%0 Journal Article %C Unite de neuroanesthesie-reanimation, departement d'anesthesie-reanimation, groupe hospitalier de la Pitie-Salpetriere, APHP et universite Pierre-et-Marie-Curie (Paris-VI), 47-83, boulevard de l'hopital, 75013 Paris, France %A Abdennour, L %A Lescot, T %A Weiss, N %A Galanaud, D %A Naccache, L %A Carpentier, A %A Puybasset, L %J Ann Fr Anesth Reanim %D 2007 Mar %T [On the difficulty of Traumatic brain injured patients end-of-life decisions.] %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17400424 %X Traumatic brain injury occurs abruptly, involves multiple specialized teams, solicits the health care system in its emergency dimension and engages the well being of the patient and his relatives for a life time period. Clinicians are faced with issues of uppermost importance: medical issues such as predicting long term neurological outcome of the comatose patient, ethical issues because of the influence of intensive care on the long term survival of patients in vegetative and minimally conscious state, legal issues as the consequence of the current law which has set a new concept of proportionality of care, social issues as the result of the very high cost of these pathologies. This review will focus on the brain explorations that are required such as CT scan, evoked potentials, electroencephalography, magnetic resonance imaging and magnetic resonance spectroscopy to provide to the clinician a multimodal assessment of the brain state to predict outcome of coma. Such assessment is mandatory to answer the crucial question of proportionality of care in these patients. However, these techniques need further validation on large series of patients before being useful on clinical practice %0 Journal Article %C Sheba Medical Center, Department of Oncology, Tel-Hashomer, Israel %A Catane, R %A Beck, A %A Inbar, Y %A Rabin, T %A Shabshin, N %A Hengst, S %A Pfeffer, R M %A Hanannel, A %A Dogadkin, O %A Liberman, B %A Kopelman, D %J Ann Oncol %D 2007 Jan %N 1 %P 163-7 %T MR-guided focused ultrasound surgery (MRgFUS) for the palliation of pain in patients with bone metastases--preliminary clinical experience %V 18 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17030549 %X BACKGROUND: Magnetic resonance-guided focused ultrasound surgery (MRgFUS) is a noninvasive thermal ablation technique, shown to be clinically effective in the treatment of uterine fibroids and is being evaluated as a method of thermal ablation of benign and malignant breast tumors. To evaluate the safety and initial efficacy of MRgFUS for the palliation of pain caused by bone metastases, in patients for whom other treatments are either not effective or not feasible. MATERIALS AND METHODS: Thirteen patients suffering from symptomatic bone metastases underwent MRgFUS procedure. Treatment safety was evaluated by assessing the incidence and severity of device-related complications up to 6 months after treatment. Effectiveness of pain palliation was evaluated by visual analog scale, pain questionnaires and changes in the patients' medication. RESULTS: Fifteen procedures were carried out. Mean follow-up was 59 days. Twelve patients received adequate treatment and were available for follow-up. Two patients died due to disease progression during the first month after treatment. No severe adverse events were recorded. The remaining 10 patients reported prolonged improvement in pain score and/or reduced analgesic dosage. CONCLUSION: MRgFUS may provide a safe and effective noninvasive alternative for the palliation of pain, caused by bone metastases %0 Journal Article %A Carmona-Bayonas, A %J Ann Oncol %D 2007 Jan %N 1 %P 199-200 %T Concurrent radiotherapy and capecitabine, followed by high-dose methotrexate consolidation, provided effective palliation in a patient with leptomeningeal metastases from breast cancer %V 18 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=16980605 %0 Journal Article %C Author Affiliations: School of Social Work, New York University, New York; School of Social Administration, Temple University, Philadelphia, Pa %A Wakefield, Jerome C %A Schmitz, Mark F %A First, Michael B %A Horwitz, Allan V %J Arch Gen Psychiatry %D 2007 Apr %N 4 %P 433-40 %T Extending the bereavement exclusion for major depression to other losses: evidence from the national comorbidity survey %V 64 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17404120 %X CONTEXT: Symptoms of intense bereavement-related sadness may resemble those of major depressive disorder (MDD) but may not indicate a mental disorder. To avert false-positive diagnoses, DSM criteria for MDD exclude uncomplicated bereavement of brief duration and modest severity. However, the DSM does not similarly exempt depressive reactions to other losses, even when they are uncomplicated in duration and severity. OBJECTIVE: To test the validity of the DSM exclusion of uncomplicated depressive symptoms only in response to bereavement but not in response to other losses. DESIGN: Community-based epidemiological study. PARTICIPANTS: From the National Comorbidity Survey (NCS) of 8098 persons aged 15 to 54 years representative of the US population, we identified individuals who met MDD symptom criteria and whose MDD episodes were triggered by either bereavement (n = 157) or other loss (n = 710). Intervention We divided the bereavement and other loss trigger groups into uncomplicated and complicated cases by applying the NCS algorithm for uncomplicated bereavement to the reactions to other losses. We then compared uncomplicated bereavement and uncomplicated reactions to other losses on a variety of disorder indicators and symptoms. MAIN OUTCOME MEASURES: Nine disorder indicators, as follows: number of symptoms, melancholic depression, suicide attempt, duration of symptoms, interference with life, recurrence, and 3 service use variables. RESULTS: Episodes of uncomplicated depression triggered by bereavement and by other loss have similar symptom profiles and are not significantly different for 8 of 9 disorder indicators. Moreover, uncomplicated reactions, whether triggered by bereavement or other loss, are significantly lower than complicated reactions on almost all disorder indicators. CONCLUSION: The NCS data do not support the validity of uniquely excluding uncomplicated bereavement but not uncomplicated reactions to other losses from MDD diagnosis %0 Journal Article %C Department of Radiation Oncology, South Western Sydney Area Cancer Services, Sydney, New South Wales, Australia. lois.holloway@swsahs.nsw.gov.au %A Holloway, L %J Australas Radiol %D 2007 Feb %N 1 %P 62-7 %T Current practice when treating lung cancer in Australasia %V 51 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17217491 %X A multidisciplinary meeting was held by the radiation oncology department of South Western Sydney Area Cancer Services in March 2003. This meeting was advertised in all radiation oncology departments in Australia and New Zealand. As a precursor to this meeting, a survey was undertaken on the use of radiotherapy for treating lung cancer. All departments in Australia and New Zealand were asked to participate. The survey considered planning techniques, delivery set-up and prescription doses for non-small-cell and small-cell lung cancer and palliative and radical treatments. A wide range in the techniques used was seen across departments, particularly when prescription doses and fractionation were considered %0 Journal Article %A Lett, Dan %J CMAJ %D 2007 Jan %N 3 %P 310-1 %T Manitoba physicians consider DNR guidelines %V 176 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17261820 %0 Journal Article %C School of Nursing Midwifery and Social Work, University of Manchester, Manchester, United Kingdom. jane.griffiths@manchester.ac.uk %A Griffiths, Jane %A Ewing, Gail %A Rogers, Margaret %A Barclay, Stephen %A Martin, Anna %A McCabe, Janet %A Todd, Chris %J Cancer Nurs %D 2007 Mar-Apr %N 2 %P 156-62 %T Supporting cancer patients with palliative care needs: district nurses' role perceptions %V 30 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17413782 %X The aim of this study was to examine UK district nurses' perceptions of their role in supporting palliative care cancer patients. Patients with cancer are living longer with the disease. District nurses are the largest UK workforce caring for people with cancer at home, the preferred place of care. Meeting patients' supportive and palliative care needs is complex. Little is known about district nurses' supportive role in the early phase of palliative care. Semistructured interviews were conducted with 34 district nurses. Data were analyzed thematically, with assistance from Atlas/ti. A dominant theme emerging from the interviews was ambiguity in the district nurses' supportive role in early palliative care. District nurses discussed the importance of making contact early on to support cancer patients and their families but had difficulty articulating this "support." Ambiguity, lack of confidence, and perceived skill deficits presented district nurses with dilemmas that were difficult to resolve. District nurses have great potential for meeting cancer patients' supportive and palliative care needs, a potential not currently realized. Education alone is unlikely to improve practice without an understanding of the tensions faced by district nurses in their work. Recognizing and addressing dilemmas in the everyday work of district nurses is central to moving practice forward %0 Journal Article %C Department of Pediatrics, Clinic of Pediatric Hematology Oncology, University of Padova, Padova, Italy. Matteoberna@alice.it %A Bernardi, Matteo %A Catania, Gianluca %A Tridello, Gloria %J Cancer Nurs %D 2007 Mar-Apr %N 2 %P E20-6 %T Knowledge and attitudes about cancer pain management: a national survey of Italian hospice nurses %V 30 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17413771 %X To obtain information about the knowledge and attitudes of Italian hospice nurses concerning cancer pain management and to determine the predictor of nurses' pain management knowledge. Nationwide descriptive study. Hospice nurses in Italy from 9 hospice units distributed in the north, center, and south of Italy. Sixty-six nurses completed the questionnaire, indicating a 66.6% response rate. The Nurses' Knowledge and Attitudes Survey (Italian version) and a background information form were used to collect the data. Knowledge and attitudes regarding cancer pain. Among the 39 pain knowledge questions assessed, the mean number of correctly answered question was 24.4 (SD = 4.2), with a range of 15 to 35 items correctly answered. The correct answer rate for the entire scale, on average, was 62.7% (SD = 28%). Further analysis of items showed that more than 30% of hospice nurses underestimated the patients' pain and they did not treat the pain in the correct way; they had an incorrect