%0 Journal Article %C Unite de neuroanesthesie-reanimation, departement d'anesthesie-reanimation, groupe hospitalier de la Pitie-Salpetriere, APHP et universite Pierre-et-Marie-Curie (Paris-VI), 47-83, boulevard de l'hopital, 75013 Paris, France %A Abdennour, L %A Lescot, T %A Weiss, N %A Galanaud, D %A Naccache, L %A Carpentier, A %A Puybasset, L %J Ann Fr Anesth Reanim %D 2007 May %N 5 %P 445-51 %T [On the difficulty of Traumatic brain injured patients end-of-life decisions] %V 26 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17400424 %X Traumatic brain injury occurs abruptly, involves multiple specialized teams, solicits the health care system in its emergency dimension and engages the well being of the patient and his relatives for a life time period. Clinicians are faced with issues of uppermost importance: medical issues such as predicting long term neurological outcome of the comatose patient, ethical issues because of the influence of intensive care on the long term survival of patients in vegetative and minimally conscious state, legal issues as the consequence of the current law which has set a new concept of proportionality of care, social issues as the result of the very high cost of these pathologies. This review will focus on the brain explorations that are required such as CT scan, evoked potentials, electroencephalography, magnetic resonance imaging and magnetic resonance spectroscopy to provide to the clinician a multimodal assessment of the brain state to predict outcome of coma. Such assessment is mandatory to answer the crucial question of proportionality of care in these patients. However, these techniques need further validation on large series of patients before being useful on clinical practice %0 Journal Article %C Laboratoire de Biologie Appliquee, Faculte des Sciences et Techniques, Tanger, Maroc %A Agouti, Imane %A Badens, Catherine %A Abouyoub, Ahmed %A Khattab, Mohamed %A Sayah, Fouad %A Barakat, Amina %A Bennani, Mohcine %J Hemoglobin %D 2007 %N 2 %P 141-9 %T Genotypic correlation between six common beta-thalassemia mutations and the XmnI polymorphism in the Moroccan population %V 31 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17486495 %X beta-Thalassemia (thal) is the most common recessive inherited disorder in Mediterranean populations. It is estimated that the frequency of this disease in the Moroccan population is between 1.5 and 3.0%. Severe forms of homozygous thalassemia cases require expensive and technically demanding curative (bone marrow transplantation) or palliative (chronic transfusion/chelation) therapies. The -158 (C-->T) polymorphism of the (G)gamma-globin gene (XmnI polymorphism) is known to ameliorate the severity of the disease because of it strong association with an increased production of fetal hemoglobin (Hb F). Among the many known mutations in Morocco, six are common [codon 39 (C-->T), frameshift codon (FSC) 8 (-AA), IVS-II-745 (CG), FSC 6 (-A), -29 (A-->G) and IVS-I-1 (G-->A)]. In this study, we have investigated, in 82 Moroccan beta-thalassemic chromosomes, the correlation between the six common mutations and the XmnI polymorphism using the Fisher exact test. The XmnI polymorphism was divided into two categories, (XmnI [+] and XmnI [-]) and the six common Moroccan mutations into two groups (group I with FSC 8 and group II without FSC 8). Correlation was carried out between the XmnI [+] category and the six common mutations individually that showed that 68% of chromosomes in the XmnI [+] category had the FSC 8 (-AA) mutation. The results reported here show that there is a positive correlation between the XmnI polymorphism and FSC 8 mutation in linkage with haplotype IV [- + - + + - +] (p <10(-5)). In conclusion, molecular determination of genetic markers in early childhood will help to identify candidates for pharmacological Hb F switching by hydroxyurea (HU). In the Moroccan population, a good response to HU treatment should be suspected in cases with the -158 (C-->T) polymorphism in linkage with haplotype IV and internal beta-globin gene framework 3 %0 Journal Article %C Department of Surgery, Saad Specialist Hospital, Al-Khobar 31952, Saudi Arabia. halkhayat@yahoo.com %A Al-Khayat, Haitham %A Al-Khayat, Hisham %A Al-Baker, Osama %A Groof, Ala' %A Sadeq, Adnan %A Hayati, Hussein %A Zarka, Zaki A %J Surg Neurol %D 2007 May %N 5 %P 540-3 %T Cervical radiculopathy secondary to Hodgkin's lymphoma %V 67 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17445629 %X BACKGROUND: Spinal cord/root compression is a rare complication of HL and usually seen in the setting of progressive, advanced disease. It is extremely rare to occur as an initial presentation of HL. We report a case of HL presented with bilateral cervical radiculopathy. METHODS: A case report of a 42-year-old woman who presented with C8 cervical radiculopathy and paraspinal mass with extradural extension in C7-T1. Biopsy revealed HL. This case report represents a case of HL presenting with epidural disease, with nerve root compression as the only apparent site of clinical involvement. A review of the literature of patients with HL presenting with spinal cord/root compression is presented. RESULT: Our patient received chemotherapy and external beam radiation therapy. She achieved good recovery of her symptoms and complete response by radiologic criteria. Based on a review of the literature, Hodgkin's disease involving the spinal epidural space is very responsive to chemoradiotherapy with good prognosis for both functional recovery and complete response. CONCLUSION: Chemoradiotherapy is a successful treatment for Hodgkin's disease presenting with spinal root compression. Surgery should be reserved for urgent decompression, if needed; palliation; and maintenance of function and stability %0 Journal Article %A Ali, Robin R %A Winkfield, Karen M %A Galanos, Anthony N %J Am J Hosp Palliat Care %D 2006 Aug-Sep %N 4 %P 267; author reply 267-8 %T Antidepressant medication use in palliative care %V 23 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17060289 %0 Journal Article %C Service d'immuno-hematologie pediatrique, Hopital Debrousse, Hospices Civils de Lyon, Lyon, France %A Andre, J- M %A Cimaz, R %A Ranchin, B %A Galambrun, C %A Bertrand, Y %A Bouvier, R %A Rieux-Laucat, F %A Trescol-Biemont, M C %A Cochat, P %A Bonnefoy-Berard, N %J Lupus %D 2007 %N 2 %P 95-100 %T Overexpression of the antiapoptotic gene Bfl-1 in B cells from patients with familial systemic lupus erythematosus %V 16 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17402365 %X Genetic determinants taking part in the development of systemic lupus erythematosus (SLE) are complex and not fully characterized. Dysregulated expression of genes involved in the control of apoptosis has been previously suggested. We report here a consanguineous family with SLE manifestations in three siblings associated in one of them with severe lymphoproliferative features. Laboratory studies showed no defect in CD95-mediated cell death. Screening expression of Bcl-2 family genes that regulate mitochondrial apoptosis pathway showed an overexpression of the antiapoptotic Bfl-1 gene. Real time RT-PCR analysis indicated that overexpression of Bfl-1 was restricted to B-cells, with normal expression in T-cells. Those results suggest that overexpression of Bfl-1 could result in impaired B-lymphocyte homeostasis and inappropriate immune response leading to autoimmune manifestations %0 Journal Article %C Center for Rheumatology and Bone Research, Wheaton, Maryland 20902, USA. hsbbaraf@mac.com %A Baraf, Herbert S B %A Fuentealba, Carlos %A Greenwald, Maria %A Brzezicki, Jan %A O'Brien, Katherine %A Soffer, Beth %A Polis, Adam %A Bird, Steven %A Kaur, Amarjot %A Curtis, Sean P %J J Rheumatol %D 2007 Feb %N 2 %P 408-20 %T Gastrointestinal side effects of etoricoxib in patients with osteoarthritis: results of the Etoricoxib versus Diclofenac Sodium Gastrointestinal Tolerability and Effectiveness (EDGE) trial %V 34 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17304660 %X OBJECTIVE:. To compare the gastrointestinal (GI) tolerability, safety, and efficacy of etoricoxib and diclofenac in patients with osteoarthritis (OA). METHODS: In total, 7111 patients (mean age 64 yrs) diagnosed with OA were enrolled in a randomized, double-blind trial. Patients received etoricoxib 90 mg qd (n = 3593) or diclofenac sodium 50 mg tid (n = 3518). Gastroprotective agents and low-dose aspirin were prescribed per treatment guidelines. The primary endpoint was the cumulative rate of discontinuations due to clinical and laboratory GI adverse experiences (AE). General safety was assessed, including adjudication of thrombotic cardiovascular (CV) safety data. Efficacy was evaluated using the least-square (LS) mean change from baseline patient global assessment of disease status (PGADS; 0-4 point scale). RESULTS: Mean (SD, maximum) duration of treatment was 9.3 (4.4, 16.5) and 8.9 (4.5, 16.6) months in the etoricoxib and diclofenac groups, respectively. The cumulative discontinuation rate due to GI AE was significantly lower with etoricoxib than diclofenac [9.4 vs 19.2 events per 100 patient-years (PY), respectively; hazard ratio (HR) 0.50 (95% CI 0.43, 0.58; p < 0.001). Rates of thrombotic CV events were similar with etoricoxib and diclofenac [1.25 vs 1.15 events per 100 PY, respectively; HR 1.07 (95% CI 0.65, 1.74)]. The incidence of patients who discontinued due to hypertension-related AE was significantly higher with etoricoxib compared to diclofenac (2.3% vs 0.7%; p < 0.001), although few AE were severe (3 etoricoxib, 1 diclofenac). Etoricoxib and diclofenac treatment resulted in similar improvements in PGADS from baseline of -0.78 (95% CI -0.80, -0.75) and -0.75 (95% CI -0.77, -0.72), respectively. CONCLUSION: Treatment with etoricoxib 90 mg was associated with significantly better GI tolerability compared to diclofenac in this population of patients with OA. Etoricoxib 90 mg, a dose 50% higher than indicated for OA, resulted in more discontinuations due to hypertension-related AE %0 Journal Article %C Palliative Care Service, Wellmont Health Systems, Adventa Hospice, and Quillen College of Medicine, Rogersville, Tennessee, USA %A Baumrucker, Steven J %A Carter, Greg %A Morris, Gerald M %A Stolick, Matt %A Sheldon, Joanne E %A Brothers, Diane %J Am J Hosp Palliat Care %D 2006 Aug-Sep %N 4 %P 332-7 %T Amyotrophic lateral sclerosis and physician assisted suicide %V 23 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17060299 %0 Journal Article %C Department of Family Medicine, University of Rochester, Rochester, New York, USA. wbayer1@rochester.rr.com %A Bayer, William %A Mallinger, Julie B %A Krishnan, Ashok %A Shields, Cleveland G %J Ethn Dis %D 2006 Autumn %N 4 %P 914-9 %T Attitudes toward life-sustaining interventions among ambulatory black and white patients %V 16 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17061746 %X OBJECTIVES: The purpose of this study was to evaluate racial differences in preference for life-sustaining interventions in the context of various physical and mental health scenarios. DESIGN: Data were collected by using an investigator-administered survey. SETTING AND PATIENTS: Consecutive patients who self-identified as African American or Caucasian were recruited from two private primary care practices in Rochester, New York. MAIN OUTCOME MEASURES: Patients were asked to decide whether they would accept or decline life-sustaining intervention in eight scenarios, each involving a different combination of mental and physical disability. Information on religiousness, family integration, and experience with creating a healthcare proxy was also collected, as these variables were believed to be potential confounders of the relationship between race and preference. RESULTS: Data from 77 patients (50 Black patients and 27 White patients) were analyzed. In multivariate log linear modeling, race was a significant predictor of preference for life-sustaining therapy, even after controlling for degree of mental and physical disability. Religiousness, family integration, and experience with creating a healthcare proxy did not explain racial differences in preference for life-sustaining therapy. CONCLUSIONS: We have shown that ambulatory Black patients aged > or = 50 years are more likely than White patients to prefer life-sustaining care, and that these preferences persist across a wide range of mental and physical disabilities. This attitude conflicts with the prevailing ethic regarding end-of-life care, and Black patients and their families may consequently find have difficulty obtaining medical care that is consistent with their cultural values and beliefs. Policy decisions regarding end-of-life care must reflect a culturally diverse perspective %0 Journal Article %C Department of Nursing, Indiana University-Purdue University, 2101 East Coliseum Boulevard, Fort Wayne, IN 46805, USA. beckmans@ipfw.edu %A Beckman, Sarah %A Boxley-Harges, Sanna %A Bruick-Sorge, Cheryl %A Salmon, Becky %J Holist Nurs Pract %D 2007 May-Jun %N 3 %P 135-9 %T Five strategies that heighten nurses' awareness of spirituality to impact client care %V 21 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17471051 %X Professional practice standards mandate that spiritual nursing care is a responsibility, not an option. This article explores 5 experiential learning activities that seek to heighten a person's awareness of his or her own spirituality and that also increases one's sensitivity to the spiritual needs of others %0 Journal Article %C Department of Radiation Oncology, Tata Memorial Hospital. Kharghar, Navi Mumbai, India. tejpalgupta@rediffmail.com %A Bedre, Girish %A Gupta, Tejpal %A Rajasekharan, Preetha %A Munshi, Anusheel %A Jalali, Rakesh %J JOP %D 2007 %N 4 %P 444-9 %T Cerebellar, pancreatic, and paraspinal metastases in soft tissue sarcomas: unusual sites or changing patterns? %V 8 