%0 Journal Article %C Department of Anesthesiology and Pain Medicine, Juntendo University School of Medicine, Tokyo %A Akiyama, Yasuko %A Iseki, Masako %A Izawa, Rika %A Ishii, Kouta %A Miyazaki, Toyo %A Yamaguchi, Seiko %A Tani, Yuichiro %J Masui %D 2007 Mar %N 3 %P 317-23 %T [Usefulness of fentanyl patch (Durotep) in cancer patients when rotated from morphine preparations] %V 56 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17366919 %X BACKGRAOUND: The transdermal fentanyl patch (Durote patch) is an opioid preparation requiring replacement once in three days, which is occasionally prescribed to replace morphine preparations. The conversion ratio from morphine to fentanyl has been claimed to be 100:1 or 150:1, but there may exist individual variations. METHODS: We retrospectively evaluated the analgesic effects and adverse effects of fentanyl patch in 24 cases among 22 patients (11 men and 11 women). RESULTS: There were some reasons for switching; the major one was for home-care. In most cases rotation was completed in a few days and the side effects disappearance or were reduced, but 4 cases of them showed severe diarrhea or exhibited exacerbation of the pain, and had to go back to morphine. There were a wide variations of conversion ratio with a mean of 96.6. CONCLUSIONS: The fentanyl patch is a useful agent to control severe cancer pain because of excellent analgesic effect, less adverse effects and more convenience as well as itsundesirable characteristics when transition of patients to home-care is considered or oral administration should be avoided. Above all it offers a great possibility to improve cancer patient's quality of life %0 Journal Article %C Dept. of Pharmaceutical Service (Pharmacy), Jikei University, School of Medicine %A Andoh, Naomi %A Katoh, Eiko %A Katoh, Junichiroh %A Kikuno, Fumitoyo %A Sakuyama, Toshikazu %A Uno, Shinji %A Hirano, Akio %A Inoue, Daisuke %A Kobayashi, Tadashi %A Mouri, Junichi %A Aiba, Keisuke %J Gan To Kagaku Ryoho %D 2006 Dec %P 315-7 %T [The role of the pharmacist to an inpatient in order to switch from inpatient treatment to a home-based care of an outpatient--the usefulness of a patient record notebook in cancer chemotherapy] %V 33 Suppl 2 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17469372 %X We have been successfully using a patient's record notebook in home-based outpatient cancer chemotherapy since 2003. Many of the patients expressed their satisfaction carrying a patient record notebook through our questionnaires designed to illicit details of their side effects during the chemotherapy. There are so many tasks the patient has to do by his own once he leaves the hospital and to become an outpatient. One of the important tasks the patient has to do is how to take care of the side effect by himself. In fact, some of the patients had a difficulty in evaluating their own side effect symptoms. In evaluating the side effect of patients by a pharmacist, he should not rely on the patient record notebook alone, but careful attention has to be paid to a patient's general condition by our medical team members consisting of inpatient pharmacists, surgeons, chemotherapists, palliative care physicians, nurses, social workers and others. In order to proceed with the safety of chemotherapy, it is critical to have a consensus based on medical policies concerning the reduction of side effects and to support the fight against cancer with the medical team members. The results also suggest that the patient record notebook is more useful for pharmacists in controlling of side effects and to adopt a prudent policy for chemotherapy %0 Journal Article %C UPMC-Montefiore Hospital, University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA 15213 %A Arnold, Robert M %J J Palliat Med %D 2007 Apr %N 2 %P 484-5 %T Screening for depression in palliative care #146 %V 10 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17472521 %0 Journal Article %C American Academy of Neurology, St. Paul, MN 55116, USA. dbacon@aan.com %A Bacon, Dana %A Williams, Michael A %A Gordon, James %J Neurology %D 2007 Apr %N 14 %P 1097-100 %T Position statement on laws and regulations concerning life-sustaining treatment, including artificial nutrition and hydration, for patients lacking decision-making capacity %V 68 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17404191 %0 Journal Article %C Nuclear Medicine Unit, Department of Endocrinology, Poznan University of Medical Sciences, Poznan, Poland %A Baczyk, Maciej %A Czepczynski, Rafal %A Milecki, Piotr %A Pisarek, Marlena %A Oleksa, Robert %A Sowinski, Jerzy %J Nucl Med Commun %D 2007 Apr %N 4 %P 245-50 %T 89Sr versus 153Sm-EDTMP: comparison of treatment efficacy of painful bone metastases in prostate and breast carcinoma %V 28 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17325585 %X BACKGROUND AND AIM: Painful bone metastases are most frequent in patients with advanced prostate or breast carcinoma. The aim of this study was to compare the analgesic effect of radionuclide therapy using Sr and Sm-EDTMP in patients with painful bone metastases of these tumours. MATERIAL AND METHODS: One hundred patients treated with radionuclide bone palliation therapy were analysed. The study population consisted of 60 male patients with advanced prostate carcinoma and 40 female patients with advanced breast carcinoma. Fifty patients (30 men and 20 women) were treated with Sr (150 MBq). The other 50 patients were treated with Sm-EDTMP (37 MBq x kg). The treatment efficacy was evaluated by a visual analogue scale (VAS), Karnofsky performance scale, and dosage of analgesic drugs used. RESULTS: Complete pain relief was found in 40% of women and 40% of men treated using Sm-EDTMP and in 25% of women and 33% of men treated with Sr. No analgesic effect occurred in 20% of patients. A better analgesic effect was found in cases of osteoblastic metastases compared to mixed metastases. Statistically significant reduction of pain intensity, use of analgesic drugs and improvement of performance in Karnofsky scale was found in cases of both radionuclides. CONCLUSIONS: The analgesic effects of Sr and Sm-EDTMP was similar in both prostate and breast carcinoma. However, the effect was dependent on the type of metastases; better response was observed in cases of osteoblastic metastases than in patients with mixed metastases. Severe adverse reactions after this therapy were rare %0 Journal Article %C Department of Oncology, Palliative and End of Life Task Force, Memphis, Tennessee %A Baker, Justin N %A Torkildson, Christy %A Baillargeon, Jacques G %A Olney, Cynthia A %A Kane, Javier R %J J Palliat Med %D 2007 Apr %N 2 %P 420-9 %T National Survey of Pediatric Residency Program Directors and Residents Regarding Education in Palliative Medicine and End-of-Life Care %V 10 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17472514 %X Purpose: To determine how palliative and end-of-life care can best be incorporated into the training of pediatric residents. Methods: From 2001 to 2002, we surveyed 246 directors and 235 residents of pediatric residency programs. We elicited responses regarding (1) perceived relevance of pediatric palliative care, (2) residents' exposure to palliative medicine, (3) competency of faculty and matriculating residents in palliative care, (4) core palliative medicine competencies, and (5) the best teaching/learning format for palliative care. Results: Fifty-five directors (22.4%) and 98 residents (42.0%) responded. More than three quarters of directors (78.1%) agreed with the statement that palliative care as a competency is "somewhat" to "very" important. Approximately one third (32.7%) agreed with the statement that their residents were not clinically exposed to end-of-life care; 99.0% of the residents indicated participation in such care. Almost one third of directors (27.3%) indicated that they had no faculty available to teach palliative care. Only 38.2% agreed with the statement that matriculating residents are competent in palliative medicine while many residents indicated having limited or no training in core palliative care competencies. Discussion/Conclusions: For palliative care principles to be better incorporated into pediatric practice, they must be incorporated into residency education, optimally through informal teaching and during rounds. Finding ways to teach residents palliative medicine during clinical "teachable moments" and standardizing didactic curricula should become a priority in palliative and end-of-life care education %0 Journal Article %C Northeastern Ohio Universities College of Medicine, Rootstown, Ohio 44272, USA. tbarreir@neoucom.edu %A Barreiro, Timothy J %A Gemmel, David J %J Crit Care Clin %D 2007 Apr %N 2 %P 201-22, ix %T Noninvasive ventilation %V 23 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17368166 %X Noninvasive positive-pressure ventilation (NPPV) is the delivery of mechanical-assisted breathing without placement of an artificial airway such as an endotracheal tube or tracheostomy. During the first half of 20th century, negative-pressure ventilation (iron lung) provided mechanical ventilatory assistance. By the 1960s, however, invasive (ie, by means of an endotracheal tube) positive-pressure ventilation superseded negative-pressure ventilation as the primarily mode of support for ICU patients because of its superior delivery of support and better airway protection. Over the past decade, the use of NPPV has been integrated into the treatment of many medical diseases, largely because the development of nasal ventilation. Nasal ventilation has the potential benefit of providing ventilatory assistance with greater convenience, comfort, safety, and less cost than invasive ventilation. NPPV is delivered by a tightly fitted mask or helmet that covers the nares, face, or head. NPPV is used in various clinical settings and is beneficial in many acute medical situations. This article explores the trends regarding the use of noninvasive ventilation. It also provides a current perspective on applications in patients with acute and chronic respiratory failure, neuromuscular disease, congestive heart failure, and sleep apnea. Additionally, it discusses the general guidelines for application, monitoring, and avoidance of complications for NPPV %0 Journal Article %A Baumrucker, Steven J %J Am J Hosp Palliat Care %D 2006 Jun-Jul %N 3 %P 170-2 %T The ethics of withdrawing treatment: how should the choice be made? %V 23 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17060274 %0 Journal Article %C Palliative Care Service, Wellmont Health Systems, Adventa Hospice, and Quillen College of Medicine, Rogersville, Tennessee, USA %A Baumrucker, Steven J %A Douglas, Sharon P %A Morris, Gerald M %A Stolick, Matt %A Brothers, Diane %J Am J Hosp Palliat Care %D 2006 Jun-Jul %N 3 %P 236-40 %T Continuation of feeding tube %V 23 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17060285 %0 Journal Article %A Beccaro, M %A Costantini, M %A Merlo, DF %J BMC Public Health %D 2007 Apr %N 1 %P 66 %T Inequity in the provision of and access to palliative care for cancer patients. Results from the Italian survey of the dying of cancer (ISDOC) %V 7 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17466064 %X ABSTRACT: BACKGROUND: The palliative services and programs have been developed with different intensity and modalities in all countries. Several studies have reported that a geographic variation in the availability and provision of palliative care services between and within countries exists, and that a number of vulnerable groups are excluded from these services. This survey estimates the distribution of places of care for Italian cancer patients during the last three months of their lives, the proportion receiving palliative care support at home and in hospital, and the factors associated with the referral to palliative care services. METHODS: This is a mortality follow-back survey of 2,000 cancer deaths identified with a 2-stage probability sample, representative of the whole country. Information on patients experience was gathered from the non-professional caregiver through an interview, using an adapted version of the VOICES questionnaire. A section of the interview concerned the places of care and the palliative care services provided to patients. Multivariate logistic regression analyses were conducted to identify the determinants of palliative care service use. RESULTS: Valid interviews were obtained for 67% of the identified caregivers (n=1,271). Most Italian cancer patients were cared for at home (91%) or in hospital (63%), but with substantial differences within the country. Only 14% of Italian cancer patients cared for at home against 20% of those admitted to hospital, received palliative care support. The principal determinants identified for receiving these service were: an extended interval between diagnosis and death (P=0.01) and the caregivers high educational level (P=0.01) for patients at home; the low patients age (P<0.01) and the caregivers high educational level (P=0.01) for patients in hospital. CONCLUSIONS: In Italy palliative care services are not equally available across the country. Moreover, access to the palliative care services is strongly associated with socio demographic characteristics of the patients and their caregivers. Italian Policy-makers need to equalise palliative care provision and access across the country to meet the needs of all cancer patients %0 Journal Article %C Department of Clinical and Health Psychology, Utrecht University, Utrecht, Netherlands. p.a.boelen@fss.uu.nl %A Boelen, Paul A %A de Keijser, Jos %A van den Hout, Marcel A %A van den Bout, Jan %J J Consult Clin Psychol %D 2007 Apr %N 2 %P 277-84 %T Treatment of complicated grief: a comparison between cognitive-behavioral therapy and supportive counseling %V 75 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17469885 %X Few studies have examined treatments for complicated grief--a debilitating condition that can develop after the loss of a loved one. This study compared the effectiveness of cognitive-behavioral therapy with a nonspecific treatment with supportive counseling (SC). Using a minimization method, 54 mourners with clinically significant levels of complicated grief were allocated to 1 of 3 treatment conditions: (a) a condition of 6 sessions of cognitive restructuring (CR) and 6 sessions of exposure therapy (ET; CR + ET), (b) a condition in which these interventions were applied in reversed order (ET + CR), and (c) 12 sessions of SC. Outcomes showed that the 2 cognitive-behavioral therapy conditions produced more improvement in complicated grief and general psychopathology than SC in the completers and intention-to-treat groups. Comparison of the cognitive-behavioral conditions showed that "pure" exposure was more effective than "pure" cognitive restructuring, that adding ET to CR led to more additional improvement than adding CR to ET, and that ET + CR was more efficacious than CR + ET. Effect sizes of ET + CR were encouraging and compare favorably with those found in earlier bereavement intervention studies %0 Journal Article %A Broderick, J %A Connolly, S %A Feldmann, E %A Hanley, D %A Kase, C %A Krieger, D %A Mayberg, M %A Morgenstern, L %A Ogilvy, CS %A Vespa, P %A Zuccarello, M %J Stroke %D 2007 May %T Guidelines for the Management of Spontaneous Intracerebral Hemorrhage in Adults. 