self-evaluation about their pain management knowledge. Results from stepwise regression showed that nurses with higher mean correct answer scores had attended more courses on pain education. From these results, we conclude that there are still significant knowledge deficits and erroneous beliefs that may hamper treatment of hospice patients in pain. The results of this study could be useful to institutions involved in the education and application of patient pain management %0 Journal Article %C Tuen Mun Hospital, Tuen Mun %A Lai, Y L %A Chan, Carmen W H %A Lopez, Violeta %J Cancer Nurs %D 2007 Mar-Apr %N 2 %P E1-8 %T Perceptions of dyspnea and helpful interventions during the advanced stage of lung cancer: Chinese patients' perspectives %V 30 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17413770 %X Dyspnea is a distressful but neglected symptom in oncology practice and research. The aim of this study was to describe the experience of dyspnea and helpful interventions in Chinese patients with advanced lung cancer admitted in the palliative care unit in 1 region in Hong Kong. A qualitative description approach using in-depth interviews was used to guide this study. Eleven participants agreed to be interviewed with age ranging from 51 to 80 years. They have been diagnosed with lung cancer from 1 to 12 months, and all required oxygen therapy from dyspnea. The results of content analysis revealed 4 main themes: (1) characteristics of dyspnea, (2) impact of dyspnea, (3) strategies used to manage dyspnea, and (4) nurses' role in managing dyspnea. Patients in this study found no Chinese words to adequately define and describe dyspnea and relied on sensations they experienced during the dyspnea episode. The impact of dyspnea was multidimensional, and patients used various strategies to manage dyspnea, including avoiding triggers and utilizing traditional Chinese medicine. Healthcare professionals were perceived to play a very inadequate role in assisting patients with dyspnea, and participants suggested that they should take a more active role in educating and supporting patients with dyspnea %0 Journal Article %C Oncology Department, St George's Hospital, St James' Wing, Blackshow Road, London SW17 0QT, UK. amichael@sgul.ac.uk %A Michael, A %A Hill, M %A Maraveyas, A %A Dalgleish, A %A Lofts, F %J Clin Oncol (R Coll Radiol) %D 2007 Mar %N 2 %P 150-3 %T 13-cis-Retinoic acid in combination with gemcitabine in the treatment of locally advanced and metastatic pancreatic cancer--report of a pilot phase II study %V 19 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17355112 %X AIMS: Adenocarcinoma of the pancreas is a cancer with extremely poor prognosis and limited therapeutic options. Retinoids are derivatives of vitamin A involved in the control of many biological functions, including cell growth and differentiation and the induction of apoptosis. On the basis of pre-clinical evidence and some clinical data, we conducted a phase II study of 13-cis-retinoic acid (13-cis-RA) in combination with gemcitabine in patients with unresectable pancreatic carcinoma. MATERIALS AND METHODS: Patients with histologically confirmed unresectable pancreatic carcinoma were treated with gemcitabine 1000 mg/m2 on days 8, 15, 22 plus 13-cis-RA 1 mg/kg on days 1-14 for six cycles. The end points included the objective response rate and median survival. RESULTS: Thirty patients were recruited, 15 men and 15 women; 20 patients were evaluable. The median age was 65 years (range 44-79 years) and the median Karnofsky performance status was 80% (range 60-100%). The median follow-up was 21 months. One patient achieved a partial remission, seven patients had stable disease and 12 patients developed progressive disease. Toxicity was mainly haematological, with eight cases of grade 3 and four cases of grade 4 neutropenia, thrombocytopenia and anaemia. The median survival was 7.8 months (range 2.6-21.6 months). CONCLUSIONS: The combination of gemcitabine and 13-cis-RA was well tolerated, but we did not see improvement in the response rate. Further studies with other retinoids may be beneficial to patients with unresectable pancreatic cancer %0 Journal Article %C Department of Internal Medicine, University of Manitoba, CancerCare Manitoba, Winnipeg, Manitoba, Canada. piotr.czaykowski@cancercare.mb.ca %A Czaykowski, P %A Hui, D %J Clin Oncol (R Coll Radiol) %D 2007 Mar %N 2 %P 143-9 %T Chemotherapy in small bowel adenocarcinoma: 10-year experience of the British Columbia Cancer Agency %V 19 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17355111 %X AIMS: Small bowel adenocarcinoma (SBA) is a rare, frequently lethal, malignancy. Little is known about the use and value of chemotherapy in patients with SBA. We assessed this issue in a consecutive cohort of patients from British Columbia, Canada. MATERIALS AND METHODS: Consecutive patients with SBA seen at the British Columbia Cancer Agency from January 1990 to September 2000 were identified. A retrospective systematic chart review was undertaken and a survival analysis conducted. RESULTS: Forty-eight SBA were identified in 47 subjects. Chemotherapy was given to 21 of the 47 subjects (45%). Of 19 patients treated initially with curative intent, the median overall survival was 38.6 months. Five received adjuvant chemotherapy, with two subsequently recurring. Thirty-seven patients initially or eventually had advanced disease: 16 received 22 palliative intent fluoropyrimidine-based regimens. Only one partial response was seen in the first line (objective response rate 6%). The median overall survival for those who received palliative chemotherapy was 15.6 months compared with 7.7 months for those who did not. CONCLUSIONS: Chemotherapy use is common in SBA. Our data and available published studies suggest that chemotherapy may provide benefit, but the optimal chemotherapy regimen and the degree of benefit remain to be defined. A sound approach to investigate the management of rare malignancies is desperately needed %0 Journal Article %C Faculty of Health Care and Social Sciences, University of Luton, Park Square, Luton LU1 34JU, UK %A Johns, Christopher %J Complement Ther Clin Pract %D 2007 May %N 2 %P 71-7 %T Journeying with Peter and Sam: Reflections on a healing attitude %V 13 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17400141 %X Reflection enables the practitioner to learn through everyday experiences towards realising desirable practice however it is articulated. In this paper I share my story in journeying with Peter and Sam in a hospice setting with the intention to ease suffering. In considering what is significant within this story, I pay particular attention to the idea of a healing attitude for deeper reflection in order to develop my appreciation of the nature and significance of a healing attitude %0 Journal Article %C From the Cleveland Clinic, Cleveland, OH (MLS); Memorial Hermann Hospital, Houston, TX (GG); The University of Texas School of Public Health, Houston, TX (JS); and The University of Texas M. D. Anderson Cancer Center, Houston, TX (CLW) %A Smith, ML %A Gremillion, G %A Slomka, J %A Warneke, CL %J Crit Care Med %D 2007 Mar %T Texas hospitals' experience with the Texas Advance Directives Act* %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17414082 %X OBJECTIVE:: The Texas Advance Directives Act (TADA) provides legal immunity for physicians who discontinue life-sustaining treatment judged to be medically inappropriate. The process includes review and affirmation of physicians' judgments by an ethics or medical committee. This study was undertaken to determine awareness of and experience with the medical appropriateness review process at Texas Hospital Association (THA) member hospitals from 1999 to 2004. DESIGN:: Cross-sectional, descriptive, 20-item written survey instrument. SETTING:: University cancer center. SUBJECTS:: Subjects were 409 hospital members of THA in 2004. INTERVENTIONS:: Mailed surveys. MEASUREMENTS AND MAIN RESULTS:: Participants returned 197 of 409 surveys usable for analysis (48.2%). Eighty-one percent of respondents (n = 159) were aware of all the provisions of the TADA. Thirty percent of respondents (n = 58) stated that their hospitals' TADA policy or procedure had been used to review specific patient cases. However, only 46 hospitals indicated a specific number of cases reviewed. Six of these 46 surveys were judged to be too inconsistent to be usable. The 40 remaining hospitals reviewed a total of 256 cases. For 70% of the 256 reported cases (n = 178), review committees agreed with physicians that the treatments in question were medically inappropriate. CONCLUSIONS:: A minority of THA hospitals have used their policies or procedures to review specific patient cases. Most cases were resolved before the end of the mandated 10-day waiting period because patients died, patients or representatives agreed to forgo the treatment in question, or patients were transferred. Discontinuation of life-sustaining treatment against patient or patient representative wishes occurred in only a small number of cases %0 Journal Article %C Department of Anesthesiology, Pain and Palliative Medicine, Radboud University, Nijmegen, The Netherlands %A Vissers, Kris Cp %A Hasselaar, Jeroen %A Verhagen, Stans Ahhvm %J Curr Opin Anaesthesiol %D 2007 Apr %N 2 %P 137-42 %T Sedation in palliative care %V 20 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17413397 %X PURPOSE OF REVIEW: Palliative sedation, the conscious induction of sleep in patients with a very short life expectancy who suffer intractable physical and existential distress, may offer the patient and his or her relatives a more peaceful dying. This technique is still subject to several ethical and medical controversies justifying a review of the recent literature on this subject. RECENT FINDINGS: The available evidence consists of few prospective trials and mainly retrospectively collected case reports. Two guidelines are published in the period under review. The most important points stressed in these reviews are the careful information exchange with the patient, if possible, and his or her proxies, a gradually increased sedation allowing respite if possible to evaluate the effect of the sedation and the need for consultation with colleagues, preferentially physicians experienced in palliative care. Stopping artificial nutrition and hydration is a medical decision that should be taken after evaluation of the potential side effects and consultation with the patient and relatives. SUMMARY: Palliative sedation may be considered for terminally ill patients who suffer intractable symptoms. Ideally it should be included in the patient's trajectory that has been described and discussed earlier when the disease was judged to be incurable. The main goal is to offer comfort %0 Journal Article %C Department of Clinical and Health