Cervical cancer remains the commonest cancer among women in developing countries, affecting women at their peak of social and economic responsibility. In poor countries where access to diagnosis and treatment is extremely limited, most of the affected women present with late-stage disease. Many do not even have access to palliative care. Outcome in women treated for cervical cancer is strongly influenced by the stage of diagnosis. The main treatment modalities remain surgical removal for early-stage disease and chemoradiation for late-stage disease. Cancers of the vulva, vagina, penis, and anus are much less common than cervical cancer although, in most cases, they also are associated with human papillomavirus infection. Diagnosis and chief treatment modalities for cervical and these less common cancers are discussed

%0 Journal Article
%C Department of Hematology and Oncology, Ziekenhuisnetwerk Antwerpen Middelheim, Antwerp, Belgium
%A Schrijvers, Dirk
%J Lancet Oncol
%D 2007 Feb
%N 2
%P 86-7
%T Should palliative care replace palliative treatment for cancer in resource-poor countries?
%V 8
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17267318

%0 Journal Article
%A Chernick, Victor
%J Pediatr Pulmonol
%D 2006 Nov
%N 11
%P 1013
%T Stop the press-or at least stop the medication
%V 41
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=16998944

%0 Journal Article
%C The Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic Taussig Cancer Center, Cleveland, OH, USA. walsht@ccf.org
%A Walsh, Declan
%A Rybicki, Lisa
%J Support Care Cancer
%D 2006 Aug
%N 8
%P 831-6
%T Symptom clustering in advanced cancer
%V 14
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=16482450
%X A major goal of palliative medicine is to control symptoms that interfere with quality of life. Identification of symptoms that occur together (cluster) may aid in symptom management, resulting in greater therapeutic benefit to the patient. An analysis of 25 symptoms from 922 patients with advanced cancer was undertaken to determine if symptom clusters could be identified. Cluster analysis was done using an agglomerative hierarchical method with average linkage; the absolute value of the correlation between pairs of symptoms was used as the measure of similarity. A correlation of >or=0.68 was used to define the final clusters. Seven clusters were identified: (1) fatigue: anorexia-cachexia; (2) neuropsychological; (3) upper gastrointestinal; (4) nausea and vomiting; (5) aerodigestive; (6) debility; (7) pain. Recognition of symptom clusters should help understand symptom pathophysiology and target therapies that perhaps can be used to relieve multiple symptoms in that cluster. This could result in improved quality of life for patients with advanced cancer and perhaps reduce polypharmacy, lessen drug side effects, and have pharmacoeconomic benefits

%0 Journal Article
%C Academic Medical Center, University of Amsterdam
%A Gevers, J K M
%J Med Law
%D 2006 Dec
%N 4
%P 747-51
%T Terminal sedation: between pain relief, withholding treatment and euthanasia
%V 25
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17263039
%X In the last five to ten years there has been increasing debate on terminal sedation, a medical practice that is difficult to place between other decisions at the end of life, like alleviating pain, withholding treatment, and (in jurisdictions where this is allowed) euthanasia or physician-assisted suicide. Terminal sedation is the administration of sedative drugs with the aim to reduce the consciousness of a terminal patient in order to relieve distress. It is frequently accompanied by the withdrawal (or withholding) of life-sustaining interventions, such as hydration and nutrition. It is typically a measure of the last resort, to be considered in situations where all other measures to reduce pain and suffering have failed. While similar to palliative measures as far as the sedation itself is concerned, withholding of hydration and nutrition brings terminal sedation into the realm of non treatment decisions. At the same time, to the extent that the combination of these two measures may shorten the patient's life, the practice may be easily associated with euthanasia. It is no surprise therefore, that terminal sedation has been called (and has been disqualified as) 'slow euthanasia' or 'backdoor euthanasia'. This paper addresses the question how terminal sedation may be looked upon from a legal point of view. Is it indeed a disguised form of euthanasia, or should it be considered as a practice in its own right? In the latter case, what does it imply in legal terms, and under which conditions and safeguards could it be legally justified? To answer these questions, I will look first at the different clinical realities that may be brought under the heading 'terminal sedation'. Then I will deal with its two components--sedation on the one hand, and withholding artificial feeding on the other--in a legal perspective. The paper ends with conclusions on terminal sedation as a whole

%0 Journal Article
%C Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA. gavrinj@uphs.upenn.edu
%A Gavrin, Jonathan R
%J J Pain Palliat Care Pharmacother
%D 2006 
%N 4
%P 71-7
%T The American Medical Association "Pain Management: the Online Series"
%V 20
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17182513
%X There is a growing number of Internet based programs on pain management. Many of them offer continuing medical education credits (CMEs). "Pain Management: The Online Series" from the American Medical Association (AMA) is a recent addition. Its content is robust but the self-assessments tests needed to obtain CME are weak

%0 Journal Article
%A Smoyak, Shirley A
%J J Psychosoc Nurs Ment Health Serv
%D 2006 Dec
%N 12
%P 6-7
%T The Amish way. Coping with tragedy
%V 44
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17195389