2007 Update. A Guideline From the American Heart Association, American Stroke Association Stroke Council, High Blood Pressure Research Council, and the Quality of Care and Outcomes in Research Interdisciplinary Working Group %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17478736 %X Purpose--The aim of this statement is to present current and comprehensive recommendations for the diagnosis and treatment of acute spontaneous intracerebral hemorrhage. METHODS: A formal literature search of Medline was performed through the end date of August 2006. The results of this search were complemented by additional articles on related issues known to the writing committee. Data were synthesized with the use of evidence tables. The American Heart Association Stroke Council's Levels of Evidence grading algorithm was used to grade each recommendation. Prerelease review of the draft guideline was performed by 5 expert peer reviewers and by the members of the Stroke Council Leadership Committee. It is intended that this guideline be fully updated in 3 years' time. RESULTS: Evidence-based guidelines are presented for the diagnosis of intracerebral hemorrhage, the management of increased arterial blood pressure and intracranial pressure, the treatment of medical complications of intracerebral hemorrhage, and the prevention of recurrent intracerebral hemorrhage. Recent trials of recombinant factor VII to slow initial bleeding are discussed. Recommendations for various surgical approaches for treatment of spontaneous intracerebral hemorrhage are presented. Finally, withdrawal-of-care and end-of-life issues in patients with intracerebral hemorrhage are examined %0 Journal Article %C School of Population Health, University of Queensland, Herston, Queensland, Australia. s3000014@student.uq.edu.au %A Burridge, Letitia %A Winch, Sarah %A Clavarino, Alexandra %J Cancer Nurs %D 2007 Mar-Apr %N 2 %P E9-19 %T Reluctance to care: a systematic review and development of a conceptual framework %V 30 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17413772 %X Primary lay carers are increasingly important in the care of patients with cancer, but their role can be complex and extended. Potential carers may feel anything from highly committed to not at all interested in caregiving, but powerful social norms pressure them to accept the role, and reluctance may be hidden to avoid censure. The purpose of this review was to gain insights into caregiving reluctance and its consequences. The findings were organized into 4 major dimensions: demographic, physical, psychological, and social. Three major outcomes were identified: deterioration in the carer-patient relationship, reduced quality of care, and institutionalization. Definitive answers to the review questions remain elusive. Choice seems to be a major indicator of caregiving reluctance, although reluctance may not remain static over the caregiving trajectory. Caregiving reluctance remains an underexplored topic, particularly in the context of cancer %0 Journal Article %C Department of Pediatrics/Neonatology, Vanderbilt Children's Hospital, Nashville, Tennessee %A Carter, Brian Scott %A Guthrie, Scott Osborn %J J Palliat Med %D 2007 Apr %N 2 %P 375-80 %T Utility of Morbidity and Mortality Conference in End-of-Life Education in the Neonatal Intensive Care Unit %V 10 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17472509 %X Background: A monthly neonatal intensive care unit (NICU) morbidity and mortality conference (M&MC) was used to study the documentation of end-of-life (EOL) care, and integrate related education for staff and trainees. Objective: To study the current documentation of comprehensive, interdisciplinary, palliative EOL care in the NICU at the Vanderbilt Children's Hospital and improve it relative to a historical background. Design/Methods: A survey tool was developed and used at all neonatal M&MCs for 1 year (August 2003 through July 2004), in conducting a prospective chart audit of 50% of NICU deaths. The survey ascertained documentation of EOL care to include the anticipation of death by family and staff; provision of pain management; discussion of ethical and EOL decision-making issues; and the use of supportive services. Clinical education and literature references pertaining to these elements of care were presented in the conferences. Results: Twenty-six surveys were completed (48% of deaths in NICU over the study period). Documentation of EOL care ranged from excellent (pain management, 100%) to poor (spiritual support, 54%). Documentation of all other measures varied from 69% to 92%. Staff and trainees reported educational enhancement of the M&MC, and greater awareness of issues important to EOL care throughout this period. Conclusions: Areas for improving EOL care exist in the NICU. The M&MC is a familiar venue for incorporating EOL care education for staff and trainees. A survey tool may serve to aid in the assessment of documentation of such care. Staff awareness of, and attention to, EOL issues may be improved through such a mechanism %0 Journal Article %C 2100 SE 187th Avenue, Vancouver, WA 98693 %A Cinocco, Dawnrenee %J J Palliat Med %D 2007 Apr %N 2 %P 506-8 %T The difficulties of swallowing at the end of life %V 10 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17472529 %0 Journal Article %C International Observatory on End of Life Care, Institute for Health Research, Lancaster University, Alexandra Square, Lancaster, UK %A Clark, David %J Lancet Oncol %D 2007 May %N 5 %P 430-8 %T From margins to centre: a review of the history of palliative care in cancer %V 8 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17466900 %X Palliative care and hospices have developed rapidly since the late 1960s. The pioneering work of Cicely Saunders was instrumental in drawing attention to the end-of-life care needs of patients with advanced malignant disease. Palliative care began to be defined as a subject of activity in the 1970s and came to be synonymous with the physical, social, psychological, and spiritual support of patients with life-limiting illness, delivered by a multidisciplinary team. Palliative care services have developed in many settings and have often been closely related to oncology. The worldwide need for this type of care remains much greater than the available provision, but there are encouraging signs of recognition by policymakers and influential bodies, and interest in palliative care has never been greater. This paper charts the modern history of such care around the world and concludes on some current issues and future challenges %0 Journal Article %C Department of Psychiatry & Psychology, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, USA. clark.matthew@mayo.edu %A Clark, Matthew M %A Rummans, Teresa A %A Sloan, Jeff A %A Jensen, Andrus %A Atherton, Pamela J %A Frost, Marlene H %A Richardson, Jarrett W %A Bostwick, J Michael %A Johnson, Mary E %A Hanson, Jean M %A Brown, Paul D %J Am J Hosp Palliat Care %D 2006 Jun-Jul %N 3 %P 185-91 %T Quality of life of caregivers of patients with advanced-stage cancer %V 23 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17060277 %X There has been much research documenting the impact of having a loved one diagnosed with advanced cancer, but little is known about how to reduce care-giver burden. In this randomized controlled trial, the authors examined the potential relationship of an advanced cancer patient's participation in an 8-session, structured, multidisciplinary intervention on the care-giver's burden and quality of life (QOL). Although the patients randomly assigned to the intervention (n = 54) demonstrated improved QOL compared to the control condition (n = 49) participants (P < .05), there was no evidence that improving the patient's QOL made an impact on the caregiver's level of burden or the care-giver's QOL. Further investigation is warranted in this area, including interventions specifically designed and targeted to both reduce caregiver burden and to improve caregiver QOL %0 Journal Article %C Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY 10027, USA. kgc15@columbia.edu %A Coifman, Karin G %A Bonanno, George A %A Ray, Rebecca D %A Gross, James J %J J Pers Soc Psychol %D 2007 Apr %N 4 %P 745-58 %T Does repressive coping promote resilience? Affective-autonomic response discrepancy during bereavement %V 92 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17469956 %X Traditional theories of coping emphasize the value of attending to and expressing negative emotion while recovering from traumatic life events. However, recent evidence suggests that the tendency to direct attention away from negative affective experience (i.e., repressive coping) may promote resilience following extremely aversive events (e.g., the death of a spouse). The current study extends this line of investigation by showing that both bereaved and nonbereaved individuals who exhibited repressive coping behavior--as measured by the discrepancy between affective experience and sympathetic nervous system response--had fewer symptoms of psychopathology, experienced fewer health problems and somatic complaints, and were rated as better adjusted by close friends than those who did not exhibit repressive coping. Results are discussed in terms of recent developments in cognitive and neuroimaging research suggesting that repressive coping may serve a protective function %0 Journal Article %C Department of Digestive Endoscopy, General Hospital, Reggio Emilia, Italy %A Conigliaro, Rita %A Battaglia, Giorgio %A Repici, Alessandro %A De Pretis, Giovanni %A Ghezzo, Luigi %A Bittinger, Max %A Messmann, Helmut %A Demarquay, Jean-Francois %A Togni, Michele %A Blanchi, Sabrina %A Filiberti, Rosangela %A Conio, Massimo %J Eur J Gastroenterol Hepatol %D 2007 Mar %N 3 %P 195-203 %T Polyflex stents for malignant oesophageal and oesophagogastric stricture: a prospective, multicentric study %V 19 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17301645 %X OBJECTIVE: Dysphagia is the most distressing symptom in patients with cancer-related oesophageal obstruction. Endoscopic palliation aims to restore swallowing, avoid reintervention and to reduce hospitalization. This study reports an experience with a new self-expandable plastic stent (Polyflex) in patients with unresectable oesophageal and oesophagogastric junction cancer. METHODS: Sixty patients were prospectively collected. The cause of obstruction was oesophageal squamous cell carcinoma (44) and adenocarcinoma (eight), lung cancer (seven) and thyroid tumour (one). RESULTS: The stent was successfully placed in 59 patients. Early minor complications occurred in 19 patients (32%), and major complications in 13 (22%). Death occurred in three patients owing to pulmonary embolism (one) and massive haemorrhage (two). Recurrent dysphagia for early stent migration was observed in seven patients. Delayed stent migration occurred in five patients and tumour overgrowth in eight patients. The mean dysphagia score of 2.8 improved to a mean score of 1.0 after stenting (P<0.001). Overall median survival time was 4.6 months. CONCLUSIONS: Our study suggests that Polyflex stents are competitive with metal stents, with similar efficacy but lower cost. Technical improvements, however, are required to make these stents more user friendly. Large randomized clinical studies are needed to guide in the choice among the different available stents %0 Journal Article %C McMaster University, Hamilton, Ontario, Canada %A Cook, Deborah %A Rocker, Graeme %J ACP J Club %D 2007 May-Jun %N 3 %P 69 %T A communication strategy and brochure reduced the burden of bereavement on relatives of patients dying in the intensive care unit %V 146 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17474678 %0 Journal Article %C Center for Bioethics and Humanities, University of Colorado, Denver, USA. marilyn.coors@uchsc.edu %A Coors, Marilyn E %A Townsend, Susan F %J J Clin Ethics %D 2006 Fall %N 3 %P 266-74 %T Supporting pregnant women through difficult decisions: a case of prenatal diagnosis of osteogenesis imperfecta %V 17 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17186940 %0 Journal Article %C Department of Health Services Management and Policy, The George Washington University, Washington, DC, USA %A Darr, Kurt %J Hosp Top %D 2007 Winter %N 1 %P 35-9 %T Assistance in dying: part I. Europe--the vanguard %V 85 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17405423 %X This Nexus provides background information about assistance in dying. The international perspective based on developments in Western Europe, especially the Netherlands, provides a useful context in which to place events in the United States. Part II considers the history and legal context of assistance in dying in the United States. Oregon is given special attention because it remains the only state with legally sanctioned assistance in dying. Readers are urged to bear in mind the definitions and distinctions among assisted dying, the various forms of euthanasia, and physician-assisted suicide. Informed observers of the discussion will readily see that the terms and concepts are often used imprecisely and as though they are synonymous. Productive debate of assistance in dying will occur only if all those involved agree on definitions and the meaning of the concepts %0 Journal Article %C ALS Association Center, Philadelphia, Pennsylvania %A Elman, Lauren B %A Houghton, David J %A Wu, Gregory F %A Hurtig, Howard I %A Markowitz, Clyde E %A McCluskey, Leo %J J Palliat Med %D 2007 Apr %N 2 %P 433-57 %T Palliative care in amyotrophic lateral sclerosis, Parkinson's disease, and multiple sclerosis %V 10 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17472516 %X Background: Amyotrophic lateral sclerosis, Parkinson's disease, atypical parkinsonian syndromes, and multiple sclerosis are progressive neurologic disorders that cumulatively afflict a large number of people. Effective end-of-life palliative care depends upon an understanding of the clinical aspects of each of these disorders. Objectives: The authors review the unique and overlapping aspects of each of these disorders with an emphasis upon the clinical management of symptoms. Design: The authors review current management and the supporting literature. Conclusions: Clinicians have many effective therapeutic options to choose from when managing the symptoms produced by these disorders %0 Journal Article %C Department of Neurology, Hospital Universitario Central de Asturias, Oviedo, Spain %A Fernandez, Lorena Benavente %A Salas-Puig, Javier %J Epileptic Disord %D 2007 Mar %N 1 %P 65-70 %T Pure sleep seizures: risk of seizures while awake %V 9 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17307714 %X PURPOSE: To estimate the risk of seizures while awake in pure sleep epilepsies - a long follow-up study. METHODS: Fifty five patients (60% male), with pure sleep epilepsy were followed up for at least ten years. Patients younger than 18 years of age were excluded. The primary endpoint was the occurrence of seizures while awake, after a period of 10 years or longer suffering from pure sleep seizures. RESULTS: The duration of the pure sleep seizures ranged from 10 to 67 years (median 22). The patients had been followed in our Department for a mean of 12 years. Patients' ages ranged from 18 to 88 years (median 50); 44% of patients suffered from apparently generalized seizures. Epilepsy was considered undetermined in 38.2%, focal cryptogenic in 38.2%, and focal symptomatic in 21.8%. There was a single case of idiopathic generalized epilepsy. In the last evaluation, 35 patients were on monotherapy and two were not receiving treatment. Seizure frequency was < 1/year in 65.5%; 1-10/year in 14.5%; > 1/month in 9.1%. Seventeen patients (30.9%) had suffered one or more seizures while awake. Multivariate analysis showed that sudden withdrawal of treatment (p < 0.032) and polytherapy (p < 0.18) were associated with an increased risk of seizures while awake. CONCLUSIONS: In spite of a small number of seizures and good response to monotherapy, a third of the patients studied suffered seizures while awake. The significant risk factors were sudden withdrawal of treatment and polytherapy %0 Journal Article %C Department of Psychiatry, Medicine and Psychology, Dalhousie University, Halifax, Nova Scotia, Canada %A Fisk, John D %J Can J Neurol Sci %D 2007 Mar %P S32-6 %T Ethical considerations for the conduct of antidementia trials in Canada %V 34 Suppl 1 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17469679 %X Clinical trials in persons with dementia bring into focus the ethical dilemmas frequently confronting the clinician-scientist. Despite the existence of various ethical guidelines, most with common underlying principles, few are specific to dementia. A particular difficulty is finding a balance between respect for the autonomy of the individual and the protection of vulnerable persons, while at the same time defining an acceptable risk/benefit ratio for the study. The availability of symptomatic treatments for Alzheimer's disease also now make it difficult to argue that withholding treatment from those in the placebo arm of a clinical trial fulfills one's duty to provide best care. Those conducting clinical trials must be knowledgeable about existing legislation and ethical guidelines in order to justify to themselves and others, the design of clinical trials and their risks. They must be prepared to educate patients and family members about dementia and research, determine each potential subject's competence to consent, and ensure that decisions about participation are in accordance with the best interests of the subject. Ethical conduct of clinical trials of new antidementia therapies will require that everyone involved understands the values and beliefs that guide their decision-making and the potentially conflicting roles facing the clinician-scientist %0 Journal Article %C University of North Carolina %A Foster, E Michael %A Porter, Michele M %A Ayers, Tim S %A Kaplan, Debra L %A Sandler, Irwin %J Eval Rev %D 2007 Jun %N 3 %P 261-86 %T Estimating the costs of preventive interventions %V 31 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17478629 %X The goal of this article is to improve the practice and reporting of cost estimates of prevention programs. It reviews the steps in estimating the costs of an intervention and the principles that should guide estimation. The authors then review prior efforts to estimate intervention costs using a sample of well-known but diverse studies. Finally, the authors illustrate the principles with an example, the Family Bereavement Program. They conclude that example by discussing whether and how the costs of the intervention might differ when implemented in a real-world setting %0 Journal Article %C Klinik fur Innere Medizin III, (Kardiologie, Angiologie, Internistische