Psychology, Ultrecht University, PO Box 80140, 3508 TC Ultrecht, The Netherlands. P.Boelen@fss.uu.nl %A Boelen, Paul A %A Van Den Bout, Jan %J Death Stud %D 2007 Feb %N 2 %P 155-64 %T Examination of proposed criteria for complicated grief in people confronted with violent or non-violent loss %V 31 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17410694 %X In the late 1990s, a panel of experts proposed criteria for complicated grief (CG) and found these to have satisfactory operating characteristics. The present study aimed to replicate that finding in 4 groups of mourners divided by cause of loss and time from loss. Data were available from 1,052 bereaved individuals. All had completed the revised Inventory of Complicated Grief through the Internet. Receiver operator characteristic analysis was used to analyze data. Results showed that, in all 4 groups, the proposed criteria for CG performed well at distinguishing between people who did and did not meet criteria for caseness of CG %0 Journal Article %C Department of Medical History and Ethics, University of Washington, Box 357120, Seattle, WA 98195-7240, USA. tigiba@u.washington.edu %A Starks, Helene %A Back, Anthony L %A Pearlman, Robert A %A Koenig, Barbara A %A HSU, Clarissa %A Gordon, Judith R %A Bharucha, Ashok J %J Death Stud %D 2007 Feb %N 2 %P 105-30 %T Family member involvement in hastened death %V 31 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17410692 %X When patients pursue a hastened death, how is the labor of family care-giving affected? The authors examined this question in a qualitative study of 35 families. Four cases reveal the main themes: "taking care" included mutual protection between patients and family members; "midwifing the death" without professional support left families unprepared for adverse events; "tying up loose ends" included dealing with family members' fear of legal consequences; and "moving ahead" involved a greater risk of complicated grief when families encountered complications during the dying process. These results highlight the positive and negative consequences of family members' participation in a hastened death %0 Journal Article %C Kuma Hospital %A Kubota, Sumihisa %A Ohye, Hidemi %A Yano, Genichiro %A Nishihara, Eijun %A Kudo, Takumi %A Ito, Mitsuru %A Fukata, Shuji %A Amino, Nobuyuki %A Kuma, Kanji %A Miyauchi, Akira %J Endocr J %D 2006 Oct %N 5 %P 603-7 %T Two-day thionamide withdrawal prior to radioiodine uptake sufficiently increases uptake and does not exacerbate hyperthyroidism compared to 7-day withdrawal in Graves' disease %V 53 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=16896267 %X The appropriate period of antithyroid drug (ATD) discontinuation before radioiodine therapy is the most critical problem in Graves' disease patients under going treatment with ATD. To determine the optimal period that does not alter the outcome of radioiodine therapy or exacerbate hyperthyroidism, we compared serum FT4 levels at radioiodine uptake (RAIU) and therapy outcomes between a 2-day withdrawal group and 7-day withdrawal group. We prospectively recruited 43 patients for the 2-day withdrawal protocol and retrospectively reviewed 49 patients treated with radioiodine following the protocol of 7-day withdrawal. There was no significant difference in RAIU between the 2 groups. The mean serum FT4 level measured on the first day of 24-h RAIU of the 7-day group was significantly higher than that in the 2-day group. There were no significant differences in the outcomes at each point (6 months, 1 year, and 2 years after therapy) between the 2 groups. Our results indicated that withdrawal of ATD for 2 days is superior to 7 days in that 2 days discontinuation did not exacerbate hyperthyroidism. In order to prevent serum thyroid hormone increase after ATD withdrawal and radioiodine therapy, a 2-day ATD withdrawal period before radioiodine therapy may be useful for high-risk patients such as the elderly and patients with cardiac complications. We believe that the 2-day ATD withdrawal method may be useful for patients undergoing treatment with ATD who are to undergo radioiodine therapy %0 Journal Article %C Department of Radiology, Christie Hospital, Manchester, UK. hans-ulrich.laasch@christie-tr.nwest.nhs.uk %A Laasch, H-U %A Martin, D F %J Endoscopy %D 2007 Mar %N 3 %P 247-55 %T Radiologic gastrostomy %V 39 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17402168 %X Radiologic gastrostomy has a higher success rate and a lower complication rate and offers a greater choice of tubes than percutaneous endoscopic gastrostomy (PEG). The position and configuration of the stomach and colon are clearly seen under fluoroscopy, and ultrasound can be used to locate the liver. Radiologic gastrostomy procedures can be performed when there are oropharyngeal tumors, or esophageal strictures and stents, and can be performed under local anesthesia alone. Peroral push-gastrostomies are preferable for palliative care and for patients with neurogenic dysphagia, but percutaneously inserted tubes should be used in patients with upper gastrointestinal cancers in order to avoid tumor seeding. Unfortunately, awareness of and access to radiologic techniques are still limited and this has led to the development of "adventurous" techniques for placing endoscopes in stomachs rather than applying simple fluoroscopic alternatives %0 Journal Article %C Diplomadas en Enfermeria. Unidad de Cuidados Intensivos. Clinica Universitaria. Universidad de Navarra. Pamplona. Espana. mdelbarrio@unav.es %A Del Barrio Linares, M %A Jimeno San Martin, L %A Lopez Alfaro, P %A Ezenarro Muruamendiaraz, A %A Margall Coscojuela, M A %A Asiain Erro, M C %J Enferm Intensiva %D 2007 Jan-Mar %N 1 %P 3-14 %T [Care to the end-stage patient: help and obstacles perceived by Intensive Care nurses.] %V 18 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17397608 %X BACKGROUND: The Intensive Care Unit (UCI) environment is not the most appropriate for the development of the end-of-life process, due to the fact that ICU is a hi-tech setting and its focus is on curing and giving life support, rather than delivering palliative care to patients. AIMS: To investigate supportive behaviours and obstacles, and the nurses' demographic characteristics. METHOD: A descriptive correlational design was used in five tertiary Spanish hospitals. A convenience sample included 151 critical care nurses. A self-administered anonymous questionnaire (Beckstrand and Kirchhoff, 2005) was used to investigate supportive behaviours and obstacles perceived by nurses providing end-of-life care, in a scale from 0 to 5 (O = not help/obstacle; 5 = main help/obstacle). Some demographic data of the sample were also collected. FINDINGS: Nurses mean age was 35 (min. 22-max. 57; SD = 7,6) and had an average of 9,2 (min. 1-max. 30; SD = 6,9) years of experience working in ICU. Physicians agreeing on direction of patient care was perceived as the most supportive item (x = 4.46); whereas ethics committee constanly involved in the unit as the least supportive one (x = 2.93). The main obstacle for nurses was patient having pain that is difficult to control or alleviate (x = 4.38), and nurses knowing poor prognosis before family was seen as the less important obstacle (x = 1.37) Statistically significant correlations were found between nurses age and years of experience in ICU and their perception of some helps/obstacles. Statistically significant diferences were found between nurses with postgraduate education in intensive care and those without it and their perception of some helps/obstacles. CONCLUSIONS: Intensive care nurses perceive adequate patients' pain management, agreement between health professionals on decision-making, and facilitating a comfortable environment for patients and families, during the whole end-of-life process as a priority %0 Journal Article %C Department. of Chemical Engineering, and Center for Industrial Ecology, School of Forestry and Environmental Studies, Yale University, 205 Prospect St., New Haven, Connecticut 06511, USA. jeremiah.johnson@yale.edu %A Johnson, Jeremiah %A Harper, E M %A Lifset, Reid %A Graedel, T E %J Environ Sci Technol %D 2007 Mar %N 5 %P 1759-65 %T Dining at the periodic table: metals concentrations as they relate to recycling %V 41 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17405228 %X A correlation between the prices of a variety of substances and their dilutions in their initial matrices was shown in 1959 by T.K. Sherwood. The research presented here shows that the relationship holds for engineering metals today, which we termed the metals-specific Sherwood plot. The concentrations of metals in products (e.g., printed wiring boards and automobiles) and waste streams (e.g., municipal solid waste, and construction and demolition debris) were plotted with this correlation. In addition, for the products and waste streams that undergo disassembly at end-of-life, the metals concentrations of the disassembled components were also plotted. It was found that most of the metals that are currently targeted for recycling have post-disassembly concentrations that lie above the metals-specific Sherwood plot (i.e., have concentrations that are more enriched than minimum profitable ore grades). This suggests that material concentration plays a role in the viability of recycling at end-of-life. As products grow in complexity and the variety of materials used, analyses such as this one provide insight for policymakers and those interested in material sustainability into macro-level trends of material use and future recycling practices %0 Journal Article %C aBarrister, Outer Temple Chambers bBarrister, Hailsham Chambers, London %A Foster, Charles %A Carpenter, Jamie %J Eur J Gastroenterol Hepatol %D 2007 May %N 5 %P 389-93 %T Nutritional support at the end of life: the relevant legal issues %V 19 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17413289 %0 Journal Article %C Department of Gastroenterology and Nutrition, Russells Hall Hospital, Dudley, West Midlands, England %A Jones, Barry J M %J Eur J Gastroenterol Hepatol %D 2007 May %N 5 %P 383-8 %T Nutritional support at the end of life: the relevant ethical issues %V 19 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17413288 %X This article attempts to summarize the ethics of nutritional support at the end of life. Although ethics are timeless, they have to be applied or adapted to new situations arising from our ability to prolong life by the application of relatively new nutritional treatments. The application of the law, and guidance from professional bodies on withholding or withdrawing treatment remains an emotive challenge for all involved in nutritional care and for society as a whole %0 Journal Article %C Klinik fur Gynakologie, Departement Frauenheilkunde, Zurich, Schweiz. cornelia.hallenbarter@usz.ch %A Betschart, C %A von