%0 Journal Article
%C The Harry R. Horvitz Center for Palliative Medicine (A World Health Organization Demonstration Project), Cleveland Clinic Taussig Cancer Center, Cleveland Clinic Foundation, 9500 Euclid Avenue, M76, Cleveland, OH 44195, USA
%A Gallagher, Lisa M
%A Lagman, Ruth
%A Walsh, Declan
%A Davis, Mellar P
%A Legrand, Susan B
%J Support Care Cancer
%D 2006 Aug
%N 8
%P 859-66
%T The clinical effects of music therapy in palliative medicine
%V 14
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=16538499
%X GOAL: This study was to objectively assess the effect of music therapy on patients with advanced disease. PATIENTS AND METHODS: Two hundred patients with chronic and/or advanced illnesses were prospectively evaluated. The effects of music therapy on these patients are reported. Visual analog scales, the Happy/Sad Faces Assessment Tool, and a behavior scale recorded pre- and post-music therapy scores on standardized data collection forms. A computerized database was used to collect and analyze the data. RESULTS: Utilizing the Wilcoxon signed rank test and a paired t test, music therapy improved anxiety, body movement, facial expression, mood, pain, shortness of breath, and verbalizations. Sessions with family members were also evaluated, and music therapy improved families' facial expressions, mood, and verbalizations. All improvements were statistically significant (P<0.001). Most patients and families had a positive subjective and objective response to music therapy. Objective data were obtained for a large number of patients with advanced disease. CONCLUSIONS: This is a significant addition to the quantitative literature on music therapy in this unique patient population. Our results suggest that music therapy is invaluable in palliative medicine

%0 Journal Article
%C Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
%A Orkin, Aaron
%J J Palliat Care
%D 2006 Winter
%N 4
%P 312-4
%T The dying of Carol Hill: a medical student's notes on palliative care
%V 22
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17263062

%0 Journal Article
%C Addenbrooke's Hospital, Hills Road, Cambridge, UK. sara.booth@addenbrookes.nhs.uk
%A Booth, Sara
%A Farquhar, Morag
%A Gysels, Marjolein
%A Bausewein, Claudia
%A Higginson, Irene J
%J Palliat Support Care
%D 2006 Sep
%N 3
%P 287-93
%T The impact of a breathlessness intervention service (BIS) on the lives of patients with intractable dyspnea: a qualitative phase 1 study
%V 4
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17066970
%X OBJECTIVE: Disabling breathlessness is the most common symptom of advanced cardiopulmonary disease. It is usually intractable, even when patients receive maximal medical therapy for their underlying condition. A pilot study was undertaken to evaluate a newly formed palliative Breathlessness Intervention Service (BIS). METHODS: The methodology followed the Medical Research Council's Framework for the Evaluation of Complex Interventions (Phase I). Qualitative interviews were completed with patients and relatives who had used the service and clinicians who had referred to it. The focus of the interviews was the participants' experience of using BIS. RESULTS: Patients valued the positive educational approach taken to breathlessness, emphasizing what was possible rather than what had been lost. Non-pharmacological strategies, especially the hand-held fan and exercises, were rated very helpful and new to patients. Participants reiterated that breathlessness was frightening and isolating, exacerbating the disability it caused: the easy access to advice and flexibility of BIS helped to alleviate this. Participants wanted a written record of the advice given. Carers welcomed the focus on their needs. Clinicians valued sharing the management of patients with an intractable problem. SIGNIFICANCE OF RESULTS: This Phase I study has helped to remodel the service rapidly by uncovering the aspects of BIS that users find most valuable and areas that need change or improvement. The BIS needs to provide written information, to reinforce and extend contacts with other agencies to build on support it already provides for patients and carers, and extend its flexibility and accessibility. Providing a "drop-in" service and continuing education after the initial program of contacts is completed could be a useful service development, warranting further evaluation. A qualitative methodology involving service users and referrers can help to shape service development rapidly

%0 Journal Article
%C E lizabeth L amb is a women's health and family nurse practitioner at Virginia Commonwealth University Health System in Richmond, Virginia. She is currently working in the specialty field of urogynecology
%A Lamb, Elizabeth H
%J J Perinat Educ
%D 2002 Spring
%N 2
%P 33-40
%T The impact of previous perinatal loss on subsequent pregnancy and parenting
%V 11
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17273295
%X The loss of any pregnancy through miscarriage, ectopic pregnancy, stillbirth, or neonatal death presents as a significant life crisis for any woman and has far-reaching implications into a couple's future aspirations. Planning another pregnancy after dealing with a perinatal loss is difficult and plagued by ambivalence, doubts, and insecurities. Despite this ambivalence, a majority of women do become pregnant within a year following a perinatal loss. Four recurring issues surrounding perinatal loss and subsequent pregnancy have been identified in this literature review: the effect of the grief process on the subsequent pregnancy; parental coping mechanisms during the subsequent pregnancy; replacement or vulnerable child syndrome; and parenting issues with the subsequent live-born child. Issues surrounding anxiety as a coping mechanism during a pregnancy following a perinatal loss are documented consistently in the literature; however, less is known about the impact that a loss has on parenting behaviors with subsequent children. Further research is imperative to examine these issues in more detail so that evidence-based practices can be established and updated. Health care providers are in a unique position to assist these couples in dealing with the issues that a perinatal loss may place on subsequent pregnancies. By providing a reassuring and supportive environment, women can achieve a positive pregnancy outcome with the correct tools to decrease anxiety and enhance attachment to the subsequent healthy child