Intensivmedizin), Universitatskliniken des Saarlandes, Homburg/Saar, Germany. efriedrich@med-in.uni-sb.de %A Friedrich, Erik B %A Bohm, Michael %J Heart %D 2007 May %N 5 %P 626-31 %T Management of end stage heart failure %V 93 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17435073 %0 Journal Article %C IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Pediatric Intensive Care Unit, Via della Commenda 9, 20122, Milan, Italy, a.giannini@policlinico.mi.it %A Giannini, A %J Intensive Care Med %D 2007 Apr %T Ethics and end-of-life care in the new training curriculum for ICU physicians in Italy %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17468846 %0 Journal Article %C The Harry R. Horvitz Center for Palliative Medicine %A Glare, Paul %A Walsh, Declan %A Sheehan, Denice %J Am J Hosp Palliat Care %D 2006 Jun-Jul %N 3 %P 229-35 %T The adverse effects of morphine: a prospective survey of common symptoms during repeated dosing for chronic cancer pain %V 23 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17060284 %X Little information is available about the incidence, prevalence, or severity of morphine side effects during repeated individualized dosing for chronic cancer pain, although it has been widely used in this way for more than 30 years. The authors' aim was to describe the prevalence of symptoms possibly attributable to morphine side effects in a convenience sample of patients with pain due to advanced cancer. They used a prospective survey of inpatients and outpatients on regularly dosed morphine, with a questionnaire administered weekly for 4 weeks. Forty-two of 56 eligible patients completed at least the first questionnaire, with 30 completing all 4. Dry mouth was the most common symptom reported (point prevalence, 95%); this was often moderate to severe in intensity (57%) and was the most persistent symptom (period prevalence, 20%). Sedation and constipation were frequent (point prevalence, 88%) and was often moderate or severe at some point (55% and 62%, respectively) but had low period prevalence. Nausea was reported by less than half the patients. Myoclonus was common (point prevalence, 83%) but was usually mild and not persistent. Total daily morphine dose had little impact on side-effect patterns. Constipation, dysphoria, myoclonus, nausea, and sedation were more likely to be severe following dose increases. In conclusion, although constipation, nausea, and sedation are well described as side effects of morphine administration, others such as dry mouth and myoclonus appear to be underestimated. Validated patient-based measures of opioid side effects are needed %0 Journal Article %C Department of Geriatrics, Mount Sinai School of Medicine, New York, New York and James J. Peters VA Medical Center, Bronx, New York %A Goldstein, Nathan E %A Fischberg, Daniel %J J Palliat Med %D 2007 Apr %N 2 %P 476-82 %T Update in hospice and palliative care 2005 %V 10 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17472519 %0 Journal Article %C Bay Pines VA Medical Center, Bay Pines, Florida 33744, USA. deborah.grassman@med.va.gov %A Grassman, Deborah %J Am J Hosp Palliat Care %D 2006 Jun-Jul %N 3 %P 241-2 %T The threshold of death: fertile ground for healing %V 23 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17060286 %0 Journal Article %C 1513 University Avenue, 4105 Mechanical Engineering Building, Madison, WI 53706, USA. dhgustaf@facstaff.wisc.edu %A Gustafson, David H %J J Med Internet Res %D 2007 %N 1 %P e6 %T A good death %V 9 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17478415 %X The Institute of Medicine defines a good death a "one that is free from avoidable death and suffering for patients, families and caregivers in general accordance with the patients' and families' wishes.". The current system creates barriers to reducing the stress and suffering that accompany a patient's end of life. Data and eHealth technology, if it were more accessible, could help patients, families, and caregivers to cope with end of life issues %0 Journal Article %C Research & Development unit, Stockholms Sjukhem Foundation, Stockholm, Sweden. carina.lundh@stockholmssjukhem.se %A Hagelin, Carina Lundh %A Wengstrom, Yvonne %A Runesdotter, Sara %A Furst, Carl Johan %J Acta Oncol %D 2007 %N 1 %P 97-104 %T The psychometric properties of the Swedish Multidimensional Fatigue Inventory MFI-20 in four different populations %V 46 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17438711 %X The Multidimensional Fatigue Inventory (MFI-20) scale is widely used for measuring fatigue in cancer care. This questionnaire has been translated into Swedish and used in Swedish cancer populations, and the aim of this study was to test the validity and reliability of the Swedish version in four populations, with a total of 584 patients. The participants were classified into four groups: palliative cancer patients, cancer patients receiving radiation therapy, non-cancer outpatients, and a group of hospital staff. The MFI-20 consists of five subscales of fatigue: General Fatigue (GF), Physical Fatigue (PF), Reduced Motivation (RM), Reduced Activity (RA) and Mental Fatigue (MF). We have tested the convergent validity of the MFI-20 using the Category Ratio instrument (CR-10). The validity and the reliability of MFI-20 were acceptable. All subscales of the MFI-20 were correlated, and all were also correlated with the CR-10 score (p < or = 0.001). General Fatigue was highly correlated with Physical Fatigue for the three patient groups, but this was not the fact for healthy staff. Deleting some items increased Cronbach's alpha of the subscale to which these items belonged (where alpha measures the reliability of the results). The level of non-response was low (less than 1.2%) and there was no pattern to the items omitted. We conclude that the MFI-20 is a valid and reliable instrument for measuring fatigue in patients and in healthy individuals. The results support, to some extent, earlier findings and one item can be removed from the Swedish version of the MFI-20 %0 Journal Article %C Division of Education and Research, SMDC Health System, Duluth, Minnesota %A Haller, Irina V %A Gessert, Charles E %J J Palliat Med %D 2007 Apr %N 2 %P 400-7 %T Utilization of medical services at the end of life in older adults with cognitive impairment: focus on outliers %V 10 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17472512 %X Background: The use of intensive medical care near end of life is often questioned because of potential burden to patients, their families, and society. Efforts to moderate intensive end-of-life care may be facilitated by early identification of those at greatest risk for receiving such care. Objective: To examine factors associated with intensive end-of-life medical care utilization in nursing home residents with severe cognitive impairment. Design: Retrospective review of existing Medicare data: 1998-2001 Minimum Data Set (MDS), Medicare Denominator, MedPAR, and hospice files. Methods: Subjects were Minnesota and Texas nursing home residents from rural and urban counties (USDA metro-nonmetro continuum codes: 0-2 urban, 6-9 rural), who had severe cognitive impairment and who died during 2000-2001. Hospice and managed care enrollees were excluded. High medical care users were defined as subjects with 7+ intensive care unit (ICU) days in the last 90 days of life. Measures of end-of-life medical care utilization intensity included tube feeding on the last MDS report, number of hospital and ICU days, and total hospital charges during the study period. Results: The study population included 1494 nursing home residents who were hospitalized within 90 days prior to death; 82 (5%) met the high medical care user criteria. In multivariable analysis: urban location (p < 0.001), lack of do-not-resuscitate directive (p = 0.002), non-white race (p = 0.021), and having 3+ comorbidities (p = 0.021) were independently associated with high medical care utilization. Conclusions: Urban nursing home location and lack of do-not-resuscitate directives were the strongest predictors of high medical care utilization near the end of life %0 Journal Article %A Hilbert, Gilles %A Vargas, Frederic %A Gruson, Didier %J Crit Care Med %D 2007 Mar %N 3 %P 977-8 %T Never the tube! Try the mask! %V 35 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17421104 %0 Journal Article %C St. Christopher's Hospital for Children, Philadelphia, PA, USA. Elizabeth.Hobdell@tenethealth.com %A Hobdell, Elizabeth F %A Grant, Mitzie L %A Valencia, Ignacio %A Mare, Jane %A Kothare, Sanjeev V %A Legido, Agustin %A Khurana, Divya S %J J Neurosci Nurs %D 2007 Apr %N 2 %P 76-82 %T Chronic sorrow and coping in families of children with epilepsy %V 39 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17477221 %X Epilepsy, a common problem in child neurology, affects the entire family. There is a potential for such psychosocial consequences as parental chronic sorrow and alterations in coping. In this study, 67 parents completed brief questionnaires about their sorrow and coping styles. Results demonstrated chronic sorrow as measured by the Adapted Burke Questionnaire (10.45 ± 7.9). Interestingly, the total score was not significantly different between parents of children with refractory and nonrefractory epilepsy or parents of children with comorbid or without comorbid conditions. Selection of the individual item disbelief, however, was significantly increased in parents of children with nonrefractory epilepsy, and selection of the item anger was significantly increased in parents of children with comorbid conditions. Parental coping styles were similar to those reported in the normative data for the instrument used, the Coping Health Inventory for Parents (CHIP). The correlation between chronic sorrow and coping was significant between the grief component of sorrow and Coping Pattern II of the CHIP. Implications for practice include earlier identification of parental feelings of sorrow and coping styles, which may contribute to a positive outcome %0 Journal Article %C Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA %A Howe, Edmund G %J J Clin Ethics %D 2006 Fall %N 3 %P 195-206 %T Beyond respect for autonomy %V 17 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17186932 %0 Journal Article %C Department of Medical Oncology, Dana Farber Cancer Institute and Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA. Pasi_Janne@dfci.harvard.edu %A Janne, Pasi A %A Wozniak, Antoinette J %A Belani, Chandra P %A Keohan, Mary-Louise %A Ross, Helen J %A Polikoff, Jonathan A %A Mintzer, David M %A Ye, Zhishen %A Monberg, Matthew J %A Obasaju, Coleman K %J J Thorac Oncol %D 2006 Jul %N 6 %P 506-12 %T Pemetrexed alone or in combination with cisplatin in previously treated malignant pleural mesothelioma: outcomes from a phase IIIB expanded access program %V 1 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17409909 %X BACKGROUND: In a randomized phase III trial, pemetrexed plus cisplatin was associated with improved survival compared with cisplatin alone for patients with malignant pleural mesothelioma (MPM). However, there are limited data available on the efficacy of these and other chemotherapy regimens in patients who have received previous systemic chemotherapy. To gather additional efficacy and safety data of pemetrexed/cisplatin and pemetrexed alone in previously treated patients, we examined patients treated on the Eli Lilly and Company expanded access program (EAP). PATIENTS AND METHODS: Patients with malignant mesothelioma were enrolled in this trial. Of 1056 patients receiving at least one dose of the study drug, 187 (17.7%) were previously treated patients with MPM. Patients were treated every 21 days with pemetrexed 500 mg/m alone (n = 91) or in combination with cisplatin 75 mg/m (n = 96) for a maximum of six cycles. All patients received folic acid and vitamin B12 supplementation and steroid prophylaxis. Serious adverse events (SAEs) were reported by investigators and compiled in a pharmaco-vigilance database for all patients enrolled in the EAP. RESULTS: Median age of the previously treated pleural mesothelioma subset was 66 years (range, 27-87 years). Based on 153 evaluable patients (a subset of the larger intent-to-treat population of 187), the overall response rate was 32.5% for pemetrexed and cisplatin and 5.5% for pemetrexed alone. The disease control rate (response rate + stable disease) was 68.7% for pemetrexed and cisplatin and 46.6% for pemetrexed alone. Median survival was 7.6 months for pemetrexed plus cisplatin (67% censored) and 4.1 months for pemetrexed alone (55% censored). The most commonly reported serious adverse events in the overall EAP irrespective of causality were dehydration (7.2%), nausea (5.2%), vomiting (4.9%), dyspnea (3.8%), and pulmonary embolism (2.4%). CONCLUSIONS: The data from this EAP study suggest that patients with previously treated MPM can benefit from treatment with pemetrexed alone or in combination with cisplatin. The treatment is associated with acceptable toxicity %0 Journal Article %C Jinno Clinic %A Jinno, Kimio %A Tsuda, Machiko %A Sekiguchi, Yuko %A Nakamura, Yohko %A Fujita, Tomomi %A Notoh, Hiroyuki %J Gan To Kagaku Ryoho %D 2006 Dec %P 355-7 %T ["My tiny windows"--a nurse's point of view--case study from a home palliative care meeting] %V 33 Suppl 2 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17469385 %X In visiting nursing care for home palliative care, nurses should take medical care with a holistic viewpoint. Nurses are not only a daily care provider to clients, but nurses are also necessary to think of themselves as being a person because they are in contact with clients' lives every day. In this home palliative care case, nurses had a chance to intervene with a woman with end-stage-cancer. Once in a while, the client had refused visiting nursing care with no reason. So it was necessary to have meetings frequently to discuss the problem. One of the things we thought was that we had to listen to the client and to watch her expression and behavior very carefully. This case study suggested that nurses should reconsider their practices to improve and to establish their original methods of nursing along with their clients %0 Journal Article %C University of Tennessee College of Medicine, Chattanooga 37403, USA. Roger.Jones@erlanger.org %A Jones, Roger C %A Desbiens, Norman A %J Tenn Med %D 2007 Mar %N 3 %P 39-42 %T Tennessee helps clinicians with end-of-life care issues %V 100 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17474553 %0 Journal Article %C Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, Weill Medical College of Cornell University, New York, New York 10021, USA. krugl@mskcc.org %A Krug, Lee M %A Heelan, Robert T %A Kris, Mark G %A Venkatraman, Ennapadam %A Sirotnak, F M %J J Thorac Oncol %D 2007 Apr %N 4 %P 317-20 %T Phase II trial of pralatrexate (10-propargyl-10-deazaaminopterin, PDX) in patients with unresectable malignant pleural mesothelioma %V 2 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17409804 %X BACKGROUND: Several previous clinical trials have shown that malignant pleural mesothelioma is responsive to antifolates. The dihydrofolate reductase inhibitor, pralatrexate, has a favorable toxicity profile, primarily limited to stomatitis, and has demonstrated activity in patients with non-small cell lung cancer. In mesothelioma cell lines and xenografts, pralatrexate demonstrated significant antitumor activity. METHODS: We conducted this phase II study to determine the response rate of malignant pleural mesothelioma to pralatrexate at a dose of 135 mg/m2 i.v. every 2 weeks. After a protocol amendment, patients were supplemented with vitamin B12 and folic acid at the time of starting therapy. RESULTS: A total of 16 assessable patients were enrolled. No complete or partial responses were observed. Two patients with epithelioid histology had minor responses. Three other patients remained on study with stable disease for 9, 9, and 48 months. The median time to progression was 3 months. The overall median survival time was 7 months (95% confidence interval: 3.2-16.2 months) and the one-year survival was 31% (95% confidence interval: 15%-65%). Three patients (19%) had grade 2 stomatitis, eight (50%) had grade 3, and one (6%) had grade 4. CONCLUSIONS: With this particular dose and schedule, pralatrexate as a single agent had no activity in malignant pleural mesothelioma %0 Journal Article %C Timothy Kwok MD MBChB FRCP Professor Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China %A Kwok, Timothy %A Twinn, Sheila %A Yan, Elsie %J J Adv Nurs %D 2007 May %N 3 %P 256-62 %T The attitudes of Chinese family caregivers of older people with dementia towards life sustaining treatments %V 58 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17474914 %X Aim. This paper is a report of a study to examine attitudes towards life-sustaining treatment in family caregivers of older Chinese people with dementia. Background. Deferring decisions about life-sustaining treatments to surrogate decision-makers is common among older people with