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17625297 %X CONTEXT: Soft tissue sarcomas generally first metastasize to the lungs followed by the involvement of other sites such as lymph nodes and bones as part of the disseminated disease. Cerebellar and pancreatic metastases from tumors of mesenchymal origin such as soft tissue sarcomas are exceptional, more so in the absence of pulmonary metastases. CASE REPORT: A previously treated case of chest wall sarcoma presented with the sudden onset of neurological symptoms. An MRI brain scan was suggestive of a solitary cerebellar metastasis. A CT scan of the thorax and abdomen showed no evidence of disease. A metastasectomy of the solitary brain lesion confirmed a deposit from a previously treated sarcoma. Within two months he presented with central abdominal pain and low backache radiating down both lower limbs. FDG-PET and CT scans revealed a large pancreatic and left paraspinal mass with intense tracer uptake suggestive of metastatic involvement. There was no evidence of pulmonary metastases. A CT-guided biopsy was suggestive of high-grade sarcoma. He was treated with palliative radiotherapy with good symptomatic relief. CONCLUSION: Cerebellar, pancreatic, and paraspinal metastases from soft tissue sarcomas are rare, especially in the absence of pulmonary metastases. A high index of suspicion is necessary, and appropriate imaging should be considered for symptomatic patients %0 Journal Article %C Intensive Care/Anaesthesia, General Infirmary at Leeds, Great George Street, LS1 3EX, Leeds, UK. dominic.bell@leedsth.nhs.uk %A Bell, Dominic %J Intensive Care Med %D 2007 Jan %N 1 %P 158-62 %T The legal framework for end of life care: a United Kingdom perspective %V 33 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17091245 %0 Journal Article %C Urological Department, Akershus University Hospital, Nordbyhagen, Norway. viktor.berge@akersykehus.no %A Berge, Viktor %A Thompson, Trevor %A Blackman, Donald %J Scand J Urol Nephrol %D 2007 %N 3 %P 198-203 %T Use of additional treatment for prostate cancer after radical prostatectomy, radiation therapy, androgen deprivation, or watchful waiting %V 41 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17469027 %X OBJECTIVE. To examine how the use of additional treatment for prostate cancer differs as a function of the initial therapy (radical prostatectomy [RP], radiation therapy [RT], androgen deprivation therapy [ADT], or watchful waiting [WW]) for men with non-metastatic prostate cancer. MATERIAL AND METHODS. A dataset was created that combined information from the Surveillance, Epidemiology, and End Results program and Medicare claims for hospital and physician services. To identify patients receiving additional cancer treatment, we searched the claims for the presence of RP, RT (palliative radiation not included), or ADT. RESULTS. The study population consisted of 12 711 patients: as initial treatment, 3940 (31.0%) had RP, 3950 (31.1%) RT, 1209 (9.5%) ADT, and 3612 (28.4%) WW. The RP group had a less favorable distribution of tumor differentiation than the RT group. Only 54.6% of men who had initial RP had localized cancer. In men who had initial RP, 8.1% had RT and 12.4% ADT during the follow-up period, which was 6-66 months after the initial therapy ended. Among patients who had initial RT or WW, 22.8% and 22.1%, respectively had ADT during the follow-up period. CONCLUSION. Older American men with prostate cancer who are initially treated with RT or simply observed (WW) are more likely than men who undergo RP to receive ADT as a follow-up treatment %0 Journal Article %C Rutgers University, New Brunswick, NJ, USA. bluebond@camden.rutgers.edu %A Bluebond-Langner, Myra %A Belasco, Jean Bello %A Goldman, Ann %A Belasco, Carmen %J J Clin Oncol %D 2007 Jun %N 17 %P 2414-9 %T Understanding parents' approaches to care and treatment of children with cancer when standard therapy has failed %V 25 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17557955 %X PURPOSE: To examine US and United Kingdom (UK) parents' approaches to care and treatment when standard therapy has failed and consider implications for clinical practice. METHODS: We conducted a prospective, ethnographic study of parents, patients, and staff, including participant-observation; open-ended, semistructured interviews; and review of medical records at a US and UK pediatric oncology center. Thirty-four children (n = 17 US, 17 UK), whose disease had recurred with less than 30% chance of cure, were enrolled between March 2001 and June 2002 and followed until death (n = 11 US, 14 UK) or close of study in December 2005 (n = 6 US, 3 UK). RESULTS: There were no major differences between parents' approaches in the US and UK despite differences in health care systems, institutions, and parents' religion or ethnicity. All parents continued to have or request meetings with the oncologist and investigative procedures. No parent initiated discontinuation of cancer- or symptom-directed interventions. In 28 of 34 cases (13 US, 15 UK), parents continued to pursue cancer-directed therapies; in 16 of 28 cases (seven US, nine UK), parents initiated inquires beyond what was offered. CONCLUSION: Understanding parents' behavior requires attention to the reason and emotion they bring to decision making and their children's care, their unique responsibilities as parents, and what they learn throughout the illness. Parents do not see cancer-directed therapy and symptom-directed care as mutually exclusive, alternative approaches. Parents will not be constrained by what the oncologist offers. Physicians and parents discuss and negotiate care and treatment throughout the illness. Our findings suggest developing integrative care models incorporating cancer-directed, symptom-directed, and supportive care throughout the illness; they are most consistent with parents' approaches and advances in pediatric oncology %0 Journal Article %C Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA. pete6174@umn.edu %A Brandenburg, B M P %A Andersen, A E %J Eat Weight Disord %D 2007 Jun %N 2 %P 97-100 %T Unintentional onset of anorexia nervosa %V 12 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17615494 %X OBJECTIVE: The purpose of this article is to report a series of patients with an onset of anorexia nervosa precipitated by unintended weight loss rather than the more typical onset following intentional dieting, or the occasional iatrogenic beginning. METHOD: Retrospectively, case notes of 66 consecutive outpatient evaluations at an eating disorder diagnostic clinic between 2002 and 2006 were reviewed. RESULTS: Five cases, 7.6%, of inadvertent onset anorexia nervosa were identified. Causes of the inadvertent weight loss were varied: the mourning of a death, a parasitic infection, medication side effects and surgery. None had intended to lose weight. CONCLUSIONS: We postulate that inadvertent weight loss may be as powerful a trigger as intentional dieting to initiating anorexia nervosa in predisposed individuals; self-induced weight loss may not be a necessary precursor to anorexia nervosa %0 Journal Article %C Center on Aging, Office of Public Health Studies, University of Hawaii, Honolulu, USA. kbraun@hawaii.edu %A Braun, Kathryn L %A Karel, Harumi %A Zir, Ana %J Am J Hosp Palliat Care %D 2006 Aug-Sep %N 4 %P 269-76 %T Family response to end-of-life education: differences by ethnicity and stage of caregiving %V 23 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17060290 %X The authors developed and tested 5 educational booklets to improve end-of-life knowledge, attitudes, intention, and practices in a multiethnic sample of family caregivers of well, homebound, and institutionalized elders. Of 570 participants, 424 (74%) read at least 1 booklet and completed pretests and posttests. At 3-month follow-up, small improvements were seen in completion of advance directives, and significant increases were seen in proportions of caregivers with funeral or burial plans and willingness to consider hospice. The booklets had wide appeal, but end-of-life measures varied by care-giver stage and ethnicity, suggesting that these factors need to be considered in developing education interventions for family caregivers %0 Journal Article %C School of Nursing, McMaster University, Hamilton, ON. bryantl@mcmaster.ca %A Bryant-Lukosius, Denise %A Green, Esther %A Fitch, Margaret %A Macartney, Gail %A Robb-Blenderman, Linda %A McFarlane, Sandra %A Bosompra, Kwadwo %A DiCenso, Alba %A Matthews, Susan %A Milne, Harry %J Can J Nurs Leadersh %D 2007 %N 2 %P 50-68 %T A survey of oncology advanced practice nurses in Ontario: profile and predictors of job satisfaction %V 20 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17619596 %X The purpose of this study was to examine role structures and processes and their impact on job satisfaction for oncology advanced practice nurses (APNs) in Ontario. APNs caring for adult, paediatric or palliative patients in integrated regional cancer programs, tertiary care hospitals or community hospitals and agencies were invited to complete a mailed self-report questionnaire. A total of 73 of 77 APNs participated in the study. Most APNs (55%) were acute care nurse practitioners employed by regional cancer programs or tertiary care hospitals. Adult patients with breast or haematological cancers and those receiving initial treatment or palliative care were the primary focus of APN roles. APN education needs related to specialization in oncology, leadership and research were identified. Overall, APNs were minimally satisfied with their roles. Role confidence (beta = .404, p = .001) and the number of overtime hours (beta = -.313, p = .008) were respective positive and negative predictors of APN job satisfaction. Progress in role development is described, and recommendations for improving role development and expanding the delivery of oncology APN services are provided %0 Journal Article %C School of Nursing, University of KwaZulu-Natal, Durban 4041, South Africa. brysiewiczp@ukzn.ac.za %A Brysiewicz, Petra %J Accid Emerg Nurs %D 2007 Apr %N 2 %P 88-93 %T The lived experience of working in a mortuary %V 15 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17451956 %X A four year action research study was undertaken in an attempt to foster change in the current management of sudden deaths in the Accident and Emergency Departments in South Africa. During the phase of interviewing bereaved families and health professionals it became apparent that there was a need to involve mortuary staff as victims of sudden deaths have to undergo an autopsy. The researcher chose an interpretive hermeneutic phenomenological research approach to explore the lived experience of working in a mortuary. The mortuary is a place of mystery, sadness, grief or repulsion and we all hope, while we are alive, we will never need to visit. For families who have lost a loved one to a sudden death, this becomes a reality. Working in a mortuary is an extremely stressful experience which is made worse in South Africa due to the large number of people dying sudden violent deaths due to trauma. The themes which emerged from the interviews with mortuary staff were; secondary trauma for families, delays by health professionals and dehumanised mortuary staff. There is a need for a change in the way bereaved families are being managed as well as revision of the environment for the staff working in mortuaries %0 Journal Article %C Centro de Investigacion en Enfermedades Tropicales, Departamento de Parasitologia, Facultad de Microbiologia, Universidad de Costa Rica. Chinchillacm@UCIMED.com %A Carmona, Misael Chinchilla %A Bermudez, Olga Guerrero %A Gutierrez-Espeleta, Gustavo A %A Porras, Ronald Sanchez %A Ortiz, Beatriz Rodriguez %J Rev Biol Trop %D 2005 Sep-Dec %N 3-4 %P 437-45 %T [Intestinal parasites in howler monkeys Alouatta palliata (Primates: Cebidae) of Costa Rica] %V 53 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17354453 %X Fecal samples of 102 howler monkeys (Alouatta palliata) from several sites of Costa Rica were studied for intestinal parasites. The zones studied were: Central Valley (San Ramon, Alajuela), Central Pacific (Chomes and Manuel Antonio National Park. Puntarenas), North Pacific (Palo Verde Park and Playa Potrero, Guanacaste). Chira Island in the Nicoya Gulf and Caribean area (Cahuita. Limon). Animals were anesthetized with dards containing Telazol in order to collect the fecal material; some monkeys defecated spontaneously and others by direct stimulation. Samples were studied in saline solution (0.85%) and a Iodine solution, or stained with Haematoxylin. The material was also cultured in Dobell culture medium to determine the presence of amoeba and flagellates. Strongvloides. Controrchis. Trypanoxyuris genera were found in 3.4% of the samples. In addition 16.7% to 80% of the animals showed protozoa infection with Endolimax, Entamoeba, Trichomonas and Giardia. It is discussed the relationships of parasite infection with environmental conditions, animal population and human presence, specially in the monkey conservation programs point of view %0 Journal Article %C HEAD, Suicide Prevention Research Unit, Centre for Mental Health Studies, Hunter Mail Centre, NSW 2310, Australia. carter@mail.newcastle.edu.au %A Carter, G L %A Clover, K A %A Parkinson, L %A Rainbird, K %A Kerridge, I %A Ravenscroft, P %A Cavenagh, J %A McPhee, J %J Psychooncology %D 2007 Apr %N 4 %P 295-303 %T Mental health and other clinical correlates of euthanasia attitudes in an Australian outpatient cancer population %V 16 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=16921477 %X A majority of patients with cancer have been reported to endorse euthanasia and physician assisted suicide (PAS) in general and a substantial proportion endorse these for themselves. However, the potential influence of mental health and other clinical variables on these decisions is not well understood. This