%0 Journal Article
%C St. Clare Hospice, Hastingwood, Essex, United Kingdom
%A Abbas, SQ
%J J Pain Symptom Manage
%D 2007 Jun
%T Pleural Effusion Aspiration in a Small Hospice Setting
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17555918

%0 Journal Article
%C Hamilton Health Sciences, Hamilton, ON. alvarkim@hhsc.ca
%A Alvarado, Kim
%J Can J Nurs Leadersh
%D 2007 
%N 1
%P 72-90
%T Factors influencing implementation of medical directives by registered nurses: the experience of a large Ontario teaching hospital
%V 20
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17472142
%X OBJECTIVE: To understand factors that affect the implementation of medical directives by registered nurses in a large teaching hospital. DESIGN: Qualitative nested case study. PARTICIPANTS AND SETTING: A large multi-site teaching hospital that utilizes over 20 different medical directives was chosen as the setting for this case study. Three distinct medical directives within this setting were selected to obtain maximum variation in the number of individuals involved in a particular directive and type of clinical area. Between March and October 2005, 27 individuals concerned with clinical implementation of these medical directives were interviewed using a semi-structured interview schedule. The registrars of two regulatory bodies that oversee policies related to medical directives and a consultant with expertise in medical directives were also interviewed. Eleven documents related to the use of medical directives were identified using purposive document sampling methods and were included in the study. RESULTS: Implementation of medical directives is influenced by a variety of factors, including nurse confidence and willingness to assume responsibility, the amount of new learning needed to carry out the directive and additional paperwork required. Perceived usefulness of the medical directive, physician support of nurses' use of the directives and frequency of encounter with that type of patient were also important factors. The implementation of a medical directive is a complex process; directives are difficult to write well and often affect the scope of practice of other healthcare professionals. The amount of education and monitoring required to implement a directive needs careful consideration to ensure the appropriate resources are available to support implementation. CONCLUSIONS: Greater attention to the factors that facilitate implementation of medical directives is required in order to implement directives in an efficient and effective manner

%0 Journal Article
%C Royal National Throat Nose and Ear Hospital, London, UK
%A Anagnostou, F
%A Graham, J
%A Crocker, S
%J Cochlear Implants Int
%D 2007 Jun
%N 2
%P 68-86
%T A preliminary study looking at parental emotions following cochlear implantation
%V 8
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17549804
%X This preliminary research investigated the emotions of parents with cochlear implanted children. The object for the research was first to compare four emotions engendered in parents of deaf children before and after cochlear implantation. Second, to monitor changes in these emotions during a period of up to four years after implantation. Third, to see whether any of the emotions studied was significantly more prominent than the others, and fifth to identify any differences in emotions that were related to the gender of parents.A self-report questionnaire was given to 112 participants of whom 53 replied. There were equal groups of parents in two categories, those with children up to two years after implantation, and those two to four years after implantation. The responses were interpreted using parametric statistics. The results highlight that grief is the strongest emotional condition that parents experience before and up to two years after implantation, alongside family adjustments. Parents of the up to two years after implantation group generally have stronger feelings and are less satisfied than parents in the over two years implanted group. Finally, fathers use denial more than mothers. Considerations for future research and implications for paediatric cochlear implant teams will be discussed. Copyright (c) 2007 John Wiley & Sons, Ltd

%0 Journal Article
%C Department of Surgery (T.A.), University of Texas, Southwestern Medical Center, and Veterans Administration North Texas Health Care System (T.A.), Dallas, Texas; Gastroenterology and Hepatology Department (T.B.), Mayo Clinic-Rochester, Rochester, Minnesota; Oncology Department (S.M.), La Maddalena Cancer Center, Palermo, Italy; Department of Biometry (S.G.), Arizona Cancer Center, University of Arizona, Tucson, Arizona; Department of Surgery (D.C.), Memorial Sloan-Kettering Cancer Center, New York, New York; Division of Gastroenterology (J.C.) and Department of Surgery (A.H., R.S.K.), University of Arizona College of Medicine, Tucson, Arizona; National Coalition for Cancer Survivorship (E.S.), Silver Spring, Maryland; and Southern Arizona Veterans Affairs Health Care System (R.S.K.); Tucson, Arizona, USA
%A Anthony, T
%A Baron, T
%A Mercadante, S
%A Green, S
%A Chi, D
%A Cunningham, J
%A Herbst, A
%A Smart, E
%A Krouse, RS
%J J Pain Symptom Manage
%D 2007 May
%T Report of the Clinical Protocol Committee: Development of Randomized Trials for Malignant Bowel Obstruction
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17544243
%X Malignant bowel obstruction (MBO) is a commonly encountered palliative care problem. There have been very few comparative trials in this area, and consequently there is very little clinical evidence upon which therapy can be rationally based. The purpose of this paper is to highlight the discussion and decision-making process that was undertaken by the Clinical Protocol Subcommittee during the development of a proposed clinical trial of best medical care versus surgical or endoscopic treatment for MBO. The development of the proposed clinical trials followed an orderly process. The first step taken was a discussion of a specific definition for MBO. Once agreed upon, this definition helped identify inclusion and exclusion criteria for the proposed trial. This was followed by an extensive literature review, which helped define both surgical and endoscopic approaches to MBO as well as what constituted best medical care. An extensive discussion was then undertaken concerning the best outcome measure of success for medical, surgical, and endoscopic interventions. All of the above steps culminated in two proposed protocols, one for MBO of the small intestine distal to the ligament of Treitz and a second for colonic obstructions. The small intestinal trial is designed to compare surgical intervention versus best medical care, whereas the colonic trial seeks to compare surgery with endoscopically placed intraluminal stents coupled with best medical care

%0 Journal Article
%C Department of Radiology, Royal Cornwall Hospital, Truro, Cornwall, United Kingdom. euan.armstrong@ukonline.co.uk
%A Armstrong, Euan M
%A Fox, Bruce M
%J Dis Colon Rectum
%D 2007 Mar
%N 3
%P 399-400
%T Assistance of colorectal stent insertion by sphincterotome
%V 50
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17216143
%X PURPOSE: Palliation of patients with unresectable colorectal carcinoma is an effective treatment and technical failure is undesirable. Insertion of colorectal stent using a combined radiologic and colonoscopic technique may be technically limited by the ability to negotiate tortuous bends, particularly if the bowel is fixed. METHODS: We used a through scope sphincterotome, which improved the ability to traverse difficult strictures. RESULTS: We have used the technique in four cases as a last resort. This resulted in a technical success in all four cases (100 percent). CONCLUSIONS: Sphincterotome is a useful adjunct in stenting difficult colorectal tumor strictures

%0 Journal Article
%C School of Nursing, Oregon Health and Science University, Portland, OR 97239-2941, USA
%A Baggs, Judith Gedney
%A Norton, Sally A
%A Schmitt, Madeline H
%A Dombeck, Mary T
%A Sellers, Craig R
%A Quinn, Jill R
%J J Crit Care
%D 2007 Jun
%N 2
%P 159-68
%T Intensive care unit cultures and end-of-life decision making
%V 22
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17548028
%X PURPOSE: Prior researchers studying end-of-life decision making (EOLDM) in intensive care units (ICUs) often have collected data retrospectively and aggregated data across units. There has been little research, however, about how cultures differ among ICUs. This research was designed to study limitation of treatment decision making in real time and to evaluate similarities and differences in the cultural contexts of 4 ICUs and the relationship of those contexts to EOLDM. MATERIALS AND METHODS: Ethnographic field work took place in 4 adult ICUs in a tertiary care hospital. Participants were health care providers (eg, physicians, nurses, and social workers), patients, and their family members. Participant observation and interviews took place 5 days a week for 7 months in each unit. RESULTS: The ICUs were not monolithic. There were similarities, but important differences in EOLDM were identified in formal and informal rules, meaning and uses of technology, physician roles and relationships, processes such as unit rounds, and timing of initiation of EOLDM. CONCLUSIONS: As interventions to improve EOLDM are developed, it will be important to understand how they may interact with unit cultures. Attempting to develop one intervention to be used in all ICUs is unlikely to be successful

%0 Journal Article
%C University of Wales, Swansea
%A Bain, Steve
%J Dent Update
%D 2007 Apr
%N 3
%P 188
%T Physical signs for the general dental practitioner. Case 43. Beau's lines
%V 34
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17506461

%0 Journal Article
%C Mid West HSE, Limerick Mental Health Services, St Joseph's Hospital, Ireland. mary.begley@mailh.hse.ie
%A Begley, Mary
%A Quayle, Ethel
%J Crisis
%D 2007 
%N 1
%P 26-34
%T The lived experience of adults bereaved by suicide: a phenomenological study
%V 28
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17555030
%X In recent years, a plethora of research studies have attempted to delineate the grief experiences associated with suicide from those of other sudden traumatic deaths. The emerging consensus suggests that bereavement through suicide is more similar than different to other bereavements, but is characterized by the reactions of shame, stigma, and self-blame. The causal nature of these reactions has yet to be fully understood. This study reports on the lived experiences of eight adults bereaved by suicides, which were obtained through in-depth interviews. Data were analyzed using interpretative phenomenological analysis. Four main themes dominated the relatives' grief experiences. First, the early months were checkered by attempts to "control the impact of the death." The second theme was the overwhelming need to "make sense of the death" and this was coupled with a third theme, a marked "social uneasiness." Finally, participants had an eventual realization of a sense of "purposefulness" in their lives following the suicide death. Overall, the findings suggest that suicide bereavement is molded and shaped by the bereaved individual's life experiences with the deceased and their perceptions following social interactions after the event. The findings from this study suggest that "meaning making" may be an important variable in furthering our understanding of the nuances in suicide bereavement

%0 Journal Article
%C Washington State University, Intercollegiate College of Nursing, Spokane, USA
%A Bindler, Ruth C
%A Ball, Jane W
%J Pediatr Nurs
%D 2007 Mar-Apr
%N 2
%P 121-6
%T The Bindler-Ball Healthcare Model: a new paradigm for health promotion
%V 33
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17542233
%X Nursing of children requires integration of components from many knowledge areas, and nurses must consistently plan and carry out interventions to promote health and prevent disease and injury for children and adolescents. A new healthcare model is applied to child health nursing within all healthcare contexts, from acute care settings to chronic care services to well child focused care. Health promotion and health maintenance are defined and explored, along with application of these concepts in major types of care along the healthcare continuum. The influences of family, culture, and community are viewed as integral to health promotion strategies. The nurse plans for health promotion and health maintenance activities during all acute, chronic, and end-of-life care for youth. The healthcare model is a new and creative method in which to frame healthcare for children

%0 Journal Article
%C Union University, 1050 Union University Dr., Jackson, TN 38305, USA
%A Blakley, Theresa L
%J J Pastoral Care Counsel
%D 2007 Spring-Summer
%N 1-2
%P 59-69
%T Murder and faith: a reflected case study of pastoral interventions in traumatic grief
%V 61
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17547249
%X Pastoral response to death in the family of a congregate is familiar terrain for most ministers. Pastors are often called upon to pray for the sick, comfort the bereaved, and preside at memorial services and graveside gatherings. While most get some orientation in the work of death and dying in seminary, few are prepared to minister effectively to church members who suffer traumatic bereavement caused by human-perpetrated violence. This paper describes the power of facilitated cathartic narrative, bearing witness, and reflective meaning-making in a case study involving a pastor, his wife, and the grief-stricken widow of a murdered comrade in ministry

%0 Journal Article
%C VA Medical Center-Nursing, 4150 Clement St (118), San Francisco, CA 94121. Martha.Buffum@va.gov
%A Buffum, Martha D
%A Hutt, Evelyn
%A Chang, Victor T
%A Craine, Michael H
%A Snow, A Lynn
%J J Rehabil Res Dev
%D 2007 
%N 2
%P 315-30
%T Cognitive impairment and pain management: Review of issues and challenges
%V 44
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17551882
%X The assessment and treatment of pain in persons with cognitive impairments pose unique challenges. Disorders affecting cognition include neurodegenerative, vascular, toxic, anoxic, and infectious processes. Persons with memory, language, and speech deficits and consciousness alterations are often unable to communicate clearly about their pain and discomfort. Past research has documented that persons with cognitive impairments, particularly dementia, are less likely to ask for and receive analgesics. This article provides an overview of the assessment, treatment, and management of pain in adults with cognitive impairments. We review types of cognitive impairment; recent work specific to best practices for pain management in patients with dementia, including assessment-tool development and pharmacological treatment; challenges in patients with delirium and in medical intensive care and palliative care settings; and directions for future research