%0 Journal Article
%C Edmonton Palliative Care Program, Edmonton, Alberta, Canada
%A Mirhosseini, Mehrnoush
%A Oneschuk, Doreen
%A Hunter, Brad
%A Hanson, John
%A Quan, Hue
%A Amigo, Pablo
%J J Palliat Care
%D 2006 Summer
%N 2
%P 69-74
%T The role of antibiotics in the management of infection-related symptoms in advanced cancer patients
%V 22
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17265658
%X We prospectively evaluated the effect of antibiotic treatment on infection-related symptoms in patients with advanced cancer, in addition to assessing infection characteristics. METHODS: A questionnaire was completed for enrolled patients using a personal digital assistant. Pre-antibiotic and post-antibiotic treatment Edmonton Symptom Assessment Scale (ESAS) scores were evaluated. Patient and the patient's physician identified infection-related symptoms experienced by the patient, which were documented under the "other" category on the ESAS. Pre-antibiotic and post-antibiotic scores of the patient and physician for the identified infection-related symptoms were evaluated. RESULTS: Twenty-six patients on a tertiary palliative care unit with 31 episodes of infection were included for analysis. Patients' pre- and post-antibiotic ESAS scores revealed a small improvement in all variables except anxiety. Patient assessment of symptoms related to infection showed a small improvement in all symptoms, with dsyuria being statistically significant. Physician assessment revealed a slight improvement for all the symptoms, although only cough was statistically significant. A general comparative physician assessment of patient outcome following antibiotic treatment suggested symptom improvement in 48.4% of patients. However, 50% of patients died within a week of antibiotic discontinuation. CONCLUSIONS: Antibiotic treatment appears to offer a mild improvement in infection-related symptoms. Patients reported the greatest improvement in dysuria, and physicians, in cough. Despite this symptomatic improvement, one quarter of the patients died within one week of antibiotic administration. Further comparative studies to evaluate symptomatic benefit, patient burden, and cost/benefit of antibiotic therapy in the treatment of infections in advanced cancer patients are required

%0 Journal Article
%C NAYNA PHILIPSEN is Director of Education, Examination, Research, and Communication for the Maryland Board of Nursing. She is also a health educator at St. Agnes HealthCare in Baltimore, Maryland
%A Philipsen, Nayna C
%A Haynes, Dorothy R
%J J Perinat Educ
%D 2005 Fall
%N 4
%P 46-8
%T The similarities between birth plans and living wills
%V 14
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17273453
%X Birth plans and living wills are both advance directives that promote individualized care and improved outcomes for individuals and their families

%0 Journal Article
%C Department of Neurosurgery, San Raffaele Hospital, Milano, Italy. bernucci.claudio@hsr.it
%A Bernucci, Claudio
%A Giovanelli, Massimo
%J Spine
%D 2007 Jan
%N 2
%P 281-4
%T Translaminar microsurgical approach for lumbar herniated nucleus pulposus (HNP) in the "hidden zone": clinical and radiologic results in a series of 24 patients
%V 32
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17224827
%X STUDY DESIGN: Clinical series. OBJECTIVE: To describe an alternative surgical approach for disc herniations in the "hidden zone." SUMMARY OF BACKGROUND DATA: Many spine surgeons have suggested different surgical approaches for symptomatic preforaminal and foraminal disc herniations. However, almost every surgical approach has certain shortcomings when it comes to exposing the "hidden zone" without causing some degree of spinal instability. METHODS: Twenty-four patients with preforaminal and foraminal disc herniation underwent surgical treatment via a translaminar microsurgical approach. RESULTS.: Excellent results were obtained in all patients in terms of pain relief, and all had improvement in motor strength except for 1 patient. No spinal instability was seen at the latest follow-up. CONCLUSIONS: A classic interlaminar interspace approach combined with a very limited translaminar fenestration seem to be an acceptable surgical method for accessing a preforaminal disc herniation, and this technique has proven to be safe and did not cause any instability at the latest follow-up

%0 Journal Article
%C Department of Palliative Care, RWTH Aachen, Aachen, Germany
%A Reineke-Bracke, Heike
%A Radbruch, Lukas
%A Elsner, Frank
%J J Palliat Med
%D 2006 Oct
%N 5
%P 1210-4
%T Treatment of fatigue: modafinil, methylphenidate, and goals of care
%V 9
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17040162

%0 Journal Article
%C Hampshire Hematology Oncology, Dickinson Hospital, Northampton, MA 01060, USA. emonrock@mac.com
%A Rockwell, Lindsay E
%J J Clin Oncol
%D 2007 Feb
%N 4
%P 454-5
%T Truthtelling
%V 25
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17264345