study of 228 outpatients attending an oncology clinic in Newcastle, Australia used a cross-sectional design and logistic regression modelling to examine the relationship of demographic, disease status, mental health and quality of life variables to attitudes toward euthanasia and PAS. The majority reported support for euthanasia (79%, n=179), for PAS (69%, n=158) and personal support for euthanasia/PAS (68%, n=156). However, few reported having asked their doctor for euthanasia (2%, n=5) or PAS (2%, n=5). Three outcomes were modelled: support for euthanasia was associated with active religious belief (adjusted odds ratio (AOR) 0.21, 95% CI: 0.10-0.46); support for PAS was associated with active religious belief (AOR 0.35, 95% CI: 18-0.70) and recent pain (AOR 0.87, 95% CI: 0.0.76-0.99); and personal support for euthanasia/PAS was associated with active religious belief (AOR 0.26, 95% CI: 0.14-0.48). Depression, anxiety, recent suicidal ideation, and lifetime suicide attempt were not independently associated with any of the three outcomes modelled %0 Journal Article %C Centre de biologie et pathologie est, Hospices civils de Lyon, Service de neurobiologie, Groupement hospitalier Est, Lyon Bron %A Caudie, C %A Bouhour, F %A Petiot, P %A Gonnaud, P-M %A Antoine, J-C %A Vial, C %J Ann Biol Clin (Paris) %D 2007 Jul-Aug %N 4 %P 369-75 %T [Diagnostic value of the anti-IgM SGPG Elisa (Buhlmann laboratories AG) in 147 sera with a monoclonal IgM anti-MAG/SGPG antibody-associated neuropathy.] %V 65 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17627917 %X Binding of monoclonal IgM antibodies in serum to antigens of the peripheral nervous system such as MAG and SG(L)PG was measured by various non standardised methods. In this study we evaluated a new commercially available IgM anti-SGPG ELISA (Buhlmann Laboratories AG, Switzerland). The results were compared with three different markers and methods: (1) an in-house thin-layer overlay chromatography for IgM reactivity against sulfated glucuronosyl paragloboside (SGPG) antibodies (gold standard), (2) an indirect immunofluorescent assay for detecting IgM antibodies against myelin, and (3) IgM anti-MAG antibodies, a commercially available Kit based on ELISA technology, manufactured by Buhlmann Laboratories AG. 147 patient sera with anti-MAG/SGPG neuropathy and 121 control sera from patients with peripheral neuropathy were analysed. The anti-SGPG autoantibody ELISA turned out to be a very reliable commercially available test with no technical difficulties and both, excellent sensitivity (0.98), and specificity (0.98) for detecting MAG/SGPG antibody-mediated demyelinating neuropathies. Anti-SGPG antibody titers have pratical implications for both, management and follow-up of neuropathies treated with rituximab %0 Journal Article %C Department of Hematology and Medical Oncology, Hospital Clinico Universitario, Facultad de Medicina y Odontologia, Universidad de Valencia, Valencia, Spain. andres.cervantes@uv.es %A Cervantes, A %A Rodriguez Braun, E %A Perez Fidalgo, A %A Chirivella Gonzalez, I %J Clin Transl Oncol %D 2007 Apr %N 4 %P 208-15 %T Molecular biology of gastric cancer %V 9 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17462972 %X Despite its decreasing incidence overall, gastric cancer is still a challenging disease. Therapy is based mainly upon surgical resection when the tumour remains localised in the stomach. Conventional chemotherapy may play a role in treating micrometastatic disease and is effective as palliative therapy for recurrent or advanced disease. However, the knowledge of molecular pathways implicated in gastric cancer pathogenesis is still in its infancy and the contribution of molecular biology to the development of new targeted therapies in gastric cancer is far behind other more common cancers such as breast, colon or lung. This review will focus first on the difference of two well defined types of gastric cancer: intestinal and diffuse. A discussion of the cell of origin of gastric cancer with some intriguing data implicating bone marrow derived cells will follow, and a comprehensive review of different genetic alterations detected in gastric cancer, underlining those that may have clinical, therapeutic or prognostic implications %0 Journal Article %C Department of Orthopedic Surgery, China Medical University Hospital, Taichung, Taiwan. yenjenc@yahoo.com %A Chen, Yen-Jen %A Chang, Gee-Chen %A Chen, Hsien-Te %A Yang, Tsung-Ying %A Kuo, Benjamin Ing-Tiau %A Hsu, Horng-Chaung %A Yang, Hui-Wen %A Lee, Tu-Sheng %J Spine %D 2007 Jul %N 15 %P E413-8 %T Surgical results of metastatic spinal cord compression secondary to non-small cell lung cancer %V 32 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17621197 %X STUDY DESIGN: The results for 37 surgical interventions in 31 consecutive patients with non-small cell lung cancer (NSCLC) with symptomatic spinal cord compression were reviewed retrospectively. OBJECTIVES: To evaluate postoperative outcomes and survival rates of NSCLC patients surgically treated for symptomatic spinal metastasis. SUMMARY OF BACKGROUND DATA: For patients with spinal cord compression secondary to lung cancer, the prognosis is usually poor. However, with the development of new chemotherapeutic drugs and targeted therapeutic agents, the survival rate may be better. METHODS: From November 2000 to March 2005, 31 patients with symptomatic metastatic spinal cord compression secondary to NSCLC underwent palliative surgery using a posterolateral transpedicular approach (PTA) or combined posterior and anterior procedures. The indication for surgery was neurologic progression due to spinal cord compression. RESULTS: The patients ranged in age from 20 to 81 years (mean, 61.4 years). Twenty-eight patients (90%) underwent PTA, and 3 patients had combined posterior and anterior procedures. Neurologic improvement by at least one Frankel grade was noted in 25 of 31 cases (80%). Overall, 74% of patients (23 of 31) were able to walk after surgery. There was no case of intraoperative mortality, but two deaths occurred in the postoperative period. Median survival time was 8.8 months. CONCLUSIONS: Even though lung cancer is considered an aggressive tumor, it is justifiable to aggressively treat patients with symptomatic spinal cord compression. Surgery by PTA can lead to good results in these patients %0 Journal Article %C Department of Neurosurgery, Stanford University School of Medicine, Stanford, California 94305, USA. sam@samuelcheshier.com %A Cheshier, Samuel H %A Bababeygy, Simon R %A Higgins, Dominique %A Parsonnet, Julie %A Huhn, Stephen L %J Neurosurgery %D 2007 Jul %N 1 %P E167; discussion E167 %T Cerebral myiasis associated with angiosarcoma of the scalp: case report %V 61 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17621006 %X OBJECTIVE: Primary human cerebral myiasis is an exceedingly rare condition and is almost never encountered by physicians in developed countries. The case report summarizes a case of extensive cerebral myiasis in a periurban community in the United States. CLINICAL PRESENTATION: After a minor motor vehicle accident, police brought a 75-year-old man to the emergency room because he was observed to have a large cranial lesion. Examination revealed a 15 x 17 cm frontal bone defect with eroded frontal dura, exposed cortex, and massive cortical maggot infestation. INTERVENTION: The patient was empirically treated with intravenous antibiotics for meningitis. Maggots (Phaenicia sericata, or the green bottle fly) were removed by suction, attrition, and gentle contact exposure to a mild bleach solution. Biopsy of the scalp and cranium revealed angiosarcoma, for which operative treatment was refused. The patient was transferred to a skilled nursing facility for palliative care where he died 3 months later. CONCLUSION: This is the first published case of cerebral myiasis in the United States. Although human cerebral myiasis is rare, conditions do exist in this country that permit myiasis %0 Journal Article %C Departments of Psychiatry (H.M.C.), Family Medicine (H.M.C.), Community Health Sciences (H.M.C., T.H.), and Faculty of Nursing (T.F.H., S.M.), University of Manitoba, Winnipeg; Manitoba Palliative Care Research Unit (H.M.C., T.F.H, S.M.), and Patient and Family Support Services (H.M.C., T.F.H.), CancerCare Manitoba, Winnipeg; and St. Boniface General Hospital (M.H.), Winnipeg, Manitoba, Canada; and WA Centre for Cancer & Palliative Care (H.M.C., L.J.K.), Curtin University, Perth, Australia %A Chochinov, HM %A Kristjanson, LJ %A Hack, TF %A Hassard, T %A McClement, S %A Harlos, M %J J Pain Symptom Manage %D 2007 Jul %T Burden to Others and the Terminally Ill %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17616329 %X Studies of patients who are terminally ill consistently identify strong associations between "sense of burden to others" and marked end-of-life distress. However, little research has addressed the issue of burden to others among patients nearing death. The aim of this study was to carefully examine "burden to others" and clarify its relationship with various psychosocial, physical, and existential issues arising in patients who are terminally ill. A cohort of 211 patients with end-stage cancer were assessed, using an assortment of validated psychometrics to document psychosocial, physical, and existential aspects of their end-of-life experience. This included an assessment of their sense of "burden to others." Forty percent of participants indicated a negligible sense of burden to others, scoring within the lowest quarter on an ordinal measure of "burden to others"; 25% scored within the second lowest quarter; 12% within the third quarter; and 23% within the highest or most severe range. The most highly correlated variables with "sense of burden to others" included depression (r=0.460; df=201, P<0.0001), hopelessness (r=0.420; df=199, P<0.0001), and outlook (r=0.362; df=200, P<0.0001). Four variables emerged in a multiple regression analysis predicting burden to others, including hopelessness, current quality of life, depression, and level of fatigue [R(2) adj=0.32, F(6,174)=13.76, P<0.0001]. There was no association between sense of burden to others and actual degree of physical dependency. Feeling a sense of burden to others is common among dying patients. Although 40% of the sample reported little in the way of sense of burden to others, the remainder endorsed higher degrees of burden-related distress, with 23% scoring within the most severe range. The lack of association between "sense of burden to others" and the degree of physical dependency suggests this perception is largely mediated through psychological and existential considerations. Strategies that target meaning and purpose, depression, and level of fatigue could lessen this source of distress and enhance quality, dignity-conserving care %0 Journal Article %C Hospices Civils de Lyon- Universite Lyon 1, Lyon, France. roland.cimaz@chu-lyon.fr %A Cimaz, R %A Meregalli, E %A Biggioggero, M %A Airo, P %A Danieli, E %A Antonioli, C M %A Motta, M %A Chirico, G %A Columbrita, D %A Frassi, M %A Meroni, P L %A Tincani, A %J Lupus %D 2007 %N 2 %P 129-32 %T Response to tetanus vaccination in infants exposed in utero to immunosuppressants for maternal autoimmune disorders %V 16 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17402369 %X Immunosuppressive drugs given during pregnancy to mothers suffering from a systemic autoimmune disease (AID) can cross the placenta, thus being potentially able to affect the offspring immune system. Aim of our study was to evaluate the in vivo immune function of a series of these newborns. Twenty-two babies born from mothers suffering from autoimmune diseases (AID) who had been taking immunosuppressive drugs during pregnancy were evaluated for their response to vaccination with C. Tetani toxoid. Six babies born from mothers receiving low-dose aspirin only were used as controls. The immune response to C. Tetani vaccination was evaluated with an ELISA to detect circulating antibodies. Five children out of 28 (17%) did not achieve a protective titer of anti C. Tetani toxoid IgG. No clear relationship was found between specific drug exposure and antibody response. Our findings suggest that maternal immunosuppressive treatment given for a systemic AID can affect the response to an active immunization, without specificities for drug types used %0 Journal Article %A Cuadrado-Pereira, Marianela %A Rodriguez-Saenz, Jorge %A Andujar-Felix, Job %J Bol Asoc Med P R %D 2007 Jan-Mar %N 1 %P 60-3 %T Spinal cord high grade astrocytoma %V 99 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17616049 %X OBJECTIVES: To describe the medical history, psychosocial aspects and the rehabilitation management of a patient with a high-grade astrocytoma of the spinal cord. To review the literature regarding the epidemiology, classification, treatment, prognosis, and outcomes of astrocytomas involving the spinal cord. To discuss issues and controversies in the rehabilitation management of spinal cord high-grade astrocytomas. SETTING: Inpatient Spinal Cord Injury Rehabilitation Unit of Veterans Affair Medical Center; San Juan, Puerto Rico. MAIN OUTCOME MEASURES: Survival time and Functional Independence Measure (FIM) prior to and after receiving comprehensive intensive inpatient rehabilitation treatment. RESULTS: Aggressive multimodality treatment including acute inpatient interdisciplinary rehabilitation approach provided excellent results exceeding survival time and functional expectations for a patientwith high-grade astrocytoma. CONCLUSIONS: This case report stands out for two main reasons: (1) the survival time of more than three years, which exceeded the expected survival time of ten months for a patient diagnosed with spinal cord high grade astrocytoma and (2) for the outcomes achieved through an intensive comprehensive acute inpatient interdisci-plinary rehabilitation