%0 Journal Article
%C Section Hematology Oncology (111), VA New Jersey Health Care System, Associate Professor of Medicine, New Jersey Medical School, PDIA Faculty Scholar, 385 Tremont Avenue, East Orange, NJ 07018. Victor.chang@med.va.gov
%A Chang, Victor T
%A Sorger, Brooke
%A Rosenfeld, Kenneth E
%A Lorenz, Karl A
%A Bailey, Amos F
%A Bui, Trinh
%A Weinberger, Lawrence
%A Montagnini, Marcos
%J J Rehabil Res Dev
%D 2007 
%N 2
%P 279-94
%T Pain and palliative medicine
%V 44
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17551879
%X Severe pain is highly prevalent, with rates of 40% to 70% in patients with advanced cancer, liver disease, heart failure, human immunodeficiency virus, and renal failure. Wide variations in pain assessment and reporting methods and the measurement of multiple symptoms should be addressed in future studies. Regarding psychological approaches, determining whether hypnotherapy or other individual psychotherapeutic interventions reduce pain and/or psychological distress in a palliative care population is difficult. Interest is increasing in the concept of demoralization syndromes and the role of posttraumatic stress disorder in modulating responses to pain at the end of life. We review evidence from multiple studies that the use of rehabilitative therapy improves functional status and pain control among patients with advanced cancer, and we raise the possibility that rehabilitation therapy will be helpful in patients with other advanced diseases. We summarize ongoing clinical trials of electronic order sets, clinical care pathways, and care management pathways to improve pain management in palliative care. Wagner's Chronic Illness Model provides a way of analyzing how healthcare systems can be changed to provide adequate and continuing pain management in palliative care. Much work remains to ensure that pain is recognized, treated, and monitored effectively

%0 Journal Article
%C Discipline of Psychological Medicine, Monash University, Melbourne, General Hospital and Primary Care Psychiatry, Monash Medical Centre, Melbourne, and beyondblue, The National Depression Initiative, Victoria, Australia
%A Clarke, David M
%J Aust J Rural Health
%D 2007 Jun
%N 3
%P 148-54
%T Growing old and getting sick: Maintaining a positive spirit at the end of life
%V 15
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17542785
%X End of life throws up significant mental health challenges. A high proportion of people in the terminal stages of illness experience depressive symptoms. This paper integrates a theory of hierarchy of human needs and empirical research describing experiences of grief and depression in terminal illness, to develop a model of care aimed at reducing depression and suffering. This care attends to physical, psychological, social and spiritual aspects, taking into account the concerns of patients and their families. Professional help can be offered to patients to restore dignity and hope, strengthen their ways of coping, and encourage social connections. To offer this, a well-resourced and coordinated, multidisciplinary and skilled workforce is needed

%0 Journal Article
%C Department of Health Services Management and Leadership, School of Public Health and Health Services, The George Washington University Medical Center, USA
%A Darr, Kurt
%J J Health Law
%D 2007 Winter
%N 1
%P 29-63
%T Physician-assisted suicide: legal and ethical considerations
%V 40
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17549931
%X As medicine's technical limits have become increasingly clear, Americans seem more willing to address end-of-life decisionmaking. A major development during the 1990s was physician assistance in dying: physician-assisted suicide in Michigan, Oregon's Death with Dignity Act, and developments in Europe, most notably The Netherlands. This evolution toward recognizing the appropriateness of assistance in dying raises legal and ethical issues for physicians and healthcare institutions such as nursing facilities and acute care hospitals. These issues include the effects on providers' values systems, the trust between patient and provider, and the "slippery slope" that voluntary, active assistance in dying will become involuntary, active assistance. This Article addresses the policy issues that institutions must confront in a changing environment

%0 Journal Article
%A Davis, Carol
%J Nurs Stand
%D 2007 May
%N 36
%P 20-1
%T Caring for children at home
%V 21
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17549970
%X There are wide variations in the way children's palliative care needs are met in the community. Researchers are helping to improve services

%0 Journal Article
%C Divisione di Nefrologia, Dipartimento di Scienze Biomediche e Chirurgiche, Azienda Ospedaliera, Universita' degli Studi, Verona - Italy
%A De Biase, V
%A Tobaldini, O
%A Casarotti-Todeschini, S
%A Gambaro, G
%J G Ital Nefrol
%D 2007 May-Jun
%N 3
%P 255-61
%T [Treatment of uremia in frail elderly patients: the issue of prolonged conservative management.]
%V 24
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17554738
%X The chronic use of renal replacement therapy in frail elderly patients sometimes provides no tangible benefits and may even have a negative fallout on their quality of life, making prolonged conservative management a reasonable option. However, this is mostly a feeling, since very few papers have addressed this issue and there is no evidence-based medicine related to it. On the other hand, ethical issues are extraordinarily relevant and in this clinical setting extend beyond topics such as end-of-life care and advance care planning. It is evident that clinical decision-making in frail elderly patients with endstage renal disease may be very difficult and needs to be supported by ad hoc clinical trials. In the meantime, the ethical issues must be discussed in society

%0 Journal Article
%A Duggleby, Wendy
%J Int J Palliat Nurs
%D 2007 Apr
%N 4
%P 152
%T Making a difference in palliative care nursing
%V 13
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17551417

%0 Journal Article
%C College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
%A Duggleby, Wendy
%A Wright, Karen
%A Williams, Allison
%A Degner, Lesley
%A Cammer, Allison
%A Holtslander, Lorraine
%J J Palliat Care
%D 2007 Spring
%N 1
%P 24-31
%T Developing a living with hope program for caregivers of family members with advanced cancer
%V 23
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17444459
%X A theory-based intervention, the Living with Hope Program (LWHP), was designed to foster hope in caregivers of family members with advanced cancer. The LWHP was developed from qualitative data and using Harding and Higginson's recommendations for family caregiver interventions as a guide. The LHWP is: (a) focused specifically on the caregivers themselves, (b) theory based, (c) feasible, (d) acceptable, and (e) pilot tested. The program consists of a hope video and a hope activity titled Stories of the Present. A mixed-method, concurrent triangulation, pre- and post-test design was used to pilot test the LWHP The results of the pilot test suggest the LWHP is easy to use, flexible, and feasible, and shows promise in increasing hope and quality of life scores in family caregivers

%0 Journal Article
%C Department of Palliative Care, Policy and Rehabilitation, King's College London, Denmark Hill, London, UK. polly.edmonds@kcl.ac.uk
%A Edmonds, P
%A Vivat, B
%A Burman, R
%A Silber, E
%A Higginson, I J
%J Mult Scler
%D 2007 Jun
%N 5
%P 660-7
%T ;Fighting for everything': service experiences of people severely affected by multiple sclerosis
%V 13
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17548447
%X BACKGROUND: No previous research exists specifically exploring the needs of those people severely affected by multiple sclerosis (MS). METHODS: Semi-structured interviews were conducted with people identified by the referring health or social care professional as being severely affected by their MS and informal carers, in order to explore their perceptions of their illness and care. The data were analysed for themes using the constant comparative approach. RESULTS: The data relate to 32 people severely affected by MS, who identified several broad themes, relating to loss and change, and provision of services and care. In relation to service provision, people with MS (PwMS) and their carers identified two, interlinked themes - a lack of continuity and co-ordination of care, and a lack of information about services, aids and adaptations, welfare benefits and end-of-life issues. A further theme was identified, which underpinned and linked the two other themes, that of ;fighting for everything' - a sense that people had to struggle for their needs to be met. CONCLUSION: There is a need to develop models of care in order to better meet patients and carers needs for information, co-ordination, and to reduce the feeling of struggling to receive services

%0 Journal Article
%A Forrest, Sarah
%A Barclay, Stephen
%J Br J Gen Pract
%D 2007 Jun
%N 539
%P 503
%T Viewpoint - Palliative care: A task for everyone
%V 57
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17550684

%0 Journal Article
%A Fortune, Peter-Marc
%J BMJ
%D 2007 May
%N 7603
%P 1072
%T Are we asking the right questions?
%V 334
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17525410

%0 Journal Article
%C Neurodevelopmental Disabilities Program, Children's Hospital Boston, Division of General Pediatrics, Boston, MA 02115, USA. Sandra.friedman@childrens.harvard.edu
%A Friedman, Sandra
%A Gilmore, Dana
%J Intellect Dev Disabil
%D 2007 Apr
%N 2
%P 90-7
%T Factors that impact resuscitation preferences for young people with severe developmental disabilities
%V 45
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17428144
%X A cross-sectional descriptive study was performed to evaluate resuscitation decisions and factors that impact these choices for young people with severe developmental disabilities residing in a skilled nursing facility. Decision-makers were provided with information to clarify resuscitation preferences. Parents/guardians of 30 of the 67 residents also completed a survey. A significant number of decision-makers changed their resuscitation preference to DNR after detailed explanations were provided. Survey results suggest that interpersonal relationships, such as those with family members, religious leader, and physician, were more influential for families who chose full resuscitation compared to those with DNR preferences. Factors such as perception of quality of life and medical condition of the individuals with developmental disabilities were not significantly different between these two groups

%0 Journal Article
%C Divisione di Nefrologia, Dipartimento di Scienze Biomediche e Chirurgiche, Azienda Ospedaliera, Universita' degli Studi, Verona - Italy
%A Gambaro, G
%J G Ital Nefrol
%D 2007 Maggio-Giugno
%N 3
%P 240-254
%T [Advance directives for health care: law initiatives in the current legislature.]
%V 24
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17554737
%X no abstract

%0 Journal Article
%C Catedratica en la Facultad de Ciencias y Tecnologia del Recinto Metropolitano de la Universidad Interamericana de Puerto Rico, San Juan
%A Gaya Gonzalez, Lillian
%J P R Health Sci J
%D 2006 Dec
%N 4
%P 347-54
%T [In Process Citation]
%V 25
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17550103
%X Recently the world was drawn into the news of the Terri Schiavo case. Like in that case many other patients and relatives face similar situation. We foresee more medical and legal struggles caused primarily by the use of advanced life-sustaining medical technology that could prolong the life of human beings with progressive neurodegenerative disorders, or acquired irreversible brain injury. This is an appropriate time to ponder the course of action when we "neither live nor die". We agree, as Terri Schiavo's parents' representatives affirm, that Terri was not in a terminal state (end-of-life situation). Her life could have been prolonged for another fifteen years. However, her clinical presentation was not easy to comprehend by some. That way Terri has become a window through which the educated public realized that ethical decisions regarding medical affairs are always played in an environment of uncertainty and probabilities. One of the factors that make such situation more painful is the patient's incompetence to respond. In the long run, despite the family tragedy, we can not deny that the Schiavo case provides us the basis for a thorough and careful reflection about our human brittleness

%0 Journal Article
%C Division of Nephrology, Department of Medicine, Tufts University, Boston, Massachusetts, USA, and Baystate Medical Center, Springfield, Massachusetts, USA
%A Germain, Michael J
%A Cohen, Lewis M
%A Davison, Sara N
%J Semin Dial
%D 2007 May-Jun
%N 3
%P 195-9
%T Withholding and withdrawal from dialysis: what we know about how our patients die
%V 20
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17555480
%X Withholding and withdrawal of dialysis has been a reality since dialysis was invented. Only in the past 20 years has it been formally studied, and we still have a great deal to learn. The nephrology community has slowly come to accept that, for some of our patients, not having dialysis is a better option than continuing or initiating therapy. The principles of palliative care throughout the disease trajectory and hospice care at end of life are germane to this population due to its high symptom burden and mortality rate. We review what is currently known concerning patients who choose to withhold or withdraw from dialysis, and the current barriers (and solutions) to providing them with optimal palliative care

%0 Journal Article
%C Reproductive Toxicology Division, National Health and Environmental Effects Research Laboratory, Office of Research and Development, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina 27711, USA. goldman.jerome@epa.gov
%A Goldman, Jerome M
%A Murr, Ashley S
%A Cooper, Ralph L
%J Birth Defects Res B Dev Reprod Toxicol
%D 2007 Apr
%N 2
%P 84-97
%T The rodent estrous cycle: characterization of vaginal cytology and its utility in toxicological studies
%V 80
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17342777
%X While an evaluation of the estrous cycle in laboratory rodents can be a useful measure of the integrity of the hypothalamic-pituitary-ovarian reproductive axis, it can also serve as a way of insuring that animals exhibiting abnormal cycling patterns are disincluded from a study prior to exposure to a test compound. Assessment of vaginal cytology in regularly cycling animals also provides a means to establish a comparable endocrine milieu for animals at necropsy. The procedure for obtaining a vaginal smear is relatively non-invasive and is one to which animals can become readily accustomed. It requires few supplies, and with some experience the assessments can be easily performed in fresh, unstained smears, or in fixed, stained ones. When incorporated as an adjunct to other endpoint measures, a determination of a female's cycling status can contribute important information about the nature of a toxicant insult to the reproductive system. In doing so, it can help to integrate the data into a more comprehensive mechanistic portrait of the effect, and in terms of risk assessment, may provide some indication of a toxicant's impact on human reproductive physiology