dementia. However, surrogate decision-makers frequently lack knowledge about disadvantages and benefits of treatments and do not understand the principles of surrogate decision-making. Method. A total of 51 Chinese family caregivers were interviewed during 2003 and 2004. The interview included an assessment of their knowledge about cardiopulmonary resuscitation and tube feeding, a questionnaire to assess their anticipated decisions for four treatments (cardiopulmonary resuscitation, artificial ventilation, tube feeding and antibiotic administration) if the older relative suffered critical illness or irreversible coma, and their comfort and certainty in making such decisions. Findings. Family caregivers displayed poor knowledge about life-sustaining treatments, with 30 (59%) and 13 (26%) unable to name any feature of cardiopulmonary resuscitation and tube feeding, respectively. Most relied on their own views in decision-making rather than on what they thought their relative would have wanted. Most family caregivers were reluctant to forgo treatments. Nursing home residence predicted family caregivers' willingness to forgo artificial ventilation for critical illness. Financial burden predicted inclination to forgo antibiotics for critical illness and irreversible coma, as well as tube feeding in irreversible coma. Conclusion. More dialogue and education are needed about end of life issues in the early phase of dementia. Nurses should be aware of the cultural implications of surrogate decision-making for Chinese family caregivers %0 Journal Article %C Centre of Medical Law and Ethics, School of Law, King's College London, London, UK %A Lewis, Penney %J J Law Med Ethics %D 2007 Spring %N 1 %P 197-210 %T The empirical slippery slope from voluntary to non-voluntary euthanasia %V 35 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17341228 %X This article examines the evidence for the empirical argument that there is a slippery slope between the legalization of voluntary and non-voluntary euthanasia. The main source of evidence in relation to this argument comes from the Netherlands. The argument is only effective against legalization if it is legalization which causes the slippery slope. Moreover, it is only effective if it is used comparatively-to show that the slope is more slippery in jurisdictions which have legalized voluntary euthanasia than it is in jurisdictions which have not done so. Both of these elements are examined comparatively %0 Journal Article %C Authors' Affiliations: Departments of Surgery and Clinical Nutrition, Sahlgrenska University Hospital, Goteborg University, Goteborg, Sweden %A Lundholm, Kent %A Korner, Ulla %A Gunnebo, Lena %A Sixt-Ammilon, Petra %A Fouladiun, Marita %A Daneryd, Peter %A Bosaeus, Ingvar %J Clin Cancer Res %D 2007 May %N 9 %P 2699-706 %T Insulin treatment in cancer cachexia: effects on survival, metabolism, and physical functioning %V 13 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17473202 %X PURPOSE: The present study was designed to evaluate whether daily insulin treatment for weight-losing cancer patients attenuates the progression of cancer cachexia and improves metabolism and physical functioning in palliative care. EXPERIMENTAL DESIGN: One hundred and thirty-eight unselected patients with mainly advanced gastrointestinal malignancy were randomized to receive insulin (0.11 ± 0.05 units/kg/d) plus best available palliative support [anti-inflammatory treatment (indomethacin), prevention of anemia (recombinant erythropoietin), and specialized nutritional care (oral supplements + home parenteral nutrition)] according to individual needs. Control patients received the best available palliative support according to the same principles. Health-related quality of life, food intake, resting energy expenditure, body composition, exercise capacity, metabolic efficiency during exercise, and spontaneous daily physical activity as well as blood tests were evaluated during follow-up (30-824 days) according to intention to treat. RESULTS: Patient characteristics at randomizations were almost identical in study and control groups. Insulin treatment for 193 ± 139 days (mean ± SD) significantly stimulated carbohydrate intake, decreased serum-free fatty acids, increased whole body fat, particularly in trunk and leg compartments, whereas fat-free lean tissue mass was unaffected. Insulin treatment improved metabolic efficiency during exercise, but did not increase maximum exercise capacity and spontaneous physical activity. Tumor markers in blood (CEA, CA-125, CA 19-9) did not indicate the stimulation of tumor growth by insulin; a conclusion also supported by improved survival of insulin-treated patients (P < 0.03). CONCLUSION: Insulin is a significant metabolic treatment in multimodal palliation of weight-losing cancer patients %0 Journal Article %C Department of Internal Medicine, Toride Kyodo General Hospital, Japan. yoshimaeda43@yahoo.co.jp %A Maeda, Yoshitaka %A Kikuchi, Masanori %A Shiigai, Tatsuo %J Intern Med %D 2007 %N 7 %P 427 %T Renal pelvic cancer revealed by renal biopsy %V 46 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17409612 %0 Journal Article %C Queen's University, Belfast %A Maguire, Ann %A Price, Jayne %J Paediatr Nurs %D 2007 Apr %N 3 %P 34-7 %T Reflecting on practice in children's palliative care %V 19 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17472196 %X Palliative care nursing practice can be enhanced if the clinical judgements made in applying palliative care philosophy to individual situations are critically examined and challenged. A model of reflection developed specifically for children's palliative care practice is illustrated here using a critical incident in which the parents of a child with complex disabilities were helped to reduce their caring role and accept increased support. As a result of the structured reflection, the importance of assessing for signs of stress in parents and the wider family was recognised. Additionally, the need for more research specific to the needs of families with more than one child with life-limiting illness was identified as a mechanism for improving the quality of care delivered %0 Journal Article %C Department of Radiotherapy, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India. imallick@gmail.com %A Mallick, Indranil %A Sharma, Suresh C %A Behera, Digambar %J Lung Cancer %D 2007 Mar %N 3 %P 313-8 %T Endobronchial brachytherapy for symptom palliation in non-small cell lung cancer--analysis of symptom response, endoscopic improvement and quality of life %V 55 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17157949 %X AIMS: Endobronchial brachytherapy (EBBT) is a useful modality for the palliation of endobronchial symptoms in advanced non-small cell lung cancer (NSCLC). We report our experience with a special emphasis on duration of symptom palliation and the impact on quality of life (QOL). MATERIALS AND METHODS: The records of 95 previously untreated patients with locally advanced NSCLC were treated with palliative radiation using EBBT with or without palliative external radiation (XRT) were analysed. Eighty patients received EBBT and palliative XRT. EBBT was delivered in two sessions of EBBT 8Gy each or a single session of 10Gy. Fifteen patients received EBBT alone to 15Gy in a single session. Symptomatic response rates, duration of symptom palliation, obstruction scores and complications were assessed and compared. Quality of life outcomes, measured using the EORTC QLQ C30 and LC13 questionnaires, were analysed. RESULTS: The overall symptomatic response rates were 93% for dyspnea, 81% for cough, 97% for haemoptysis and 91% for obstructive pneumonia. The median time to symptom relapse was 4-8 months for all symptoms, and the median time to symptom progression was 6-11 months. Quality of life showed significant improvement in symptom scores, functional scales and overall QOL. Complication rates were low. Only one patient died of fatal haemoptysis. CONCLUSION: EBBT is thus a safe and effective palliative tool in advanced non-small cell lung cancer, with a relatively long duration of symptom palliation and a considerable improvement in the quality of life. There is significant reduction of endobronchial obstruction %0 Journal Article %C University Hospital of Amiens, CHU, Place Victor Pauchet 80054 Amiens cedex 1, France. manaouil.cecile@chu-amiens.fr %A Manaouil, C %A Gignon, M %A Decourcelle, M %A Jarde, O %J J Med Ethics %D 2007 May %N 5 %P 278 %T A new legal frame for end of life in France %V 33 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17470504 %0 Journal Article %A McBrien, M E %A McCarroll, C %A Heyburn, G %J Anaesthesia %D 2007 Apr %N 4 %P 413-4; author reply 414-5 %T Who or what defines a patient's best interests? %V 62 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17381583 %0 Journal Article %C From the Valley Radiotherapy Associates Division of Clinical Research, El Segundo, CA; Valley Radiotherapy Associates Medical Group, El Segundo, CA; double daggerSt. Joseph Hospital, Orange, CA; section signProvidence St. Joseph Medical Center, Burbank, CA; paragraph signUCLA School of Medicine and Public Health, Los Angeles, CA; parallelArlene Fink Associates, Los Angeles, CA; and **Little Company of Mary Hospital Cancer Center, Torrance, CA %A McCloskey, SA %A Tao, ML %A Rose, CM %A Fink, A %A Amadeo, AM %J Cancer J %D 2007 March/April %N 2 %P 130-137 %T National Survey of Perspectives of Palliative Radiation Therapy: Role, Barriers, and Needs %V 13 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17476142 %X PURPOSE:: Despite growth of palliative care programs and evidence on the effectiveness of radiotherapy in palliating cancer symptoms, radiotherapy is probably underused in this setting. Radiation and medical oncologists and palliative medicine specialists were surveyed regarding the perceived role of palliative radiotherapy and barriers to its use. METHODS:: The survey was sent electronically to all physician members of the American Society for Therapeutic Radiology and Oncology (ASTRO) and the American Academy of Hospice and Palliative Medicine (AAHPM) and a random sample of American Society of Clinical Oncology (ASCO) members, with known e-mail addresses. RESULTS:: Response rates were 27%, 14% and 26% for ASTRO, ASCO, and AAHPM respondents, respectively. Although most felt radiotherapy is an effective and important option for palliation of some common cancer symptoms, referrals for such therapy may be declining. Most agreed that radiation oncologists should be more involved in palliative care; however, multiple barriers were identified, such as poor reimbursement, emotional burden of care, insufficient training/knowledge, and the sense of unwillingness of others to share delivery of such services. CONCLUSIONS:: Although multiple barriers limit optimal integration, most agree that there should be greater national and professional society efforts to promote the advancement of radiation oncology in the area of palliative care %0 Journal Article %C The Royal Belfast Hospital for Sick Children, Belfast, UK. c.mccusker@qub.ac.uk %A McCusker, C G %A Doherty, N N %A Molloy, B %A Casey, F %A Rooney, N %A Mulholland, C %A Sands, A %A Craig, B %A Stewart, M %J Arch Dis Child %D 2007 Feb %N 2 %P 137-41 %T Determinants of neuropsychological and behavioural outcomes in early childhood survivors of congenital heart disease %V 92 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17030557 %X AIMS: To evaluate the relative effect of cyanosis, surgical interventions and family processes on neuropsychological and behavioural outcomes in 4-year-old survivors of serious congenital heart disease (CHD). METHODS: 90 children with a range of cyanotic and acyanotic conditions, who underwent either corrective or palliative surgery, completed a neuropsychological and behavioural evaluation. Families of participants were also profiled by evaluation of maternal mental health, worry, social support, parenting style and family functioning. RESULTS: Compromised neuropsychological outcomes were associated with a combination of cyanotic conditions and open-heart surgery, but this was not exacerbated by having a complex, palliative, status. Both cyanotic and acyanotic conditions were associated with specific sensorimotor delays, regardless of method of the correction. Only children with complex conditions and palliative interventions seemed at risk of poor behavioural outcomes; indeed, children with cyanosis with complete repair showed favourable behavioural outcomes compared with controls. Multivariate analyses highlighted the sometimes greater relevance of family processes (eg parenting style, maternal mental health and worry), rather than disease or surgical factors, in predicting especially behavioural outcomes. CONCLUSIONS: The findings (1) suggest a more complex relationship between cyanosis, surgical methods of correction, neuropsychological and behavioural outcomes than previously charted, (2) highlight that family processes may be aetiologically more important than disease and surgical factors, and (3) indicate specific targets for secondary prevention programmes for this at-risk population %0 Journal Article %C International Program of Psycho-Social Health Research, Central Queensland University, Kenmore, Queensland 4069, Australia %A McGrath, Pam %A Phillips, Emma %J Nurs Forum %D 2007 Apr-Jun %N 2 %P 65-72 %T Making them more vulnerable: nursing insights on the irony of using questionnaires %V 42 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17474939 %X TOPIC. Nursing insights on the experience of using standardized questionnaires during hospice care. PURPOSE. To explore and describe the experience of hospice staff using questionnaires on hospice clients: whether such instruments help or hinder the holistic, compassionate hospice practice and to set this topic on the research agenda in the hope of generating critical reflection on this important aspect of hospice care. SOURCES. A cross-section of hospice staff interviewed about their experience with administering the questionnaires. (Findings from research conducted with hospice clients on their experience of questionnaires are published separately.) CONCLUSIONS. The initial findings indicate that staff perceive questionnaires as negatively impacting on their efforts to engage in holistic and compassionate hospice practice and point to a major irony that questionnaires, designed for the supportive care of the vulnerable, actually make the vulnerable more vulnerable %0 Journal Article %C School of Nursing and Midwifery, Queen's University, Belfast %A McNeilly, Patricia %A Price, Jayne %J Paediatr Nurs %D 2007 Apr %N 3 %P 33-4 %T A reflective model for paediatric palliative care %V 19 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17472195 %0 Journal Article %C Palliative Care Institute of Southeast LA, Covington, Louisiana %A McNulty, Jack P %J J Palliat Med %D 2007 Apr %N 2 %P 293-6 %T Can Levorphanol be Used Like Methadone for Intractable Refractory Pain? %V 10 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17472497 %X Background: Levorphanol has been reported to provide analgesia at doses that suggest it does not act like other pure agonist opioids. A dual effect of action on both opioid receptors and n-methyl, d-aspartate (NMDA) receptors has been proposed to be responsible for this effect. Method: Case series of patients treated with levorphanol when pain did not respond adequately to other opioids, including methadone. Results: During a 5-year period in a single palliative medicine practice, 20 of 244 patients with chronic nonmalignant pain in a palliative care clinic and 11 of 1508 terminally ill patients enrolled in hospice care whose severe chronic pain was not relieved by treatment with other opioids were treated with oral levorphanol. Of those 31 patients, 16 (52%) reported excellent relief of pain and 7 (22%) reported fair relief for a total response rate of 74%. Discussion: These results suggest that levorphanol has a role in the treatment of pain syndromes that are refractory to other opioids. The pattern of relief seen in this case series is similar to that reported for methadone. Could it be that levorphanol may have a role like methadone for pain that is poorly controlled with other pure agonist opioids? We summarize what is known about levorphanol and provide a table for converting other opioids to levorphanol that was used for this case series %0 Journal Article %C Director of the Center to Advance Palliative Care at Mount Sinai School of Medicine, Director of The Lilian and Benjamin Hertzberg Palliative Care Institute, Professor of Geriatrics and Internal Medicine at Mount Sinai School of Medicine, and Catherine Gaisman, Professor of Medical Ethics at Mount Sinai School of Medicine in New York City %A Meier, DE %A Beresford, L %J J Palliat Med %D 2007 Apr %N 2 %P 284-289 %T Pediatric Palliative Care Offers Opportunities for Collaboration %V 10 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17472495 %0 Journal Article %C Coda Alliance, San Jose, California %A Menkin, Elizabeth S %J J Palliat Med %D 2007 