program which helped the patient achieve previous premorbid functional goals. Further studies are needed to compare these outcomes versus the ones that can be achieved through the implementation of rehabilitation management and care programs in long term care facilities such as nursing homes and hospice among others %0 Journal Article %C Pain and Palliation Research Group, Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway %A Dale, O %A Thoner, J %A Nilsen, T %A Tveita, T %A Borchgrevink, PC %A Klepstad, P %J Eur J Clin Pharmacol %D 2007 Jul %T Serum and cerebrospinal fluid morphine pharmacokinetics after single doses of intravenous and intramuscular morphine after hip replacement surgery %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17619868 %X AIM: To compare the time course of morphine and metabolite concentrations in serum and cerebrospinal fluid (CSF) after intravenous and intramuscular administration after surgery. METHODS: This was a randomized double-blind, double-dummy study in patients who had undergone hip replacement surgery. Morphine (M, 10 mg) was administered intravenously (IV) or intramuscularly (IM). Arterial blood and CSF samples (from a spinal catheter) were drawn simultaneously at 10, 30, 60, and 120 min after administration. Morphine and metabolites [morphine-3-glucuronide (M-3-G), morphine-6-glucuronide (M-6-G), and normorphine (NM)] were determined by a validated liquid chromatography-tandem mass spectrometry method. RESULTS: Thirty-eight patients were included: 13 men and 25 women, 20 in the IV, 18 in the IM group. Serum concentrations of M after 10 min were consistently higher after IM than IV, concentrations of M-3-G and M-6-G after IM surpassed those of IV after 45 min. NM was not found. None of the metabolites was found in CSF. CSF morphine concentrations and CSF/serum concentration ratios were consistently higher after IV compared to IM. The mean AUC(CSF)/AUC(serum) (0-120 min) concentration ratios were 0.18 and 0.09 after IV and IM, respectively. CONCLUSIONS: The uptake of morphine to the CSF was consistently higher after IV administration than after IM already after 10 min. The higher CSF concentration may be caused by an initially higher morphine blood/CSF gradient following IV morphine injection. The pharmacokinetic findings are compatible with a more rapid and extensive initial effect of IV morphine compared with IM %0 Journal Article %C School of Nursing, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44118, USA. Barbara.daly@case.edu %A Daly, Barbara J %A Douglas, Sara L %A Foley, Helen %A Lipson, Amy %A Liou, Chiou-Fang Emily %A Bowman, Karen %A Kwilosz, Donna %A Koroukian, Siran %A O'Toole, Elizabeth %A Smyth, Kathleen %A Townsend, Aloen %A VonGruenigen, Vivian %A Rose, Julia %J Psychooncology %D 2007 Apr %N 4 %P 358-64 %T Psychosocial registry for persons with cancer: a method of facilitating quality of life and symptom research %V 16 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=16986173 %X Research focused on the psychosocial aspects of the experience of persons with cancer and their family caregivers is hampered by the methodological challenges inherent in quality of life research. A data registry offers a potential solution to many of these problems in providing a large, comprehensive database, using standardized instruments. We report here our preliminary experience with establishing a Psychosocial Registry designed to advance research in the psychological, social, and spiritual aspects of quality of life of newly diagnosed cancer patients and their family caregivers. The first six months of enrollment demonstrated that the majority of newly diagnosed patients approached for consent (68%) and their primary family caregiver (92%) were willing to participate in the registry; of these, 80% also agreed to be contacted in the future for additional studies. Face-to-face interview was the preferred method of data collection. Our preliminary experience suggests that continuation of the registry with the current modest level of resources would generate a sample of approximately 1000 patients in three years. The long-range goal is to establish a national psychosocial data registry that will enroll patients at diagnosis and follow them through the entire cancer experience, including end of life or survivorship %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 %C Centre hospitalier universitaire Saint-Louis, Assistance publique-Hopitaux de Paris, 1, avenue Claude-Vellefaux, 75475 Paris cedex 10, France. davous@ccr.jussieu.fr %A Davous, D %A Doz, F %A Heard, M %J Arch Pediatr %D 2007 Mar %N 3 %P 274-8 %T [End of life and clinical research in pediatric oncology] %V 14 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17218088 %X The objective of a phase I trials in paediatrics is to determine the recommended dose of a new treatment in children while evaluating its toxicity. These trials are proposed when no effective curative treatment is available. The probability of a benefit in terms of disease control is certainly very low, but greater than zero. On the basis of the work conducted by an Assistance publique-Hopitaux de Paris Espace ethique group in collaboration with parents, healthcare personnels and a philosopher, phase I therapeutic trials can be considered to be an ethically acceptable proposal provided the criteria and risks of inclusion in such a trial are clearly defined. This article discusses the main elements of this process and is designed to provide guidelines for healthcare personnel and parents. The need for an information provided gently but honestly, the importance of a sufficient time to think about the proposed trial, a two-sided dialogue and partnership between the various actors, and the priority given to the child's best interest, as should always be the case, constitute the decisive elements to guide the proposed inclusion in a phase I trial. These conditions help to ensure that a decision is reached which appears to be morally founded for all parties, while allowing the child to remain alive up until the end, i.e. a human being capable of relating. This decision allows parents and healthcare personnel to retain a good self-image; if the child dies, it is by keeping their self-esteem that parents can live with their bereavement and healthcare personnel can reinvest in other patients %0 Journal Article %C Department of Endocrine Surgery, Medical University of Lodz, Polish Mother's Memorial Hospital-Research Institute %A Dedecjus, Marek %A Kolomecki, Krzysztof %A Brzezinski, Jan %A Adamczewski, Zbigniew %A Tazbir, Jozef %A Lewinski, Andrzej %J Endocr J %D 2007 Feb %N 1 %P 63-9 %T Influence of L-thyroxine administration on poor-platelet plasma VEGF concentrations in patients with induced short-term hypothyroidism, monitored for thyroid carcinoma %V 54 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17090953 %X Angiogenesis is a process of new blood vessel development from pre-existing vasculature. It is a crucial process in normal physiology, as well as in several pathological conditions. The vascular endothelial growth factor (VEGF) represents a family of specific endothelial cell mitogens, involved in normal angiogenesis and in tumour development. The aim of the present study was to estimate the influence of L-thyroxine (L-T4) administration on poor-platelet plasma (P-PP) VEGF concentrations in patients with induced short-term hypothyroidism, monitored for differentiated thyroid carcinoma. In the present study, P-PP concentrations of VEGF, thyroglobulin, thyrotropin and free thyroid hormones were investigated in a population of 24 hypothyroid patients, who were withdrawn from L-T4 treatment for 5 weeks and studied before and after 2 months of L-T4 therapy. Only healthy female patients with no evidence of metastasis in whole body scintigraphy were included in the study. They were then compared with 20 healthy control subjects, matched for age, sex and body mass index (BMI). The patients had significantly lower plasma VEGF concentrations before treatment with L-T4 than after administration of that hormone. There was no significant difference in plasma VEGF levels, either between the patients treated with L-T4, and the controls, or between the patients untreated with L-T4, and the controls. Even short-time changes in thyrometabolic profile exert an important influence on P-PP VEGF concentrations, even if there is no thyroid tissue %0 Journal Article %C Medical PET Group-Biological Imaging (E0601), Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany, a.dimitrakopoulou-strauss@dkfz.de %A Dimitrakopoulou-Strauss, A %A Hoffmann, M %A Bergner, R %A Uppenkamp, M %A Eisenhut, M %A Pan, L %A Haberkorn, U %A Strauss, LG %J Mol Imaging Biol %D 2007 Jul %T Prediction of Short-term Survival in Patients with Advanced Nonsmall Cell Lung Cancer Following Chemotherapy Based on 2-Deoxy-2-[F-18]fluoro-D: -glucose-Positron Emission Tomography: A Feasibility Study %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17623254 %X INTRODUCTION: Dynamic positron emission tomography (PET) studies with 2-deoxy-2-[F-18]fluoro-D: -glucose (FDG) were performed in patients with advanced nonsmall cell lung cancer (NSCLC) who received palliative chemotherapy to evaluate the impact of full kinetic analysis and assess its value with regard to short or long survival. MATERIALS AND METHODS: The evaluation includes 42 metastatic lesions in 14 patients with NSCLC. All patients received a combined chemotherapeutic protocol consisting of vinorelbin and oxaliplatin. The survival data served as reference for the PET data. All patients were examined before onset of chemotherapy and on day 15-21 after onset of the first cycle. The following parameters were retrieved from the dynamic PET studies: standardized uptake value (SUV), fractal dimension, two-compartment model with computation of k1, k2, k3, k4 (unit: 1/min), the fractional blood volume, and the FDG-influx according to Patlak was calculated using the formula (k1 x k3) / (k2 + k3). We used a two-group classification, namely, a short- and long-term survival group based on the median survival time (193 days) as a cutoff. A support vector machines (SVM) analysis was used for classification of the two a prior defined groups. RESULTS: The observed survival times varied from 40 to 392 days with a median survival time of 193 days. Most kinetic parameters demonstrated only small changes mostly declining after one cycle. The change in all kinetic parameters did not correlate to the survival-based classification. The change in SUV was significant between the first and second study (p = 0.006) but without an impact on the prediction of short or long survival. SVM-based analysis revealed the highest correct classification rate (CCR) between short and long survival for the combination of SUV and influx of the first study and SUV, influx, k2, and k4 of the second study with a CCR of 95.2%. CONCLUSION: The results demonstrate that a full kinetic analysis of the FDG kinetics in NSCLC is helpful for the classification into short or long survival and may be used to identify those patients who may benefit from this palliative chemotherapeutic protocol %0 Journal Article %C School of Nursing, University of Washington, Seattle, WA %A Doorenbos, Ardith Z %A Given, Barbara %A Given, Charles W %A Wyatt, Gwen %A Gift, Audrey %A Rahbar, Mohammad %A Jeon, Sangchoon %J Res Nurs Health %D 2007 Jun %N 3 %P 270-81 %T The influence of end-of-life cancer care on caregivers %V 30 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17514724 %X The purpose of this secondary analysis was to glean from prospective data whether those caring for elderly family members recently diagnosed with cancer who ultimately died reported different caregiver depressive symptomatology and burden than caregivers of those who survived. Findings from interviews with 618 caregivers revealed that caregiver depressive symptomatology differed based on family members' survival status, and spousal caregivers experienced greater burden when a family member was near death than did non-spousal caregivers. Family member symptoms and limitations in daily living, as well as caregiver health status, age, and employment, were associated with caregiver depressive symptomatology and burden; however, these associations had no interaction with family member survival status. (c) 2007 Wiley Periodicals, Inc. Res Nurs Health 30: 270-281, 2007 %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 Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Brightleaf Square Suite 23-A, 905 West Main Street, DUMC Box 3071, Durham, NC 27710, USA. eric.elbogen@duke.edu %A Elbogen, Eric B %A Swanson, Jeffrey W %A Appelbaum, Paul S %A Swartz, Marvin S %A Ferron, Joelle %A Van Dorn, Richard A %A Wagner, H Ryan %J Law Hum Behav %D 2007 Jun %N 3 %P 275-89 %T Competence to complete psychiatric advance directives: effects of facilitated decision making %V 31 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17294136 %X Psychiatric advance directives (PADs) statutes presume competence to complete these documents, but the range and dimensions of decisional competence among people who actually complete PADs is unknown. This study examines clinical and neuropsychological correlates of performance on a measure to assess competence to complete PADs and investigates the effects of a facilitated PAD intervention on decisional capacity. N=469 adults with psychotic disorders were interviewed at baseline and then randomly assigned to either a control group in which they received written materials about PADs or to an intervention group in which they were offered an opportunity to meet individually with a trained facilitator to create a PAD. At baseline, domains on the Decisional Competence Assessment Tool for PADs (DCAT-PAD) were most strongly associated with IQ, verbal memory, abstract thinking, and psychiatric symptoms. At one-month follow-up, participants