%0 Journal Article
%C Leeds General Infirmary, Leeds, UK
%A Gratrix, Andrew P
%A Pittard, Alison J
%A Bodenham, Andrew R
%J Anaesthesia
%D 2007 May
%N 5
%P 434-7
%T Outcome after admission to ITU following out-of-hospital cardiac arrest: are non-survivors suitable for non-heart-beating organ donation?
%V 62
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17448052
%X We have reviewed retrospective data from two large UK teaching hospitals regarding outcome following out-of-hospital cardiac arrest and the suitability of non-survivors for non-heart-beating organ donation. Patients were selected retrospectively from consecutive admissions from two intensive care units who had presented following out-of-hospital cardiac arrest, to a total of 50 patients in each centre. They had all been resuscitated to achieve a spontaneous cardiac output at the scene, in transit or after arrival in hospital, and required further intensive care support due to cardiovascular, respiratory, or neurological impairment. Eighty-six patients (86%) died in the Intensive Care Unit and only 14 (14%) survived to discharge from the Unit. A further nine (9%) patients died in hospital before discharge home. Four patients (4%) were alive after 6 months and three (3%) were alive after 1 year. Fifty-seven (57%) of patients had active withdrawal of treatment with only four (4%) being potentially suitable for organ procurement having not been excluded because of age, medical history or the length of time to die following withdrawal of treatment. Our results show that only a small increase in donor organs could be potentially achieved from this population. Further work is required to determine whether such patients should be considered as non-heart-beating donors

%0 Journal Article
%C Philosophy Department, Campus Box 232, University of Colorado, Boulder, CO 80309-0232, USA. bhale@colorado.edu
%A Hale, B
%J J Med Ethics
%D 2007 Jan
%N 1
%P 24-7
%T Culpability and blame after pregnancy loss
%V 33
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17209106
%X The problem of feeling guilty about a pregnancy loss is suggested to be primarily a moral matter and not a medical or psychological one. Two standard approaches to women who blame themselves for a loss are first introduced, characterised as either psychologistic or deterministic. Both these approaches are shown to underdetermine the autonomy of the mother by depending on the notion that the mother is not culpable for the loss if she "could not have acted otherwise". The inability to act otherwise is explained as not being as strong a determinant of culpability as it may seem at first. Instead, people's culpability for a bad turn of events implies strongly that they have acted for the wrong reasons, which is probably not true in the case of women who have experienced a loss of pregnancy. The practical conclusion of this paper is that women who feel a sense of guilt in the wake of their loss have a good reason to reject both the psychologistic and the deterministic approaches to their guilt-that they are justified in feeling upset about what has gone wrong, even responsible for the life of the child, but are not culpable for the unfortunate turn of events

%0 Journal Article
%C Medical Psychology Research Unit (K.H., J.M.C., P.N.B., R.H., M.H.N.T.), NHMRC Clinical Trials Centre (S.M.P., S.W., S.C., D.G.), School of Psychology (P.N.B., R.H.), and Department of Cancer Medicine (M.H.N.T.), University of Sydney, Camperdown, New South Wales; Department of Palliative Care (J.M.C.), Royal North Shore Hospital, St. Leonards, New South Wales; Palliative and Supportive Services (D.C.), Flinders University, Bedford Park, South Australia; and Department of Palliative Care (P.G.), Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
%A Hancock, K
%A Clayton, JM
%A Parker, SM
%A Walder, S
%A Butow, PN
%A Carrick, S
%A Currow, D
%A Ghersi, D
%A Glare, P
%A Hagerty, R
%A Tattersall, MH
%J J Pain Symptom Manage
%D 2007 May
%T Discrepant Perceptions About End-of-Life Communication: A Systematic Review
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17544247
%X Little research has compared the perceptions of health professionals (HPs), patients, and caregivers about the communication of prognostic information. The objectives of this literature review were to determine 1) patient and caregiver perceptions of levels of information received about prognosis and end-of-life (EoL) issues regarding a life-limiting illness; 2) patient perceptions of, and factors related to their understanding and awareness of prognosis; 3) HPs' perceptions of patients wishes about disclosure of prognosis and factors related to their decision whether to disclose; and 4) concordance between HPs and patients/caregivers regarding the information given by HPs about prognostic and EoL issues. Relevant studies meeting the inclusion criteria were identified by searching computerized databases (MEDLINE, EMBASE, CINAHL, PsychINFO, Cochrane Register of Controlled Trials [Central]) up to November 2004. The reference lists of identified studies were hand searched for further relevant studies. Inclusion criteria were studies of any design evaluating communication of prognostic information that included adult patients with an advanced, life-limiting illness; their caregivers; and qualified HPs. Fifty-one studies were identified. There was a large discrepancy between patients/caregivers and HPs regarding the amount of information they believed had been given. Patients' understanding and awareness of information received conflicted with the HPs' perceptions of patients' understanding and awareness of the information that had been given. HPs tended to underestimate patients' need for information and overestimate patients' understanding and awareness of their prognosis and EoL issues. HPs need to repeatedly check patients' understanding and preferences for information

%0 Journal Article
%C Specialist Registrar in Palliative Medicine, Ty Oliven, Morriston Hospital, Swansea, UK. dgharris@doctors.org.uk
%A Harris, Dylan
%J Postgrad Med J
%D 2007 Jun
%N 980
%P 362-6
%T Forget me not: palliative care for people with dementia
%V 83
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17551065
%X Dementia is a progressive life limiting condition with increasing prevalence and complex needs. Palliative care needs of patients with dementia are often poorly addressed; symptoms such as pain are under treated while these patients are over subjected to burdensome interventions. Research into palliative care in dementia remains limited but recent developments together with national guidelines and policies set foundations for improving the delivery of palliative care to this group of the population

%0 Journal Article
%C Jaeb Center for Health Research, 15310 Amberly Drive, Tampa, FL 33647, USA. pedig@jaeb.org
%A Hertle, Richard W
%A Scheiman, Mitchell M
%A Beck, Roy W
%A Chandler, Danielle L
%A Bacal, Darron A
%A Birch, Eileen
%A Chu, Raymond H
%A Holmes, Jonathan M
%A Klimek, Deborah L
%A Lee, Katherine A
%A Repka, Michael X
%A Weakley, David R Jr
%J Arch Ophthalmol
%D 2007 May
%N 5
%P 655-9
%T Stability of visual acuity improvement following discontinuation of amblyopia treatment in children aged 7 to 12 years
%V 125
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17502505
%X OBJECTIVE: To assess the stability of visual acuity improvement during the first year after cessation of amblyopia treatment other than spectacle wear in children aged 7 to 12 years. METHODS: At the completion of a multicenter randomized trial during which amblyopia treated with patching and atropine improved by at least 2 lines on the electronic Early Treatment of Diabetic Retinopathy Study testing protocol, 80 patients aged 7 to 12 years were followed up while not receiving treatment (other than spectacle wear) for 1 year. MAIN OUTCOME MEASURE: Ten letters or more (> or =2 lines) worsening of visual acuity (measured using the electronic Early Treatment of Diabetic Retinopathy Study testing protocol) during the year following treatment discontinuation. RESULTS: During the year following cessation of treatment, the cumulative probability of worsening visual acuity (> or =2 lines) was 7% (95% confidence interval, 3%-17%); 82% of patients maintained an increase in visual acuity of 10 letters or more compared with their visual acuity before starting treatment. CONCLUSION: Visual acuity improvement occurring during amblyopia treatment is sustained in most children aged 7 to 12 years for at least 1 year after discontinuing treatment other than spectacle wear. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT00094692

%0 Journal Article
%C Hals-Nasen-Ohrenklinik und Poliklinik Charite, Campus Mitte, Berlin. matthias.hoelzl@charite.de
%A Holzl, M
%A Stolzel, K
%A Schrom, T
%A Scherer, H
%A Lammert, I
%J Laryngorhinootologie
%D 2007 May
%N 5
%P 346-51
%T [Is orbital exenteration indicated for extensive primary mucosal melanomas of the sinunasal system?]
%V 86
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17226435
%X Primary mucosal melanomas are most frequently localized in the sinunasal system. Orbital involvement must be excluded in the mostly advanced tumor stage. The aim of our study was to find possible indications for orbital exenteration in the T3-4 sinunasal tumor stage. We evaluated 14 treatment courses at our department from 1988 to 2004. The analysis disclosed orbital involvement in 43 % of the patients. The one patient submitted to orbital exenteration had a survival of only 28 months, which was not relevantly longer than in the other 9 patients with a T3-4 tumor stage (median survival of 27 months) or to the two patients with purely palliative treatment (survival of 10 and 21 months). We conclude that, due to the high generalized metastasis rate, radical surgical procedures can only prolong survival in individual cases of advanced-stage sinunasal tumors. Orbital decompression should be considered with reference to the quality of life

%0 Journal Article
%C Liver Transplantation Program and Department of Surgery, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung, Taiwan
%A Hsu, Li-Wen
%A Goto, Shigeru
%A Nakano, Toshiaki
%A Lai, Chia-Yun
%A Lin, Yu-Chun
%A Kao, Ying-Hsien
%A Chen, Shu-Hui
%A Cheng, Yu-Fan
%A Jawan, Bruno
%A Chiu, King-Wah
%A Chen, Chao-Long
%J Transpl Immunol
%D 2007 Feb
%N 2
%P 137-46
%T Immunosuppressive activity of serum taken from a liver transplant recipient after withdrawal of immunosuppressants
%V 17
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17306745
%X In orthotopic liver transplantation (OLT), tolerance is induced in a certain combination of donors and a recipient in rats and, in some clinical cases, rejection has not occurred in OLT patients after weaning off immunosuppression. However, this mechanism has not yet been elucidated. Among our cases of liver transplantation (LTx), one OLT patient (Patient A) has not required immunosuppressive drugs for the last 5 years, following post-transplant lymphoproliferative disease (PTLD). This patient's serum interleukin-2 levels were undetectable following withdrawal of immunosuppressants. The same serum taken after discontinuing the immunosuppressants inhibited concanavalin A blast cultured cells and up-regulated the IL-4/IFN-gamma gene expression ratio. These results suggested that other proteins were induced following withdrawal of immunosuppressants. Proteomic assay demonstrated 12 differentiated spots exclusive to this patient where immunosuppressants have been discontinued. Haptoglobin, found to have immunosuppressive activity in vitro, may play an important role in the maintenance of drug-free tolerance as a natural immunological suppressor after cessation of immunosuppression. Proteomic analysis will allow us to develop a novel weaning protocol for patients on long-term immunosuppression to avoid major immunosuppressant-related complications

%0 Journal Article
%C Department of Medicine (K.S.J., J.A.T.), Division of Geriatrics (K.S.J.), Center for the Study of Aging and Human Development (K.S.J., M.K., J.A.T.), and Center for Palliative Care (K.S.J., J.A.T.), Duke University School of Medicine; and Department of Biostatistics and Bioinformatics (M.K.), Duke University, Durham, North Carolina; and VITAS Healthcare Corporation (D.T.), Miami, Florida, USA
%A Johnson, KS
%A Kuchibhatla, M
%A Tanis, D
%A Tulsky, JA
%J J Pain Symptom Manage
%D 2007 Jun
%T Racial Differences in the Growth of Noncancer Diagnoses Among Hospice Enrollees
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17555922
%X Patients with noncancer life-limiting illnesses now represent over half of all hospice enrollees, compared to only one-quarter of enrollees in 1992. Whether this growth in enrollees with noncancer diagnoses has been similar for Caucasians and African-Americans, a group historically underrepresented in hospice, has not been described. The purpose of this study was to compare rates of noncancer diagnoses among African-American and Caucasian hospice enrollees. We analyzed data from the administrative database of VITAS Healthcare Corporation, including all African-Americans and Caucasians discharged from hospice between January 1, 1999 and December 31, 2003. Of the 166,390 eligible discharges, 14.6% were African-American, and 85.4% were Caucasian. Over the five-year study period, there was a similar increase in the crude proportion of enrollees with noncancer diagnoses in both groups, from 42% to 49.7% among African-Americans and 57.9% to 64.3% among Caucasians. However, in multivariate analysis (adjusted for age, gender, admission level of care, payment source, Health Maintenance Organization (HMO) use, discharge year, and hospice program characteristics-size, location, presence of an inpatient unit), African-Americans had 32% lower odds of having a noncancer (vs. cancer) diagnosis than Caucasians (odds ratio [OR] 0.68 [0.66, 0.77]). While numerous studies document lower rates of hospice use among African-Americans than Caucasians, these findings suggest disease-specific differences in patterns of hospice use, with greater disparities in hospice use among African-Americans with noncancer diagnoses than those with cancer diagnoses. Targeted efforts to increase hospice use among African-Americans with noncancer diagnoses may be important in reducing racial disparities in overall hospice use and improving the quality of care for dying African-Americans

%0 Journal Article
%A Johnson, Miriam J
%J Postgrad Med J
%D 2007 Jun
%N 980
%P 395-401
%T Management of end stage cardiac failure
%V 83
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17551071
%X Optimum heart failure medication and an increasing array of interventions have had an enormous effect on morbidity and mortality over the past 10 years. However, patients with end stage disease can still be highly symptomatic. Moreover, such patients are disadvantaged compared with patients with malignant disease. They are less likely to have an understanding of their illness or have access to supportive care. They are also less likely to have the opportunity to plan for care with regard to death and dying. There is increasing demand that the multi-professional clinical team gain good communication and supportive care skills, and that appropriate access to specialist palliative care services is available