Orelli, S %A Mihic, D %A Fink, D %J Gynakol Geburtshilfliche Rundsch %D 2007 %N 1 %P 39-44 %T [Primary malignant melanoma of the vagina--case report and review of the literature] %V 47 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17272935 %X The primary malignant melanoma of the vagina is a very rare tumor with less than 300 cases reported worldwide. Metastatic melanomas of the vagina are even rarer and only 5 cases have been reported so far. We describe the case of patient with a melanoma of the left side of the vagina with a tumor size of 6 cm and a tumor invasion of 2.5 cm. At the time of diagnosis there were no signs of nodal metastases in the positron emission tomography. In the literature, wide local excision with adjuvant radiotherapy is recommended, and radical surgery with adjuvant radiotherapy as second-line therapy. Both procedures show similar 5-year survival rates. To reduce the risk of metastases, we had planned an immunotherapy with interferon-alpha, which has been shown to improve relapse-free and overall survival in patients with high-risk cutaneous melanoma. Unfortunately, the cancer was found to have heavily metastasized 6 months later; the patient therefore received a palliative chemotherapy with dacarbazine and thalidomide %0 Journal Article %C Blessed Sacrament Parish, Madison, USA %A Father, Patrick Norris %J Health Prog %D 2007 Mar-Apr %N 2 %P 46-51 %T The ethics of end-of-life issues. Fr. O'Rourke has made wide-ranging contributions to thinking on the topic %V 88 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17408148 %0 Journal Article %A Yohannes, AM %J Health Qual Life Outcomes %D 2007 Apr %N 1 %P 17 %T Palliative care provision for patients with chronic obstructive pulmonary disease %V 5 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17407591 %X ABSTRACT: Chronic obstructive pulmonary disease (COPD) is a major cause of disability, morbidity and mortality in old age. Patients with advanced stage COPD are most likely to be admitted three to four times per year with acute exacerbations of COPD (AECOPD) which are costly to manage. The adverse events of AECOPD are associated with poor quality of life, severe physical disability, loneliness, depression and anxiety symptoms. Currently there is a lack of palliative care provision for patients with advanced stage COPD compared with cancer patients despite having poor prognosis, intolerable dyspnoea, lower levels of self efficacy, greater disability, poor quality of life and higher levels of anxiety and depression. These symptoms affect patients quality of life and can be a source of concern for family and carers as most patients are likely to be housebound and may be in need of continuous support and care. Evidence of palliative care provision for cancer patients indicate that it improves quality of life and reduces health care costs. The reasons why COPD patients do not receive palliative care are complex. This partly may relate to prognostic accuracy of patients survival which poses a challenge for healthcare professionals, including general practitioners for patients with advanced stage COPD, as they are less likely to engage in end-of-life care planning in contrast with terminal disease like cancer. Furthermore there is a lack of resources which constraints for the wider availability of the palliative care programmes in the health care system. Potential barriers may include unwillingness of patients to discuss advance care planning and end-of-life care with their general practitioners, lack of time, increased workload, and fear of uncertainty of the information to provide about the prognosis of the disease and also lack of appropriate tools to guide general practitioners when to refer patients for palliative care. COPD is a chronic incurable disease; those in an advanced stage of the disease pursuing intensive medical treatment may also benefit from simultaneous holistic care approach of palliative care services, medical services and social services to improve quality of end of life care %0 Journal Article %C Instituto Nacional de Cancer, Centro de Tratamento Intensivo, 10 Andar, Pca. Cruz Vermelha 23, CEP 20230-130, Rio de Janeiro, Brazil, marciosoaresms@yahoo.com.br %A Soares, M %A Terzi, RG %A Piva, JP %J Intensive Care Med %D 2007 Apr %T End-of-life care in Brazil %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17410343 %0 Journal Article %C Birmingham/Atlanta VA Geriatric Research, Education, and Clinical Center University of Alabama at Birmingham %A Williams, BR %A Sawyer, Baker P %A Allman, RM %A Roseman, JM %J J Aging Health %D 2007 Apr %N 2 %P 313-333 %T Bereavement Among African American and White Older Adults %V 19 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17413138 %X PURPOSE: The authors examined epidemiology and sociodemographic predictors of spousal, nonspousal family, and friendship bereavement among African American and White community-dwelling older adults using longitudinal data from 839 participants of the University of Alabama at Birmingham Study of Aging, a prospective cohort study of a random sample of Alabama Medicare beneficiaries. METHOD: Authors calculated cumulative incidences of each type of loss and used logistic regression to identify factors significantly and independently associated with loss. RESULTS: Of participants, 71% reported at least one loss; 50% reported nonspousal family loss, and 37% reported friendship loss. For married participants, the cumulative incidence of spousal loss was 8.1%. Female sex and income < $12,000 were predictors of spousal loss. Female sex and education >/= 12 years were predictors of friendship loss. Higher educated African American women were at greater risk of nonspousal family loss. DISCUSSION: Future research should examine bereavement burden and identify health outcomes of multiple losses %0 Journal Article %C Department of Palliative and Supportive Services, Flinders University, Bedford Park, South Australia, Australia %A Currow, David C %A Stevenson, James P %A Abernethy, Amy P %A Plummer, John %A Shelby-James, Tania M %J J Am Geriatr Soc %D 2007 Apr %N 4 %P 590-5 %T Prescribing in palliative care as death approaches %V 55 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17397439 %X OBJECTIVES: To determine how prescribing for comorbid illnesses and symptom control changes during the palliative phase of a terminal illness. DESIGN: This prospective cohort study explores the relative contribution to prescribing of symptom-specific medications (SSMs) and long-term medications for comorbid medical conditions. SETTING: Regional consultative palliative care program, Adelaide, South Australia. PARTICIPANTS: Two hundred sixty consecutive patients, 96% of whom had cancer, who enrolled and subsequently died in a larger randomized trial exploring palliative service delivery. MEASUREMENTS: Medication and performance data were collected monthly from referral until death (mean 107 days, median 93 days, standard deviation (SD) 103 days, range 11-752 days). Prespecified subgroup analyses of age, performance status, and the baseline use of medications for comorbid medical conditions were performed. RESULTS: At baseline, the mean total number of medications+/-SD was 4.9+/-2.8 (range 0-16), SSMs was 2.3+/-1.5 (range 0-7), and medications for comorbid medical conditions was 2.6+/-2.4 (range 0-13). As death approached, the total number of medications increased because of SSM prescribing (2.5 more medications, 95% confidence interval (CI)=2.2-2.9; P<.001) with a decrease in medications for comorbid medical conditions (1.1 fewer medications, 95% CI=0.8-1.3; P<.001). There was an increase in the number of medications meeting Beers' criteria for high-risk inappropriate medication use for SSMs (29% to 48%). More SSMs were prescribed in people with better performance status, and older participants took more medications for comorbid medical conditions. CONCLUSION: Prescribing changes as life-limiting illnesses progress, with older people taking more medications. Medications for comorbid medical conditions should be reviewed in the context of their original therapeutic goals %0 Journal Article %C Department of Psychology and Organizational Science, College of Arts and Sciences, University of North Carolina, Charlotte, NC 28223, USA %A Rogelberg, Steven G %A Reeve, Charlie L %A Spitzmuller, Christiane %A DiGiacomo, Natalie %A Clark, Olga L %A Teeter, Lisa %A Walker, Alan G %A Starling, Paula G %A Carter, Nathan T %J J Am Vet Med Assoc %D 2007 Mar %N 5 %P 713-9 %T Impact of euthanasia rates, euthanasia practices, and human resource practices on employee turnover in animal shelters %V 230 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17331057 %X OBJECTIVE: To examine the effects of euthanasia rates, euthanasia practices, and human resource practices on the turnover rate among employees with euthanasia responsibilities at animal shelters. DESIGN: Cross-sectional original study. SAMPLE POPULATION: 36 shelters across the United States that employed at least 5 full-time employees and performed euthanasia on site. PROCEDURES: By mail, 1 survey was sent to each shelter. Surveys were completed by a senior member of management and were returned by mail. Questions assessed characteristics (eg, euthanasia rates) and practices of the animal shelter, along with employee turnover rates. By use of correlation coefficients and stepwise regression analyses, key predictors of turnover rates among employees with euthanasia responsibilities were investigated. RESULTS: Employee turnover rates were positively related to euthanasia rate. Practices that were associated with decreased turnover rates included provision of a designated euthanasia room, exclusion of other live animals from vicinity during euthanasia, and removal of euthanized animals from a room prior to entry of another animal to be euthanized. Making decisions regarding euthanasia of animals on the basis of factors other than behavior and health reasons was related to increased personnel turnover. With regard to human resources practices, shelters that used a systematic personnel selection procedure (eg, standardized testing) had comparatively lower employee turnover. CONCLUSIONS AND CLINICAL RELEVANCE: Data obtained may suggest several specific avenues that can be pursued to mitigate turnover among employees with euthanasia responsibilities at animal shelters and animal control or veterinary medical organizations %0 Journal Article %C Centre for the Diagnosis and Treatment of Congenital Heart Defects, Ospedali Riuniti di Bergamo, Bergamo, Italy %A Seddio, Francesco %A Migliazza, Lucia %A Borghi, Adele %A Crupi, Giancarlo %J J Cardiovasc Med (Hagerstown) %D 2007 Feb %N 2 %P 119-22 %T Previous palliation in patients with tetralogy of Fallot does not influence the outcome of later repair %V 8 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17299294 %X OBJECTIVE: Primary repair is the treatment of choice in patients with tetralogy of Fallot. The timing of repair, however, remains controversial, and an initial palliative procedure might be considered a valuable option in the early management of symptomatic young infants and in those with either unfavourable anatomy, major associated lesions or chromosomal abnormalities with a poor life expectancy. METHODS: We reviewed the management of 100 consecutive patients with tetralogy of Fallot who were operated upon at our department during an 8-year period from June 1995 to March 2003. The rationale for the choice of the initial management and the outcome in terms of morbidity and mortality in patients who underwent primary repair was compared to that observed in patients who had had a two-stage repair. RESULTS: Age less than 3 months, the presence of either an unfavourable anatomy or major associated defects and genetic disorders with poor life expectancy were the indications for an initial palliation, which was carried out in 31 patients. There were no hospital deaths, and 28 of these patients underwent later repair with one hospital death (3.5%). Two patients with severe chromosomal abnormalities died at home and the remainder required a further palliation because of severely hypoplastic pulmonary arteries. Primary repair was carried out in 69 patients with one hospital death (1.4%). A transannular patch, which was used in 80% of our patients, was not an incremental risk factor for death regardless of the type of repair. Eight patients were reoperated on because of either residual right ventricular outflow tract obstruction with (four patients) or without (one patient) residual ventricular septal defect or isolated residual ventricular septal defect (three patients). All reoperations occurred in patients undergoing primary repair. CONCLUSIONS: The outcome of patients undergoing repair of tetralogy of Fallot is not influenced in terms of either mortality or morbidity by an initial palliative procedure %0 Journal Article %C *Department of Gastroenterology, Universite Libre de Bruxelles, Belgium daggerDepartment of Internal Medicine, Henry Ford Health System, Detroit, MI %A Antaki, F %A Lukowski, A %J J Clin Gastroenterol %D 2007 Apr %N 4 %P 412-415 %T The Model for End-stage Liver Disease (MELD) Predicts Survival of Liver Cirrhosis Patients After Discharge to Hospice %V 41 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17413612 %X AIM: To assess if the Model for End-stage Liver Disease (MELD) score correlates with survival of liver cirrhosis patients after discharge to hospice. METHODS: Patients who were discharged to a hospice program for decompensated liver cirrhosis during a 7-year period were identified. MELD score was calculated for all patients. Medical records and the Social Security Death Index (SSDI) were used to determine the exact date of death and survival after discharge. RESULTS: Fifty patients were identified. Average MELD score was 26.4. Exact date of death was available for 42 of these patients. Average survival after discharge to hospice was 36.83 days. There was a moderate correlation (r=-0.61, P<0.0001) between MELD scores and survival after hospice discharge. The area under the receiver operating characteristic curve for MELD score predicting 30-day mortality was 0.84. MELD score >/=25 predicted 30-day mortality with a sensitivity of 74.19%, a specificity of 90.91%, and an accuracy of 78.58%. The positive predictive value was 95.83% and the negative predictive value 55.56%. CONCLUSIONS: Patients with cirrhosis who are not candidates for liver transplantation are referred to hospice care at a late stage with an average survival of 1 month. The MELD score correlates with survival of cirrhosis patients enrolled in hospice and can be used to estimate 30-day mortality. Further, research is needed to determine a MELD score that predicts a survival of 6 months or less, an important determinant of appropriate hospice referrals %0 Journal Article %C School of Nursing, The University of Salford, Lancashire, UK %A Evans, Marie Josephine %A Hallett, Christine E %J J Clin Nurs %D 2007 Apr %N 4 %P 742-51 %T Living with dying: a hermeneutic phenomenological study of the work of hospice nurses %V 16 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17402956 %X Aims. (i) Explore the meaning of comfort care for hospice nurses. (ii) Provide an understanding of how this work is pursued in the hospice setting. (iii) Examine the means by which hospice nurses provide comfort to hospice patients. Background. The concepts of 'comfort' and 'comfort care' have long been a subject for examination by nurse researchers. The paper provides an overview of selected, relevant literature in this area. The methods used by nurse researchers have almost always been qualitative, and have focused on the meaning of nursing care for dying patients, from both nurses' and patients' perspectives. Design and methods. The paper reports a hermeneutic phenomenological study of the work of 15 hospice nurses based in one hospice in the north of England. Sampling was purposive, and data were collected by means of semi-structured interviews. A reflective diary was also kept. The interpretation of data was guided by phenomenological and hermeneutic methodology. Results. The nurses interviewed spoke openly about their experiences of working with hospice patients. They saw the relief of suffering through 'comfort care' as an important element of their work. The findings are presented under three thematic headings: 'Comfort and relief', 'Peace and ease' and 'Spirituality and meaning'. Conclusion. Hermeneutic phenomenology is an important method for uncovering the complex realities of nursing work. The nurses' perspectives on 'comfort care' they offer to patients were revealed by the data presented here, which were interpreted to offer a unique perspective on this type of nursing work. Relevance to clinical practice. These findings offer insights to nurses in both hospice and other settings; they give a number of perspectives on the nature of 'comfort care' and the meanings attached to it by experienced hospice nurses' %0 Journal Article %C Eric.Reiman@bannerhealth.com %A Reiman, Eric M %J J Clin Psychiatry %D 2007 Mar %N 3 %P 428-9 %T Clinical trials and tribulations %V 68 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17388714 %0 Journal Article %C Department of Public Health, University of Liverpool, Liverpool, UK %A Hanratty, Barbara %A Burstrom, Bo %A Walander, Anders %A Whitehead, Margaret %J J Health Serv Res Policy %D 2007 Apr %N 2 %P 90-4 %T Inequality in the face of death? Public expenditure on health care for different socioeconomic groups in the last year of life %V 12 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17407658 %X OBJECTIVE: To investigate the association between public expenditure on health care in the last year of life and individual socioeconomic status in Sweden. METHODS: Population-based study of public expenditure using linked registers for all 16,617 deaths among Stockholm County Council residents in 2002 (population 1.8 million). Age-standardized, total and per capita spend were calculated by income categories, age and specialty. Multivariate analysis examined the association between socioeconomic status and public expenditure. RESULTS: County council expenditure on health care in the last year of life rose with increasing income of the deceased person. Median per capita expenditure increased from 55,417 Swedish Kronor (SEK) (US$ 7542) in the lowest income group to SEK 94,678 (US$ 12,887) in the highest. Total age-standardized spend increased by 60% across the same interval (80,227 [95% confidence interval (CI) 79,946-80,497] to SEK 127,344 [95% CI 126,969-127,719]). Expenditure decreased with increasing age over 65 years in all income groups. Higher income was independently associated with greater total public health spend in multivariate analysis, adjusting for age, sex, health-care utilization and major diagnostic groups. CONCLUSIONS: There is inequality in public expenditure on health care at the end of life across socioeconomic groups in Stockholm. This phenomenon merits attention within Sweden, and beyond, in countries with less comprehensive welfare systems %0 Journal Article %A Cole, B Eliot %J J Opioid Manag %D 2007 Jan-Feb %N 1 %P 5-7 %T Can we continue to do business as usual? %V 3 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17367088 %0 Journal Article %C Unidade de Cuidados Continuados, Instituto Portugues de Oncologia, Porto, Portugal %A Goncalves, Ferraz %J J Opioid Manag %D 2006 May-Jun %N 3 %P 174-6 %T Morphine toxicity in renal failure %V 2 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17319451 %0 Journal Article %C Southern Illinois University, Carbondale, USA %A Kapp, Marshall B %J J Opioid Manag %D 2006 May-Jun %N 3 %P 128-9 %T Pain control for dying patients: hastening death or ensuring comfort? %V 2 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17319445 %0 Journal Article %C Department of Science and Research in Palliative Medicine, University of Bonn; and Center for Palliative Medicine, Malteser Hospital Bonn/Rhein-Sieg Bonn, Germany %A Clemens, Katri Elina %A Klaschik, Eberhard %J J Pain Symptom Manage %D 2007 Apr %N 4 %P 473-81 %T Symptomatic therapy of dyspnea with strong opioids and its effect on ventilation in palliative care patients %V 33 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17397708 %X This study assessed the effect of opioid treatment on ventilation in dyspneic palliative care patients who received symptomatic treatment with strong opioids. The assessments measured changes in peripheral arterial oxygen saturation (SaO(2)), transcutaneous arterial pressure of carbon dioxide (tcPCO(2)), respiratory rate (f), and pulse rate (PF) during the titration phase with morphine or hydromorphone. The aims of the study were to verify the efficacy of opioids for the management of dyspnea, assess the effect on ventilation, and show whether nasal O(2) insufflation before opioid application leads to a decrease in the intensity of dyspnea. Eleven patients admitted to our palliative care unit were included in this prospective, nonrandomized trial. At admission, all patients suffered from dyspnea. tcPCO(2), SaO(2), and PF were measured transcutaneously by means of a SenTec Digital Monitor (SenTec AG, Switzerland). During O(2) insufflation, the intensity of dyspnea did not change. In contrast, the opioid produced a significant improvement in the intensity of dyspnea (P=0.003). Mean f decreased as early as 30minutes after the first opioid administration, declining from 41.8+/-4.7 (35.0-50.0) to 35.5+/-4.2 (30.0-40.0), and after 90minutes, to 25.7+/-4.5 (20.0-32.0) breaths/min. Other monitored respiratory parameters, however, showed no significant changes. There was no opioid-induced