in the intervention group showed more improvement on the DCAT-PAD than controls, particularly among participants with pre-morbid IQ estimates below the median of 100. The results suggest that PAD facilitation is an effective method to boost competence of cognitively-impaired clients to write PADs and make treatment decisions within PADs, thereby maximizing the chances their advance directives will be valid %0 Journal Article %C Arizona Cancer Center, Tucson, AZ 85724, USA %A Engelhardt, Kevin %A Riley, Christopher %A Cooke, Laurence %A Mahadevan, Daruka %J Curr Drug Discov Technol %D 2006 Dec %N 4 %P 231-43 %T Monoclonal antibody therapies targeting pancreatic ductal adenocarcinoma %V 3 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17430101 %X Pancreatic ductal adenocarcinoma (PDA) is a lethal disease with a poor prognosis where incidence mirrors mortality. Gemcitabine and gemcitabine plus erlotinib (epidermal growth factor receptor tyrosine kinase inhibitor) are the only FDA approved therapies for unresectable or metastatic PDA and are at best palliative. Hence, considerable efforts have been initiated to identify novel targets for monoclonal antibody (Mab) therapies that may safely and effectively be combined with gemcitabine. Mabs to cell surface receptors and/or their ligands have shown efficacy in pre-clinical and clinical studies in both solid and hematological malignancies and can safely be given with chemotherapy. A number of clinical trials have evaluated the safety and efficacy of Mabs targeting the tumor and/or tumor micro-environment and in combination with chemotherapy for PDA with very little success. Here we review the rationale for Mab therapies, targeted clinical trials, rational basis for target selection, pre-clinical models and promising novel cell surface targets and/or growth factor ligands that are amenable to ongoing and future Mab therapies that hold promise and hope for patients and their families with this devastating disease %0 Journal Article %C Cancer Therapy Centre, Liverpool Hospital, Liverpool, Sydney, NSW 1870, Australia. vjestall@hotmail.com %A Estall, Vanessa %A Barton, Michael B %A Vinod, Shalini K %J J Thorac Oncol %D 2007 Jun %N 6 %P 531-6 %T Patterns of radiotherapy re-treatment in patients with lung cancer: a retrospective, longitudinal study %V 2 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17545849 %X INTRODUCTION: The optimal initial radiotherapy utilization rate for lung cancer is estimated to be 76% of all new cases. The actual re-treatment rate has not been defined. Re-treatment information can aid clinical decision making and resource planning. The aim of this study was to examine the indications for re-treatment in a population cohort and report the proportion of patients who receive more than one radiotherapy treatment for lung cancer throughout their lifetime. METHODS: A retrospective longitudinal analysis of a cohort of patients with lung cancer treated with radiotherapy in the South Western Sydney Area Health Services (SWSAHS) in 1993 and 1996 was performed. The indication for and timing of all episodes of radiotherapy were recorded and analyzed using SPSS Data 3.5 software (SPSS, Inc., Chicago, IL). RESULTS: Of the 527 patients diagnosed with lung cancer in the study period, 279(53%) were treated at least once with radiotherapy. Initial radiotherapy was palliative for 79%, definitive for 14%, and adjuvant for 7%. The most common sites of initial radiotherapy were chest (79%), bone (10%), and brain (9%). Of the 279 patients, 73 (27%) received treatment with a second course of radiotherapy, 19 (7%) had a third radiotherapy episode, and 6 (2%) had a fourth. One patient had five radiotherapy episodes. Overall, there were 328 radiotherapy courses delivered to the 279 patients. DISCUSSION: The re-treatment rate for our cohort was 27%, exceeding other estimations of re-treatment. Common sites re-treated were chest and bone. Re-treatment was 17% of the initial linear accelerator treatment delivery work load for lung cancer %0 Journal Article %C Cleveland Clinic Foundation, Cleveland, OH 44195, USA %A Fader, Amanda Nickles %A Rose, Peter G %J J Clin Oncol %D 2007 Jul %N 20 %P 2873-83 %T Role of surgery in ovarian carcinoma %V 25 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17617518 %X Surgery plays a critical role in the optimal management of all stages of ovarian carcinoma. In apparent early-stage ovarian cancer, a comprehensive surgical evaluation allows stratification of patients into low- and high-risk categories. Low-risk patients may be candidates for fertility-sparing surgery and can safely avoid chemotherapy and be observed. Treatment of patients with high-risk early- or advanced-stage ovarian cancer usually requires a combined modality approach. Although it is well known that epithelial ovarian cancer is moderately chemosensitive, what distinguishes it most from other metastatic solid tumors is that surgical cytoreduction of tumor volume is highly correlated with prolongation of patient survival. Procedures such as radical pelvic surgery, bowel resection, and aggressive upper abdominal surgery are commonly required to achieve optimal cytoreduction. Women who develop recurrent disease may be eligible for a secondary cytoreductive surgery or may require a surgical intervention to palliate disease-related symptoms. For women at high risk of ovarian cancer, prophylactic bilateral salpingo-oophorectomy significantly reduces the incidence of this disease. The purpose of this article is to provide a comprehensive review of the surgical management of ovarian carcinoma. The roles of primary, interval, and secondary cytoreductive surgeries; second-look procedures; and palliative surgery are reviewed. The indications for fertility-sparing and minimally invasive surgery as well as the current guidelines for prophylactic surgery in high-risk mutation carriers are also discussed %0 Journal Article %C Department of Veterinary Clinical Medicine, University of Illinois at Urbana-Champaign, Urbana, IL 61802-4714, USA. t-fan@uiuc.edu %A Fan, Timothy M %A de Lorimier, Louis-Philippe %A O'Dell-Anderson, Kristen %A Lacoste, Hugues I %A Charney, Sarah C %J J Vet Intern Med %D 2007 May-Jun %N 3 %P 431-9 %T Single-agent pamidronate for palliative therapy of canine appendicular osteosarcoma bone pain %V 21 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17552447 %X BACKGROUND: Canine appendicular osteosarcoma (OSA) causes focal bone destruction, leading to chronic pain and reduced quality-of-life scores. Drugs that inhibit pathologic osteolysis might provide additional treatment options for managing cancer-induced bone pain. Aminobisphosphonates induce osteoclast apoptosis, thereby reducing pain associated with malignant osteolysis in human patients with cancer. HYPOTHESIS: Treatment of dogs with pamidronate administered intravenously will alleviate bone pain and reduce pathologic bone turnover associated with appendicular OSA in dogs. ANIMALS: Forty-three dogs with naturally occurring appendicular OSA administered pamidronate intravenously. METHODS: Prospective study. Therapeutic responses in dogs treated with pamidronate administered intravenously and nonsteroidal anti-inflammatory drugs (NSAID) were evaluated by using a numerical cumulative pain index score (CPIS), and by quantifying urine N-telopeptide (NTx) excretion and relative primary tumor bone mineral density (rBMD) assessed with dual energy x-ray absorptiometry. In addition, variables, including pamidronate dose, skeletal mass, baseline and change for CPIS, urine NTx and rBMD during treatment, and baseline tumor volume and radiographic pattern were compared between dogs clinically responsive and nonresponsive to pamidronate therapy. RESULTS: Twelve of 43 dogs (28%) had pain alleviation for >4 months, lasting a median of 231 days. Changes in CPIS and rBMD during treatment were statistically different between responders and nonresponders (P = .046 and .03, respectively). CONCLUSIONS AND CLINICAL IMPORTANCE: Substantiated by reductions in CPIS and increases in rBMD, single-agent pamidronate administered intravenously with NSAID therapy relieves pain and diminishes pathologic bone turnover associated with appendicular OSA in a subset of dogs %0 Journal Article %C IVF Unit Hammersmith Hospital, St Joseph's Hospice Support Group Facilitator, 8 Wood Lane, Highgate London. jacquifeld@yahoo.co.uk %A Feld, Jacqueline %A Heyse-Moore, Louis %J Am J Hosp Palliat Care %D 2006 Aug-Sep %N 4 %P 287-96 %T An evaluation of a support group for junior doctors working in palliative medicine %V 23 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17060292 %X Evidence suggests that doctors working in palliative medicine experience stress and burnout. This study has 2 parts. The first investigates a pilot scheme in an inner-city hospice where junior doctors met for confidential every-third-week support sessions with an independent facilitator. Data collected from 25 doctors attending the group suggest that all respondents found it helpful, particularly through sharing clinical experiences, establishing relationships, having a confidential forum for discussion, and having protected time set aside for the group. All indicated they would value similar support in other medical settings. In the second part of the study, contact was made with 62 other adult and children's hospices in the United Kingdom to seek evidence of support provision for junior doctors in other centers. Forty-seven (76%) replied. Six (13%) had a doctors' support group. Twenty (43%) had other support measures, such as close informal support, input by a psychologist, mentoring, and clinical supervision %0 Journal Article %C Critical Care Center, Hospital de Sabadell, Parc Tauli s/n, 08208, Sabadell, Spain. rfernandez@cspt.es %A Fernandez, Rafael %A Baigorri, Francisco %A Artigas, Antonio %J Intensive Care Med %D 2007 Feb %N 2 %P 350-4 %T Noninvasive ventilation in patients with "do-not-intubate" orders: medium-term efficacy depends critically on patient selection %V 33 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17093982 %X OBJECTIVE: Randomized clinical trials demonstrating benefits of noninvasive ventilation (NIV) systematically exclude patients with "do-not-intubate" (DNI) orders, but in daily clinical practice these patients are frequently treated with NIV. A recent North American study found a 43% hospital survival rate in patients with DNI orders. Our hypothesis was that, due to the very different social and cultural setting, written DNI orders in a southern European country would be restricted to a population with a poor outcome, independently of whether they receive NIV, and we analyzed hospital survival in patients receiving NIV and the impact of DNI orders on survival. DESIGN AND SETTING: Retrospective cohort study in a general ICU in a university-affiliated hospital. PATIENTS AND METHODS: All 233 patients treated with NIV during 2002-2004. We recorded clinical characteristics on admission, mortality risk by APACHE II and ICU and hospital outcome, and 6-month outcome. RESULTS: Hospital survival was 66%. Survival was better in the 199 patients without DNI orders than in the 36 with DNI orders both during hospitalization (74% vs. 26%, OR 7.9) and after 6 months (64% vs. 15%, OR 10.2). In both groups the presence of COPD was associated with better prognosis during hospitalization, but not in the medium-term. CONCLUSION: Our study suggests that NIV offers low expectations for medium-term survival in DNI patients %0 Journal Article %C Department of Microbiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore %A Foo, Damian Guang Wei %A Alonso, Sylvie %A Phoon, Meng Chee %A Ramachandran, N P %A Chow, Vincent Tak Kwong %A Poh, Chit Laa %J Virus Res %D 2007 Apr %N 1 %P 61-8 %T Identification of neutralizing linear epitopes from the VP1 capsid protein of Enterovirus 71 using synthetic peptides %V 125 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17222936 %X Enterovirus 71 (EV71) is the main causative agent of Hand, foot and mouth disease (HFMD) and has been associated with severe neurological diseases resulting in high mortalities. Currently, there is no vaccine available and treatment is limited to palliative care. In this study, antisera were raised in mice against 95 overlapping synthetic peptides spanning the VP1 capsid protein of EV71. Two peptides, SP55 and SP70, containing amino acid 163-177 and 208-222 of VP1, respectively, are capable of eliciting neutralizing antibodies against EV71 in the in vitro microneutralization assay. SP70 was identified to be particularly potent in eliciting a neutralizing antibody titer comparable to that obtained with a whole virion-immune serum. Immunization of mice with either SP55 or SP70 triggered an EV71-specific IgG response as high as that obtained with the whole virion as immunogen. The IgG sub-typing revealed that the neutralizing antibodies elicited by both synthetic peptides are likely belonging to the IgG1 sub-type. Alignment with databases showed that the amino acid residues of SP70 are highly conserved amongst the VP1 sequences of EV71 strains from various sub-genogroups. Altogether, these data indicate that SP70 represents a promising candidate for an effective synthetic peptide-based vaccine against EV71 %0 Journal Article %C Pain and Palliation Research Group (O.M.S.F., P.C.B.), Department of Circulation and Medical Imaging, and Pain and Palliation Research Group (T.S., S.K.), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim; Department of Surgery (O.M.S.F.), Sandnessjoen Hospital, Helgelandssykehuset; and Center for Pain and Complex Disorders (P.C.B.), Department of Anaesthesiology, and Palliative Medicine Unit (S.K.), Department of Oncology, St. Olav University Hospital, Trondheim, Norway %A Fredheim, OM %A Borchgrevink, PC %A Saltnes, T %A Kaasa, S %J J Pain Symptom Manage %D 2007 Jul %T Validation and Comparison of