%0 Journal Article
%C University of Kansas School of Medicine-Wichita, 1010 N. Kansas, 67214-3199, Wichita, KS
%A Johnston, S C
%A Pfeifer, M P
%J J Gen Intern Med
%D 1998 Jan
%N 1
%P 43-5
%T Patient and physician roles in end-of-life decision making
%V 13
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17551800
%X This study is a cross-sectional descriptive survey of randomly selected primary care patients and physicians regarding patient, physician, and family roles in end-of-life decision making. The subjects included 329 adult outpatients and 272 practicing physicians. Physicians were more likely than patients to believe the patient alone was responsible for making end-of-life decisions. Patients were more likely than physicians to believe the physician should provide a recommendation in addition to facts to help the patient make end-of-life decisions. We conclude that patients prefer a more active role for physicians in both decision making and discussion of end-of-life care than do physicians themselves

%0 Journal Article
%C Bronglais Hospital, Aberystwyth, UK. gudrun.jones@ceredigion-tr.wales.nhs.uk
%A Jones, Gudrun
%J Int J Palliat Nurs
%D 2007 Apr
%N 4
%P 184-9
%T Complementary and psychological therapies in a rural hospital setting
%V 13
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17551422
%X The National Institute for Clinical Excellence (NICE) (2004) in the UK has led the way in recognising the need for a holistic approach to the support and care of people with cancer, with the publication of Guidance on Cancer Services: Improving Supportive and Palliative Care for Adults with Cancer. This article describes a three-year project, funded by the Big Lottery Fund through Macmillan Cancer Support. The project is being implemented by an art therapist, clinical psychologist, complementary therapist and administrator together with the existing team of three Macmillan nurses, an art therapist and two Macmillan occupational therapists. The project aims to provide a service to patients, carers and to the health professionals who work with people with cancer and their families. The service is located in a rural and Welsh-speaking area; as such, accessibility of the service and language choice play an important role in the delivery of support and treatments

%0 Journal Article
%C Christian College of Nursing, Gwangju, South Korea; College of Nursing, Catholic University of Korea Song-eui Campus, Seoul, South Korea
%A Kang, Hee-Young
%A Yoo, Yang-Sook
%J Arch Psychiatr Nurs
%D 2007 Jun
%N 3
%P 132-40
%T Effects of a bereavement intervention program in middle-aged widows in Korea
%V 21
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17556106
%X Dan-jeon is a meditative practice composed of both breathing and stretching exercises causing life energies to circulate blood throughout the body. Following a bereavement intervention program composed of Dan-jeon breathing sessions, a self-help group activity, and a health check, an experimental group showed significantly greater decrements in grief levels and symptoms of stress over a control group who received only a health check. Among the participants, there were no significant differences in immune response, percentages of T lymphocytes, helper T lymphocytes (Th), suppressor T lymphocytes (Ts), B lymphocytes, natural killer cells, monocytes, and Th:Ts ratios

%0 Journal Article
%C Department of Transplantation and Immunology, Horizontal Medical Research Organization, Faculty of Medicine, Kyoto University, 54 Kawaramachi-Shogoin, Sakyo-ku, Kyoto city 606-8507, Japan. tkoshiba@kuhp.kyoto-u.ac.jp
%A Koshiba, Takaaki
%A Li, Ying
%A Takemura, Mami
%A Wu, Yanling
%A Sakaguchi, Shimon
%A Minato, Nagahiro
%A Wood, Kathryn J
%A Haga, Hironori
%A Ueda, Mikiko
%A Uemoto, Shinji
%J Transpl Immunol
%D 2007 Feb
%N 2
%P 94-7
%T Clinical, immunological, and pathological aspects of operational tolerance after pediatric living-donor liver transplantation
%V 17
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17306739
%X In the setting of our pediatric living-donor liver transplantation (LDLT), 87 patients (15.0% of all the patients: significantly higher proportion, compared with those of other transplant centers) achieved complete withdrawal of immunosuppression, which is referred to as "operational tolerance". Immunosuppressants were completely discontinued for 54 patients as scheduled, and for 33 because of EBV infection or other complications. Immunological analyses of the peripheral blood derived from operationally tolerant patients demonstrated that non-deletional tolerance takes place in which potentially reactive T cells to donor-antigens remain physically in the immune repertoire, but specifically suppressed by certain mechanisms. Not only CD4(+)CD25(high+) T cells were increased in the proportion in the tolerant patients' peripheral lymphocytes and suppressed MLR specifically to the donor antigen, but also FOXP3 expressing cells were present within the tolerant liver. Thus, among several mechanisms accounting for non-deletional tolerance, Tregs are likely to involve at least in part in our tolerant patients. Vdelta1gammadeltaT cells, a subset of gammadeltaT cells, which otherwise reside mainly in the intestine, emerge into the peripheral blood during successful pregnancy but not abortive pregnancy. Since Vdelta1gammadeltaT cells produce massive IL-10, it is proposed that Vdelta1gammadeltaT cells induce fetomaternal tolerance by promoting Th2 immune deviation. Consistent with pregnancy, IL-10 producing Vdelta1gammadeltaT cells emerge into the blood of our tolerant patients. This may reflect a common feature between fetomaternal tolerance and transplant tolerance. We began protocol biopsy in post-LDLT patients who exhibit normal liver function from January 2003. Operationally tolerant patients, albeit showing normal liver function, exhibited decrease in size and increase in number of the bile duct and the fibrosis to a greater extent, compared with patients on maintenance immunosuppression. This warrants serial protocol biopsy before and after complete cessation of immunosuppression even in the presence of normal liver function

%0 Journal Article
%C Department of Psychology, Rutgers University, Piscataway, New Jersey
%A Kressel, Laura M
%A Chapman, Gretchen B
%J Med Decis Making
%D 2007 May-Jun
%N 3
%P 299-310
%T The Default Effect in End-of-Life Medical Treatment Preferences
%V 27
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17545499
%X BACKGROUND: Living wills are intended to preserve patient autonomy, but recent studies suggest that they do not always have their desired effect. One possible explanation is that living wills do not capture the authentic preferences of the patients who write them but instead reflect transient contextual effects on preferences. PURPOSE: Two experiments examined whether end-of-life treatment preferences expressed in a living will were influenced by the presence of default options. METHOD: College students participated in 2 Web-based questionnaire experiments (Ns = 182 and 51). Participants were randomly assigned to 1 of 2 or 3 default conditions. RESULTS: In experiment 1, participants expressed significantly different treatment preferences in 3 normatively equivalent, check box-formatted living wills that were either positively worded ("indicate medical treatments you would want administered"), negatively worded ("indicate treatments you would want withheld"), or of forced-choice format (P = 0.01). Participants expressed a stronger preference to receive treatment in the negatively worded document than in the positively worded document as a consequence of preferring the default option in both cases. Participants in experiment 2 were also influenced by the presence of a default option, but this time, while writing narrative living wills after viewing 1 of 2 sample living wills. In this experiment, the sample living will represented the default preference. The participants' own living wills tended to express preferences similar to those in the sample (P = 0.0005). CONCLUSION: The default manipulations in both experiments had potent but transient effects and influenced what participants wrote in their living wills but not their responses to later medical scenarios. Expression of end-of-life treatment preferences appears to be temporarily constructed from the decision-making context. These results have implications for surrogate decision making and the use of the living will as a tool to preserve patient autonomy

%0 Journal Article
%C Southern Arizona Veterans Affairs Health Care System, and the University of Arizona College of Medicine, Tucson, Arizona, USA
%A Krouse, RS
%J J Pain Symptom Manage
%D 2007 May
%T The International Conference on Malignant Bowel Obstruction: A Meeting of the Minds to Advance Palliative Care Research
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17544251
%X There is a dearth of well-designed clinical research focusing on palliative care in cancer patients, especially those who are near the end of life. Reasons for this include ethical dilemmas in conducting such trials, communication barriers between specialties, and unclear standards for best care practices. To ensure that patients with incurable illnesses are offered the best available care, it is essential to develop and disseminate research methodologies well suited to this population. Given the multidimensional and culture-dependent nature of the end-of-life experience, it is necessary to adopt an interdisciplinary approach to developing research methods. As a means of initiating the process of palliative clinical research methodology development, malignant bowel obstruction (MBO) was used as a model to develop a research protocol. Although many treatment options for MBO have been proposed, existing literature offers little guidance with regard to algorithms for optimal management. To this end, an international leaders in quality-of-life research, ethnocultural variability, palliative medicine, surgical oncology, gastroenterology, major consortium research, medical ethics, and patient advocacy/cancer survivors was convened in Pasadena, California, on November 12-13, 2004. Participants also represented the broad ethnic and racial perspectives required to develop culturally sensitive research methods. Consensus on methodological approaches was attained through vigorous debate. Using the conference-developed MBO model to implement trials will advance palliative care research

%0 Journal Article
%C Southern Arizona Veterans Affairs Health Care System, and the University of Arizona College of Medicine, Tucson, Arizona, USA
%A Krouse, RS
%J J Pain Symptom Manage
%D 2007 May
%T Lessons Learned from a Collaborative Meeting to Construct a Palliative Care Protocol
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17544248
%X As the treatment of advanced illness necessitates a multidimensional and culturally sensitive approach, a conference of international leaders in affected disciplines (quality of life research, ethno-cultural variability, palliative medicine, surgical oncology, gastroenterology, major consortium research, medical ethics, and patient advocacy/cancer survivors) was organized to provide the necessary expertise and broad ethnic and racial perspectives. During the course of the two-day conference, participants first deliberated in small groups focused on specific areas of concern to palliative care research: outcome measures, ethical dilemmas, barriers, and solutions, cross-cultural issues, palliative care study implementation, and protocol development. Each group presented the results of their meetings, and the conference as a whole worked out the final details of a research protocol for malignant bowel obstruction. Lessons learned in the process of conceiving and organizing the meetings, implementing, and disseminating the results of the conference provide insight into the usefulness of this method for developing workable palliative care research methodologies

%0 Journal Article
%C Department of Philosophy, Dalhousie University, 6555 Young Street, Halifax, Nova ScotiaB3L 2A5, Canada. monique.lanoix@dal.ca
%A Lanoix, Monique
%J Am J Bioeth
%D 2007 Mar
%N 3
%P 34-6
%T When cure entails care
%V 7
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17366230

%0 Journal Article
%C Aras Moyola, Department of Nursing and Midwifery Studies, The National University of Ireland, Galway, Ireland
%A Larkin, PJ
%A de, Casterle BD
%A Schotsmans, P
%J J Adv Nurs
%D 2007 Jun
%T Towards a conceptual evaluation of transience in relation to palliative care
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17543009
%X Aim. This paper is a report of a concept evaluation of transience and its relevance to palliative care. Background. A qualitative study into palliative care patients' experiences of transition revealed a gap between current definitions of transition and their expression of the palliative care experience. Transience appears to offer a better definition but remains conceptually weak, with limited definition in a healthcare context. Methods. A qualitative conceptual evaluation of transience was undertaken using two case examples, interview data and the literature. Multiple sources were used to identify the literature (1966-2006), including a search on Cumulative Index to Nursing and Allied Health Literature Medline, and Ovid and Arts and Humanities Index using the keywords 'transience' and 'palliative care'. Thirty-one papers related to transience were retrieved. Analysis and synthesis formulated a theoretical definition of transience relative to palliative care. Findings. Transience is a nascent concept. Preconditions and outcomes of transience appear contextually dependent, which may inhibit its conceptual development. Transience depicts a fragile emotional state related to sudden change and uncertainty at end-of-life, exhibited as a feeling of stasis. Defining attributes would seem to include fragility, suddenness, powerlessness, impermanence, time, space, uncertainty, separation and homelessness. Conclusions. Transience is potentially more meaningful for palliative care in understanding the impact of end-of-life experiences for patients than current conceptualizations of transition as a process towards resolution. As a nascent concept, it remains strongly encapsulated within a framework of transition and further conceptual development is needed to enhance its maturity and refinement

%0 Journal Article
%A Leijerstam, Fredrik
%J Lakartidningen
%D 2007 Apr
%N 17
%P 1343; author reply 1343
%T [New guidelines support physician-assisted suicide!]
%V 104
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17547284

%0 Journal Article
%C Faculty of Nursing, Institute of Aging, University of Toronto, Canada. doris.leung@utoronto.ca
%A Leung, Doris
%J Int J Palliat Nurs
%D 2007 Apr
%N 4
%P 170-4
%T Granting death with dignity: patient, family and professional perspectives
%V 13
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17551420
%X Dignity is a complex construct lacking clear meaning. While conceptualizing dignity as a basic right is useful in determining and justifying social and economic costs of health care, it is insufficient in considerations of personal dignity at the end of life. There is a dissonance between how dignity is shown to matter to healthcare professionals compared to patients. Furthermore, dignity is not clearly linked in the empirical literature to variables of quality of life and to a dignified death. Current studies about the construct of dignity enhance understanding of how we extrinsically construct moral worth, but not of how individuals interpret intrinsic moral worth through maintaining their personal integrity and attitudes of being cared for. References to key qualitative studies illuminate how clinicians ethically negotiate a creation of dying with dignity. As one's personal integrity fades, caregivers (i.e. healthcare providers, family and friends) are challenged to recognise and attend to the individual's vulnerability. I suggest that caregivers nurture personal integrity - through gestures that remember and honour aspects of the other as he/she was once known. Perhaps only through others can dying people be granted death with a sense of personal dignity