%0 Journal Article
%C Department of Hepato-Gastroenterology and Nutrition, ADEN-EA3234/IFRMP23 Research Group, Rouen University Hospital Charles-Nicolle, France
%A Lecleire, Stephane
%A Di Fiore, Frederic
%A Antonietti, Michel
%A Ben Soussan, Emmanuel
%A Hellot, Marie-France
%A Grigioni, Sebastien
%A Dechelotte, Pierre
%A Lerebours, Eric
%A Michel, Pierre
%A Ducrotte, Philippe
%J Gastrointest Endosc
%D 2006 Oct
%N 4
%P 479-84
%T Undernutrition is predictive of early mortality after palliative self-expanding metal stent insertion in patients with inoperable or recurrent esophageal cancer
%V 64
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=16996335
%X BACKGROUND: Self-expanding metallic stents (SEMS) are a first-line therapeutic procedure in the palliative treatment of dysphagia in patients with esophageal cancer. However, the impact of SEMS insertion on patient nutritional status has never been assessed. OBJECTIVE: To evaluate the nutritional status of patients after insertion of a SEMS and the impact of a preexisting undernutrition status on survival. DESIGN: Retrospective observational study. PATIENTS: A total of 120 patients treated in a single center by insertion of a SEMS for relief of dysphagia in the palliative treatment of esophageal cancer were retrospectively included. MAIN OUTCOME MEASUREMENTS: Efficacy of SEMS was assessed by the Ogilvie's dysphagia score. Patient nutritional and clinical statuses were evaluated at SEMS insertion, and patients were regularly followed until death. Independent predictive factors of early 30-day mortality were researched. RESULTS: Dysphagia scores decreased after SEMS insertion in 89.1% of patients, with median scores decreasing from 3.0 to 1.0 (P < .05). There was a significant decrease in body mass index (BMI) (P < .04), serum albumin level (P < .01), and World Health Organization (WHO) performance index (P < .02) at a 1-month evaluation. Serum albumin level, BMI <18 kg/m(2), and WHO performance index >2 at SEMS insertion were independent predictive factors of 30-day mortality. CONCLUSIONS: This study suggested that palliative stent placement in esophageal cancer was effective to relieve dysphagia but was not followed by an improvement of nutritional parameters. Moreover, it underlined the key role played by undernutrition on survival

%0 Journal Article
%J BMJ
%D 2007 Feb
%N 7588
%P 283
%T Unhurried listening helps relatives through grief
%V 334
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17289720

%0 Journal Article
%C University of Manchester
%A Young, A
%A Tattersall, H
%J J Deaf Stud Deaf Educ
%D 2007 Feb
%T Universal Newborn Hearing Screening and Early Identification of Deafness: Parents' Responses to Knowing Early and Their Expectations of Child Communication Development
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17277310
%X This article presents results from an interview study of 45 parents/caregivers (representing 27 families) whose infants were correctly identified as deaf during the first phase of the implementation of the national universal Newborn Hearing Screening Programme in England. Average age of children when parents were interviewed was 25 weeks. Two issues are explored: (a) how parents talk about significance of knowing early that their child is deaf and (b) parents' expectations of their child's development in light of early identification. Although results demonstrate clear support from parents' perspective of knowing early, they also identify the psychological complexities of recognizing both the grief and reassurance that early knowledge brings; the risks of early knowledge-inducing timetables of expectations that create distress when not met speedily; the extent to which parental models of the developmental advantages of early identification are underpinned by notions of normal speech and the possibility of being like hearing children; and the pervasiveness of deficit and illness models associated with having identified deafness early. Implications for parental support and professional responses are also discussed

%0 Journal Article
%C Departments of Clinical Epidemiology and Biostatistics (E.N., C.K.) and Medicine (E.K.), Faculty of Medicine (E.K.), and Institute of Psychology (P.B.), Makerere University, Kampala, Uganda
%A Namisango, Eva
%A Katabira, Elly
%A Karamagi, Charles
%A Baguma, Peter
%J J Pain Symptom Manage
%D 2007 Feb
%N 2
%P 189-202
%T Validation of the Missoula-Vitas Quality-of-Life Index Among Patients with Advanced AIDS in Urban Kampala, Uganda
%V 33
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17280924
%X The Missoula-Vitas Quality-of-Life Index (MVQOLI) is a unique tool specifically designed to measure quality of life (QOL) in advanced illness in a palliative care setting. The aim of this study was to explore its cross-cultural validity. We used a culturally adapted version in a local language, Luganda, and tested the MVQOLI-M in 200 patients with advanced AIDS in urban Kampala, Uganda. Content validity was assessed using the content validity ratio approach. Reliability was assessed using Cronbach's alpha (alpha), and test-retest reliability was evaluated using the intraclass correlation coefficient. All items and domains were rated content valid and there was good construct validity. The instrument demonstrated good internal consistency (alpha=0.83). The transcendence domain was the best predictor of overall QOL. The MVQOLI-M is an acceptable, valid, and reliable measure of QOL for people with advanced AIDS and findings demonstrate the importance of measuring the transcendence domain in QOL in advanced illness

%0 Journal Article
%C School of Social Work, University of Missouri, Columbia, Missouri, USA
%A Oliver, Debra Parker
%A Wittenberg-Lyles, Elaine M
%A Day, Michele
%J J Palliat Care
%D 2006 Winter
%N 4
%P 275-80
%T Variances in perceptions of interdisciplinary collaboration by hospice staff
%V 22
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17263054
%X The purpose of this descriptive project is to use the Modified Index of Interdisciplinary Collaboration (MIIC) to assess the perceptions of collaboration of 95 staff from all disciplines on five different hospice teams. Specifically, the research questions for the project are: 1) Are there variances in perceptions of collaboration between hospice programs? 2) Are there variances in perceptions of collaboration between and within hospice programs by staff in different disciplines? Significant variances were found in the perceptions of interdisciplinary collaboration between hospice teams. There were no significant differences found between hospice providers of different disciplines. The study concludes that measurement of collaboration is important given the emphasis in hospice on collaboration, and that the MIIC is one tool that can be used for that purpose

%0 Journal Article
%A Dean, Mervyn
%J Can Fam Physician
%D 2006 Aug
%P 952; discussion 952
%T What's in it for me?
%V 52
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17273495