the Health-Related Quality of Life Instruments EORTC QLQ-C30 and SF-36 in Assessment of Patients with Chronic Nonmalignant Pain %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17618079 %X The EORTC QLQ-C30 health-related quality of life (HRQoL) questionnaire was developed for use in clinical cancer trials. It has also been applied in studies of patients with chronic nonmalignant pain in spite of nondocumented validity. Validation of the EORTC QLQ-C30 in this patient population and comparison with the traditional first choice HRQoL instrument in chronic nonmalignant pain, the SF-36, are, therefore, required. Two hundred eighty-six patients admitted to the tertiary multidisciplinary pain center at St. Olav University Hospital in Trondheim, Norway, completed both the EORTC QLQ-C30 and the SF-36 at admittance. Correlations between EORTC QLQ-C30 and SF-36 measures of the same concept were between 0.70 and 0.81 for all five domains covered by both instruments. Internal consistency was below 0.70 for the EORTC QLQ-C30 scales physical functioning (0.57), pain (0.68), role functioning (0.43), cognitive functioning (0.66), and nausea/vomiting (0.53), as well as the SF-36 scale role emotional functioning (0.66). Large floor or ceiling effects were seen for several EORTC QLQ-C30 scales. While SF-36 addresses no other symptoms than pain and fatigue, the EORTC QLQ-C30 also includes sleep, financial difficulties, nausea/vomiting, dyspnea, appetite loss, constipation, and diarrhea. Even though some EORTC QLQ-C30 scales have unsatisfactory internal consistency, EORTC QLQ-C30, similar to SF-36, has overall acceptable psychometric properties. The EORTC QLQ-C30 is a valid alternative to the SF-36 when a broader assessment of symptoms is desired %0 Journal Article %C Nursing Law and Politics, Faculty of Health, London South Bank University, UK %A Fullbrook, Suzanne %J Br J Nurs %D 2007 May %N 10 %P 600-1 %T Best interests: a review of issues that affect nurses' decision making %V 16 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17577164 %X 'Best interests' is a term that is often misunderstood and incorrectly applied in practice. This article is the first of three dedicated to an explanation of the legal principles and practical applications of the term when applied to the provision of treatment and care of patients. Elements of the debate are explored that relate to aspects of daily treatment and care and to circumstances where the issue(s) relate to end of life considerations. This first article aims to raise awareness of issues that relate to the idea of acting in a person's best interests. Potential areas of concern and apprehension on the part of healthcare providers are reviewed with the aim of preparing the reader for the more legally concentrated second article, and further to alert the reader to the possibility of uncomfortable reflection to be undertaken in a professional vein %0 Journal Article %C Nursing Law and Polititcs, Faculty of Health, London South Bank University, UK %A Fullbrook, Suzanne %A Sanders, Karen %J Br J Nurs %D 2007 Apr %N 8 %P 474-5 %T Consent and capacity 2: the Mental Capacity Act 2005 and 'living wills' %V 16 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17551430 %X The last article in this series discussed the social concerns which influenced the decision to introduce a law that laid out certain rights for certain people, with respect to healthcare choices, responsibilities and decisions. This, and the next article drawn attention to a specific aspect of the Mental Capacity Act - the issue of making a living will. At present, under common law, it is the legal right of competent adult patients to refuse medical treatments, but how is this achieved when, due to your illness or accident, you have lost the capacity to inform others of how you want your treatment to progress--or indeed that you do not want a certain treatment, or any treatment at all? This article discusses the 'living will', a written legal document made by a competent person in anticipation of becoming ill in the future %0 Journal Article %C Hospices Civils de Lyon, Claude Bernard Lyon I University, Hopital Neurologique Pierre Wertheimer, Service de Neurologie C, Lyon, France %A Gan, Jing %A Xie-Brustolin, Jing %A Mertens, Patrick %A Polo, Gustavo %A Klinger, Helene %A Mollion, Helene %A Benatru, Isabelle %A Henry, Emmanuel %A Broussolle, Emmanuel %A Thobois, Stephane %J J Neurol %D 2007 Jan %N 1 %P 99-106 %T Bilateral subthalamic nucleus stimulation in advanced Parkinson's disease: three years follow-up %V 254 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17508144 %X OBJECTIVE: To assess the long-term efficacy and safety of chronic bilateral stimulation of the subthalamic nucleus (STN) in patients with advanced Parkinson's disease (PD). METHODS: 36 consecutive patients with idiopathic Parkinson's disease treated with bilateral stimulation of the STN were studied. Parkinsonian status was assessed preoperatively and at 1 and 3 years postoperatively using the Unified Parkinson's Disease Rating Scale (UPDRS) and neuropsychological evaluation in on and off-medication / on and off stimulation conditions. RESULTS: At 3 years follow-up, STN stimulation reduced the UPDRS motor score by 54.2 % compared to baseline in the off-medication conditions. Tremor, rigidity, bradykinesia, postural stability, and gait improved by 72.2 %, 62.4 %, 56.8 %, 40.5 % and 45.3 %, respectively. UPDRS part II scores were reduced by 41.4 %. The overall dopaminergic drugs dose was reduced by 48.6 % after surgery and four patients were no longer taking antiparkinsonian medication at three years. However, axial dopa-unresponsive signs worsened in some patients. The most frequent transient adverse event consisted in mood disorders in 23 patients. CONCLUSIONS: Our data demonstrate that: 1) bilateral STN stimulation is relatively safe, improves the motor symptoms and drug-related motor complications of PD, and reduces the daily dosage of medication; 2) this benefit is sustained over time despite the occurrence of axial doparesistant signs in some patients %0 Journal Article %C Department of Hepatobiliary and Pancreatic Surgery, The Leicester General Hospital, UK. gg43@le.ac.uk %A Garcea, G %A Manson, M M %A Neal, C P %A Pattenden, C J %A Sutton, C D %A Dennison, A R %A Berry, D P %J Curr Cancer Drug Targets %D 2007 May %N 3 %P 209-15 %T Glycogen synthase kinase-3 beta; a new target in pancreatic cancer? %V 7 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17504118 %X Glycogen synthase kinase (GSK) was initially described as a key enzyme involved in glycogen metabolism. However, since that time it has been found to regulate a diverse range of cell functions. In addition to having a major role in the regulation of the important onco-protein beta-catenin, GSK is also a critical regulator of NF-kappaB. NF-kappaB comprises a family of transcription factors which activate the expression of a wide array of genes involved in inflammation, tumourigenesis, metastasis, differentiation, embryonic development, apoptosis. Inflammation mediated by the NF-kappaB family has been implicated in the initiation of pancreatic cancer, resistance to chemotherapy and the development of the debilitating cancer cachexia seen with advanced disease. Hence, GSK has potential as an important new target both in the treatment of resectable pancreatic cancer as an adjuvant to surgery, and in the palliation of inoperable tumours %0 Journal Article %C Department of Surgery, Singapore General Hospital, Outram Road, Singapore 169608 %A Goh, Brian K P %A Yeo, Allen W Y %A Koong, Heng-Nung %A Ooi, London L P J %A Wong, Wai-Keong %J Surg Today %D 2007 %N 5 %P 370-4 %T Laparotomy for acute complications of gastrointestinal metastases from lung cancer: is it a worthwhile or futile effort? %V 37 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17468816 %X PURPOSE: Complications of gastrointestinal tract (GIT) metastases from lung cancer are rare and the optimal management remains controversial. Whereas some authors advocate a nonoperative policy due to the poor prognosis, others recommend aggressive surgery as it offers effective palliation. The aim of this study is to present our experience with nine patients who underwent a laparotomy for complications of GIT metastases and to determine their outcome. METHODS: Between 1995 and 2005, nine patients who underwent a laparotomy for complications of pathologically proven GIT metastases secondary to lung cancer were retrospectively reviewed. RESULTS: All patients were male with a median age of 63 years (range, 40-70 years) at initial presentation. The sites of symptomatic GIT metastases include the ileum (n = 3), jejunum (n = 3), cecum (n = 1), duodenum (n = 2) and stomach (n = 2) and the patients presented with obstruction (n = 2), hemorrhage (n = 3), intussusception (n = 3) and perforation (n = 1). The median time of symptomatic GIT metastases from initial presentation was 2 months (range, 0-8 months) and the histological subtypes of the lung cancer were squamous cell carcinoma (n = 3), large cell carcinoma (n = 3), adenocarcinoma (n = 1), pleomorphic carcinoma (n = 1) and pleomorphic with adenocarcinoma (n = 1). All patients underwent an exploratory laparotomy and the definitive surgical procedure was dependent on the site and extent of disease. These included a small bowel resection with primary anastomosis (n = 5), a subtotal gastrectomy with an extended right hemicolectomy (n = 1), a gastrojejunostomy (n = 1), a right hemicolectomy (n = 1), and an ulcerectomy with under-running of ulcers (n = 1). Eight of the nine patients (89%) recovered from surgery and were then discharged from hospital at a median time of 9.5 days (range, 6-24 days). All these eight patients survived for more than 30 days and the median survival was 6 months (range, 2-13 months). Four of the 8 patients (50%) lived for more than 6 months and all eight patients died of advanced metastatic lung cancer with multiple sites of metastases at the time of death. CONCLUSION: Gastrointestinal tract metastases should always be considered in the differential diagnosis of lung cancer patients presenting with an acute abdomen. Aggressive surgical treatment is worthwhile in a selected group of patients as it provides effective palliation %0 Journal Article %C Bay Pines VA Medical Center, Ward 4B Hospice, PO Box 5005, Bay Pines, FL 33744, USA. deborah.grassman@med.va.gov %A Grassman, Deborah %J Am J Hosp Palliat Care %D 2006 Aug-Sep %N 4 %P 338-9 %T Angels and atheists %V 23 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17060300 %0 Journal Article %C Department of Public Health, University of Liverpool, Liverpool, UK %A Hanratty, Barbara %A Burstrom, Bo %A Walander, Anders %A Whitehead, Margaret %J J Health Serv Res Policy %D 2007 Apr %N 2 %P 90-4 %T Inequality in the face of death? Public expenditure on health care for different socioeconomic groups in the last year of life %V 12 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17407658 %X OBJECTIVE: To investigate the association between public expenditure on health care in the last year of life and individual socioeconomic status in Sweden. METHODS: Population-based study of public expenditure using linked registers for all 16,617 deaths among Stockholm County Council residents in 2002 (population 1.8 million). Age-standardized, total and per capita spend were calculated by income categories, age and specialty. Multivariate analysis examined the association between socioeconomic status and public expenditure. RESULTS: County council expenditure on health care in the last year of life rose with increasing income of the deceased person. Median per capita expenditure increased from 55,417 Swedish Kronor (SEK) (US$ 7542) in the lowest income group to SEK 94,678 (US$ 12,887) in the highest. Total age-standardized spend increased by 60% across the same interval (80,227 [95% confidence interval (CI) 79,946-80,497] to SEK 127,344 [95% CI 126,969-127,719]). Expenditure decreased with increasing age over 65 years in all income groups. Higher income was independently associated with greater total public health spend in multivariate analysis, adjusting for age, sex, health-care utilization and major diagnostic groups. CONCLUSIONS: There is inequality in public expenditure on health care at the end of life across socioeconomic groups in Stockholm. This phenomenon merits attention within Sweden, and beyond, in countries with less comprehensive welfare systems %0 Journal Article %C Division of Public Health, University of Liverpool, Liverpool, L69 3GB, UK. B.Hanratty@liverpool.ac.uk %A Hanratty, Barbara %A Burstrom, Bo %A Walander, Anders %A Whitehead, Margaret %J J Epidemiol Community Health %D 2007 May %N 5 %P 447-8 %T Changes in income in the years before death: a record linkage study in Stockholm County %V 61 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17435213 %0 Journal Article %C Utrecht University, Faculty of Science, Department of Pharmaceutical Sciences, Division of Biomedical Analysis, Sorbonnelaan 16, 3584 CA Utrecht, The Netherlands. s.harmsen@pharm.uu.nl %A Harmsen, S %A Meijerman, I %A Beijnen, J H %A Schellens, J H M %J Cancer Treat Rev %D 2007 Jun %N 4 %P 369-80 %T The role of nuclear receptors in pharmacokinetic drug-drug interactions in oncology %V 33 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17451886 %X Drug-drug interactions can have a major impact on treatment outcome in cancer patients. These patients are at high risk of such interactions, because they are treated with combinations of multiple cytotoxic anticancer drugs or hormonal agents often co-administered with prophylactic antiemetics and analgesics to provide palliation. Interactions between drugs can affect the pharmacokinetics of concomitantly administered chemotherapeutic agents. Especially, due to the specific properties of anticancer drugs, such as a narrow therapeutic index