%0 Journal Article
%C Hillman Center for Pediatric Transplantation, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
%A Mazariegos, George V
%A Sindhi, Rakesh
%A Thomson, Angus W
%A Marcos, Amadeo
%J Transpl Immunol
%D 2007 Feb
%N 2
%P 114-9
%T Clinical tolerance following liver transplantation: long term results and future prospects
%V 17
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17306742
%X The ongoing quest of achieving clinical transplantation tolerance has been fueled, in large part, by the success of solid organ transplantation. Long term morbidity following transplantation now is primarily related to complications of immunosuppression (IS) such as malignancy, drug toxicity, or infection. This report provides long term follow-up on a large cohort of operationally tolerant patients, provides clinical guidelines to be considered in IS withdrawal, and identifies future prospects for achieving consistent clinical tolerance following liver transplantation (LT)

%0 Journal Article
%C Tri-Institutional Training Program in Laboratory Animal Medicine and Science, Memorial-Sloan Kettering Cancer Center, Rockefeller University, New York, NY, USA. alyssa.mcintyre@spcorp.com
%A McIntyre, Alyssa R
%A Drummond, Robert A
%A Riedel, Elyn R
%A Lipman, Neil S
%J J Am Assoc Lab Anim Sci
%D 2007 Mar
%N 2
%P 65-73
%T Automated mouse euthanasia in an individually ventilated caging system: system development and assessment
%V 46
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17343356
%X We developed a CO2 euthanasia system that functions as an individually ventilated caging system and that accommodates the simultaneous euthanasia of as many as 70 cages of mice. The automated, logic-controlled system allows euthanasia of mice in their home cage, provides consistent and reproducible delivery of CO2, permits visualization of animals during euthanasia, and integrates various safety features. Requirements for the safe use of this system are that all cage locations are to be filled and that engineering controls (that is, a thimble connection) be used to minimize CO2 contamination of the immediate environment. The system was evaluated using mice that were nongravid and greater than 6 d of age. CO2 measurements were made over time to assess the reproducibility of intracage CO2 levels and the effect of 3 supply plenum pressures (0.35, 0.25, and 0.15 in. H2O) on maximal intracage CO2 concentration, CO2 fill slope, time until CO2 detection, and time until maximal CO2 concentration. Results indicate that both supply plenum pressure and cage position on the rack affect intracage CO2 concentrations. We also conducted behavioral assessments of mice undergoing euthanasia to evaluate distress during euthanasia at 2 plenum pressures (0.15 and 0.35 in. H2O). Personnel experienced with laboratory mice did not discern differences in mouse distress associated with either cage location or plenum pressure. This system was safe, effective, and labor-saving for euthanizing large numbers of mice in an aesthetically acceptable and humane manner compatible with recommendations provided in the ACLAM 2005 Report on Euthanasia

%0 Journal Article
%C Faculty of Nursing Sciences, Universite Laval, Quebec, Canada. diane.morin@fsi.ulaval.ca
%A Morin, Diane
%A Saint-Laurent, Louise
%A Bresse, Marie-Pier
%A Dallaire, Clemence
%A Fillion, Lise
%J Int J Palliat Nurs
%D 2007 Apr
%N 4
%P 190-6
%T The benefits of a palliative care network: a case study in Quebec, Canada
%V 13
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17551423
%X This article aims to present the beneficial effects associated with the local implementation of an integrated network in palliative care, as perceived by diverse constituency groups. A case study was conducted in the province of Quebec, Canada, using individual (n=16) and group (n=16) interviews, with a total of 106 participants (i.e. managers and formal and informal caregivers). From a content analysis, two categories of beneficial effects emerged: those associated with professional practice and those with patient services. The most important effects of this organisational initiative were found to be the recognition of the palliative care domain necessitating specialized competencies, an improved interdisciplinary collaboration, and more efficient circulation of information between care settings, as well as improved accessibility, continuity and quality of care and services to patients at the end of life

%0 Journal Article
%C Department of Palliative and Supportive Care, Palliative Care Team, and Seirei Hospice (T.M.), Seirei Mikatahara General Hospital, Shizuoka; School of Human Culture (H.M.), Kyoto Notre Dame University, Kyoto; Human Science (K.H.), Osaka University, Osaka; Hospice (K.T.), Yodogawa Christian Hospital, Osaka; Faculty of Nursing (J.K.), Hamamatsu University School of Medicine, Shizuoka; Department of Psychiatry (H.O.), Kanagawa Cancer Center, Yokohama; Psycho-Oncology Division, National Cancer Center Research Institute East (N.A., Y.U.), Chiba; Psychiatry Division (N.A., Y.U.), National Cancer Center Hospital East, Chiba; Department of Palliative Medicine (Y.K.), Shizuoka Cancer Center, Shizuoka; and Department of Psychiatry (T.A.), Nagoya City University Medical School, Nagoya, Japan
%A Morita, T
%A Murata, H
%A Hirai, K
%A Tamura, K
%A Kataoka, J
%A Ohnishi, H
%A Akizuki, N
%A Kurihara, Y
%A Akechi, T
%A Uchitomi, Y
%J J Pain Symptom Manage
%D 2007 May
%T Meaninglessness in Terminally Ill Cancer Patients: A Validation Study and Nurse Education Intervention Trial
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17544250
%X Recent empirical studies revealed that fostering patients' perception of meaning in their life is an essential task for palliative care clinicians. However, few studies have reported the effects of training programs for nurses specifically aimed at improving skills to relieve the meaninglessness of terminally ill cancer patients, and we have had no specific measurement instruments. The primary aims of this study were 1) to validate measurement tools to quantify nurses' self-reported practice and attitudes toward caring for terminally ill cancer patients feeling meaninglessness and 2) to explore the effects of the five-hour educational workshop focusing on meaninglessness on nurses' self-reported practice, attitudes toward caring for such patients, confidence, burnout, death anxiety, and meaning of life. A quasi-experimental pre-post questionnaire survey was performed on 147 nurses. The questionnaire was distributed before, the intervention workshop and one and six months after. The workshop consisted of lecture, role-play, and the exercise of assessment and care planning based on two vignette verbatim records. First, using the first questionnaire sample and an additional sample of 20 nurses for the test-retest examination, we validated a six-item Self-Reported Practice scale, and an eight-item Attitudes Toward Caring for Patients Feeling Meaninglessness scale with three subscales (Willingness to Help, Positive Appraisal, and Helplessness). The nurses also completed a scale to assess confidence in caring for terminally ill patients with meaninglessness, the Maslach Burnout Inventory, the Death Attitude Inventory, the Frommelt Attitudes Toward Care of the Dying scale, the Self-Reported Practice Score in General Communication, and the three pain-related items from the Palliative Care Quiz for Nursing. For the Self-Reported Practice scale and the subscales of the Attitudes Toward Caring for Patients Feeling Meaninglessness scale, the Cronbach's alpha coefficients were 0.63-0.91, and the intra-class correlations were 0.89-0.94. The Self-Reported Practice scale significantly, but moderately, correlated with the Self-Reported Practice Score in General Communication (P=0.41). The Willingness to Help and Helplessness subscales significantly but weakly correlated with the Frommelt scale (P=-0.27, 0.21). Both scales did not correlate or minimally correlated with the Palliative Care Quiz for Nursing (P<0.20). The construct validity was confirmed using factor analysis. At the follow-up, of 147 nurses who participated into this workshop, 91 (62%) and 80 (54%) nurses responded. Self-reported practice and confidence significantly improved, whereas helplessness, emotional exhaustion, and death anxiety significantly decreased. The percentages of nurses who evaluated this program as "useful" or "very useful" were 79% (to understand the conceptual framework in caring for terminally ill patients with meaninglessness), 73% (to help in self-disclosing nurses' personal beliefs, values, and life goals), and 80% (to help in learning how to provide care for patients with meaninglessness). The Self-Reported Practice scale and the Attitudes Toward Caring for Patients Feeling Meaninglessness scale are reliable and valid tools to specifically quantify nurses' self-reported practice and attitudes toward caring for terminally ill cancer patients feeling meaninglessness of life. The five-hour workshop appeared to have a modest but significant beneficial effect on nurse-reported practice, attitudes, and confidence in providing care for terminally ill cancer patients feeling meaninglessness. Further educational intervention trials with control groups are promising

%0 Journal Article
%C University of Padova, Padova, Italy. ughetta.moscardino@unipd.it
%A Moscardino, Ughetta
%A Axia, Giovanna
%A Scrimin, Sara
%A Capello, Fabia
%J Soc Sci Med
%D 2007 Apr
%N 8
%P 1776-87
%T Narratives from caregivers of children surviving the terrorist attack in Beslan: issues of health, culture, and resilience
%V 64
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17257726
%X Acts of terrorism have an extremely negative impact on the mental health of children and families. The school siege in Beslan, Russia, in 2004, represents a particularly traumatizing event as it was directed specifically at children and involved the entire community. This qualitative study aims to: (a) examine caregiver reactions to the terrorist attack in Beslan as reported 3 months after the traumatic event; (b) determine the extent to which indigenous cultural values and religious belief systems play a role in Beslan's caregivers' reactions to such event; and (c) identify variables that may function as sources of resilience to caregivers. A convenience sample of 17 primary caregivers from Beslan with at least one child who survived the school siege were asked to participate in semi-structured interviews. Narratives generated from the interviews were qualitatively analyzed using a thematic approach; nine major themes were identified. Caregivers' concerns centered on children's physical and psychological well-being, the reorganization of family life, and the disruption of community ties. Cultural values of pride, heroism, courage, and revenge emerged as relevant aspects shaping caregivers' reactions to the traumatic event. Possible sources of resilience included the willingness to return to normality, social support, and the reaffirmation of positive, culturally shared values in face of the perceived threat of future terrorist attacks. Findings are discussed in terms of their theoretical implications on the effects of trauma on children and families as well as interventions with highly traumatized populations in diverse cultural settings

%0 Journal Article
%C Pain Relief and Palliative Care Unit, Department of Radiology, Areteion Hospital, School of Medicine, University of Athens, Athens, Greece
%A Mystakidou, K
%A Tsilika, E
%A Parpa, E
%A Pathiaki, M
%A Galanos, A
%A Vlahos, L
%J Depress Anxiety
%D 2007 Jun
%T The relationship between quality of life and levels of hopelessness and depression in palliative care
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17557316
%X There is growing interest in the psychological distress and quality of life of cancer patients. The aim of this study was to compare the responses of 102 advanced cancer patients on a quality of life scale (as measured by the SF12) with the Beck Depression Inventory (BDI) and the Beck Hopelessness Scale (BHS), as well as the impact of depression and hopelessness on quality of life. Significant associations were found between gender (P=.027), performance status (P=.003), opioids (P=.002), depression (P<.0005), and hopelessness (P<.0005) with the SF12-Mental Component Score (MCS). Gender (P=.07), metastasis (P=.001), opioids (P=.0005), and education (P=.045) correlated significantly with SF12-Physical Component Score (PCS). In the prediction of MCS, the dimensions of age, hopelessness, gender, and performance status were statistically significantly high (P<.0005), explaining 48% of variance. For PCS, the predictor variables were education, metastasis, and opioids (25% of variance). Quality of life, in this patient population, was predicted by the level of hopelessness and patients' demographic and clinical characteristics. Depression and Anxiety 0:1-7, 2007. (c) 2007 Wiley-Liss, Inc

%0 Journal Article
%C Department of Respiratory Medicine, Yokohama Municipal Citizens Hospital
%A Nagashima, Yasuhiro
%A Okamoto, Hiroaki
%A Narita, Yusuke
%A Hida, Naoya
%A Naoki, Katsuhiko
%A Kunikane, Hiroshi
%A Watanabe, Koshiro
%J Nihon Kokyuki Gakkai Zasshi
%D 2007 May
%N 5
%P 430-5
%T [Perforation of the small intestine caused by metastasis from primary lung cancer: report of two cases and the discussion of 48 cases published in the Japanese literature]
%V 45
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17554989
%X Case 1 was a 62-year-old man who had performance status (PS) of 1 and stage IIIB adenocarcinoma of the lung. Because he showed progressive disease after induction chemoradiotherapy, he started to receive best supportive care alone. Three months after initial diagnosis, he complained of abdominal pain. As a result of computed tomography of the abdomen. He was diagnosed with abdominal pain probably caused by ileal perforation. An operation was undertaken and the surgical findings showed perforation by small intestine metastasis from lung adenocarcinoma. After the operation, he survived more than ten months. Case 2 was a 54-year-old man who had a PS of 3 and stage IV large cell carcinoma. After chemotherapy and sequential cranial radiotherapy, he developed anemia of unknown cause. He also complained of an abdominal pain during hospitalization and digestive tract perforation was diagnosed by a CT scan of the abdomen. He underwent surgery and the surgical findings showed a metastasis of large cell carcinoma in the small intestine. He died in a hospice two months after the operation. In the Japanese literature from 1983 to 2006. 48 operated cases with perforation caused by small intestine metastasis of lung cancer have been reported in full-length papers. Although the postoperative median survival time was 48 days, only one surgery-related death occurred. Patients who had a history of prior cancer treatment before surgery tended to achieve more prolonged survival compared to those who had not cancer treatment, probably due to poor PS. The preoperative PS may be one important prognostic factor in these patients