respiratory depression %0 Journal Article %C Pain Relief and Palliative Care Unit (K.M., E.S., E.P., A.G.), and Department of Radiology (L.V.), Areteion Hospital, School of Medicine, University of Athens, Athens, Greece %A Mystakidou, Kyriaki %A Tsilika, Eleni %A Parpa, Efi %A Galanos, Antonis %A Vlahos, Lambros %J J Pain Symptom Manage %D 2007 Apr %N 4 %P 454-61 %T Psychometric properties of the impact of event scale in greek cancer patients %V 33 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17397706 %X To develop the Greek version of the Impact of Event Scale-Revised (IES-R-Gr), assess its psychometric properties, and finally to examine the impact of cancer diagnosis to a palliative care patient sample, the IES-R was translated into Greek using the "forward-backward" procedure. It was administered twice, at one-week intervals, to 82 eligible patients with advanced cancer. Together with the IES-R-Gr scale, the patients also completed the Hospital Anxiety and Depression (HAD) Scale. Reliability was assessed in terms of internal consistency (Cronbach's alpha coefficients) and test/retest (Spearman's r value and Kendall's tau-b). Construct validity was demonstrated through association with the HAD Scale, and convergence and discriminative validity and interscale correlations were also assessed. The Greek version of the IES-R had Cronbach's alphas for the intrusion, avoidance, and hyperarousal scales of 0.72, 0.77, and 0.85, respectively. Overall test-retest reliability was satisfactory at P<0.0005. Satisfactory construct validity was supported by the correlation analysis between the IES-R-Gr subscales and anxiety and depression. Factor analysis yielded three factors, explaining 57.26% of the variance. Interscale and interitem correlations were found satisfactory at P<0.0005. These results demonstrate that the IES-R-Gr is an instrument with satisfactory psychometric properties and is a valid research tool for the impact of cancer diagnosis in advanced cancer patients %0 Journal Article %C School of Nursing (S.T.T., M.-L.C.), Chang Gung University, Tao-Yuan; National Taipei College of Nursing (E.-W.H.), Taipei; Bureau of Health Promotion (S.-L.K., S.-C.H.), Department of Health, Taipei; and Sun Yat-Sen Cancer Center (G.L.L.), Taipei, Taiwan, Republic of China %A Tang, ST %A Chen, ML %A Huang, EW %A Koong, SL %A Lin, GL %A Hsiao, SC %J J Pain Symptom Manage %D 2007 Apr %N 4 %P 446-453 %T Hospice Utilization in Taiwan by Cancer Patients Who Died Between 2000 and 2004 %V 33 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17397705 %X To facilitate utilization of hospice services, Taiwan uses the National Health Insurance (NHI) as a major policy instrument. To evaluate the effect of this policy on hospice utilization by cancer patients during their final year of life, a retrospective cohort study was conducted by linking individual patient-level data from the National Register of Deaths Database and the NHI claims database to examine changes in the rates of hospice utilization, durations of patient survival (DOS) after enrollment, and the rates of late referrals to hospice care from 2000 to 2004. Among the 103,097 cancer patients who died between 2000 and 2004, the rate of hospice utilization during their final year of life grew substantially from 5.5% to 15.4%. However, Taiwanese cancer patients were enrolled in hospice care close to death (median DOS ranged from 14 to 47 days). Except for the small proportion of patients who received both inpatient hospice care and hospice home care, one-third to one-fourth of cancer decedents died within 7 days after being enrolled in hospice care. Although the rate of late referrals to hospice care did not vary much over time, the mean DOS for hospice care changed significantly. Many Taiwanese cancer patients who could potentially benefit from hospice care do not receive it in time. Further research is warranted to investigate factors influencing hospice use and the timing of hospice referrals to facilitate appropriate use of hospice care for cancer patients in Taiwan %0 Journal Article %C The Center on Age and Community/Applied Gerontology (J.K.), University of Wisconsin-Milwaukee, Milwaukee, Wisconsin; School of Aging Studies (J.R.S.), University of South Florida, Tampa, Florida; Department of Nursing Education (K.D.A.), The George Washington University School of Medicine and Health Sciences, Washington, DC; National Hospice and Palliative Care Organization (K.B.), Alexandria, Virginia; The Hospice Institute of the Florida Suncoast (K.A.E.), Clearwater, Florida, and The Center for Hospice, Palliative Care and End-of-life Studies (K.A.E.), University of South Florida, Tampa, Florida, USA %A Kwak, J %A Salmon, JR %A Acquaviva, KD %A Brandt, K %A Egan, KA %J J Pain Symptom Manage %D 2007 Apr %N 4 %P 434-445 %T Benefits of Training Family Caregivers on Experiences of Closure During End-of-Life Care %V 33 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17397704 %X Caregiving at Life's End (CGLE) is a program for family caregivers caring for someone during the last years of life that focuses on the emotional, spiritual, and practical aspects of life and relationship completion and closure. This study evaluated the effectiveness of CGLE in improving three major outcomes: comfort with caregiving, closure, and caregiver gain. Family caregivers (n=2,025) participated in programs facilitated by health and human service professionals (n=142) who completed a CGLE train-the-trainer workshop conducted by The Hospice Institute of the Florida Suncoast. The caregivers completed training rosters and pre- and/or post-surveys. Group differences are reported in baseline characteristics and change in three outcomes for caregivers who completed 1) both pre- and post-survey, 2) pre-survey only, and 3) post-survey only. For those who completed both surveys (n=926), paired t-tests and multiple linear regression tested the impact of program length on caregiver outcomes. Caregivers participated in, on average, four sessions and 7.7 hours of training. The majority of caregivers were Caucasian (88%), female (81%), and on average, 60 years old. Significant improvement was found in all three outcomes (P<0.001). The program length made a difference for improvement in comfort with caregiving and closure but not in caregiver gain. Caregivers who are caring for someone during the last years of life benefit from a program that focuses on the life-changing or transformative aspects of caregiving in the last years of life, as well as practical aspects of caregiving. The ability to support caregivers in this relatively low impact intervention can be used in hospice and nonhospice settings %0 Journal Article %C Temmy Latner Centre for Palliative Care (A.F.H., V.C., S.L.L.), Mount Sinai Hospital, and Division of Family and Community Medicine (A.F.H., R.M., V.C., S.L.L.), University of Toronto, Toronto, Ontario, Canada; Sheffield Macmillan Unit for Palliative Care (K.S.), Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK; Hospital for Sick Children (R.A.), University of Toronto, Toronto, Ontario, Canada; and Palliative Medicine & Supportive Care Program (D.D.), Kingston Regional Cancer Center, Queen's University, Kingston, Ontario, Canada %A Husain, AF %A Stewart, K %A Arseneault, R %A Moineddin, R %A Cellarius, V %A Librach, SL %A Dudgeon, D %J J Pain Symptom Manage %D 2007 Apr %N 4 %P 389-397 %T Women Experience Higher Levels of Fatigue Than Men at the End of Life: A Longitudinal Home Palliative Care Study %V 33 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17397700 %X Few studies have evaluated sex differences in the prevalence, severity, and correlates of fatigue at the end of life. The Brief Fatigue Inventory, McGill Quality of Life (MQOL) Questionnaire, and Karnofsky Performance Scale were administered at two-week intervals to 102 patients in a home palliative program. Outcomes in the sample and a regional palliative database (n=3,096) were analyzed. Cancer was the diagnosis in 96% of patients enrolled. Prevalence (P=0.0091) and severity of fatigue (P<0.001) were higher in women at entry and in a repeated measures analysis over time (severity, P=0.0048). Performance status did not explain this difference. MQOL scores were inversely correlated to fatigue (Spearman coefficient=-0.48, P<0.0001), but did not differ by sex. There was no difference in fatigue interference with MQOL in women and men. Although depression was higher in women (P=0.042) and related to fatigue at entry, it did not explain the sex difference in fatigue scores. Of the sociodemographic variables examined, neither education nor living situation contributed to the fatigue difference. This study shows a sex effect in the fatigue experienced by patients with advanced illnesses, which is not explained by baseline differences in performance, depression, MQOL, education, or living situation. That fatigue interference with MQOL is the same for men and women suggests that higher fatigue scores in women reflect not only a difference in the dimension of fatigue severity, but are also relevant in relation to impact on QOL. Assessment of fatigue should include the dimension of QOL important for both women and men %0 Journal Article %C Division of Nursing Research, Department of Oncology, Patient Care Services, and St. Jude Palliative and End-of-Life Care Task Force at St. Jude Children's Research Hospital, Memphis, TN 38105, USA %A Hinds, PS %A Brandon, J %A Allen, C %A Hijiya, N %A Newsome, R %A Kane, JR %J J Pediatr Psychol %D 2007 Apr %T Patient-Reported Outcomes in End-of-Life Research in Pediatric Oncology %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17403912 %X OBJECTIVE: The purpose of this review of published literature was to identify the number and focus of empirically based papers that included research methods used to directly solicit patient-reported outcomes (PRO) from pediatric oncology patients at end of life. METHODS: Key terms including "pediatric or child and oncology or cancer and end of life or palliative or hospice or dying" were used with five data bases (PubMed, Ovid, Cochrane, PsycInfo & PsycArticles, and CINAHL) for English language literature published between January, 2001 and June, 2006. All retrieved documents were independently reviewed by a panel of six (nurses, physicians, and one psychologist) with backgrounds in pediatric oncology. RESULTS: Thirty-five publications were identified but nine (25.7%) were eliminated from the analysis as they did not meet inclusion criteria. Of the remaining 26, four (15.4%) included patient-reported outcomes, six (23.1%) included parent only-reported outcomes, and five (19.2%) included staff only-reported outcomes. Nine (34.6%) were retrospective medical record reviews. Two (7.7%) included parent and record review data or parent and physician reports. CONCLUSIONS: Empirically-based end-of-life