%0 Journal Article
%A Pauls, S
%A Kruger, S
%A Mottaghy, F M
%J Rofo
%D 2007 Jan
%N 1
%P 80-2
%T [18F-FDG PET/CT in paraneoplastic osteoarthropathy]
%V 179
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17243205

%0 Journal Article
%C Equipo de Soporte de Atencion Domiciliaria (ESAD). Centro de Salud Seminario. Sector Zaragoza II. Atencion Primaria. Zaragoza. Espana. esad1y2@salud.aragon.es
%A Torrubia Atienza, Maria Pilar
%A Ruiz Bueno, Maria Pilar
%J Aten Primaria
%D 2006 Nov
%P 72-8
%T [Care at the very end of life.]
%V 38 Suppl 2
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17286939
%X Most terminally-ill patients pass through a phase of deterioration that precedes, by a few days, their death. The suffering caused by the loss is compounded by a variable number of symptoms. Given the impossibility of using the oral route, health professionals must be familiar with the subcutaneous route. Primary care professionals should be well versed in the material necessary for subcutaneous administration, the technique, which drugs should be used and at what dose, and the forms of administration. The family, as the main provider of domiciliary care, should be trained in the use of the necessary techniques and be aware of the main complications and how to deal with them. Sometimes, when symptoms are difficult to control, the use of terminal sedation must be considered. The explicit or implicit consent of the patient and/or her or her family must be obtained

%0 Journal Article
%C Equipo de Soporte de Atencion Domiciliaria de Mallorca. Hospital General. IBSalut. Palma de Mallorca. Espana. llagos69@yahoo.es
%A Llagostera Pages, Merce
%J Aten Primaria
%D 2006 Nov
%P 65-71
%T [Care of the skin.]
%V 38 Suppl 2
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17286938
%X The development of palliative care in the last decade has improved the management of typical situations such as pain. In parallel, in other alterations, which may be less important a priori but which can negatively affect the patient's quality of life, the therapeutic approach has been modified, providing new alternatives to health professionals, with positive results. This is the case of some cutaneous alterations such as pruritus, for which drugs such as paroxetine, ondansetron and opioid antagonists, as well as other drugs not previously used for this alteration, are available. In addition, the therapeutic approach to pressure ulcers has been modified by the multidisciplinary approach and the development of specific products. The present article also reviews lymphedema, fistulas, and tumoral ulcers; these alterations can have important psychological effects and lead to social isolation if not appropriately treated

%0 Journal Article
%C Grupo de Trabajo de Cuidados Paliativos semFYC, San Sebastian de los Reyes, Madrid, Spain
%A Babarro, Alberto Alonso
%J Aten Primaria
%D 2006 Oct
%N 6
%P 323-4
%T [Commentary. Should palliative treatment programs be supported by primary care teams?]
%V 38
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17173795

%0 Journal Article
%C MFyC. Centro de Salud de Sanguesa. Navarra. GdT Paliativos de semFYC. GdT Paliativos de Navarra. Grupo CyS de Navarra. Espana. solizarraga@hotmail.com
%A Lizarraga Mansoa, Socorro
%A Ayarra Elia, Maite
%A Cabodevilla Eraso, Iosu
%J Aten Primaria
%D 2006 Nov
%P 7-13
%T [Communication as the cornerstone of the care of patients with advanced cancer. Starting points for improving our communication skills.]
%V 38 Suppl 2
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17286931
%X When faced with patients at the end of life, death should not be something to be fought; rather it is pain, disability and poor quality of life before death that should be combatted. Our aim should be to help people <<die in peace>>. Dying in peace means different things to different people, from persevering with therapies in the hope of prolonging life to planning the approach to death. Understanding, without judging, and accepting the desires and needs of dying patients and people in their environment is the cornerstone of caring for patients at the end of life. In this process, communication becomes a fundamental therapeutic instrument, used to inform and deal with the patient's emotions. The patient can then gradually adapt to his or her worsening and the proximity of death. Just as the art of curing can be learned, so can the art of communication

%0 Journal Article
%C Abteilung Innere Medizin II, Universitatsklinikum Freiburg
%A Becker, G
%A Dausch, V
%A Xander, C
%A Olschewski, M
%A Momm, F
%A Blum, H E
%J Dtsch Med Wochenschr
%D 2007 Feb
%N 6
%P 256-60
%T [End-of-life care as presented in German medical textbooks.]
%V 132
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17268950
%X BACKGROUND: There is a need for improved end-of-life care, especially in the light of demographic changes with an increased incidence of cancer. Although medical textbooks are central to the training of medical students and also serve as a reference for more experienced clinicians, only few data exist on the extent to which medical textbooks address end-of-life care. We analysed the quantity and quality of information on end-of-life care given in German textbooks on different medical disciplines. MATERIAL AND METHODS: 26 top-selling German medical textbooks were analysed for the presentation of end-of-life care in chapters that address the 13 most common causes of death worldwide RESULTS: In the 159 chapters analysed for information on traditional topics, like risk factors or early diagnosis (group A), such information was provided in 52% compared with only 9% on end-of-life topics, such as symptom management or manner of death (group B) (p=0.0001). There was no statistically significant difference between the different medical specialities (p=0.22). Line-by-line analysis showed that the phrase death or related terms was mentioned in only 57 of 159 chapters dealing with the most common causes of death worldwide. CONCLUSION: The top-selling German textbooks that were analysed generally offer little helpful information on end-of-life care of patients