%0 Journal Article
%C Bristol Public Health Directorate Bristol Primary Care NHS Trust, Bristol, UK
%A Naqvi, Habib
%J J Adv Nurs
%D 2007 Jun
%N 6
%P 615
%T Palliative care for South asians: muslims, hindus and sikhs
%V 58
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17542806

%0 Journal Article
%C Division of Cardiology, Hyogo Prefectural Amagasaki Hospital, Higashidaimotsucho 1-1-1, Amagasaki, Hyogo
%A Nishi, Kiyoto
%A Sato, Yukihito
%A Miyamoto, Tadashi
%A Taniguchi, Ryoji
%A Matsuoka, Tatsuhiko
%A Kuwabara, Yasuhide
%A Isoda, Kei
%A Yamane, Keiichirou
%A Hatakenaka, Tsutomu
%A Fujinaga, Keiko
%A Fujiwara, Hisayoshi
%A Takatsu, Yoshiki
%J J Cardiol
%D 2007 May
%N 5
%P 251-8
%T [Infusion therapy at outpatient clinic in chronic end-stage heart failure]
%V 49
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17552290
%X OBJECTIVES: To determine whether drug infusions at ambulatory clinic in patients with end stage congestive heart failure are safe and reduce the period of hospitalization. METHODS: Between May 2000 and November 2006, 21 ambulatory patients with end stage congestive heart failure were treated with infusions of the natriuretic peptide, carperitide (6 patients, 43 infusions of mean 0.033 microg/kg/min for mean 3.7 hr), the phosphodiesterase inhibitor, olprinone (19 patients, 75 infusions of mean 0.11 microg/kg/min for mean 3.8 hr), or the catecholamines, dopamine or dobutamine(5 patients, 89 infusions of mean 3.3 microg/kg/min for mean 3.2 hr). RESULTS: Systolic and diastolic blood pressure was lower after infusion of carperitide, whereas catecholamines increased systolic blood pressure and heart rate (all differences from baseline p < 0.0001). Olprinone changed neither blood pressure nor heart rate. No adverse effect was observed, including arrhythmias or change in blood pressure requiring cessation of drug infusion. Mean urinary output per infusion was 979 ml for carperitide, 720ml for olprinone, and 594ml for catecholamines. There was no correlation between mean urinary output and dose of furosemide administered during intermittent infusion therapy. There was a close correlation between pre-infusion blood pressure and urinary output(systolic: p < 0.05; diastolic: p < 0.0001). Infusion therapy reduced the length of hospitalization (p < 0.05) in 7 patients from April 2005. CONCLUSIONS: Ambulatory, low-dose infusion therapy may not decrease the mortality of patients in end-stage congestive heart failure, but was safe and might represent an acceptable end-of-life therapeutic option

%0 Journal Article
%C School of Applied Psychosocial Studies, Faculty of Health and Social Work, University of Plymouth, Devon, England, United Kingdom
%A Phillips, Catherine
%J J Palliat Care
%D 2007 Spring
%N 1
%P 59-60
%T Narrating pain in an emergency ward
%V 23
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17444465

%0 Journal Article
%A Rabinstein, Alejandro A
%A Diringer, Michael N
%J Neurology
%D 2007 May
%N 20
%P 1647-8
%T Withholding care in intracerebral hemorrhage: realistic compassion or self-fulfilling prophecy?
%V 68
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17502543

%0 Journal Article
%C Universidad Central del Caribe, San Juan, PR 00920-4361. ramirj@hotmail.com
%A Ramirez-Rivera, Jose
%A Cruz, Juan
%A Jaume-Anselmi, Francisco
%J P R Health Sci J
%D 2006 Dec
%N 4
%P 325-9
%T Euthanasia, assisted suicide and end-of-life care: attitudes of students, residents and attending physicians
%V 25
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17550099
%X BACKGROUND: Attitudes in regard to end-of life issues are evolving in Western societies. We have sought to trace this evolution in the relatively homogeneous cultural setting of Puerto Rico. METHODS: One hundred fifty-two medical students, 62 medical residents and 84 members of three medical faculties were asked whether in terminally ill patients they: 1) would support a request for euthanasia(E); 2) if legalized, would engage in, would oppose or would not be opposed to others engaging physician-assisted suicide(PAS); 3) would consider ethical to prescribe full doses of drugs needed to alleviate pain, even if they knew it would hasten death; 4) would agree to limit certain resources for the terminally ill. Gender and religious affiliation were also requested. RESULTS: Twenty-eight percent of the students, 26% of the residents and 31% of the faculty supported E. Only 13% of the students, 18% of the residents and 11% of the faculty would engage in PAS. Men were more willing than women to acquiesce to a request for E or PAS. Religious affiliation or its absence did not influence the support or opposition to E and PAS. If it would hasten death, 86% of the residents, but only 65% of the faculty considered ethical to prescribe the dose of drugs needed to alleviate pain. More than 2/3 of the students, residents and faculty favored the limiting of certain resources for the terminally ill. CONCLUSIONS: In our cultural and medical environment, men are more willing than women to engage in E or PAS. The attitude towards E and PAS is not influenced by religious affiliation. If it hastens death, some still consider unethical to prescribe full doses of drugs needed to alleviate pain in the dying patient

%0 Journal Article
%C Department of Oncology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA. rao.ravi@mayo.edu
%A Rao, Ravi D
%A Brown, Paul D
%A Buckner, Jan C
%J Oncology (Williston Park)
%D 2007 Apr
%N 4
%P 473-81; discussion 482, 484, 489
%T Innovation in the management of brain metastases
%V 21
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17474347
%X Metastatic lesions to the brain occur commonly in oncology patients and portend a very poor outcome, as they often occur in the setting of progressive systemic metastatic disease and can result in neurologic deterioration that may preclude therapy. Therapy of patients with brain metastases requires a combination of measures to achieve local control at the site of metastasis (e.g., with surgical resection or radiosurgery) and to reduce the subsequent risk of recurrences elsewhere in the brain (e.g., with whole-brain radiation). Successful therapy of extracranial systemic metastases is required for optimal outcomes. Clinical trials are currently underway to define the optimal role of whole-brain radiation and radiosurgery in different subsets of patients. Novel therapies to enhance radiation responsiveness are also under investigation. In the current review, we discuss recent developments in the management of patients with brain metastases

%0 Journal Article
%C University of British Columbia School of Nursing, Surrey
%A Roberts, Della
%A Tayler, Carolyn
%A MacCormack, Diane
%A Barwich, Doris
%J Can Nurse
%D 2007 May
%N 5
%P 24-7
%T Telenursing in hospice palliative care
%V 103
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17555161
%X During the last months of life, many people with advanced illness will be living in their homes. Coping with changing symptoms, and ultimately preparing for death, becomes part of daily life. Whether the ill person is at home for days or for months, they depend on family or friends to be primary caregivers, supported by home-based services. However, after physician and home health offices close, many patients and their caregivers are left to cope alone. The authors describe an innovative partnership between B.C. NurseLine (a provincial tele-triage and health information call centre), the British Columbia Ministry of Health and Fraser Health Hospice Palliative Care program that created after-hours access to care for dying patients and their families in one of Canada's largest health authorities. The article outlines how information and communications technology enabled merging the capacity and expertise of B.C. NurseLine with the expertise of specialized community-based palliative care services to achieve outcomes of improved symptom management, decreased visits to emergency rooms and enhanced support for families who are caring for loved ones at home. For nurses caring for home-based patients, there are lessons to be learned about how to maximize technology to create systems that both improve access to care and are sustainable in the future

%0 Journal Article
%C Kevin L. Ross, RN, is National Director of Nursing, Critical Care Systems, Inc., Nashua, NH. Caryn M. Bing, RPh, MS, FASHP, is Operations Performance Manager, Critical Care Systems, Inc., Nashua, NH
%A Ross, Kevin L
%A Bing, Caryn M
%J Home Healthc Nurse
%D 2007 Jun
%N 6
%P 370-7
%T Emergency management: expanding the disaster plan
%V 25
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17556918
%X A comprehensive emergency management plan (CEMP) is key to minimizing the disruption of patient care and services during and after a natural or man-made disaster. The home health nurse can play a key role in enhancing, expanding, and evaluating the effectiveness of the organization's disaster plan. The components of a CEMP and lessons learned from actual implementation of disaster plans in home care are addressed. The disasters and emergencies of the past few years, such as threats of terrorism, hurricanes, floods, wildfires, tornadoes, and earthquakes, have validated the need to extend the emergency preparedness plan to a more comprehensive approach to emergency management. Communities, healthcare providers, and individuals/families all have been urged to take a more comprehensive look at their readiness for these types of events. Home healthcare organizations, including home health agencies, hospice providers, infusion providers, and medical equipment companies, can take a fresh and comprehensive look at their emergency management plan

%0 Journal Article
%C National Institute of Cancer
%A Santos, MC
%A Pagliuca, LM
%A Fernandes, AF
%J Rev Lat Am Enfermagem
%D 2007 Apr
%N 2
%P 350-354
%T Palliative care to the cancer patient: reflections according to Paterson and Zderad's view
%V 15
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17546371
%X This reflective study presents the approach of the Nursing Palliative Care to the cancer patient without therapeutic possibility according to the Paterson and Zderad's Humanistic Nursing Theory. The palliative care aims to provide the patient without therapeutic possibility and his family better quality of life. When the nurse, in addition to delivering palliative care to the cancer patient, uses the Humanistic Theory, (s)he starts to recognize each person as a singular existence. This recognition permits one to understand the person's meaning in the process of his(er) disease

%0 Journal Article
%C Division of Gastroenterology and Hepatology, Veterans Affairs Medical Center, University of Kansas School of Medicine, Kansas City, MO, USA psharma@kumc.edu
%A Sayana, H
%A Wani, S
%A Sharma, P
%J Minerva Gastroenterol Dietol
%D 2007 Jun
%N 2
%P 157-69
%T Esophageal adenocarcinoma and Barrett's esophagus
%V 53
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17557044
%X Esophageal adenocarcinoma (EAC) is the most rapidly rising incidence cancer associated with a poor 5-year survival rate. Barrett's esophagus (BE) is a well established premalignant condition for the development of EAC and hence it is imperative that patients with BE or at risk for developing BE should be identified and managed appropriately. The endoscopic recognition of BE should include the assessment of the circumferential (C) and maximum (M) extent of the endoscopically visualized BE segment as well as endocsopic landmarks (The Prague C&M criteria). Although controversial, clinical strategies of screening and surveillance have focused on identification of esophageal neoplasia at an early asymptomatic and curable stage with the ultimate goal of preventing deaths from this cancer. Risk stratification that involves screening and surveillance of high risk individuals may improve the efficacy and effectiveness of these programs. The future of this endeavor lies in the identification and validation of biomarkers coupled with enhanced endoscopic techniques such as narrow band imaging, autofluorescence imaging, confocal laser endomicroscopy etc. Endoscopic therapies (endoscopic mucosal resection, ablative therapies) have become attractive alternatives for the treatment of high grade dysplasia and/or early EAC in BE patients. The main stays of treatment of advanced cancers are debulking surgery, chemotherapy, radiotherapy and palliative care measures

%0 Journal Article
%C *Memory Clinic Slingeland Hospital daggerAlzheimer Centre Nijmegen, University Medical Centre Nijmegen, the Netherlands
%A Scholzel-Dorenbos, CJ
%A van, der Steen MJ
%A Engels, LK
%A Olde, Rikkert MG
%J Alzheimer Dis Assoc Disord
%D 2007 April/June
%N 2
%P 172-178
%T Assessment of Quality of Life as Outcome in Dementia and MCI Intervention Trials: A Systematic Review
%V 21
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17545745
%X We conducted a systematic review of the use of quality of life (QoL) measures as outcome in pharmacological and nonpharmacologic intervention trials in patients with Mild Cognitive Impairment or dementia, and their proxies. Randomized controlled trials (RCTs) were identified from a search of the Specialized Register of the Cochrane Dementia and Cognitive Improvement Group in April 2006. We also checked references and systematic reviews. Primary and secondary end points were screened for QoL-scales, and it was registered whether information on responsiveness was provided. We found 117 pharmacologic and 108 nonpharmacologic RCTs. One of the pharmacologic and 4 of the nonpharmacologic studies used QoL as primary outcome, and 2 and 3, respectively, as secondary end point. Altogether QoL was assessed in only 10 (4.4%) of these RCTs, of which 2 reported on responsiveness of QoL. This review provides evidence that QoL-instruments are seldom used as outcome measures in RCTs in dementia and Mild Cognitive Impairment, and that information on responsiveness is scarce. QoL-measures should be applied more often in clinical trials, as currently no disease modifying drugs are available, although there are valid and reliable QoL-measures for dementia that reflect the aims of palliative care and provide transparent information about patient's and caregiver's treatment benefits. We recommend further research efforts aimed at the determination of the minimal important difference in QoL-scales and the responsiveness of QoL-scales. Subsequently, QoL should be measured as relevant end point, both in patients and their proxies, in all clinical trials in dementia