publications in pediatric oncology are relatively few in number and nearly 85% of completed studies do not include PRO %0 Journal Article %C Department of Preventive Medicine, School of Public Health, Seoul National University. health21@cheju.ac.kr %A Choo, Soo-Young %A Lee, Sang-Yi %A Kim, Chul-Woung %A Kim, Su Young %A Yoon, Tae-Ho %A Shin, Hai Rim %A Moon, Ok Ryun %J J Prev Med Pub Health %D 2007 Jan %N 1 %P 36-44 %T [Educational differences in health care utilization in the last year of life among South Korean cancer patients] %V 40 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17310597 %X OBJECTIVES: There have been few studies examining the differences in health care utilization across social classes during the last year of life. Therefore, in this study we analyzed the quantitative and qualitative differences in health care utilization among cancer patients across educational classes in their last year of life, and derived from it implications for policy. METHODS: To evaluate health care utilization by cancer patients in the last year of life, Death certificate data from 2004 were merged with National Health Insurance data (n = 60,088). In order to use educational level as a social class index, we selected the individuals aged 40 and over as study subjects (n = 57,484). We analyzed the differences in the medical expenditures, admission days, and rates of admission experience across educational classes descriptively. Multiple regression analysis was conducted to evaluate the association between medical expenditures and independent variables such as sex, age, education class, site of death and type of cancer. RESULTS: The upper educational class spent much more on medical expenditures in the last one year of life, particularly during the last month of life, than the lower educational class did. The ratio of monthly medical expenditures per capita between the college class and no education class was 2.5 in the last 6-12 months of life, but the ratio was 1.6 in the last 1 month. Also, the lower the educational class, the higher the proportion of medical expenditures during the last one month of life, compared to total medical expenditures in the last one year of life. The college educational class had a much higher rate of admission experiences in tertiary hospitals within Seoul than the other education classes did. CONCLUSIONS: This study shows that the lower educational classes had qualitative and quantitative disadvantages in utilizing health care services for cancer in the last year of life %0 Journal Article %C Err. Dunant Hospital, Surgical Services, 107-9 Mesogion Avenue, Block A/7th Floor, Athens, Greece. ipapadim@dunant.gr %A Papadimitriou, John D %A Skiadas, Panayiotis %A Mavrantonis, Constantinos S %A Polimeropoulos, Vassilis %A Papadimitriou, Dimitris J %A Papacostas, Kyriaki J %J J R Soc Med %D 2007 Jan %N 1 %P 25-8 %T Euthanasia and suicide in antiquity: viewpoint of the dramatists and philosophers %V 100 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17197683 %0 Journal Article %C Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea %A Choi, Jin Soo %A Choo, Sung Wook %A Park, Kwang Bo %A Shin, Sung Wook %A Yoo, So-Young %A Kim, Ji Hye %A Do, Young Soo %J Korean J Radiol %D 2007 Jan-Feb %N 1 %P 57-63 %T Interventional management of malignant colorectal obstruction: use of covered and uncovered stents %V 8 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17277564 %X OBJECTIVE: We wanted to evaluate usefulness of uncovered stent in comparison with covered stent for the palliative treatment of malignant colorectal obstruction. MATERIALS AND METHODS: Covered (n = 52, type 1 and type 2) and uncovered (n = 22, type 3) stents were placed in 74 patients with malignant colorectal obstruction. Stent insertion was performed for palliative treatment in 37 patients (covered stent: n = 23 and uncovered stent: n = 14). In the palliative group, the data on the success of the procedure, the stent patency and the complications between the two groups (covered versus uncovered stents) were compared. RESULTS: The technical success rate was 89% (33/37). Symptomatic improvement was achieved in 86% (18/21) of the covered stent group and in 92% (11/12) of the uncovered stent group patients. The period of follow-up ranged from three to 319 days (mean period: 116+/-85 days). The mean period of stent patency was 157+/-33 days in the covered stent group and 165+/-25 days in the uncovered stent group. In the covered stent group, stent migration (n = 11), stent fracture (n = 2) and poor expansion of the stent (n = 2) were noted. In the uncovered stent group, tumor ingrowth into the stents (n = 3) was noted. CONCLUSION: Self-expanding metallic stents are effective for relieving malignant colorectal obstruction. The rate of complications is lower in the uncovered stent group than in the covered stent group %0 Journal Article %A Agarwal, Ritesh %J Lung Cancer %D 2007 Feb %N 2 %P 253-4 %T Iodopovidone: an inexpensive and effective agent for chemical pleurodesis %V 55 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17118489 %0 Journal Article %C Division of Hematology, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN 55905, USA. dispenzieri.angela@mayo.edu %A Dispenzieri, Angela %A Rajkumar, S Vincent %A Gertz, Morie A %A Fonseca, Rafael %A Lacy, Martha Q %A Bergsagel, P Leif %A Kyle, Robert A %A Greipp, Philip R %A Witzig, Thomas E %A Reeder, Craig B %A Lust, John A %A Russell, Stephen J %A Hayman, Suzanne R %A Roy, Vivek %A Kumar, Shaji %A Zeldenrust, Steven R %A Dalton, Robert J %A Stewart, A Keith %J Mayo Clin Proc %D 2007 Mar %N 3 %P 323-41 %T Treatment of newly diagnosed multiple myeloma based on Mayo Stratification of Myeloma and Risk-adapted Therapy (mSMART): consensus statement %V 82 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17352369 %X Multiple myeloma is a neoplastic plasma cell dyscrasia that on a yearly basis affects nearly 17,000 individuals and kills more than 11,000. Although no cure exists, many effective treatments are available that prolong survival and improve the quality of life of patients with this disease. The purpose of this consensus is to offer a simplified, evidence-based algorithm of decision making for patients with newly diagnosed myeloma. In cases in which evidence is lacking, our team of 18 Mayo Clinic myeloma experts reached a consensus on what therapy could generally be recommended. The focal point of our strategy revolves around risk stratification. Although a multitude of risk factors have been identified throughout the years, including age, tumor burden, renal function, lactate dehydrogenase, beta2-microglobulin, and serum albumin, our group has now recognized and endorsed a genetic stratification and patient functional status for treatment %0 Journal Article %A Samuels, Alec %A Barrister, J P %J Med Sci Law %D 2007 Jan %N 1 %P 90-2 %T Assisted dying for the terminally ill %V 47 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17345899 %0 Journal Article %C Diagnostic and Surgical Endoscopy Unit, National Cancer Institute, 20133 Milan, Italy. pasquale.spinelli@istitutotumori.mi.it %A Spinelli, Pasquale %A Calarco, Giuseppe %A Mancini, Andrea %A Ni, Xiao-Guang %J Minim Invasive Ther Allied Technol %D 2006 %N 6 %P 339-47 %T Operative colonoscopy in cancer patients %V 15 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17190658 %X Gastrointestinal endoscopy has experienced tremendous developments in technology and equipment over the past decades. It is not only a diagnostic tool, but it also allows some interventional treatments in benign and malignant digestive diseases. Operative colonoscopy has been used to perform curative treatment of various kinds of polyps, flat and carpet-like adenomas and early colorectal carcinomas. Endoscopic palliative treatment strategies, such as the placement of self-expandable metal stents (SEMS), laser ablation, photodynamic therapy (PDT), argon plasma coagulation (APC), electrocoagulation, and injection therapy, have been proved to effectively alleviate advanced colorectal cancer (CRC) associated symptoms and maintain or improve the quality of the patient's remaining life %0 Journal Article %C University of New Mexico Children's Hospital, Albuquerque, USA. tromesberg@salud.unm.edu %A Romesberg, Tricia L %J Neonatal Netw %D 2007 Mar-Apr %N 2 %P 111-5 %T Building a case for neonatal palliative care %V 26 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17402603 %X The concept of palliative care, well recognized in the adult population, has not been fully implemented in the pediatric population. Yet there is an urgent need to define and provide excellence in end-of-life care for infants and their families. Beneficent end-of-life care for the dying neonate includes efforts directed at comfort care, assistance with end-of-life decision making, and bereavement support. Through research and education, the challenges to implementing neonatal palliative care programs can be overcome. This article describes the components of neonatal palliative care, identifies the challenges associated wiith the implementation of such programs, and proposes strategies for addressing these challenges %0 Journal Article %C Department of Renal Medicine, Birmingham Heartlands Hospital, Birmingham, UK %A Lambie, Mark %A Rayner, Hugh C %A Bragg-Gresham, Jennifer L %A Pisoni, Ronald L %A Andreucci, Vittorio E %A Canaud, Bernard %A Port, Friedrich K %A Young, Eric W %J Nephrol Dial Transplant %D 2006 Oct %N 10 %P 2814-20 %T Starting and withdrawing haemodialysis--associations between nephrologists' opinions, patient characteristics and practice patterns (data from the Dialysis Outcomes and Practice Patterns Study) %V 21 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=16820372 %X BACKGROUND: The incidence and prevalence of haemodialysis vary widely across countries. The variation may be attributable to differences in the incidence of end-stage renal disease and/or in the availability of haemodialysis. Previous studies have identified differences in nephrologists' opinions about the availability of haemodialysis and its appropriateness for patients with comorbidities. We studied the associations between nephrologists' opinions, availability of haemodialysis, patient characteristics and comorbidities, and facilities' withdrawal rates. METHODS: Most of our analyses used data from 242 haemodialysis units in six countries (France, Germany, Italy, Spain, UK and the USA) in the first phase of the Dialysis Outcomes and Practice Patterns Study (DOPPS I). Opinions about access to and practice patterns in dialysis facilities, measured by the level of agreement with standardized statements, were collected from medical directors and nurse managers. A sub-analysis considered data from corresponding facilities in DOPPS II. RESULTS: We found wide variations in the prevalence of waiting