Apr %N 2 %P 297-303 %T Go Wish: A Tool for End-of-Life Care Conversations %V 10 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17472498 %X The Go Wish card game is an advance care planning tool developed by Coda Alliance to help people have conversations about end-of-life care. Initially, this tool was designed as an easy, entertaining exercise for low-functioning assisted-living facility residents, their family members, and their CNA/nursing assistants (many of whom have limited English language skills.) Use of the tool can be proctored by staff or even a caregiver after minimal instruction. It turns out to be a widely applicable and inexpensive tool to help people discuss end-of-life care. The cards focus the conversations, provide important vocabulary to give voice to patients' needs and concerns, and offer a means for sharing those ideas. The Go Wish tool has developed into professionally designed and printed cards that are boxed as a game set. This paper describes the development of the Go Wish cards and reports on some of the diverse cases in which they have been useful %0 Journal Article %C Department of Chest Diseases, Osmangazi University Medical Faculty, Turkey. metintas@superonline.com %A Metintas, Muzaffer %A Ak, Guntulu %A Erginel, Sinan %A Alatas, Fusun %A Yildirim, Huseyin %A Kurt, Emel %A Metintas, Selma %J Lung Cancer %D 2007 Mar %N 3 %P 379-87 %T A retrospective analysis of malignant pleural mesothelioma patients treated either with chemotherapy or best supportive care between 1990 and 2005 A single institution experience %V 55 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17174436 %X The aim of this study was to investigate the efficacy and safety profile of chemotherapy (CT) compared to best supportive care (BSC) in patients with histopathologically confirmed diffuse malignant pleural mesothelioma (DMPM). A total of 161 patients between 1990 and 2004 treated either with CT (109 patients) or BSC (52 patients) depending on patients choice were evaluated in this analyses. Chemotherapy protocols included a combination of cisplatin, mitomycin C and recombinant interferon alpha 2a (CM-In), or cisplatin, mitomycin C and ifosfamide (CMI), or cisplatin and gemcitabine (CG). We found a significant difference in the median survivals of the patients with CT compared to BSC, 11.3 months versus 8.0. Objective response rate was 28/109 (25.7%) with 3.7% of complete response rate. Stable disease rate was 39/109 (35.8%). There was a significant difference between median survivals of patients with objective response (17 months) and median survivals of patients with progressive diseases (6 months) and also with stable diseases (16 months). There was a significant difference between the stable disease and the progressive disease. Stages 3 and 4 patients of epithelial cell type having received chemotherapy live longer than those not having received chemotherapy (12 months versus 4). There was no significant difference between the survivals of the different chemotherapy regimens. The toxicity with CT regimens were mild and well-tolerated. We conclude that CT prolongs survival compared to BSC in patients with DMPM. Survivals of patients with objective response prolong considerably with CT compared BSC. We observed that stages 3 and 4 patients with epithelial cell type got benefit from CT. Especially, of epithelial cell type stages 1 and 2 should receive multimodal treatment %0 Journal Article %C Psychoanalytic Center of Philadelphia, USA %A Miller, Frederick C %J Psychoanal Study Child %D 2006 %P 275-93 %T Successful mourning: maternal loss and grieving by proxy in Fly Away Home %V 61 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17370464 %X Fly Away Home is a captivating movie which beautifully portrays how profound losses can result in successful mourning. Movies can have lasting appeal when they convey universal themes such as loss and restitution in ways that not only illustrate underlying psychoanalytic processes but also confirm, clarify, or contradict them. A review of the literature on mourning reveals a preponderance of extrapolations from examples of unsuccessful grieving, resulting in an emphasis on a pathological perspective of an otherwise natural process. In Fly Away Home an adolescent girl whose own mother has recently died adopts orphaned goslings. They imprint on her as their mother and she must learn to fly an airplane in order to lead them on their first migration. In doing so she eventually demonstrates a variety of displaced enactments of the consolidation of a healthy maternal identification, or grieving by proxy. The movie also illustrates the risks of loss manifested as injury or defectiveness, the father as a temporary maternal proxy, the reconstruction of a new family, and the resumption of adolescent development, which are discussed in this paper as important components of this natural process of loss and restitution resulting in successful grieving %0 Journal Article %C Department of Adult Nursing/Palliative Care Nursing, School of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan %A Miyashita, Mitsunori %A Sanjo, Makiko %A Morita, Tatsuya %A Hirai, Kei %A Kizawa, Yoshiyuki %A Shima, Yasuo %A Shimoyama, Naohito %A Tsuneto, Satoru %A Hiraga, Kazuaki %A Sato, Kazuki %A Uchitomi, Yosuke %J J Palliat Med %D 2007 Apr %N 2 %P 390-9 %T Barriers to providing palliative care and priorities for future actions to advance palliative care in Japan: a nationwide expert opinion survey %V 10 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17472511 %X Objectives: Palliative care specialists are faced with extensive barriers to providing effective palliative care. We carried out a survey to identify existing barriers from the point of view of palliative care experts in Japan and determine the priorities for future actions to overcome these barriers. Methods: We conducted a cross-sectional mail survey in December 2004. We sent out 2607 questionnaires to members of the Japanese Society of Palliative Medicine and Hospice Palliative Care Japan. We asked all respondents two open-ended questions regarding barriers and future actions in the context of palliative care in Japan. In total, 426 questionnaires were returned (response rate of 16%). Results: We identified 95 different answers concerning barriers to providing effective palliative care. The three most frequent answers were "general medical practitioners' lack of interest, knowledge, and skills" (n = 203), "general population's lack of knowledge and misunderstandings about palliative care" (n = 122), and "general medical practitioners' failure to provide information and lack of communication skills" (n = 89). We identified 136 different answers concerning future actions required to improve palliative care. The three most frequent answers were "organize study sessions on palliative care or case conferences in hospitals" (n = 122), "provide information about palliative care to the general population" (n = 117), and "in undergraduate education, make palliative care a compulsory course" (n = 88). Conclusions: We identified numerous barriers to providing effective palliative care, related to not only medical practitioners, but also economic factors and the general population. These findings suggest that to overcome these barriers, we need to take action on many fronts, including increasing social awareness and effecting political change, as well as addressing problems relating to practitioners. We prioritized the future actions. The most frequent urgent problems were identified. We hope that collaborative efforts by the relevant organizations will improve palliative care in Japan %0 Journal Article %A Moore, Alison %J Health Serv J %D 2007 Apr %N 6050 %P 14-5 %T Taking the private pennies--without the public grief %V 117 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17477241 %0 Journal Article %C Section of Geriatrics, Baylor College of Medicine, Institute for Palliative Medicine, The Methodist Hospital, Houston, Texas %A Morrison, Laura J %A Scott, Judy Opatik %A Block, Susan D %J J Palliat Med %D 2007 Apr %N 2 %P 313-30 %T Developing initial competency-based outcomes for the hospice and palliative medicine subspecialist: phase I of the hospice and palliative medicine competencies project %V 10 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17472502 %X As a newly recognized subspecialty, the field of hospice and palliative medicine (HPM) must transition existing pathways for board certification, fellowship standards, and fellowship accreditation to one based on the Accreditation Council for Graduate Medical Education and American Board of Medical Specialties competency framework. The Competencies Work Group of the American Board of Hospice and Palliative Medicine, using an iterative process informed by the field, has developed a set of Initial Competency-based Outcomes for the HPM Subspecialist. These competencies will set the standard for the "competent hospice and palliative medicine subspecialist physician," guiding future HPM fellowship training and potential midcareer HPM training opportunities. Lessons learned are highlighted %0 Journal Article %C Neurology Clinic Namba %A Namba, Reiko %J Gan To Kagaku Ryoho %D 2006 Dec %P 239-42 %T [Palliative care at the end of life for intractable neurological diseases] %V 33 Suppl 2 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17469347 %X Palliative care at the end of life for intractable neurological diseases has come into discussion recently. According to the care guidelines for amyotrophic lateral sclerosis (ALS), suggested by the Japan Neurology Societies, neurological doctors should primarily aim at reducing patients' pain, share decisions with patients, and care for breathing difficulties, pain, and anxieties positively with the use of narcotics, like the care for cancer patients. Between June 2003 and June 2006, 58 of 79 patients (73%) refused a treatment to prolong their life, such as tracheal positive pressure ventilation (TPPV), and 19 of 24 (79%) patients desired to remain at home; these patients represented the majority. I will introduce the examples of ALS patients who refused TPPV, those who had intubation and ventilator attachment unwillingly at the time of emergency medical admission, and those who refused tube feedings. I will also report the practice on a patient with multi-system atrophy who was not self-decisive, the procedure of easing pain and its efficacy on the 9 ALS examples of home death, and the problems seen from 10 examples of death at a hospital. Hereafter, it is necessary to discuss intensely the problems of end-of-life palliative care especially for intractable neurological diseases in order to establish a methodology and to popularize it %0 Journal Article %C Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India %A Neyaz, Z %A Srivastava, Deep N %A Thulkar, S %A Bandhu, S %A Gamanagatti, S %A Julka, P K %A Chattopadhyaya, T K %J Acta Radiol %D 2007 Mar %N 2 %P 156-64 %T Radiological evaluation of covered self-expandable metallic stents used for palliation in patients with malignant esophageal strictures %V 48 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17354135 %X PURPOSE: To study the role of self-expandable metallic stents in malignant esophageal strictures in terms of patency, improved dysphagia score, and possible associated complications. MATERIAL AND METHODS: Twenty-two patients with inoperable carcinoma of the esophagus underwent stent placement. Four different varieties of covered stents were used. Stenting was performed under fluoroscopic guidance and local pharyngeal anesthesia. During follow-up, patients were examined clinically and radiologically to assess the effectiveness of stents in relieving dysphagia, to check the stent position, patency, and possible complications. RESULTS: Fluoroscopic placement of the stent was successful and well tolerated in all patients without any serious complications. Accurate stent placement was possible in 95% of cases. The mean dysphagia score prior to stenting was 3.5 and poststent 1.2, with an improvement of 2.3 degrees. In two patients with associated fistulas, complete closure was seen after stent insertion. There was poor stent expansion in three patients. Significant tumor overgrowth occurred in two patients, and a second overlapping stent was deployed in one case. Three patients developed food impaction, which needed endoscopic removal of impacted food in two cases. CONCLUSION: Fluoroscopic placement of self-expandable metallic stents is a safe and effective method of palliating severe dysphagia and fistulas in patients with inoperable esophageal carcinoma. However, complications such as tumor overgrowth and food impaction may require reintervention after stent placement %0 Journal Article %C Dept. of Outpatient Nursing, Nakatsu Gastrointestinal Hospital %A Nitta, Michiko %A Tamaki, Satomi %A Nakazono, Kazuko %A Nakamura, Naoko %A Seguchi, Asami %A Gosho, Yoshie %A Kudoh, Misuzu %A Chigira, Naoko %A Hasegawa, Chikako %A Tokunaga, Kiyoko %A Imanaga, Hiromi %A Fukano, Masahiro %A Iwamoto, Takuya %J Gan To Kagaku Ryoho %D 2006 Dec %P 364-5 %T [Nursing experience in palliative care at the outpatient clinic] %V 33 Suppl 2 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17469388 %X Seven of the 17 patients reported that they were satisfied with the palliative care at our outpatient clinic. A patient's will to stay home, a devoted key person to the patient, procedures such as good pain control and an oral intake were considered to be important factors in palliative care at the outpatient clinic. We should understand that the patient's family attending the outpatient clinic is a part of their important daily life, so we try to make them feel comfortable whenever they come to see us. We should also strive for building more experience in palliative care for patients and their families. Based on our experience, we anticipate that outpatient care will be increased in the future. In the meantime, advanced nursing skills and techniques are needed %0 Journal Article %C Hopital Regional de Sudbury Regional Hospital, Regional Cancer Program, Sudbury, ON, Canada %A Noble, J %A Ellis, P M %A Mackay, J A %A Evans, W K %J J Thorac Oncol %D 2006 Nov %N 9 %P 1042-58 %T Second-line or subsequent systemic therapy for recurrent or progressive non-small cell lung cancer: a systematic review and practice guideline %V 1 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17409993 %X PURPOSE: This clinical practice guideline, based on a systematic review, evaluates second-line or subsequent therapy for patients with recurrent or progressive non-small cell lung cancer. METHODS: Relevant randomized trials and meta-analyses were identified through a systematic search of the literature. External feedback was obtained from practitioners in Ontario, and the guideline was approved by the provincial Lung Cancer Disease Site Group. RESULTS: Twenty-four randomized trials met the eligibility criteria. Two phase III trials demonstrated a significant benefit in overall survival and quality of life (QOL) for single-agent docetaxel. A pooled analysis comparing docetaxel administered weekly versus three-weekly found similar survival between the schedules and a non-significant reduction in febrile neutropenia for the weekly regimen. One phase III trial found that single-agent pemetrexed provided similar survival and QOL, compared to docetaxel. Another phase III trial demonstrated that oral topotecan was non-inferior to docetaxel for one-year survival rate, although QOL significantly favored docetaxel over topotecan. Docetaxel-based and other combination chemotherapy regimens have not been shown to be superior to single-agent docetaxel. One phase III trial revealed a statistically significant survival and QOL benefit for erlotinib over placebo for patients who were not eligible for further chemotherapy. Modest tumor response rates and symptom control have been demonstrated for gefitinib; however, a statistically significant survival benefit has not been established for gefitinib over placebo. CONCLUSION: Second-line or subsequent therapy with single-agent docetaxel, pemetrexed, or erlotinib offers patients a significant survival and QOL advantage %0 Journal Article %C Division of Geriatrics, VA Medical Center Zablocki, Milwaukee, Wisconsin %A Noorani, Nazneen Hyder %A Montagnini, Marcos %J J Palliat Med %D 2007 Apr %N 2 %P 458-64 %T Recognizing depression in palliative care patients %V 10 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17472517 %X Clinically significant depression is a common psychiatric disorder in patients with advanced and terminal diseases. Depression is often unrecognized and untreated and it causes major suffering to patients and families. Having adequate knowledge and skills to properly recognize depression in patients with advanced illnesses is essential for providing comprehensive end-of-life care. The objective of this paper is to review the key elements of the assessment of depression in palliative care patients. We also discuss the challenges of making the diagnosis, review the risk factors