%0 Journal Article
%C Department of Sociology, Augustana College, Sioux Falls, SD, USA
%A Schrader, Susan L
%A Nelson, Margot L
%A Eidsness, LuAnn M
%J S D Med
%D 2007 Apr
%N 4
%P 147-9, 151-3
%T Palliative care teams on the prairie: composition, perceived challenges & opportunities
%V 60
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17555150
%X INTRODUCTION: LifeCircle South Dakota: Partners Improving End-of-Life Care is an interdisciplinary group committed to quality end-of-life care for residents of the state. Strengthening local coalitions and building a collaborative network among palliative care providers were goals of recent educational efforts. This article presents a profile of South Dakota palliative care teams. METHODS: South Dakota health care facilities and key professionals in palliative and hospice care (n=786) were invited to attend a palliative care conference in the summer of 2006. Forty-nine teams of two or more persons registered for the conference, and 40 teams completed surveys. The questionnaires asked how palliative care is delivered in a rural state, where teams go for help and consultation, and what teams perceive as the challenges and opportunities facing interdisciplinary teams. Both qualitative and quantitative data from the purposive sample of 40 South Dakota palliative care teams were analyzed. RESULTS: Thirty-five teams (88%) indicated nursing was included on their teams while only six (15%) included physicians. Twenty-five teams (62%) desired to add chaplaincy to their teams, followed by pharmacy (25/60%) and medicine (22/55%). On average, 42% of the primary team member's time was devoted to palliative care. Pain management, other symptom management, spiritual issues, advance directives, and family support were identified as critically important to practice. Teams consulted physicians for pain and non-pain symptom management, but sought hospices and team colleagues for consultation on advance directive, family, and spiritual issues. The top challenge teams identified in delivering end-of-life care was short length of hospice stay (lateness or lack of referral to hospice). CONCLUSIONS: Survey data generated a profile of palliative care teams in the state-their composition, self-reported levels of palliative care expertise, resources utilized for consultation, and perceived challenges and opportunities facing them in providing end-of-life care. Having this understanding, along with knowing the perceived challenges and opportunities these teams face, will strengthen our ability to further enhance end-of-life care for South Dakotans

%0 Journal Article
%A Sheldon, Tony
%J BMJ
%D 2007 May
%N 7603
%P 1075
%T Incidence of euthanasia in the Netherlands falls as that of palliative sedation rises
%V 334
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17525417

%0 Journal Article
%C Mechanical Assist Device Program, Advocate Christ Medical Center, Oak Lawn, Illinois 60453, USA. mscabg@aol.com
%A Slaughter, Mark S
%A Feldman, Chad M
%A Sobieski, Michael A
%A Silver, Marc A
%A Martin, Michele M
%A Kurien, Sudha
%A Coyle, Laura A
%A Pederson, Brian
%J J Heart Lung Transplant
%D 2007 Jun
%N 6
%P 579-83
%T Utilization of acoustic signatures to identify HeartMate XVE device end-of-life
%V 26
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17543780
%X BACKGROUND: As outcomes for destination therapy continue to improve, many patients are requiring left ventricular assist device (LVAD) exchange due to end-of-life of their LVAD. Current techniques to identify and diagnose device end-of-life issues usually require invasive testing or off-site filter dust analysis. In this study we assess a non-invasive technique using acoustic signals generated from the HeartMate XVE LVAD to potentially identify impending device end-of-life issues. METHODS: Nine patients were prospectively followed after implantation of the HeartMate XVE LVAD as destination therapy between May 2004 and July 2006. Acoustic signals were collected using an aquatic hydrophone system interfaced with a data acquisition system and a standard laptop computer. Data were collected at pre-set intervals. All data/acoustic signals were prospectively interpreted by a blinded independent reviewer skilled at interpreting acoustic signals. Acoustic data suggesting possible device failure were then correlated with clinical findings and LVAD examination at the time of device removal. RESULTS: All patients survived long enough to develop signs of impending device end-of-life. Four of 9 (44%) patients developed inflow valve incompetence, 4 (44%) were identified as having significant bearing wear, and 1 (12%) had both. All acoustically identified device issues were confirmed by standard clinical examinations and testing (echocardiography, angiography, laboratory tests and filter dust analysis). The acoustic findings were subsequently confirmed at time of device exchange. All patients ultimately had their device successfully exchanged and have continued to live with their new apparatus. CONCLUSIONS: Acoustic signal monitoring can successfully identify HeartMate XVE device end-of-life. This new method provides a low-cost, reproducible, non-invasive technique that may be used to identify possible impending device failure

%0 Journal Article
%C Institute of Medical Law, University of Birmingham, USA
%A Smith, Stephen W
%J Am J Law Med
%D 2007 
%N 1
%P 55-95
%T Some realism about end of life: the current prohibition and the euthanasia underground
%V 33
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17547355

%0 Journal Article
%C Seksjon for medisinsk etikk, Institutt for allmenn- og samfunnsmedisin, Det medisinske fakultet Universitetet i Oslo, Postboks 1130 Blindern, 0318 Oslo. ingrid.sommer@studmed.uio.no
%A Sommer, Ingrid
%A Pedersen, Reidar
%A Hoie, Anne Gurine Egeland
%A Nortvedt, Per
%J Tidsskr Nor Laegeforen
%D 2007 May
%N 10
%P 1368-9
%T [Guidelines on do-not-resuscitate orders in Norwegian hospitals]
%V 127
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17519992
%X BACKGROUND: All somatic hospitals in Norway should have guidelines on do-not-resuscitate orders, according to a directive issued by the Norwegian Board of Health in 2002. MATERIAL AND METHODS: All 31 Norwegian hospital trusts were asked to send in such guidelines. 20 submitted guidelines were assessed, analysed and compared according to 19 questions. RESULTS: The guidelines have various contents. Key aspects such as indications, definitions, participation in decision-making by patients and relatives, strategies for conflict resolution, competence to consent, and advanced directives are in many guidelines either not commented, or described in an ambiguous manner. There are minor differences between the guidelines developed before and after the legal directive was issued in 2002, but legal provisions have become more heavily emphasized. INTERPRETATION: National guidelines should be developed to clarify key questions and contribute to more consistent practice concerning do-not-resuscitate orders

%0 Journal Article
%C San Francisco, California, USA
%A Strzempko Butt, Frances
%A Chesla, Catherine
%J Qual Health Res
%D 2007 May
%N 5
%P 571-85
%T Relational patterns of couples living with chronic pelvic pain from endometriosis
%V 17
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17478641
%X Chronic pelvic pain (CPP) is a disabling condition affecting 15 to 20% of U.S. women of reproductive age. Endometriosis, one of the most common causes of CPP, is associated with symptoms of pelvic pain, painful sexual intercourse, and infertility. In this qualitative study, the authors examined the relational impact of CPP from endometriosis on 13 couples through narrative interviews conducted individually and jointly. They describe five relational patterns that vary on degree of closeness, how care responsibilities are enacted, the degree to which couples are conjoined in their experiences, and how much their lives are overtaken with the disease. These patterns articulate couples' relational concerns as well as daily management of illness

%0 Journal Article
%C Vivarium Support Function, Operational Toxicology Branch, Air Force Research Laboratory, Wright-Patterson AFB, OH, USA
%A Stutler, Shannon A
%A Johnson, Eric W
%A Still, Kenneth R
%A Schaeffer, David J
%A Hess, Rex A
%A Arfsten, Darryl P
%J J Am Assoc Lab Anim Sci
%D 2007 Mar
%N 2
%P 13-20
%T Effect of method of euthanasia on sperm motility of mature Sprague-Dawley rats
%V 46
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17343347
%X Euthanasia is one of the most commonly performed procedures in laboratory animal settings. The method of euthanasia may affect experimental results in studies using animals and must be compatible with research objectives including subsequent tissue analyses. Our present study was performed to evaluate the effects of 7 euthanasia methods on sperm motility in mature rats. Rats were euthanized using CO2, 2 commercially available euthanasia solutions (Beuthanasia-D and Sleepaway), and 4 volatile anesthetics (enflurane, halothane, isoflurane, and sevoflurane). Rats euthanized by rapid decapitation alone served as negative controls, and a-chlorohydrin-treated rats euthanized by rapid decapitation were positive controls for sperm impairment. For 5 of these methods, we also measured time to ataxia, recumbency, respiratory arrest, and no auscultable heartbeat. Immediately after euthanasia of each rat, distal caudal epididymides were removed; 1 was processed for automated sperm motility analysis, and the other was frozen for subsequent concentration analysis. Time to all measured parameters was less for volatile anesthetics than for Beuthanasia-D. Times to last respiration and no heartbeat were less for halothane and isoflurane than for enflurane and sevoflurane. Percentage motile sperm did not differ significantly between methods. Percentage progressively motile sperm did not vary significantly between methods except for Beuthanasia-D, for which it was significantly less than the negative control value. Specific sperm motion parameters for each euthanasia method except CO2 and Sleepaway varied significantly from the negative control. Our results indicate that the method of euthanasia is an important consideration when rat sperm motility parameters must be evaluated

%0 Journal Article
%C Division of General Internal Medicine, College of Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (e-mail: mueller.pauls@mayo.edu)
%A Swetz, Keith M
%A Crowley, Mary Eliot
%A Hook, Christopher
%A Mueller, Paul S
%J Mayo Clin Proc
%D 2007 Jun
%N 6
%P 686-91
%T Report of 255 clinical ethics consultations and review of the literature
%V 82
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17550748
%X OBJECTIVE: To review clinical ethics consultations at a tertiary care academic medical center. METHODS: We retrospectively reviewed all ethics consultations (and associated patient medical records) conducted at the Mayo Clinic in Rochester, Minn, between April 6, 1995, and December 31, 2005. RESULTS: Of the 255 consultations, 101 (40%) reviewed intensive care unit care, 103 (40%) involved patients who died during hospitalization, and 174 (68%) were requested by physicians. The most common primary diagnoses of the patients involved were malignancy (18%, n=47), neurologic disease (18%, n=47), and cardiovascular disease (17%, n=43). Most cases involved multiple issues: patient competency and decision-making capacity (82%, n=208), staff member disagreement with care plans (76%, n=195), end-of-life and quality-of-life issues (60%, n=154), and goals of care and futility (54%, n=138). Withholding or withdrawing measures was the focus of 132 (52%) of the consultations. We also identified previously published reports of ethics consultations and compared the findings of those reports with ours. CONCLUSIONS: Despite advances in medicine, the nature of ethical dilemmas remains relatively unchanged. Issues of communication, family conflict, and futility continue to give rise to ethical quandaries

%0 Journal Article
%C Arohanui Hospice, Palmerston North, New Zealand. amanda.j.taylor@btinternet.com
%A Taylor, Amanda J
%A Randall, Clare
%J Int J Palliat Nurs
%D 2007 Apr
%N 4
%P 163-7
%T Process mapping: enhancing the implementation of the Liverpool Care Pathway
%V 13
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17551419
%X Arohanui Hospice is a 12-bed specialist palliative care service based in Palmerston North, New Zealand. It serves a population of 180 000 people spread over a wide geographical area, both urban and rural. The Liverpool Care Pathway (LCP) was initially implemented at the hospice inpatient unit in January 2005. Following this, the 'LCP Pilot Project' was developed. This project involved the implementation of the LCP within three aged residential care facilities and two wards within the regional hospital. Included in the project was a research component to enable evaluation of the effectiveness of the LCP in each setting. This article will consider and demonstrate the use of process mapping (Buckman, 2003) as a quality improvement tool to enhance the effective implementation and sustained use of the LCP for the dying patient within aged residential care. Measures are considered that support the implementation of the LCP at an organisational level rather than at a purely clinical level. While this work has been completed within the New Zealand context, it is believed that the principles are transferable to similar settings internationally

%0 Journal Article
%A Tisone, Giuseppe
%A Orlando, Giuseppe
%A Angelico, Mario
%J Transpl Immunol
%D 2007 Feb
%N 2
%P 108-13
%T Operational tolerance in clinical liver transplantation: emerging developments
%V 17
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17306741
%X There is still little understanding of the immune events that occur in transplant patients as they develop a relationship with their graft alloantigens. Though, there is an enormous interest and motivation in inducing specific unresponsiveness to organ allografts in order to allow minimization or complete withdrawal of immunosuppression in the recipient, given that life-long immunosuppressive treatment entails a high risk of infectious and metabolic complications, malignancies, and drug-specific toxicity. Clinical tolerance is defined as stable normal graft function in the total absence of a requirement for maintenance immunosuppression. Effective clinical tolerance has been reported more frequently in liver transplant recipients than after transplantation of other organs, as the liver is an immune-privileged organ for several mechanisms, most of which still remain unclear. According to the English medical literature, cautious, carefully supervised weaning of immunosuppressive drugs in controlled trials is not unreasonable, especially when monitored by protocol biopsies. The five centers in which the weaning has been attempted have reported a similar degree of success (1 out of 4 patients) and no harm to the patient over the short-term. Though, long-term follow-up has been lacking and, at present, there are no reliable immunological parameters that enable patients who can be withdrawn from immunosuppressants without the risk of rejection to be identified. To achieve that goal, appropriate collaboration and interaction between clinicians, immunologists and other basic scientists are desirable, as well as the creation of an international, maybe intercontinental, registry for tolerant patients