%0 Journal Article
%C Unidad de Hospitalizacion a Domicilio. Hospital de Cabuenes. Gijon. Asturias. Espana. clavelarce@telefonica.net
%A Arce Garcia, Maria Clavelina
%J Aten Primaria
%D 2006 Nov
%P 79-84
%T [Ethical dilemas in palliative care.]
%V 38 Suppl 2
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17286940
%X Diagnosis of terminal disease, clinical information, the indication for diagnostic or therapeutic measures and care at the end of life are all features of the care of cancer patients in which clinical and ethical issues are intimately related. In Spain, the Law of Patient Autonomy (41/2002) represents a substantial change in the physician-patient relationship, which is adjusted to the ethical principles currently in force. Knowledge of the articles relevant to palliative care is essential to appropriate decision making. Several lines of thought from the world of ethics describe methods to analyze the problems that can arise in clinical practice, and the incorporation of any one of these methods into daily clinical practice would improve the ethical quality of clinical decisions

%0 Journal Article
%C Modulo di Terapie di Supporto e Palliative, Divisione di Oncologia, Ospedale Civile degli Infermi, Rimini. dtassinari@rimini.com
%A Tassinari, Davide
%A Maltoni, Marco
%J Recenti Prog Med
%D 2006 Oct
%N 10
%P 571-9
%T [Future aims for palliative care]
%V 97
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17263049
%X The rediscovery of palliative care in oncology represents an important aspect in the clinical assistance of cancer patients with advanced or terminal disease. The main characteristic aspects of the renewed medical discipline are: the inclusion of palliative care within the comprehensive care of the oncologic patient (simultaneous care); the inclusion of the palliative care institutions (Hospices and Home Care Units) within the oncologic departments; the comprehensive approach towards the sick person and his family in a model of global care; the identification of quality of life as the main end point of a palliative approach. An adequate approach to the needs of the patient with advanced or terminal disease or to the needs of his family has to be based upon a correct assessment of the patient, and consequently of patient's prognosis. Moreover, clinical research should be based on rational principles and conducted with adequate and well-founded methodologies. Future aims for palliative care will be: the identification of foundation confirmed by basic or translational research, the conduction of trials that could validate the results of biological research in the clinical context, and the large application of the results of clinical research in clinical practice. Nevertheless, all the efforts to improve the quality of clinical research in palliative care will have to be focused on protocols of global interventions

%0 Journal Article
%C Equipo de Soporte de Cuidados Paliativos. Hospital Universitario Arnau de Vilanova. Lleida. Espana. mnabal@secpal.com
%A Nabal, Maria
%A Pascual, Antonio
%A Llombart, Antonio
%J Aten Primaria
%D 2006 Nov
%P 21-8
%T [General evaluation of patients with advanced cancer. Principles of symptom control.]
%V 38 Suppl 2
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17286933
%X Palliative medicine is defined as a model of care that improves the quality of life of patients and their families. The aim of palliative medicine is to deal with the problems associated with terminal diseases through the prevention and relief of the suffering produced by pain and other physical, psychosocial, and spiritual problems. Palliative medicine is a fundamental discipline in oncological care, which should be accessed according to the needs of each patient, independently of prognosis or specific treatment options. Any intervention in palliative care should be based on a rigorous biopsychosocial evaluation, which begins with the clinical history and is completed by analysis of symptoms, the functional situation, the psychosocial sphere, and spiritual concerns. To facilitate this task, validated scales are available that help to confirm our findings and clinical changes in the patients. The following can be considered to be basic principles of intervention in palliative care: symptom control (identification, detection of their causes, establishing realistic objectives, defining appropriate therapeutic measures), communication and emotional support, horizontal organization of the intervention and the multidisciplinary team

%0 Journal Article
%C Dept. of Surgery, Fujisaki Hospital
%A Fujisaki, Shigeru
%A Takashina, Motoi
%A Tomita, Ryouichi
%A Takayama, Tadatoshi
%J Gan To Kagaku Ryoho
%D 2006 Nov
%N 12
%P 1881-4
%T [Improvements in quality of life and survival of patients with T4 gastric cancer which invaded organs after multivisceral resections through the extension of palliative gastrectomy and post-operative chemotherapy]
%V 33
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17212135
%X For patients with a locally advanced gastric cancer, palliative gastrectomy could improve local complications, such as bleeding or obstruction, but had no impact on prognosis. This study was designed to evaluate improvements in quality of life and survival of patients with T4 gastric cancer which invaded organs exhibiting bleeding or obstruction, after multivisceral resections of these organs through the extension of palliative gastrectomy and postoperative chemotherapy. Multivisceral resections were performed on 6 patients with T4 gastric cancer with local complications, such as bleeding or obstruction, at the Department of Surgery of Fujisaki hospital from 2003-2005. The sites of the organs invaded were the pancreas in five cases, and transverse colon and gallbladder in one case. The invaded organs were resected completely in five cases, and partially in one case. Surgical margins were microscopically negative in four cases. Anatomical leakage (sutured failure) occurred to none of the patients. All in all, the oral ingestion after the surgery went well. Chemotherapy (TS-1 plus CDDP) was started with 3 patients during their stay in the hospital. In addition, post-operative chemotherapy (TS-1) at the outpatient clinic was performed on 5 of the 6 patients. More than 1 year of the performance test (PS 0 or 1 in ECOG) went well for 4 patients. Two of the 4 patients could resume their work. The median survival time was more than 419.5 days. In conclusion, we consider that multivisceral resections through the extension of palliative gastrectomy and postoperative chemotherapy for patients with T4 gastric cancer could improve quality of life and prognosis