and steep dose-toxicity curve, small pharmacokinetic changes can have significant clinical consequences like decreased therapeutic efficacy or increased toxicity. An important mechanism that underlies these interactions is the induction of enzymes or efflux transporters involved in the biotransformation and clearance of anticancer drugs. Several nuclear receptors, like the pregnane X receptor (PXR), constitutively androstane receptor (CAR), have been shown to regulate induction. Activation of these receptors will lead to induction of important enzymes like cytochrome P450 3A4 (CYP3A4), which is involved in the biotransformation of more than 50% of all clinically used drugs. Therefore, concomitant administration of agents that activate PXR will affect the pharmacokinetics of drugs that are substrate for PXRs target genes, which include CYP3A4 and MDR-1. Understanding of the molecular mechanisms that underlie enzyme induction and the identification of (new) drugs involved in pharmacokinetic drug-drug interactions may contribute to the predictability of drug-drug interactions and eventually help to develop safer anticancer regimens %0 Journal Article %C Public Health and Health Policy, Division of Community Based Sciences, University of Glasgow, 1 Lilybank Gardens, Glasgow G12 8RZ, UK. c.l.hart@udcf.gla.ac.uk %A Hart, Carole L %A Hole, David J %A Lawlor, Debbie A %A Smith, George Davey %A Lever, Tony F %J J Epidemiol Community Health %D 2007 May %N 5 %P 455-60 %T Effect of conjugal bereavement on mortality of the bereaved spouse in participants of the Renfrew/Paisley Study %V 61 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17435215 %X OBJECTIVES: To investigate how loss of a spouse affects mortality risk in the bereaved partner. DESIGN AND SETTING: Prospective cohort study in Renfrew and Paisley in Scotland. PARTICIPANTS: 4395 married couples aged 45-64 years when the study was carried out between 1972 and 1976. METHODS: The date of bereavement for the bereaved spouse was the date of death of his or her spouse. Bereavement could occur at any time during the follow-up period, so it was considered as a time-dependent exposure variable and the Cox proportional hazards model for time-dependent variables was used. The relative rate (RR) of mortality was calculated for bereaved versus non-bereaved spouses and adjusted for confounding variables. MAIN OUTCOME MEASURES: Causes of death to 31 March 2004. RESULTS: Bereaved participants were at higher risk than non-bereaved participants of dying from any cause (RR 1.27; 95% CI 1.2 to 1.35). These risks remained but were attenuated after adjustment for confounding variables. There were raised RRs for bereaved participants dying of cardiovascular disease, coronary heart disease, stroke, all cancer, lung cancer, smoking-related cancer, and accidents or violence. After adjustment for confounding variables, RRs remained higher for bereaved participants for all these causes except for mortality from lung cancer. There was no strong statistical evidence that the increased risks of death associated with bereavement changed with time after bereavement. CONCLUSIONS: Conjugal bereavement, in addition to existing risk factors, is related to mortality risk for major causes of death %0 Journal Article %C Division of General Internal Medicine (R.S.H., R.M.A.), Section of Palliative Care and Medical Ethics, University of Pittsburgh School of Medicine, and University Center for Social and Urban Research (R.S.), University of Pittsburgh, Pittsburgh, Pennsylvania, USA %A Hebert, RS %A Arnold, RM %A Schulz, R %J J Pain Symptom Manage %D 2007 Jul %T Improving Well-Being in Caregivers of Terminally Ill Patients. Making the Case for Patient Suffering as a Focus for Intervention Research %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17616333 %X Family caregivers are integral to the care of patients with physical or mental impairments. Unfortunately, providing this care is often detrimental to the caregivers' health. As a result, in the last decade, there has been a proliferation of interventions designed to improve caregivers' well-being. Interventions for caregivers of persons at end of life, however, are relatively few in number and are often underdeveloped. They also are typically designed to help reduce the work of caregiving or to help caregivers cope with the physical and emotional demands of providing care. Although useful, these interventions generally ignore a primary stressor for family caregivers-a loved one's suffering. Patient suffering, whether physical, psychosocial, or spiritual, has a major impact on family caregivers. However, interventions that focus on the relief of patient suffering as a way to improve caregiver well-being have rarely been tested. It is our view that more research in this area could lead to new and more effective interventions for family caregivers of seriously or terminally ill patients. In support of our view, we will define suffering and review the relationships between patient suffering and caregiver well-being. We will then discuss a conceptual framework for intervention design. Finally, we conclude with a discussion of implications and future directions for intervention research %0 Journal Article %C Institute of Health and Care Sciences (I.H., M.G., E.D.) and Department of Respiratory Medicine and Allergology (B.B.), Sahlgrenska Academy at Goteborg University, Goteborg, Sweden; and Johns Hopkins University School of Nursing (F.G.-J.), Baltimore, Maryland, USA %A Henoch, I %A Bergman, B %A Gustafsson, M %A Gaston-Johansson, F %A Danielson, E %J J Pain Symptom Manage %D 2007 Jul %T The Impact of Symptoms, Coping Capacity, and Social Support on Quality of Life Experience Over Time in Patients with Lung Cancer %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17616335 %X The aims of the study were to investigate lung cancer patients' quality of life (QoL) over time in a palliative setting and to determine how QoL is influenced by symptoms, coping capacity, and social support. One hundred and five consecutive patients with incurable lung cancer were included. A comprehensive set of questionnaires was used at baseline, including the Assessment of Quality of Life at the End of Life, Cancer Dyspnea Scale, Visual Analog Scale of Dyspnea, Hospital Anxiety and Depression scale, Sense of Coherence Questionnaire, and Social Support Survey, of which the first four were used also at three, six, nine, and 12 months. Dyspnea, depression, and global QoL deteriorated over time. Performance status, anxiety, depression, components of dyspnea, pain, and the meaningfulness component of coping capacity correlated with global QoL at all, or all but one follow-up measurements. In a multivariate analysis with global QoL as the dependent variable, depression was a significant predictor at four out of five assessments, whereas coping capacity, anxiety, performance status, pain, and social support entered the model at one or two assessments. Emotional distress and coping capacity influence QoL and might be targets for intervention in palliative care %0 Journal Article %C South Stockholm Geriatric Clinic, Stockholm, Sweden. anette.he@telia.com %A Henriksson, Anette %A Andershed, Birgitta %J Int J Palliat Nurs %D 2007 Apr %N 4 %P 175-83 %T A support group programme for relatives during the late palliative phase %V 13 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17551421 %X This study describes an intervention where relatives were invited to take part in a support group programme during the late palliative phase of their family member. The purpose was to describe their experiences of the support group programme and the subsequent impact on their lives as relatives of a terminally ill person. Qualitative interviews were chosen as the data collection method. The analysis was inspired by the phenomenological method as described by Giorgi (1989). The relatives' experiences were categorised into six key constituents: confirmation; insight into the gravity of the illness; sense of belonging created by similar experiences; participation in the care system; being able to rest; and strength to provide support for the patient. These six constituents resulted in a sense of safety in relation to the patient, the illness, the nursing staff and the care unit. The study's findings show that interventions of this kind may be integral to the relatives' ability to handle their situation when caring for a terminally ill family member %0 Journal Article %C University of Missouri-Kansas City School of Medicine and Truman Medical Center, USA. aehericks@comcast.net %A Hericks, Anthony J %A Bhat, Abid %J Mo Med %D 2007 May-Jun %N 3 %P 255-9 %T An overview of alpha-1 antitrypsin deficiency %V 104 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17619502 %X Alpha-1 Antitrypsin Deficiency is a common hereditary disorder that results from abnormal Alpha Antitrypsin production. This predisposes patients to early onset emphysema especially when exposed to tobacco smoke. Early recognition is important. Smoking cessation and augmentation therapy are currently the only treatments available to slow the disease process. Surgical intervention may be palliative when medical and rehabilitation efforts have failed. This paper summarizes the current literature and presents an overview of AATD %0 Journal Article %C Presbyterian Hospital of Dallas, 8200 Walnut Hill Lane, Pharmacy Department, Dallas, TX 75231, USA. robhutchison@texashealth.org %A Hutchison, Rob W %A Tucker, William F Jr %A Kim, Sunghyun %A Gilder, Richard %J Am J Hosp Palliat Care %D 2006 Aug-Sep %N 4 %P 328-31 %T Evaluation of a behavioral assessment tool for the individual unable to self-report pain %V 23 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17060298 %X Assessment of pain intensity using a standard self-reported pain score is standard practice in most institutions. These instruments require the cognitive ability to process the pain intensity into a numeric or descriptive value. Many institutions are considering adopting an assessment tool for cognitive impairment. The purpose of this study is to evaluate a clinician-administered assessment tool, PAINAD, in patients with cognitive impairment. Opioid consumption and frequency of documented unknown pain were collected in 2 cognitive impaired groups. In the control group, a self-reporting pain intensity tool was used, and in a second group, the PAINAD was used. Opioid use was significantly higher (P = .003) and the rates of reported unknown pain were significantly lower (P < .01) in the group using the PAINAD instrument compared to the control group of patients with cognitive impairment. There were no noted differences in opioid-induced adverse reactions in either group %0 Journal Article %C Institut fur Geschichte, Theorie und Ethik der Medizin, Johannes Gutenberg-Universitat Mainz, Mainz, Germany. ilkilic@uni-mainz.de %A Ilkilic, I %J Dtsch Med Wochenschr %D 2007 Jul %N 30 %P 1587-90 %T [Medical ethical aspects of culture in health care practice examples of muslim patients] %V 132 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17628845 %X In today's world, the plurality of values is considered to be a constitutive feature of modern societies. In these societies, transcultural patient-physician relationships are a part of daily medical practice. Culturally determined value systems can be crucial for understanding the perception of notions such as "health" and "illness", leading to fundamental differences in assessing medical interventions and therapeutic objectives. Therefore, transcultural conflicts of interest are presenting medical ethical decision-making with new challenges. Time and again, medical practice demonstrates that cultural differences between physician and patient are correlated with the complexity of medical ethical conflicts, as can be seen in the relationship between Muslim patients and non-Muslim physicians in the German health care system. This paper discusses some of the central issues in these relationships like communication, sense of shame, religious duties, and medical end-of-life decisions, analyzing some concrete cases. Subsequently, a number of medical ethical theses relevant for multicultural societies will be discussed %0 Journal Article %C University of Bedfordshire %A Johns, Christopher %J Nurs Stand %D 2007 May %N 38 %P 24-5 %T Deep in reflection %V 21 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17569465 %X Peer supervision requires commitment but can help improve performance--the goal of all healthcare practitioners %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 School of Nursing, University of Wisconsin-Madison, and Hospice Care Inc, Madison, Wisconsi, USA. kkehl@wisc.edu %A Kehl, Karen A %J Am J Hosp Palliat Care %D 2006 Aug-Sep %N 4 %P 277-86 %T Moving toward peace: an analysis of the concept of a good death %V 23 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17060291 %X One of the primary outcomes of end-of-life care should be the experience of a good death by the patient and the family. Yet there is no clear, shared understanding of what a good death is. This analysis of the concept of a good death has been guided by Rodgers' evolutionary method of concept analysis.