%0 Journal Article
%C Institute of Legal Medicine, University of Munster, Rontgenstrasse 23, 48149 Munster, Germany. vennemam@uni-muenster.de
%A Vennemann, M M T
%A Rentsch, C
%A Bajanowski, T
%A Zimmer, G
%J Int J Legal Med
%D 2006 Nov
%N 6
%P 352-4
%T Are autopsies of help to the parents of SIDS victims? A follow-up on SIDS families
%V 120
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=16685560
%X Little is known about what bereaved parents feel about the autopsy performed on their child. A multi-centre case control study of sudden infant death syndrome (SIDS) victims was carried out in Germany between 1998 and 2001, in which all infants had been autopsied. We performed a follow-up study 4-7 years after the parents had lost their child. A total of 141 parents filled in the questionnaire, which were sent to them by the study centre. Of these, 71% had had another child after the SIDS/sudden unexpected death in infancy. The majority (83%) of the participating parents found the autopsy helped them to cope better with the death. A large proportion (46%) did not want any professional help after the death, and 55% did not wish to have any contact with a self-help group. We conclude that the autopsy is helpful to the majority of bereaved parents. Professional help and self-help groups should be offered to the parents even if the majority in our study did not want to use either

%0 Journal Article
%C Division of Surgical Oncology and Endocrine Surgery (G.F.W.), University of Massachusetts, Worcester, Massachusetts; Division of General Internal Medicine (J.K.), University of Colorado, Denver, Colorado; Palliative Medicine Program (I.B.), Dartmouth-Hitchcock Medical Center, and Dartmouth University (I.B.), Lebanon, New Hampshire; Gerard and Lubary, Healthcare Consultants (D.G.), Las Vegas, Nevada; National Coalition for Cancer Survivorship (E.S.), Silver Spring, Maryland; Health Services Research & Development (P.S.), Department of Veterans Affairs, Washington, DC; Jonsson Comprehensive Cancer Center (P.A.G.), University of California at Los Angeles, Los Angeles, California; Department of Surgery (R.S.K.), University of Arizona College of Medicine, and Southern Arizona Veterans Affairs Health Care System (R.S.K.), Tucson, Arizona, USA
%A Whalen, GF
%A Kutner, J
%A Byock, I
%A Gerard, D
%A Stovall, E
%A Sieverding, P
%A Ganz, PA
%A Krouse, RS
%J J Pain Symptom Manage
%D 2007 May
%T Implementing Palliative Care Studies
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17544245
%X This session focused on issues related to implementation of randomized clinical trials in palliative care studies. Topics discussed included what kinds of clinical sites and patient populations were suitable, what types of clinical investigators (clinical specialty) should be involved in or lead the studies, what multisite mechanisms could be used to conduct the trials, and what funding issues were related to these studies. A trial of operative versus nonoperative management for small bowel obstruction caused by recurrent intra-abdominal cancer was considered. The feasibility of such a trial was examined in terms of whether there was "equipoise" for a majority of likely investigators in the field around the trial question, what other issues might impact accrual to the trial, and how many patients would be required to answer which of these two treatment arms was better. This last question is related to selection of a primary endpoint for the trial and was a modestly contentious issue for the trial design group. Both sensible compromises in endpoint selection and the education of the community of investigators for a particular randomized trial in palliative care are crucial steps for successful implementation. A major conclusion of this session is that implementation considerations are intimately related to the architecture of a specific trial and should be addressed practically and early in the design phase of any randomized trial addressing a palliative care question. In this respect, randomized trials in palliative care are no different than in other fields

%0 Journal Article
%C RN, MN, CHPCN(c), Lawrence Bloomberg Faculty of Nursing, University of Toronto, 155 College St, Toronto, Ontario, Canada M5T 1P8. kim.widger@utoronto.ca
%A Widger, Kimberley
%A Davies, Dawn
%A Drouin, Danielle J
%A Beaune, Laura
%A Daoust, Lysanne
%A Farran, R Peter
%A Humbert, Nago
%A Nalewajek, Filomena
%A Rattray, Marion
%A Rugg, Maria
%A Bishop, Michelle
%J Arch Pediatr Adolesc Med
%D 2007 Jun
%N 6
%P 597-602
%T Pediatric patients receiving palliative care in Canada: results of a multicenter review
%V 161
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17548766
%X OBJECTIVES: To describe the patients who received care from the 8 dedicated pediatric palliative care programs in Canada in 2002 and to estimate the number of children who may have benefited but did not receive services from these programs. DESIGN: Retrospective review of medical records combined with a survey of each program. SETTING: Seven pediatric palliative care programs based in tertiary care settings and 1 freestanding children's hospice. PARTICIPANTS: The programs cared for 317 children during 2002, of whom 123 died during that year. An additional 32 children died by the end of 2003. Main Exposure Pediatric palliative care program. RESULTS: Nearly half (48.6%) of the patients were younger than 5 years, and almost half of these were younger than 1 year. Primary diagnoses were disorders of the nervous system (39.1%), malignancies (22.1%), and conditions arising in the perinatal period or congenital anomalies (22.1%). Most of the children (43.9%) died at home, with those centers reporting more comprehensive home care services having the highest percentage of home deaths. From a national perspective, between 5% and 12% of the children who could benefit from palliative care received services from 1 of these programs. CONCLUSIONS: Pediatric palliative care programs in Canada care for a diverse population of patients with a wide range of age and disease conditions. Only a small percentage of children who die, however, receive services from these dedicated programs

%0 Journal Article
%C Department of Nursing, National Cheng Kung University Hospital, ROC. nyko@mail.ncku.edu.tw
%A Wu, Chia-Chian
%A Lai, Pei-Yi
%A Ko, Wen-Chien
%A Lee, Hsin-Chun
%A Ko, Nai-Ying
%J Hu Li Za Zhi
%D 2007 Jun
%N 3
%P 103-9
%T [Hospice care for an AIDS patient and his family.]
%V 54
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17554677
%X This article describes the emotional reactions, fear of contamination, and pressure to disclose HIV status of a patient who was recently diagnosed with AIDS, and his family. When the patient's condition deteriorated, his family and medical team faced ethical dilemmas about whether to disclose his condition to others, and the direction of his treatment. The authors and medical team applied the principles of hospice care. During each stage, the first author collected data by means of physical assessment, interview, participant observation, family meetings and team meetings, and provided a clear evaluation of the patient's clinical situation and disease prognosis. The first author applied the principles of hospice care and family-centered nursing care to enable the patient and his family to obtain physical comfort, to reduce the patient's fear of death, to enable him to enjoy the love of his whole family, and obtain his wife's forgiveness. After the patient's death, the first author called the family members and they came back to remember him in front of his room. The article shows that hospice care is crucial to AIDS patients and their families

%0 Journal Article
%C Department of Urology, East Tokyo Metropolitan Hospital
%A Yokoyama, Minato
%A Nakanishi, Yasukazu
%A Arisawa, Chizuru
%A Ando, Masao
%J Hinyokika Kiyo
%D 2007 Mar
%N 3
%P 153-6
%T [Experience with implanted venous reservoirs in patients with terminal urological cancers]
%V 53
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17447482
%X The medical records of 8 consecutive patients with terminal urological cancers who were treated with implanted venous reservoirs between October 2001 and July 2004 were retrospectively reviewed. All 8 devices were placed safely in the 8 patients, and fluids and drugs were easily administered via the reservoirs. The devices were utilized for a mean of 40.6 days (range, 18 to 98) until the patients died of the cancer, and there were no complications which required removal of the devices such as catheter or reservoir infections, catheter occlusions and catheter thromboses. Seven patients were discharged or stayed at home on weekends and received home parental nutrition (HPN) through implanted venous reservoirs. Although HPN with the implanted venous reservoir is recently becoming common in digestive surgery or gynecological fields, it still remains uncommon in the urological field. Because this device would be useful and safe for patients with terminal urological cancers, we should consider the use of implanted venous reservoirs for patients who desire terminal home care

%0 Journal Article
%C Stroke Program, University of Michigan Medical School, Ann Arbor, MI 48109-0316, USA
%A Zahuranec, D B
%A Brown, D L
%A Lisabeth, L D
%A Gonzales, N R
%A Longwell, P J
%A Smith, M A
%A Garcia, N M
%A Morgenstern, L B
%J Neurology
%D 2007 May
%N 20
%P 1651-7
%T Early care limitations independently predict mortality after intracerebral hemorrhage
%V 68
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17502545
%X OBJECTIVE: Intracerebral hemorrhage (ICH) is associated with a high early mortality rate. We examined the impact of early do not resuscitate (DNR) orders and other limitations in aggressive care on mortality after ICH in a community-based study. METHODS: Cases of spontaneous ICH from 2000 to 2003 were identified from the Brain Attack Surveillance in Corpus Christi (BASIC) project, with deaths ascertained through 2005. Charts were reviewed for early (<24 hours from presentation) DNR orders, withdrawal of care, or deferral of other life sustaining interventions, analyzed together as combined DNR (C-DNR). Multivariable Cox-proportional hazards models were used to examine the association between short- and long-term all-cause mortality and early C-DNR, adjusted for demographics and established predictors of mortality after ICH. RESULTS: Of 18,393 subjects screened for cerebrovascular disease, 270 non-traumatic ICH cases were included. Cumulative mortality risk was 0.43 at 30 days and 0.55 over the study course. Early C-DNR was noted in 34% of cases and was associated with a doubling in the hazard of death both at 30 days (hazard ratio [HR] 2.17, 95% CI 1.38, 3.41) and at end of follow-up (HR 1.92, 95% CI 1.29, 2.87) despite adjustment for age, gender, ethnicity, Glasgow Coma Scale, ICH volume, intraventricular hemorrhage, and infratentorial hemorrhage. CONCLUSIONS: Early care limitations are independently associated with both short- and long-term all-cause mortality after intracerebral hemorrhage (ICH) despite adjustment for expected predictors of ICH mortality. Physicians should carefully consider the effect of early limitations in aggressive care to avoid limiting care for patients who may survive their acute illness

%0 Journal Article
%C GPwSI adviser in palliative medicine for Drenthe, Comprehensive Cancer Centre North-Netherlands, Groningen, the Netherlands
%A van Heest, Florien
%A Finlay, Ilora
%A Otter, Renee
%A Jong, Betty Meyboom-de
%J Br J Gen Pract
%D 2007 Jun
%N 539
%P 494-6
%T The New Millennium Palliative Care Project (2000-2003): the impact of specialised GP advisors
%V 57
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17550677
%X This study describes a novel type of support for GPs caring for patients dying at home: the establishment and evaluation of a telephone advisory service for GPs, run by GPs with a special interest in palliative care (GPwSIs) in the Netherlands 2000-2003. A growing number of GPs called for advice, 10% during out of hours. Prognosis of the patients was generally short (days to weeks in 70% of cases). Most advice sought by GPs concerned symptom management and on evaluation, 85% of the GPs followed the advice

%0 Journal Article
%C Afd. Verpleeghuisgeneeskunde, VU Medisch Centrum, EMGO Instituut, Van der Boechorststraat 7, 1081 BT Amsterdam. j.vandersteen@vumc.nl
%A van der Steen, J T
%A Kruse, R L
%A van der Wal, G
%A Mehr, D R
%A Ribbe, M W
%J Ned Tijdschr Geneeskd
%D 2007 Apr
%N 16
%P 915-9
%T [Treatment of pneumonia in nursing home residents with severe dementia: for residents with poor prognosis, a more reserved approach in The Netherlands and more active treatment in the United States]
%V 151
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17500344
%X OBJECTIVE: To describe differences in the treatment of pneumonia and in the association of treatment with prognosis in Dutch and American nursing home patients with late-stage dementia. Design. Prospective studies in The Netherlands and the American state of Missouri. METHOD: In 61 Dutch nursing homes and 36 in Missouri, severely demented patients with pneumonia were included in the periods October 1996-July 1998 and August 1995-September 1998 respectively. Data was collected on their state of health, comorbidity, symptoms of pneumonia and treatment aspects such as antibiotic use, hospital admission and relief of symptoms. Comparisons were made between treatments in both countries and between groups of patients with a similar probability of mortality within 2 weeks. RESULTS: A total of 328 Dutch and 280 American patients were selected. Antibiotics were more frequently withheld in The Netherlands (in 33% of patients) than in Missouri (24%). Differences in antibiotic use were more pronounced in patients with a poor prognosis (56% versus 15%). Dutch patients were more frequently dehydrated but were less likely to receive rehydration therapy than American patients, with a larger difference in patients with a poor prognosis (2% versus 63%). Treatments to relieve symptoms that were provided more often in patients with a poor prognosis (in 20-26%) were: oxygen (both countries), and in The Netherlands also opiates, and hypnotics, sedatives or anxiolytics. CONCLUSION: In The Netherlands, curative treatment was frequently withheld in patients with severe dementia and pneumonia, and even more frequently when the prognosis was poorer. Conversely, treatment in Missouri was more active in patients with a poor prognosis. Despite more frequent palliative treatment goals in The Netherlands, treatments to relieve symptoms were provided infrequently and inconsistent with this approach. These insights may be helpful for decision-making in the treatment of pneumonia in patients with severe dementia