associated with depression and describe the features of the most common assessment tools that have been studied in this population. Finally, we highlight how to differentiate depression from normal grief, as the overlap between these conditions imposes a diagnostic challenge %0 Journal Article %C Inclusion Research Institute in Washington. D.C %A Norwood, Frances %J Med Anthropol %D 2007 Apr-Jun %N 2 %P 139-74 %T Nothing More To Do: Euthanasia, General Practice, and End-of-Life Discourse in the Netherlands %V 26 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17469014 %X Euthanasia in the Netherlands, which has been legal since 1984, is often talked about; yet, only rarely does it culminate in a euthanasia death. In 2001, for example, only 1 in 10 of those who initiated a request for euthanasia with their physician died a euthanasia death. Using data gathered during a 15-month ethnographic study with general practitioners, families, and patients, this article explores the practice of euthanasia, a practice based mainly in talk. Applying a Foucauldian concept of discourse, I will examine euthanasia as a script for how people think, feel, and act at the end of Dutch life, attempting to answer the question: What are Dutch people talking about when they talk about euthanasia? This article is intended to provide ethnographic data not currently available on the modern-day practice of euthanasia and to add to a growing body of literature on death, dying, and the role of the state %0 Journal Article %C Palliative Care Team, Dept. of Neuropsychiatry and Psychosomatic Medicine, National Hospital Organization Osaka National Hospital %A Ogawa, Asao %A Tanaka, Tomi %A Todaka, Akiko %A Yamanaka, Masako %A Matsuyama, Kazuyo %A Matsuoka, Haruna %A Makiyama, Mari %A Hirotsune, Hideto %A Tsujinaka, Toshimasa %J Gan To Kagaku Ryoho %D 2006 Dec %P 349-51 %T [Palliative care team support services by the hospital for home palliation] %V 33 Suppl 2 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17469383 %X At Osaka National Hospital, we opened a palliative care team (PCT) since July 2004. The PCT advises the symptom management of cancer patients and supports patients' decision making. By March 2006, 355 consecutive cancer patients referred to the PCT, including 221 patients with psychiatric symptoms. The duration of the treatments for psychiatric symptoms were extended longer than for physical symptoms (physical symptoms: 47.7 days, depression: 60.4, delirium: 56.0, adjustment disorders: 57.4; p < 0.05). The reasons for this prolongation are that psychiatric symptoms (especially delirium) are often overlooked, and that home doctors and visiting nurses often hesitate to take on the home medical care because of unfamiliarity with them. The management of psychiatric symptoms at home is important for appropriate end-of-life care. The PCT and regional doctors have to work closely in cooperating with the successive palliation when the patient is transformed to home medical care %0 Journal Article %A Pafko, Pavel %J Rozhl Chir %D 2007 Jan %N 1 %P 49 %T [Euthanasia] %V 86 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17458030 %0 Journal Article %C Sheila Payne BA PhD RN Help the Hospices Chair in Hospice Studies International Observatory on End of Life Care, Institute for Health Research, Lancaster University, Lancaster, UK %A Payne, Sheila %A Field, David %A Rolls, Liz %A Hawker, Sheila %A Kerr, Chris %J J Adv Nurs %D 2007 May %N 3 %P 236-45 %T Case study research methods in end-of-life care: reflections on three studies %V 58 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17474912 %X Aim. This paper is an evaluation of the use of case study methods, drawing on three research studies conducted by the authors in end-of-life care and bereavement. Background. Case study methods have their origins in social anthropology and draw on the principles of naturalistic inquiry. They have been used in a number of disciplines, including qualitative sociology, management science, education and organizational psychology for the understanding and evaluation of complex social systems. They are an appropriate research design for examining processes and outcomes in dynamic healthcare organizations, where it is important to obtain multiple perspectives. Method. We explore issues in case study research design, recruitment and data collection drawing on three studies conducted between 2000 and 2005 in six community hospitals, five adult hospice bereavement services and eight childhood bereavement services in the United Kingdom. Quantitative and qualitative data were collected using interviews, focus groups, observations, documentary analysis, standardized measures and questionnaires. Discussion. The process of case study design is described, including building upon a clear rationale for the selection of cases, collection of data, preparation of single case reports, cross-case analysis and interpretation. In a critical discussion of recruitment, we recommend identification of a key contact person at each site to facilitate access and minimize misunderstanding, disruption to clinical services and 'gate-keeping'. Three principal methods of data collection: interviews, observation and documentary data analysis form the foundation of the rich data set necessary to explore cases in their situational contexts. Conclusion. Case study methods may be empowering for participants because they value their experiences and reveal how their work contributes to teamwork within organizations. They can therefore be both affirming and challenging, as they may expose both conflicts and tensions %0 Journal Article %C Royal Berkshire Foundation NHS Trust %A Penhale, Christine %A Odell, Mandy %J Nurs Times %D 2007 Apr %N 15 %P 26-7 %T Understanding 'do not attempt resuscitation' orders %V 103 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17476846 %X This article outlines the issues that influence the process of writing a 'do not attempt resuscitation' order. It discusses advance directives, the Mental Capacity Bill and patient and relative involvement, and their impact on making decisions about cardiopulmonary resuscitation (CPR) %0 Journal Article %C Stanford University School of Medicine, 3801 Miranda Avenue, 100-4A, Palo Alto, CA 94304 %A Periyakoil, V S %J J Palliat Med %D 2007 Apr %N 2 %P 483-4 %T Panic disorder at the end of life #145 %V 10 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17472520 %0 Journal Article %C Department of Urology, University of Naples "Federico II", Italy %A Prezioso, Domenico %A Galasso, Raffaele %A Di Martino, Mario %A Iapicca, Gennaro %J Recent Results Cancer Res %D 2007 %P 251-65 %T Prostate cancer treatment and quality of life %V 175 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17432564 %X Prostate cancer is detected today at earlier stages and in younger men than ever before. A lot of men are asymptomatic and also physically and sexually active at diagnosis, and most of them are being treated by curative procedures. These trends have led to increasing numbers of patients undergoing disease management for longer periods of time. For many patients quality of life (QoL) may be just as important as survival. Thus, QoL considerations may well be the critical factor in medical decision-making for most of them. Widespread interest in studying patient-centred outcomes has led to the development of methods for health-related QoL measurements. In fact, many questionnaires have been introduced in clinical practice to assess the impact of QoL in patients (SF-36, CARES, FACT, EORTC QLQ-C30, GRISS, UCLA PCI, PCOS). Herein we evaluate the impact of QoL on patients affected by prostate cancer and treated with watchful waiting, radical prostatectomy, radiotherapy and hormonal therapy; we have also considered the role of supportive care, including the administration of analgesics, antidepressants, corticosteroids, bisphosphonates, antiemetics and stool softeners, together with psychological support. The ultimate goal of QoL research should strongly improve medical care and concretely assist patients and physicians in treatment decision-making %0 Journal Article %C Center for Ethics, Humanities, and Palliative Care, University of Rochester Medical Center, Rochester, New York %A Quill, Timothy E %J J Palliat Med %D 2007 Apr %N 2 %P 290-2 %T Is length of stay on hospice a critical quality of care indicator? %V 10 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17472496 %0 Journal Article %C California State University, Sacramento and University of California, Davis Medical Center, CA, USA %A Raingruber, Bonnie %A Milstein, Jay %J J Holist Nurs %D 2007 Mar %N 1 %P 39-49; discussion 50-1 %T Searching for circles of meaning and using spiritual experiences to help parents of infants with life-threatening illness cope %V 25 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17325313 %X One of the major challenges parents can face is learning that their child has a life-threatening illness. A phenomenological study was completed to identify which interactions with health care providers were and were not helpful. Parents discussed what it was like to have an infant with a life-threatening illness and what helped them to cope. Parents indicated that they benefited from identifying "circles of meaning," or ways in which their infant touched another life. Parents appreciated hearing from health care providers that they felt close to their infant. This sense of connection allowed parents to reconstruct a semblance of meaning in the midst of a life-altering event. Parents were also influenced by intuitive and spiritual experiences associated with their infant's illness. Parents should be encouraged to reflect on spiritual moments and to identify how their critically ill infant influenced the lives of other family members, friends, and health care professionals %0 Journal Article %C Faculty, Child and Adolescent Program, Institute for Psychoanalytic Training and Research, USA. reichbart@earthlink.net %A Reichbart, Richard %J J Am Psychoanal Assoc %D 2006 Fall %N 4 %P 1067-98 %T On men crying: Lear's agony %V 54 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17354488 %X King Lear vowed that because he was a man he would rather go mad or die than weep. Many adult male patients in psychoanalysis have just such an internal prohibition against crying, learned individually and often culturally encouraged, a prohibition that affects their ability to process loss, maintain intimacy, and accept vulnerability. It is suggested that the appropriate psychoanalytic role with these patients is to recognize and actively address this culturally supported prohibition. In addition, it is proposed that the prohibition against men crying may be a consequence of male envy of maternal traits and other feminine characteristics. Further, it is suggested that the developmental theory that the male child must "disidentify" with the mother memorializes a phallicism that often invokes the prohibition against crying in men and is itself mistaken %0 Journal Article %C Community Health and Family Medicine, Division of Palliative Medicine, University of Florida College of Medicine, Jacksonville, Florida %A Reisfield, Gary M %A Wilson, George R %J J Palliat Med %D 2007 Apr %N 2 %P 465-75 %T Rational use of sublingual opioids in palliative medicine %V 10 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17472518 %X The sublingual administration of opioid analgesics has been a mainstay in the pain management of homebound dying hospice patients who are no longer able to swallow. It is also a potentially useful route of administration in other situations in which the oral route is not available and other routes are impractical or inappropriate. Potential advantages of the sublingual route include rapid analgesic onset and avoidance of hepatic first-pass metabolism. Pharmacokinetic and pharmacodynamic studies have yielded widely disparate data on sublingual morphine. Other opioids have been less studied. Available data suggests limited sublingual availability of hydrophilic opioids (e.g., morphine, oxycodone, and hydromorphone) and superior absorption of the lipophilic opioids (e.g., methadone and the fentanils). Buprenorphine, a potent, lipophilic, partial mu-opioid receptor agonist, appears promising but awaits further study %0 Journal Article %C correspondence and M.D., Ph.D., MRCP, Senior Clinical Lecturer in Neurology, Academic Neurology Unit, University of Sheffield Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF, UK. mreuber@doctors.org.uk %A Reuber, Markus %A Howlett, Stephanie %A Khan, Ajjaz %A Grunewald, Richard A %J Psychosomatics %D 2007 May-Jun %N 3 %P 230-8 %T Non-epileptic seizures and other functional neurological symptoms: predisposing, precipitating, and perpetuating factors %V 48 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17478592 %X This naturalistic study describes potential etiological factors in outpatients with functional neurological symptoms recorded during a screening interview with a single psychotherapist in 59 consecutive patients. The most commonly identified predisposing/precipitating factors were trauma (78.0%), family dysfunction (62.7%), and bereavement (62.7%). Family dysfunction (54.2%) and affective disorder (42%) were the commonest perpetuating factors. Trauma was more common in non-epileptic seizures; health anxiety, in men; family problems, in women. This study demonstrates the heterogeneity of this patient population. Further research is indicated to explore differences in predisposing, precipitating, and perpetuating factors in different patient groups with functional symptoms %0 Journal Article %C trichards@bmj.com %A Richards, Tessa %J BMJ %D 2007 Apr %N 7598 %P 830 %T A better way to die %V 334 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17446614 %0 Journal Article %C Department of Psychiatry, Dartmouth Medical School, 2 Whipple Pl., Lebanon, NH 03766, USA. stan ley.rosenberg@dartmouth.edu %A Rosenberg, Stanley D %A Lu, Weili %A Mueser, Kim T %A Jankowski, Mary Kay %A Cournos, Francine %J Psychiatr Serv %D 2007 Feb %N 2 %P 245-53 %T Correlates of adverse childhood events among adults with schizophrenia spectrum disorders %V 58 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17287383 %X OBJECTIVE: Multiple studies have found that childhood adversity is related to a range of poor mental health, substance abuse, poor physical health, and poor social functioning outcomes in the general population of adults. However, despite the high rates of childhood adversity in schizophrenia, the clinical correlates of these events have not been systematically evaluated. This study evaluated the relationship between adverse experiences in childhood and functional, clinical, and health outcomes among adults with schizophrenia. METHODS: The authors surveyed 569 adults with schizophrenia regarding adverse childhood events (including physical abuse, sexual abuse, parental mental illnesses, loss of a parent, parental separation or divorce, witnessing domestic violence, and foster or kinship care). The relationships between cumulative exposure to these events and psychiatric, physical, and functional outcomes were evaluated. RESULTS: Increased exposure to adverse childhood events was strongly related to psychiatric problems (suicidal thinking, hospitalizations, distress, and posttraumatic stress disorder), substance abuse, physical health problems (HIV infection), medical service utilization (physician visits), and poor social functioning (homelessness or criminal justice involvement). CONCLUSIONS: The findings extend the results of research in the general population by suggesting that childhood adversity contributes to worse mental health, substance abuse, worse physical health, and poor functional outcomes in schizophrenia %0 Journal Article %C University of Colorado at Colorado Springs %A Sacks, Jodi L %A Nelson, Jenenne P %J Qual Health Res %D 2007 May %N 5 %P 675-89 %T A theory of nonphysical suffering and trust in hospice patients %V 17 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17478649 %X Suffering is a complex, dynamic experience that overarches life experiences and includes physical, social, spiritual, and emotional domains. The purpose of this grounded theory study was to uncover participants' experiences of nonphysical suffering and what was helpful during this time. Eighteen patients who were chronically ill participated in this grounded theory study. Trust was uncovered as a central issue within nonphysical suffering, whereas meaning was the vehicle that enabled the individual to move within the suffering. Participants acknowledged suffering through the identification of various meanings of a situation within their constructed reality and belief system. During individuals' suffering, time was altered and the experience occurred within an expanded present. The individual created an emotional space apart from the meaning of loss within suffering. Trust included the categories of dynamic experience, losing trust, and dealing to regain trust. Participants identified nurse trustworthiness as important