lists for new dialysis patients (UK 60%; USA 25%; Germany 0%; P < 0.05), in agreement with starting haemodialysis for patients with advanced age, dementia and comorbidities (UK, France < USA < other countries; P < 0.05), and in agreement with withdrawing dialysis (other countries < UK/USA; P < 0.05). The estimated glomerular filtration rate at the start of dialysis was not significantly different in units with waiting lists. Significant associations were found between nephrologists' opinions and the odds of patients being > or =80 years old, and between opinions and the rate and relative risk of withdrawal of haemodialysis. No significant associations were found between opinions and patients' comorbidities or dependency. CONCLUSION: Differences within and across countries in nephrologists' opinions regarding starting and withdrawing haemodialysis reflect differences in access to haemodialysis and the practice of withdrawal of haemodialysis in their facilities %0 Journal Article %A Wijdicks, Eelco F M %A Rabinstein, Alejandro A %J Neurology %D 2007 Apr %N 14 %P 1092-4 %T The family conference: end-of-life guidelines at work for comatose patients %V 68 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17404189 %0 Journal Article %J Nurs Law Regan Rep %D 2007 Jan %N 8 %P 3 %T FL: can RN opine on testamentary capacity?: court declared patient's will null and void. Miami Rescue Mission, Inc. v. Roberts, No. 3D06-1037 (Fla. App. 11/29/2006) So.2d -FL %V 47 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17310605 %0 Journal Article %A Stein, Loren N M %J Okla Nurse %D 2007 Mar-May %N 1 %P 22-3; quiz 24-5 %T Scarce resources: altered standards of care in a disaster %V 52 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17330709 %0 Journal Article %C International Outreach Program and Department of Hematology/Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA. Scott.howard@stjude.org %A Howard, Scott C %A Marinoni, Marco %A Castillo, Luis %A Bonilla, Miguel %A Tognoni, Gianni %A Luna-Fineman, Sandra %A Antillon, Federico %A Valsecchi, Maria Grazia %A Pui, Ching-Hon %A Ribeiro, Raul C %A Sala, Alessandra %A Barr, Ronald D %A Masera, Giuseppe %J Pediatr Blood Cancer %D 2007 Mar %N 3 %P 364-9 %T Improving outcomes for children with cancer in low-income countries in Latin America: a report on the recent meetings of the Monza International School of Pediatric Hematology/Oncology (MISPHO)-Part I %V 48 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=16883601 %X The difference in survival for children diagnosed with cancer between high- and low-income countries (LIC) continues to widen as curative therapies are developed in the former but not implemented in the latter. In 1996, the Monza International School of Pediatric Hematology/Oncology (MISPHO) was founded in an attempt to narrow this survival gap. During its sixth and seventh meetings, members recognized the problem of lack of affordability of essential drugs to treat childhood cancer in many LIC, and initiated an advocacy program. In 1998, MISPHO spawned a collaboration of Central American pediatric oncology centers: the Asociacion de Hemato-Oncologia Pediatrica Centroamericana (AHOPCA). AHOPCA members reported preliminary findings from several of the 10 cooperative protocols that are currently in progress. In 2003, a second regional collaborative group was formed that includes seven centers in South America. Twinning programs between MISPHO centers and centers in high-income countries (HIC) have proven invaluable to harness the resources of these centers to improve pediatric oncology care in LIC. MISPHO educational efforts include oncology nursing, supportive care, cancer-specific updates, epidemiology, and clinical research methods. Educational efforts are facilitated by educational content and online conferencing via www.cure4kids.org. Identifying preventable causes of abandonment of therapy and documenting the nutritional status of patients treated at MISPHO centers are areas of active research %0 Journal Article %C Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, The Netherlands. h.hbijma@freeler.nl %A Bijma, Hilmar H %A Van der Heide, Agnes %A Wildschut, Hajo I J %A Van der Maas, Paul J %A Wladimiroff, Juriy W %J Prenat Diagn %D 2007 Feb %N 2 %P 97-103 %T Impact of decision-making in a multidisciplinary perinatal team %V 27 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17191258 %X OBJECTIVES: (1) To describe the characteristics of decision-making about management of unborn infants with serious anomalies by a multidisciplinary perinatal team. (2) To evaluate the impact of multidisciplinary team discussions on the degree to which decisions about the management of unborn infants with serious anomalies are supported. (3) To evaluate the impact of the team discussions on the arguments used by physicians for their preferences concerning management. METHODS: Prospective analysis of 78 cases discussed within the multidisciplinary perinatal team of a tertiary centre by means of an anonymous one-page questionnaire with structured questions pertaining to the opinion of the responder on medical management of each case. RESULTS: We did not find systematic differences between specialties prior to the discussion of cases. However, discussion with the multidisciplinary perinatal team improved decision-making about management of unborn infants with serious anomalies by enhancing the degree of support for the decisions taken. The discussions of the team did not change the physicians' arguments mentioned for their preferences. CONCLUSION: Multidisciplinary team discussions improve decision-making about management of unborn infants with serious congenital anomalies %0 Journal Article %C Nuclear Medicine Unit, Department of Radiological Sciences, University of Messina, Messina, Italy %A Minutoli, F %A Herberg, A %A Spadaro, P %A Restifo Pecorella, G %A Baldari, S %A Arico, D %A Altavilla, G %A Baldari, S %J Q J Nucl Med Mol Imaging %D 2006 Dec %N 4 %P 355-62 %T [186Re]HEDP in the palliation of painful bone metastases from cancers other than prostate and breast %V 50 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17043634 %X AIM: Palliative therapy using [186Re]hydroxyethylidene diphosphonate (HEDP) has been widely tested in patients with bone metastases from prostate and breast cancers. Whereas, to the best of our knowledge, only few cases of bone metastases from tumors other than prostate and breast treated with [186Re]HEDP have been reported. The aim of this paper is to report our experience with 186Re-HEDP in the palliation of painful bone metastases from tumors other than prostate and breast. METHODS: In this study 41 patients (17 non-small cell lung cancer-NSCLC, 1 small cell lung cancer, 1 lung neuroendocrine tumor, 8 bladder cancer, 3 kidney cancer, 3 gastric cancer, 1 uterine carcinoma, 1 colon cancer, 1 rhinopharynx carcinoma, 1 medullary thyroid carcinoma, 1 ovarian cancer, 1 esophagus cancer, 2 carcinoma of unknown origin) are evaluated. All patients had lesions with increased [99mTc]MDP uptake and none had radiological findings of mainly osteolytic lesions. A total of 46 therapeutic cycles were performed using a [186Re]HEDP activity of 1 295 MBq for each administration. After treatment, patients were followed up for 3 months or to the time of pain recurrence (if longer than 3 months). Responses were evaluated using a validated method considering the modifications of pain index, analgesic intake and performance status. RESULTS: Treatment efficacy was complete in 49% (20/41) of patients, partial in 36% (15/41) and negative in 15% (6/41). Namely, we observed 35% (6/17) complete, 41% (7/17) partial and 24% (4/17) negative responses in patients with NSCLC and 63% (5/8) complete, 25% (2/8) partial and 12% (1/8) negative responses in patients affected by bladder cancer. The median duration of pain relief in responder patients was 10 weeks. A mild platelet toxicity occurred in 32% (13/41) of patients. CONCLUSIONS: Pain palliation with [186Re]HEDP seems highly effective and safe also in patients with bone metastases from cancers other than prostate and breast. Patients who can benefit from the treatment with [186Re]HEDP can be selected on the basis of [99mTc]MDP bone scan and radiological examination findings %0 Journal Article %C Department of Health Sciences, University of Leicester, UK. rb14@le.ac.uk %A Baker, Richard %A Sullivan, Emma %A Camosso-Stefinovic, Janette %A Rashid, Aly %A Farooqi, Azhar %A Blackledge, Hanna %A Allen, Justin %J Qual Saf Health Care %D 2007 Apr %N 2 %P 84-9 %T Making use of mortality data to improve quality and safety in general practice: a review of current approaches %V 16 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17403750 %X OBJECTIVE: To review studies of the use of mortality data in quality and safety improvement in general practice. DESIGN: Narrative review. METHODS: Search of Medline, Embase and CINAHL for articles reporting mortality monitoring or mortality reviews in general practice. The included articles were reported in English and of any study design, excluding case reports and comment pieces. Studies of palliative care and bereavement, and of primary care programmes in developing countries, were excluded. RESULTS: 229 articles were identified in the searches, 65 were identified as potentially relevant and 53 were included in the review. The studies addressed the impact of primary care provision on mortality rates, methods of monitoring mortality, and the role of audit and death registers in quality and safety improvement. General practitioners were interested in using mortality data but reported difficulties in obtaining complete information. There were no experimental studies of the impact of the use of mortality data, and little evidence of long-term systematic initiatives to use mortality data in quality and safety improvement in general practice. CONCLUSIONS: Mortality data are not used systematically in general practice although general practitioners appear interested in the potential of this information in improving quality and safety. Improved systems to provide complete data are needed and experimental studies required to determine the effectiveness of use of the data to improve general practice care %0 Journal Article %A Vallat, F %J Rev Sci Tech %D 2006 Dec %N 3 %P 951-60 %T [Austrian Low Countries, Europe's animal health pioneer, 1769-1776] %V 25 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17361762 %X Two previously unpublished manuscripts reveal how innovative the Austrian Low Countries were when they introduced an animal health policy to control rinderpest in 1769. The policy was novel in that it replaced the slaughter of individual sick animals with herd slaughter. Unfortunately, a number of neighbouring countries failed to emulate this sure-fire method of controlling rinderpest, among them France