%0 Journal Article
%C Dept. of Surgery, Graduate School of Medicine, Osaka University
%A Nagano, Hiroaki
%A Miyamoto, Atsushi
%A Wada, Hiroshi
%A Noda, Takehiro
%A Nakamura, Masato
%A Ota, Hideo
%A Damdinsuren, Bazarragchaa
%A Marubashi, Shigeru
%A Takeda, Yutaka
%A Umeshita, Koji
%A Dono, Keizo
%A Monden, Morito
%J Gan To Kagaku Ryoho
%D 2006 Nov
%N 12
%P 1848-51
%T [Intra arterial infusion chemotherapy combined with interferon-alpha following palliative hepatic resection against advanced hepatoma with portal venous tumor thrombus in the major trunk and multiple nodules--a preliminary study]
%V 33
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17212125
%X Recently, we reported the beneficial effects of intra arterial 5-FU infusion chemotherapy combined with interferon-alpha (IFN-alpha/5-FU combined chemotherapy) for advanced hepatocellular carcinoma (HCC). This report describes the preliminary results of treatment of IFN-alpha/5-FU combined chemotherapy following palliative hepatic resection for advanced hepatocellular carcinoma with tumor thrombus in the main trunk of the portal vein with multiple nodules in the whole liver. The 15 patients of HCC with portal venous tumour thrombi (PVTT) and multiple intra-hepatic multiple nodules (IM3) were treated with IFN-alpha/5-FU combined chemotherapy following palliative surgery in this study. No leukopenia, thrombocytopenia, or myelosuppression was observed in any of the 15 patients. Other adverse effects were, in general, clinically manageable. Concerning the anti-tumor effect, 6 showed an objective response and 9 showed a progressive disease; the response rate was 40.0% (6/15). The 1-year and 3-year survival rates were 48% and 21% in all 15 cases, respectively. In conclusion, IFN-alpha/5-FU combined therapy may be a promising modality for advanced HCC with tumor thrombi in the major trunk with multiple nodules after following palliative surgery

%0 Journal Article
%C CLAN (Comite de liaison en alimentation et nutrition), service des urgences, institut Gustave-Roussy, 94805 Villejuif Cedex. antoun@igr.fr
%A Antoun, Sami
%A Merad, Mansouriah
%A Raynard, Bruno
%A Ruffie, Pierre
%J Rev Prat
%D 2006 Nov
%N 18
%P 2025-9
%T [Malnutrition in cancer patients]
%V 56
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17274506
%X Malnutrition is common in cancer patients. Many factors contribute to weight loss: some of them can be related to diminished dietary intake, while others are more associated with metabolic changes induced by systemic inflammatory responses. This is why at a specific phase during the course of development, some cancers will benefit from nutritional support, while in theory, and others will benefit from anti-inflammatory treatment. Parenteral nutrition is indicated for severe malnourished surgical patients and for allogenic stem cell transplant patients. Tube feeding (enteral nutrition) should be considered for patients with a functional gut who are unable to ingest sufficient nutrients orally, for example head and neck cancer patients. The value of dietary counselling and oral nutritional support has not been proven in patients undergoing chemotherapy, which is why it is so difficult to propose recommendations. Some arguments seem to favour parenteral nutrition for patients with bowel obstruction suffering from advanced-stage incurable cancer. As the results of studies following omega-3 fatty acid-enriched oral nutritional support in palliative care patients are inconsistent, these products cannot be recommended

%0 Journal Article
%C Service de pharmacie
%A Federspiel, F
%A Caudron, E
%A Batista, R
%A Rajzbaum, G
%A Bouyssou, I
%A Gaillard, D
%A Bezie, Y
%J Presse Med
%D 2007 Jan
%N 1
%P 15-19
%T [Outpatient medications at the hospice.]
%V 36
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17261444
%X OBJECTIVE: To study the frequency and circumstances of patients' use of outpatient medications prescribed by their GP during hospitalization and to assess means of reducing this use. METHOD: A prevalence study of medication use was conducted at Saint Joseph's Hospital in Paris. On one day, we used a specific questionnaire to interview 151 patients in 11 different units about the type and amount of medications they had brought with them to the hospital and the type and amount they had used. RESULTS: Overall, 61% had brought their prescription medication with them, and 36% had used some of it, sometimes without informing the medical staff. In 75% of these cases, these drugs were available from the hospital pharmacy. DISCUSSION: Possible corrective steps include both technological improvements (computerized prescription) and organizational measures: systematic inquiry about and consideration of outpatient prescriptions at admission, use of validated prescription/substitution aids (Comedims), and patient information and education about drug substitutions and interactions

%0 Journal Article
%C Comite Cuidados Paliativos, Sociedad Chilena de NefrologiaChile
%A Zuniga San Martin, Carlos
%J Rev Med Chil
%D 2006 Dec
%N 12
%P 1592-3
%T [Palliative Care for renal patients.]
%V 134
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17277880