for decreasing energy expenditures associated with suffering %0 Journal Article %A Schneider, Aaron H %J Am J Hosp Palliat Care %D 2006 Jun-Jul %N 3 %P 173-4 %T Using palm-based technology in a chronic pain practice %V 23 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17060275 %0 Journal Article %C Lead Research GP, Honiton Research Practice and Honorary Senior Clinical Lecturer, Peninsula Medical School %A Seamark, David A %A Seamark, Clare J %A Halpin, David M G %J J R Soc Med %D 2007 May %N 5 %P 225-33 %T Palliative care in chronic obstructive pulmonary disease: a review for clinicians %V 100 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17470930 %X Chronic obstructive pulmonary disease (COPD) is a progressive condition characterized by airflow obstruction which ultimately kills many patients. It is common in both men and women and there is a 24-30% 5-year survival rate in the UK for those with severe disease. The annual death rate in the UK from COPD approaches that from lung cancer. Patients' symptoms can be improved by drug therapy, but stopping smoking is also an effective way of improving the outcome in patients at all stages of COPD. Predicting prognosis has been difficult in COPD due to the variable illness trajectory. However, assessment of severity of lung function impairment, frequency of exacerbations and requirement for long term oxygen therapy can help identify patients entering the final 12 months of life. Symptom burden and impact on activities of daily living for patients with COPD are comparable with that of cancer patients, and palliative care approaches are equally necessary, yet few publications exist to guide clinicians in this area. An evidence base exists for the management of dyspnoea with oxygen therapy and opioid drugs. There is less evidence for the effective treatment of depression and anxiety, fatigue and pain, and treatment is based on experience and considered best practice. This review discusses the problems that patients experience and offers practical guidance. The management of patients should be shared between primary and secondary care, with multidisciplinary teams being involved at an early stage. Patients and their families require honest and clear communication about the condition and what to expect in the future. The strict application of advance care planning and directives may not be feasible or appropriate, but there is evidence that attitudes towards resuscitation and artificial ventilation can be explored without distress. The requirement by patients and carers for surveillance and timely support is acknowledged, but how to provide such input is as yet unclear, with little evidence to support the widespread implementation of nurse-led management interventions. The hospice movement has become increasingly involved in the management of life-threatening, non-malignant disease and should be involved in the multidisciplinary care of patients dying from COPD %0 Journal Article %C Dept. of Pharmacy, Kitasato Institute Medical Center Hospital %A Shibazaki, Atsushi %A Kawahata, Kazue %A Tanaka, Hisami %A Ao, Teruaki %A Kobayashi, Noriko %A Ichihara, Hisao %J Gan To Kagaku Ryoho %D 2006 Dec %P 305-7 %T [A case report of a terminally ill patient who achieved good pain control by pharmaceutical intervention in home terminal care] %V 33 Suppl 2 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17469369 %X We provided consultations with pharmacists to a terminally ill patient with radicular pain at his home. Before pharmaceutical intervention, the patient's compliance had been poor and consequently he had not achieved stable pain. The pharmacists suggested changes in the pharmacological and physical regimen that satisfied both the patient and his family. These changes were instructed with the help of the patient's doctors, home-visiting nurses and family, and subsequently the patient's compliance improved. The patient achieved good pain control and maintained excellent quality of life up to the time of his death. By providing home consultations to a terminally ill patient, we have contributed to maintaining an acceptable quality of life for him by building a team that consisted of doctors, nurses and pharmacists %0 Journal Article %C Dept. of Nursing, Saiseikai Yokohamashi Nanbu Hospital %A Shimanaka, Masumi %A Doi, Chiharu %J Gan To Kagaku Ryoho %D 2006 Dec %P 352-4 %T [The roles and tasks of palliative care team in home-care] %V 33 Suppl 2 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17469384 %X At our hospital, a palliative care team has been established since November 2002. A total of 120 cancer patients registered at our palliative care program from April 2005 to March 2006, and 43 of them (35.8%) were discharged from the hospital. A study of the roles of a palliative care team on the transition to home-care could be summarized as follows: (1) Provide continual symptom management at a home-care setting. (2) Coordinate among multidisciplinary staffs for transition to home-care. (3) Be a consulting team on the transition to home-care. Moreover, tasks to promote an inter-regional association are as follows; (1) Cooperate with home-care nurses and home doctors to be in close contact. (2) Make sure to obtain several beds for a respite hospitalization. (3) Conduct training of medical staff on palliative care. (4) Plan enlightenment activities for patients, families, and local residents for palliative care %0 Journal Article %C Takumikai Osaka-Kita Homecare Clinic %A Shirayama, Hiroto %A Iuchi, Mitsuko %A Asada, Hiroki %A Yokoi, Hideyasu %A Fujita, Takuji %J Gan To Kagaku Ryoho %D 2006 Dec %P 341-4 %T [The influence of family willingness to home palliative care] %V 33 Suppl 2 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17469381 %X In the current state of medical treatment, cancer patients discharged from hospital to home have been increasing. For enforcement of home palliative care, we think that family willingness to care for the patient is very important. We examined how much the willingness of a family to care for the patient influences the enforcement of home palliative care and the factors that influence the willingness of care given by the family. When the family willingness to care for the patient was low, there were significantly lower patient deaths at home. Meanwhile, the length of home care was also significantly short. In fact, there was a tendency to influence the outcome of home palliative care by increasing the willingness to care for the patient by the family when the number of caregivers was high, additional medical treatment given to the patient and a good QOL at the time of discharge. Based on the STAS evaluation result, the willingness to care for the patient by the family was significantly higher when anxiety between the patient and his family is low, understanding of the state of the disease is good and communication between the patient and the family is good. We thought that the willingness to care for the patient provided by the family influences greatly in order to enforce home palliative care to be successful. We also thought that it is important to provide appropriate information to the patient and his family, and to resolve individual patients' problems as well %0 Journal Article %C Department of Diagnostic Imaging, Brown Medical School/Rhode Island Hospital, Providence, RI 02903, USA %A Simon, Caroline J %A Dupuy, Damian E %A DiPetrillo, Thomas A %A Safran, Howard P %A Grieco, C Alexander %A Ng, Thomas %A Mayo-Smith, William W %J Radiology %D 2007 Apr %N 1 %P 268-75 %T Pulmonary radiofrequency ablation: long-term safety and efficacy in 153 patients %V 243 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17392258 %X PURPOSE: To retrospectively evaluate long-term survival, local tumor progression, and complication rates for all percutaneous computed tomographic (CT)-guided lung tumor radiofrequency (RF) ablations performed at a tertiary care cancer hospital in patients who refused or who were not candidates for surgery. MATERIALS AND METHODS: This HIPAA-compliant study was approved by the institutional review board; informed consent was waived. Between 1998 and 2005, 153 consecutive patients (mean age, 68.5 years; range, 17-94 years) with 189 primary or metastatic medically inoperable lung cancers underwent percutaneous fluoroscopic CT-guided RF ablation. Clinical outcomes were compiled on the basis of review of medical records, imaging follow-up reports, and any biopsy-proved residual or recurrent disease (when available). Kaplan-Meier method was used to estimate overall survival and disease-free survival (progression) as a function of time since RF ablation. Comparisons between survival functions were performed by using the log-rank statistic; P < .05 was considered to indicate a significant difference. RESULTS: The overall 1-, 2-, 3-, 4-, and 5-year survival rates, respectively, for stage I non-small cell lung cancer were 78%, 57%, 36%, 27%, and 27%; rates for colorectal pulmonary metastasis were 87%, 78%, 57%, 57%, and 57%. The 1-, 2-, 3-, 4-, and 5-year local tumor progression-free rates, respectively, were 83%, 64%, 57%, 47%, and 47% for tumors 3 cm or smaller and 45%, 25%, 25%, 25%, and 25% for tumors larger than 3 cm. The difference between the survival curves associated with large (>3 cm) and small (< or =3 cm) tumors was significant (P < .002). The overall pneumothorax rate was 28.4% (52 of 183 ablation sessions), with a 9.8% (18 of 183 ablation sessions) chest tube insertion rate. The overall 30-day mortality rate was 3.9% (six of 153 patients), with a 2.6% (four of 153 patients) procedure-specific 30-day mortality rate. CONCLUSION: Lung RF ablation appears to be safe and linked with promising long-term survival and local tumor progression outcomes, especially given the patient population treated %0 Journal Article %C Department of Palliative Care, McMaster University, Hamilton, Ontario, Canada %A Slaven, Marissa %A Wylie, Nancy %A Fitzgerald, Beryl %A Henderson, Nancy %A Taylor, Susan %J J Palliat Med %D 2007 Apr %N 2 %P 304-7 %T Who needs a palliative care consult?: the hamilton chart audit tool %V 10 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17472499 %X Although palliative care services are becoming increasingly prevalent in acute care hospitals only a minority of patients who die in hospital or in the community have seen palliative care teams. There are large numbers of patients who might benefit from palliative care who are not receiving it. That said, identification of patients who are eligible for these services, and of those who would most benefit is problematic. Limitations in our ability to accurately predict prognosis as well as lack of universal agreement as to what constitutes a terminal illness, or "end of life" are important considerations. Another significant challenge faced by our health care systems is whether or not all "end-of-life" patients require specialized care by trained palliative care providers. Even if this were the ideal model of care, this would be unfeasible given the relatively small number of trained providers compared to the aging and dying population. Therefore it is critical that health care systems begin to standardize their approach to the identification of patients who are most in need of, and/or most likely to benefit from interventions by interdisciplinary palliative care teams. Institutions that are planning to develop new services, or expand their current services will require some method/tool to assess specific population needs at their site. The Hamilton Chart Audit (H-CAT) was developed at our institution to help identify potential palliative care needs of patients and their families. We report on development of the tool and use of the tool for a retrospective audit of 222 patients who died at our institution %0 Journal Article %C Department of Neurology, University of Kentucky, Chandler Medical Center, Lexington, Kentucky 40536-0284, USA. slevin@uky.edu %A Slevin, John T %A Gash, Don M %A Smith, Charles D %A Gerhardt, Greg A %A Kryscio, Richard %A Chebrolu, Himachandra %A Walton, Ashley %A Wagner, Renee %A Young, A Byron %J J Neurosurg %D 2007 Apr %N 4 %P 614-20 %T Unilateral intraputamenal glial cell line-derived neurotrophic factor in patients with Parkinson disease: response to 1 year of treatment and 1 year of withdrawal %V 106 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17432712 %X OBJECT: Glial cell line-derived neurotrophic factor (GDNF) infused unilaterally into the putamen for 6 months has been previously shown to improve significantly motor functions and quality of life measures in 10 patients with Parkinson disease (PD) in a Phase I trial. In the present study the authors report the safety and efficacy of continuous treatment for a minimum of 1 year. After the trial was halted by the drug sponsor, the patients were monitored for an additional 1 year during which the effects of drug withdrawal were evaluated. METHODS: During the extended study period, patients received a 30-microg/day unilateral intraputamenal infusion of GDNF at a basal infusion rate supplemented with pulsed boluses every 6 hours at a convection-enhanced delivery rate to increase tissue penetration of the protein. When the study was stopped, the delivery system was reprogrammed to deliver sterile saline at the basal infusion rate of 2 microl/hour. The Unified Parkinson's Disease Rating Scale (UPDRS) total scores after 1 year of therapy were improved by 42 and 38% in the off- and on-medication states; the motor UPDRS scores were also improved 45 and 39%, respectively. Benefits from treatment were lost by 9 to 12 months after the cessation of GDNF infusion. The UPDRS scores returned to their baseline and the patients required higher levels of conventional antiparkinsonian drugs to treat symptoms. After 11 months of treatment, the delivery system had to be removed in one patient because of risk of infection. Seven patients developed antibodies to GDNF but without evident clinical sequelae. There was no evidence for GDNF-induced cerebellar toxicity, as evaluated by magnetic resonance imaging and clinical testing. CONCLUSIONS: The unilateral administration of GDNF results in significant, sustained bilateral benefits in patients with PD. These improvements are lost within 9 months of drug withdrawal. Safety concerns with GDNF therapy can be closely monitored and managed %0 Journal Article %C Center for Studies in Practical Knowledge, Department of Philosophy, Sodertorn University College, Huddinge, 141 89, Sweden, fredrik.svenaeus@sh.se %A Svenaeus, F %J Med Health Care Philos %D 2007 May %T Do antidepressants affect the self? A phenomenological approach %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17476581 %X In this paper, I explore the questions of how and to what extent new antidepressants (selective serotonin-reuptake inhibitors, or SSRIs) could possibly affect the self. I do this by way of a phenomenological approach, using the works of Martin Heidegger and Thomas Fuchs to analyze the roles of attunement and embodiment in normal and abnormal ways of being-in-the-world. The nature of depression and anxiety disorders - the diagnoses for which treatment with antidepressants is most commonly indicated - is also explored by way of this phenomenological approach, as are the basic structures of self-being. Special attention is paid in the analysis to the moods of boredom, anxiety and grief, since they play fundamental roles in depression and anxiety disorders and since their intensity and frequency appear to be modulated by antidepressants. My conclusion is that the effect of these drugs on the self can be thought of in terms of changes in self-feeling, or, more precisely, self-vibration of embodiment. I present the idea of a spectrum of bodily resonance, which extends from the normal resonance of the lived body, in which the body is able to pick up a wide range of different moods; continuing over various kinds of sensitivities, preferences and idiosyncrasies, in which certain moods are favored over others; to cases that we unreservedly label pathologies, in which the body is severely out of tune, or even devoid of tune and thus useless as a tool of resonance. Different cultures and societies favor slightly differently attuned self-styles as paradigmatic of the normal and good life, and the popularity of the SSRIs can therefore be explained, not only by defects of embodiment, but also by the presence of certain cultural norms in our contemporary society %0 Journal Article %C St Christopher's Hospice, London SE26 6DZ, UK. n.sykes@stchristophers.org.uk %A Sykes, Nigel P %J Lancet %D 2007 Apr %N 9570 %P 1325-6 %T Morphine kills the pain, not the patient %V 369 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17448802 %0 Journal Article %C Palliative Care Team, National Hospital Organization Osaka National Hospital %A Tanaka, Tomi %A Ogawa, Asao %A Todaka, Akiko %A Yamanaka, Masako %A Matsuoka, Haruna %A Tsujinaka, Toshimasa %J Gan To Kagaku Ryoho %D 2006 Dec %P 345-7 %T [The role of an oncology certified nurse specialist in a palliative care team] %V 33 Suppl 2 