%0 Journal Article
%C Direccion General de Atencion Socio-Sanitaria y Salud. Servicio Extremeno de Salud. Merida. Badajoz. Espana. emilio.herrera@ses.juntaex.es
%A Herrera Molina, Emilio
%A Rocafort Gil, Javier
%A Cuervo Pinna, Miguel Angel
%A Redondo Moralo, Maria Jose
%J Aten Primaria
%D 2006 Nov
%P 85-92
%T [Primary palliative care: development of the contents of the primary care services portfolio and criteria for referral according to complexity.]
%V 38 Suppl 2
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17286941
%X Palliative care is an internationally recognized right that should be provided in three levels of healthcare: primary (basic), secondary (specialized teams) and tertiary (care of highly complex patients requiring hospitalization). The functions that each of these three levels should perform, the required resources, and the criteria for referring patients from primary care to palliative care teams should be defined. To define the contents of primary palliative care provesion and the threshold of complexity required to ensure appropriate referral, a four-step approach was used: systematic review of the literature, review of a draft of the services portfolio, drafting of a proposal, and validation of the proposal by a nominal group composed of primary care health professionals. In accordance with the objectives initially established, more than 1,200 articles were reviewed and a proposal was drafted and validated. This proposal contained 12 primary care services and four criteria for referring patients to specific palliative care teams. It was concluded that primary care is responsible for palliative care in the home and should guarantee to provide this care in patients with low complexity. To do this, primary care staff require adequate training that would allow them to manage physical and emotional symptoms, based on systematic evaluation with validated scales. Primary care staff also require improved coordination, so that patients can be referred according to their degree of complexity and the ability of the primary care health professional to provide the necessary care. Finally, the need to improve systems for evaluating the results obtained by the health services in the care of terminally-ill patients was detected

%0 Journal Article
%C Equipo de Soporte de Cuidados Paliativos. Hospital Perpetuo Socorro. Badajoz. Espana. mariredo@hotmail.com
%A Redondo Moralo, Maria Jose
%A Cuervo Pinna, Miguel Angel
%J Aten Primaria
%D 2006 Nov
%P 38-46
%T [Respiratory symptoms in palliative care.]
%V 38 Suppl 2
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17286935
%X Dyspnea in patients with advanced cancer is a highly frequent (affecting up to 65% of patients) and incapacitating symptom that markedly worsens quality of life; hence the importance of multidimensional evaluation of dyspnea with the aim of acting on the various triggering factors. Currently, the symptomatic treatment of choice consists of opioids, specifically morphine, which is discussed in the present article. The aim of palliative treatment in patients with malignant pleural effusion is to relieve dyspnea. The most widely used therapeutic modality is chemical pleurodesis. In patients unresponsive to pleurodesis, insertion of an endopleural catheter should be considered

%0 Journal Article
%C Oncologie medicale, centre regional de lutte contre le cancer Alexis-Vautrin, 54511 Vandcauvre-les-Nancy Cedex. i.krakowski@nancy.fnclcc.fr
%A Krakowski, Ivan
%J Rev Prat
%D 2006 Nov
%N 18
%P 1989-96
%T [Supportive care for people affected by cancer: concept and inventory of fixtures]
%V 56
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17274500
%X The concept of continuous and global care is acknowledged today by all as inherent to modern medicine. The supportive care are defined as "all care and supports necessary for ill people, at the same time as specific treatments, along all severe illnesses". This definition integrates as much the field of curative care, cure with possible after-effects as that of palliative care. A supportive care coordination is justified by the pluridisciplinarity and hyperspecialisation of the professionals, by a poor communication between the teams, by the administrative difficulties encountered by the teams participating in the supportive care. Supportive care is not a new speciality. They are a coordinated organisation with a "basic coordination" involving the activities of chronic pain, palliative care, psycho-oncology, nutrition, and social care..

%0 Journal Article
%C Servicio de Oncologia Medica. Hospital de Cruces. Osakidetza-Servicio Vasco de Salud. Barakaldo. Bizkaia. Espana
%A Munoz Llarena, Alberto
%A Mane Martinez, Joan Manel
%A Rubio Etxebarria, Itziar
%A Lopez Vivanco, Guillermo
%J Med Clin (Barc)
%D 2007 Jan
%N 3
%P 118
%T [The authonomy principle and the advance directives.]
%V 128
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17288928

%0 Journal Article
%C Institut za medicinska istrazivanja i medicinu rada, Zagreb, Hrvatska
%A Piasek, Gustav
%A Piasek, Martina
%J Arh Hig Rada Toksikol
%D 2006 Dec
%N 4
%P 459-68
%T [Tradition of hospices (xenodochia) in the town of Varazdin, Croatia]
%V 57
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17265685
%X Varazdin has a long tradition of hospices or xenodochia as institutions for accommodation and care of disabled, poor and elderly citizens, and occasional travellers. Preserved documents show that these institutions existed as early as 1454. Even though we do not know which the first xenodochium was in the town, their continuous presence is evidenced from the 15th through to the mid 20th century. A house built as a xenodochium in 1776 is still standing, but now it is a residential building. The last xenodochium was built in 1839, stopped operating in 1965, and was pulled down in 1982. This put an end to an at least five centuries long tradition of hospices in the town. In 2000, global recognition of the need for this kind of social and health care institutions, encouraged a group of Varazdin townspeople, including health care professionals gathered around Varazdinska udruga prijatelja hospicija 1457.-2000. (Varazdin Association of Hospice Friends 1457-2000), to work on establishing a modern hospice/palliative care for seriously or terminally ill and disabled persons and to restore this centuries old tradition