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17469382 %X At Osaka National Hospital, we established a hospital based palliative care team in July 2004. The team provided consultation to 355 patients (189 males and 166 females). Even though consultation was requested from every department, the department of surgery requested most with 100 cases, of which a request for lung (16%) and gastric (13%) cancer patients were asked fairly often. Some of the consultation requests were 177 in pain control, 221 in psychiatric and 91 in physical related symptoms, respectively. The department of surgery requested PCT intervention most frequently. Finally, a total of 115 patients had died, 81 were discharged and 36 were continually treated with cancer chemotherapy as an outpatient basis. OCNS have a major role in coordination with the PCT and primary team, and intervene directly in the CNS's specialty area. To provide more appropriate care services with the primary team, the OCNS should assume more responsibility for promoting a support relationship with the staff and to enhance staff skills %0 Journal Article %C Psychoanalytic Institute of the Carolinas, USA %A Tucker, Landrum Jr %J Psychoanal Study Child %D 2006 %P 82-98 %T The grandparent syndrome: a case study %V 61 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17370456 %X "The Grandparent Syndrome" was first defined by Rappaport in 1956 as "the development of detrimental character traits brought on by the identification with a grandparent ... " This paper first reviews some of the various descriptions in the analytic and anthropologic literature of the significance of grandparents in the human psyche and in culture in general. Then, the analytic treatment of a young man with an unconscious identification with his grandmother is described. He has a particular type of identification, precipitated by melancholia in childhood, which lasted well into his adult life. In the treatment the effects of the deeply entrenched identification are brought to light and the parental and grandparental transference elements which develop are analyzed over a six-year period. The difficult analysis of the patient's negative therapeutic reaction, which was intensified by his unconscious guilt, is discussed. There is a 15 and 20-yearfollow-up of the analysis when the patient, an only child, returns to the analyst to do more analytic work in grieving the death of his parents %0 Journal Article %C Dept of Surgery, Hyogo Prefectural Awaji Hospital %A Umeki, Masahiko %A Kurisu, Shigeru %A Shimizu, Kumiko %A Hosokawa, Kazumi %A Umeno, Shoko %A Mine, Kazunori %J Gan To Kagaku Ryoho %D 2006 Dec %P 270-2 %T [Enlightenment activities about home palliative care for a terminal stage of cancer] %V 33 Suppl 2 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17469357 %X In Palliative and End-of-Life Care, it is very important that we support cancer patients being at home as well as for the removal of physical and psychological symptoms. In doing so, Hyogo Prefectural Awaji Hospital and Awaji Medical Association founded the "Awaji Palliative Care Team" in April, 2004. We have conducted a monthly study, for a total of 34 times to date. And we have an open citizen lecture 3 times a year. A doctor from Awaji Medical Association or a nurse from a home nursing station are the main lecturers on "home medical care". A doctor from the Hyogo Prefectural Awaji Hospital gave a special lecture "the latest cancer treatment". We also invited experts of palliative care from outside of the island and carried out a citizen open lecture. We held a total of 6 special lectures so far %0 Journal Article %C Asthma Care and Education Unit, Department of Pulmonary Medicine, Sapir Medical Center Meir Hospital, Kfar Sava and Sackler Faculty of Medicine, Tel Aviv University, Israel. Varsanos@clalit.org.il %A Varsano, Shabtai %J Harefuah %D 2007 Apr %N 4 %P 280-5, 317 %T [Reasons for the gap between asthma in reality and GINA guidelines] %V 146 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17476936 %X Asthma is a common chronic disease worldwide, affecting 300 million people of all ages. In spite of the existence of scientifically proven clinical guidelines for the past 15 years and efficient controller medications, the gaps between asthma management in reality and the goals of the Global Initiative for Asthma (GINA) guidelines are huge. Asthma, being a chronic disease, might be a companion from early childhood to the end of life and, as such, may impose major obstacles in disease management. These obstacles may rise from patient coping skills and style, from reasons that depend on the general practitioner himself/herself and the medical establishment and, most probably, also from lack of agreement between patients and caregivers about what constitutes well-managed asthma. This review aims to reveal and clarify the known and possible reasons for the recently proven worldwide gaps that still exist between asthma in reality and the goals of asthma clinical guidelines. Presenting and discussing the reasons for these huge gaps will hopefully help general practitioners to close these gaps in order to improve their patients asthma related quality of life and preserve lung function throughout life and decrease morbidity %0 Journal Article %C Oncology Centre, Addenbrooke's Hospital, Hills Road, Cambridge CB2 2QQ, UK. kathryn.waite@addenbrookes.nhs.uk %A Waite, K %A Gilligan, D %J Clin Oncol (R Coll Radiol) %D 2007 Apr %N 3 %P 182-7 %T The role of radiotherapy in the treatment of malignant pleural mesothelioma %V 19 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17359904 %X Radiation therapy for the treatment of malignant pleural mesothelioma has historically been limited by its efficacy. However, the increasing incidence of this tumour and the emergence of new technologies present a number of opportunities and challenges for this treatment modality. Radiotherapy is used to palliate mesothelioma patients with chest wall pain. Responses of over 60% have been seen, although the duration of response is often disappointing. The optimum dose has not been shown and many of the previous studies were small retrospective studies. An improved response has been seen in several studies where hyperthermia was added to radiotherapy. However, further investigation of this technique, which is not widely available, is required. There has not been any comparison of radiotherapy with chemotherapy in the palliation of patients with malignant pleural mesothelioma. Prophylactic chest wall radiotherapy to intervention sites successfully reduces the incidence of malignant seeding along the intervention tracts. However, the optimum dose and timing of treatment are not clear. There is no role for radical radiotherapy alone, but the role of radiotherapy as part of multimodality therapy is discussed. There have been studies of intensity-modulated radiotherapy as part of multimodality therapy and this technique needs to be evaluated further %0 Journal Article %C Medical College of Wisconsin, Milwaukee, Wisconsin %A Weissman, David E %A Ambuel, Bruce %A Von Gunten, Charles F %A Block, Susan %A Warm, Eric %A Hallenbeck, James %A Milch, Robert %A Brasel, Karen %A Mullan, Patricia B %J J Palliat Med %D 2007 Apr %N 2 %P 408-19 %T Outcomes from a national multispecialty palliative care curriculum development project %V 10 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17472513 %X Background: In 1998 we completed a successful regional pilot project in palliative care curriculum development among 32 internal medicine residency programs recruited from the mid-western United States. Between 1999 and 2004 this project was expanded to include 358 U.S. programs, from four specialties, based on new training requirements in internal medicine, family medicine, neurology, and general surgery. Objective: To assess the 1-year outcomes from residency programs participating in a national multispecialty palliative care curriculum development project. Measurement: Outcome data obtained from residency programs' responses to a structured progress report 12 months after enrolling in the project and from published residency project reports. Results: Three hundred fifty-eight residency programs, representing 27% of all eligible training programs in the four specialties, participated in the project. Outcome data was available from 224 residencies (63%). Most programs started new teaching in pain, non-pain symptom management, and communication skills. More than 50% of programs integrated palliative care topics within established institutional grand rounds, morbidity/mortality conferences or morning report. More than 70% of internal medicine and family practice programs began new direct patient care training opportunities utilizing hospital-based palliative care or hospice programs. New faculty development initiatives and use of quality improvement projects to drive curriculum change were reported in less than 50% of programs. Conclusions: Focused short-term instruction in palliative care curriculum development, in a diverse group of residency programs, is feasible and associated with significant curriculum change %0 Journal Article %C Northern Ireland Hospice Care, Belfast, Northern Ireland, United Kingdom and Royal Group of Hospitals Trust, Belfast, Northern Ireland, United Kingdom %A White, Clare %A McCann, Mary Ann %A Jackson, Neil %J J Palliat Med %D 2007 Apr %N 2 %P 345-51 %T First do no harm... Terminal restlessness or drug-induced delirium %V 10 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17472505 %X Terminal restlessness is a term frequently used to refer to a clinical spectrum of unsettled behaviors in the last few days of life. Because there are many similarities between the clinical pictures observed in terminal restlessness and delirium, we postulate that at times what is referred to as terminal restlessness may actually be an acute delirium sometimes caused by medication used for symptom control. It is important therefore to consider the causes for this distressing clinical entity, treat it appropriately, and ensure the treatment provided does not increase its severity. This brief review aims to consider the medications that are commonly used toward the end of life that may result in a picture of delirium (or terminal restlessness). These include opioids, antisecretory agents, anxiolytics, antidepressants, antipsychotics, antiepileptics, steroids and nonsteroidal anti-inflammatory drugs (NSAIDs). This review also aims to raise awareness regarding the recognition and diagnosis of delirium and to highlight the fact that delirium may be reversible in up to half of all cases. Good management of delirium has the potential to significantly improve patient care at the end of life %0 Journal Article %C Primary Care Musculoskeletal Research Centre, Keele University, Staffordshire, UK %A Whitehurst, D G T %A Lewis, M %A Yao, G L %A Bryan, S %A Raftery, J P %A Mullis, R %A Hay, E M %J Arthritis Rheum %D 2007 Apr %N 3 %P 466-73 %T A brief pain management program compared with physical therapy for low back pain: results from an economic analysis alongside a randomized clinical trial %V 57 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17394176 %X OBJECTIVE: Guidelines for the management of acute low back pain in primary care recommend early intervention to address psychosocial risk factors associated with long-term disability. We assessed the cost utility and cost effectiveness of a brief pain management program (BPM) targeting psychosocial factors compared with physical therapy (PT) for primary care patients with low back pain of <12 weeks' duration. METHODS: A total of 402 patients were randomly assigned to BPM or PT. We adopted a health care perspective, examining the direct health care costs of low back pain. Outcome measures were quality-adjusted life years (QALYs) and 12-month change scores on the Roland and Morris disability questionnaire. Resource use data related to back pain were collected at 12-month followup. Cost effectiveness was expressed as incremental ratios, with uncertainty assessed using cost-effectiveness planes and acceptability curves. RESULTS: There were no statistically significant differences in mean health care costs or outcomes between treatments. PT had marginally greater effectiveness at 12 months, albeit with greater health care costs (BPM 142 pounds, PT 195 pounds). The incremental cost-per-QALY ratio was 2,362 pounds. If the UK National Health Service were willing to pay 10,000 pound per additional QALY, there is only a 17% chance that BPM provides the best value for money. CONCLUSION: PT is a cost-effective primary care management strategy for low back pain. However, the absence of a clinically superior treatment program raises the possibility that BPM could provide an additional primary care approach, administered in fewer sessions, allowing patient and doctor preferences to be considered %0 Journal Article %C The Rehabilitation Centre, The Ottawa Hospital, Ottawa, ON, Canada. kewilson@ottawahospital.on.ca %A Wilson, Keith G %A Chochinov, Harvey Max %A McPherson, Christine J %A LeMay, Katerine %A Allard, Pierre %A Chary, Srini %A Gagnon, Pierre R %A Macmillan, Karen %A De Luca, Marina %A O'Shea, Fiona %A Kuhl, David %A Fainsinger, Robin L %J J Clin Oncol %D 2007 May %N 13 %P 1691-7 %T Suffering with advanced cancer %V 25 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17470861 %X PURPOSE: The alleviation of suffering is a central goal of palliative care, but little research has addressed the construct of suffering as a global experience of the whole person. We inquired into the sense of suffering among patients with advanced cancer to investigate its causes and correlates. PATIENTS AND METHODS: Semistructured interviews were administered to 381 patients. The interviews inquired about physical symptoms, social concerns, psychological problems, and existential issues. We also asked, "In an overall, general sense, do you feel that you are suffering?" RESULTS: Almost half (49.3%) of respondents did not consider themselves to be suffering, and 24.9% felt that they suffered only mildly. However, 98 participants (25.7%) were suffering at a moderate-to-extreme level. The latter participants were more likely to experience significant distress on 20 of the 21 items addressing symptoms and concerns; the highest correlations were with general malaise (rho [rho]= 0.56), weakness ( = 0.42), pain ( = 0.40), and depression ( = .39). In regression analyses, physical symptoms, psychological distress, and existential concerns, but not social issues, contributed to the prediction of suffering. In qualitative narratives, physical problems accounted for approximately half (49.5%) of patient reports of suffering, with psychological, existential, and social concerns accounting for 14.0%, 17.7%, and 18.8%, respectively. CONCLUSION: Many patients with advanced cancer do not consider themselves to be suffering. For those who do, suffering is a multidimensional experience related most strongly to physical symptoms, but with contributions from psychological distress, existential concerns, and social-relational worries %0 Journal Article %C alethea.young@dartmouth.edu %A Young, Alethea E %J J Am Psychoanal Assoc %D 2006 Fall %N 4 %P 1257-62 %T Psychoanalysis with an adopted child %V 54 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17354499 %0 Journal Article %C Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada %A Younis, Tallal %A Milch, Robert %A Abul-Khoudoud, Nawal %A Lawrence, David %A Mirand, Amy %A Levine, Ellis G %J J Palliat Med %D 2007 Apr %N 2 %P 381-9 %T Length of survival of patients with cancer in hospice: a retrospective analysis of patients treated at a major cancer center versus other practice settings %V 10 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17472510 %X This is a retrospective study of the length of survival (LOS) in hospice of patients with cancer treated at a major cancer center compared to other treatment sites. Of 670 patients, the 185 (28%) treated at a major cancer center had unique characteristics, including higher median Palliative Performance Score (PPS) at the time of hospice enrollment (45 versus 40, p = 0.009), and longer median LOS in hospice (35 versus 21 days, p = 0.02: log rank test). Additional variables that predicted longer LOS were higher PPS, Medicare or Medicaid, self-referral, unmarried status, and non-executed advance directives. After adjusting survival for PPS with a Cox proportional hazard model, the hazard ratio for PPS remained statistically significant (95% confidence interval [CI]: 0.95-0.97] while that for the treatment site was not (95% CI: 0.73-1.04]. The performance status, and not the treatment site, was the dominant predictor of the LOS of patients with cancer in hospice %0 Journal Article %A Zandstra, Durk F %A Bosman, Rob J %J Crit Care Med %D 2007 Mar %N 3 %P 981; author reply 981 %T Intensive care unit treatment in patients > 65 yrs with a first-day sequential organ failure assessment score > 15 is not futile %V 35 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17421106