(1) Forty-two articles were analyzed. There was the strong agreement that the concept of a good death was highly individual, changeable over time, and based on perspective and experience. Medical, nursing, and patient perspectives, as well as literature in sociology, include the following attributes of a good death, listed in order of frequency of appearance in the literature: being in control, being comfortable, sense of closure, affirmation/value of the dying person recognized, trust in care providers, recognition of impending death, beliefs and values honored, burden minimized, relationships optimized, appropriateness of death, leaving a legacy, and family care %0 Journal Article %C Department of Radiotherapy, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, ul. Roentgena 5, 02-781 Warsaw, Poland. lucynak@coi.pl %A Kepka, Lucyna %A Danilova, Vera %A Saghatelyan, Tatul %A Bajcsay, Andras %A Utehina, Olga %A Stojanovic, Suzana %A Yalman, Deniz %A Demiral, Ayse %A Bondaruk, Olga %A Kuddu, Maire %A Jeremic, Branislav %J Lung Cancer %D 2007 May %N 2 %P 235-45 %T Resources and management strategies for the use of radiotherapy in the treatment of lung cancer in Central and Eastern European countries: results of an International Atomic Energy Agency (IAEA) survey %V 56 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17267070 %X PURPOSE: To assess resources and management strategies for the use of radiotherapy (RT) in the treatment of lung cancer in developing Central and Eastern European countries. MATERIALS/METHODS: Questionnaires on patterns of care of NSCLC and SCLC were sent to radiation oncologists of Central and Eastern Europe. Comparisons were made between two groups of countries-ex-USSR states and other Eastern and Central European countries. RESULTS: Twenty-four out of twenty-eight surveyed countries responded. There were significant differences in access to modern treatment facilities (3D planning systems, number of linear accelerators), percentage of patients with lung cancer receiving radiotherapy, schedules of palliative RT, use of postoperative RT for early stages between both analysed groups of countries. 3D systems were in use in 25% of centres for an entire treatment, in 28% for a part of the treatment, and in 47% curative RT was 2D planned. Sequential chemo-RT was the most common approach to radical management of NSCLC, followed by RT alone and concomitant chemo-RT; median percentages of patients receiving respective treatments per centre were 57%, 30%, and 10%. For SCLC, the concurrent approach was declared by 56%, and the sequential approach by 42% of responders. CONCLUSIONS: Patterns of care of lung cancer in the analysed countries differed in some part from existing, evidence-based data on lung cancer. In particular, this difference was observed between ex-USSR countries and the rest of European developing countries in the equipment available and specific diagnostic and treatment parameters in radiotherapy of lung cancer, the latter group's practices more resembling those of developed European countries %0 Journal Article %A Kohler, Wim %J Ned Tijdschr Geneeskd %D 2007 Jan %N 1 %P 21-5 %T [Out of bed] %V 151 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17583034 %0 Journal Article %A Kuiper, Michael A %A Whetstine, Leslie M %A Holmes, John L %A Streat, Stephen %A Burrows, Richard C %A Seppelt, Ian %A Crippen, David %J Intensive Care Med %D 2007 Mar %N 3 %P 549-50 %T Euthanasia: a word no longer to be used or abused %V 33 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17180392 %0 Journal Article %A Kuker, RA %A Mesoloras, G %A Gulec, SA %J Int Semin Surg Oncol %D 2007 Jul %N 1 %P 17 %T Optimization of FDG-PET/CT imaging protocol for evaluation of patients with primary and metastatic liver disease %V 4 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17623095 %X ABSTRACT: BACKGROUND: Accurate determination of the extrahepatic extent and intrahepatic distribution of disease is very important in patients with primary and metastatic liver disease for deciding whether a patient receives potentially curable surgery or palliative treatment. Our objective was to evaluate the efficacy of delayed phase FDG-PET/CT imaging in lesion detection and to define its clinical impact compared to triple-phase contrast enhanced CT (CECT). Methods: 30 patients underwent delayed phase FDG-PET/CT imaging (90 min whole body scan followed by a delayed abdominal scan at 120 min). Maximum standard uptake values (SUVs) and SUV ratios between tumor and normal liver parenchyma (T/N) were evaluated. In addition, comparison was made to CECT obtained within 10 days of the FDG-PET/CT to evaluate for lesion concordance within individual liver segments (Couinaud designation). Results: Sites of primary malignancies included: colorectal (19), breast (3), pancreas (2), lung (2), carcinoid (2), cholangiocarcinoma (1), and hepatocellular carcinoma (1). There was a significant increase in SUV value of liver lesions between early and delayed acquisition (P<0.001). Although there was not a significant reduction in liver background activity between the two studies, there was a strong increase in T/N ratio (P<0.001) allowing better lesion detection by visual inspection. New lesions were identified in 5 of the 30 patients, which were not appreciated on the early scan. Delayed phase FDG-PET/CT identified one lesion which was not present on the corresponding CECT. Delayed phase FDG-PET/CT revealed extrahepatic sites of metastases not appreciated on CECT in 6 patients. Conclusions: Delayed phase FDG-PET/CT protocol improved lesion detectability in primary and metastatic liver disease, revealing new lesions in 17% of the patients. Moreover, FDG-PET/CT identified extrahepatic disease not seen on CECT in 20% of the patients %0 Journal Article %A Lama T, Alexis %J Rev Med Chil %D 2006 Jan %N 1 %P 124-5 %T [Euthanasia and the right to die] %V 134 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=16532174 %0 Journal Article %C From the *Albert Einstein College of Medicine, Bronx, New York; daggerWomen's Comprehensive Headache Center, The Headache Institute, St. Luke's-Roosevelt Hospital, New York, New York; and the double daggerInstitute on Care at the End of Life, Duke University, Durham, North Carolina %A Lay, CL %A Payne, R %J Neurologist %D 2007 Jul %N 4 %P 197-204 %T Recognition and Treatment of Menstrual Migraine %V 13 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17622911 %X BACKGROUND:: Menstrual migraine is a chronic disorder affecting approximately 12.6 million women in the United States. In spite of its widespread prevalence, menstrual migraine often goes undiagnosed. REVIEW SUMMARY:: Characteristics of menstrual migraine, which include functional disability, increased headache severity, and lack of aura, are often overlooked, and therefore menstrual migraine is often underdiagnosed. Use of a 3-month diary to record migraine patterns can reveal the predictable patterns associated with menstrual migraine, and a diary is demonstrated to be a useful tool in diagnosis. Optimal treatment of menstrual migraine takes advantage of the predictability of the disorder. Treatment alternatives for menstrual migraine include acute therapy and short- or long-term preventive therapies. Acute therapy is given shortly after the migraine begins. Short-term preventive therapies are effective when administered during the time that menstrual migraine is most likely to occur; the treatment window is typically 2 days prior up to 3 days after the onset of menstruation. Providing triptans, nonsteroidal anti-inflammatory drugs, or estrogen supplements (gel or patches) during this window has been demonstrated to provide effective protection during the days when patients are at greatest risk for menstrual migraine. Alternatively, long-term preventive therapy may be required for recurrent headaches in patients with concomitant medical conditions for whom migraine therapy could serve a dual purpose. CONCLUSION:: By recognizing the patterns associated with menstrual migraine, prompt, acute, or preventive therapy can be used to effectively manage the disorder and reduce its related disability %0 Journal Article %C Centre for Biomedical Ethics and Law, Katholieke Universiteit Leuven, Kapucijnenvoer 35, B-3000 Leuven, Belgium %A Lemiengre, J %A Casterle, BD %A Verbeke, G %A Guisson, C %A Schotsmans, P %A Gastmans, C %J Health Policy %D 2007 Jul %T Ethics policies on euthanasia in hospitals-A survey in Flanders (Belgium) %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17618011 %X OBJECTIVE: To determine the prevalence, development, stance, and communication of written institutional ethics policies on euthanasia in Flemish hospitals. METHODS: Cross-sectional mail survey of general directors of all hospitals (n=81) in Flanders, Belgium. RESULTS: Of the 81 hospitals invited to participate, 71 (88%) completed the questionnaire. Of these, 45 (63%) had a written ethics policy on euthanasia. The Belgian Act on Euthanasia and centrally developed guidelines of professional organisations were the most frequently mentioned reasons for and sources used in developing ethics policies on euthanasia in hospitals. Up to one-third of hospitals reported that they developed the policy upon request from physicians or nurses, or after being confronted with a euthanasia request. Development and approval of institutional ethics policies occurred within a multidisciplinary context involving clinicians, ethicists, and hospital administrators. The majority of hospitals restrictively applied the euthanasia law by introducing palliative procedures in addition to legal due care criteria. Private Catholic hospitals, in particular, were more likely to be restrictive: euthanasia is not permitted or is permitted only in exceptional cases (in accordance with legal due care criteria and additional palliative care procedures). The majority of hospitals took the initiative to communicate the policy to hospital physicians and nurses. CONCLUSIONS: Since the enactment of the Belgian Act on Euthanasia in 2002, the debate on how to deal with euthanasia requests has intensified in Flemish hospitals. The high prevalence of written institutional ethics policies on euthanasia and other medical end-of-life decisions is one possible outcome of this debate %0 Journal Article %C Be'er Sheva Mental Health Center, PO Box 4600, Be'er Sheva 84170, Israel. lernervld@yahoo.com %A Lerner, Vladimir %A Witztum, Eliezer %J J Med Biogr %D 2007 Feb %N 1 %P 4-8 %T Alexey Kondratyevich Savrasov (1830-1897): the muse and the bottle %V 15 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17356723 %X The Russian landscape painter Alexey Savrasov lived in the middle of the 19th century. He was overwhelmed with grief at the loss of several of his children and he used alcohol to blunt the pain and anguish. The effects of psychoactive substances and especially alcohol have been linked closely to creativity. His life story demonstrates the bitter relationship between the bottle and the muse. He became dependent on alcohol, his family broke up and he was fired from work, his creativity declined and his health deteriorated. At death, he was a lonely and a forgotten man and only two persons attended his funeral %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 Department of Nuclear Medicine, University Hospital Dresden, Germany %A Liepe, Knut %A Kotzerke, Joerg %J Nucl Med Commun %D 2007 Aug %N 8 %P 623-30 %T A comparative study of 188Re-HEDP, 186Re-HEDP, 153Sm-EDTMP and 89Sr in the treatment of painful skeletal metastases %V 28 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17625384 %X AIM: The surface bone-seeking radiopharmaceuticals Re-HEDP, Re-HEDP and Sm-EDTMP, and the volume seeker Sr were investigated to determine the efficacy and toxicity in pain palliation of bone metastases. METHOD: The effect of treatment with Re-HEDP, Re-HEDP, Sm-EDTMP and Sr on pain symptoms, quality of life, and bone marrow function were studied. In total, 79 patients (18 with breast cancer and 61 with prostate cancer) were treated (31 patients with Re-HEDP, 15 patients each with Re-HEDP and Sm-EDTMP, and 18 patients with Sr). All patients were interviewed using standardized sets of questions before and after therapy weekly for 12 weeks. Blood counts were taken weekly for 6 weeks and after 12 weeks. RESULTS: In total, 73% of patients reported pain relief (77% after Re-HEDP, 67% after Re-HEDP 73% after Sm-EDTMP, and 72% after Sr). Fifteen percent of patients could discontinue their analgesics and were pain-free. Pain showed a decrease from 3.6+/-1.7 to a maximum of 2.2+/-1.8 at visual analogue scale in 10 steps (P<0.01). Patients described an improvement on the Karnofsky performance scale from 70+/-10% to 78+/-14% 12 weeks after treatment (P=0.15). There were eight patients with a thrombocytopenia grade I, two patients with grade II and one with grade III. The maximum nadir of platelet and leukocyte counts were observed between the 2 to 5 week after treatment and was reversible within 12 weeks. There were no significant differences in pain palliation, Karnofsky performance status (KPS) and bone marrow toxicity between the different radionuclides (P=0.087-0.449). CONCLUSION: All radiopharmaceuticals were effective in pain palliation, without induction of severe side effects or significant differences in therapeutic efficacy or toxicity %0 Journal Article %C Wilhelminenspital, Vienna, Austria %A Ludwig, H %A Zojer, N %J Ann Oncol %D 2007 Jan %P i37-i44 %T Supportive care %V 18 Suppl 1 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17311821 %0 Journal Article %C Authors' Affiliations: Departments of Surgery and Clinical Nutrition, Sahlgrenska University Hospital, Goteborg University, Goteborg, Sweden %A Lundholm, Kent %A Korner, Ulla %A Gunnebo, Lena %A Sixt-Ammilon, Petra %A Fouladiun, Marita %A Daneryd, Peter %A Bosaeus, Ingvar %J Clin Cancer Res %D 2007 May %N 9 %P 2699-706 %T Insulin treatment in cancer cachexia: effects on survival, metabolism, and physical functioning %V 13 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17473202 %X PURPOSE: The present study was designed to evaluate whether daily insulin treatment for weight-losing cancer patients attenuates the progression of cancer cachexia and improves metabolism and physical functioning in palliative care. EXPERIMENTAL DESIGN: One hundred and thirty-eight unselected patients with mainly advanced gastrointestinal malignancy were randomized to receive insulin (0.11 ± 0.05 units/kg/d) plus best available palliative support [anti-inflammatory treatment (indomethacin), prevention of anemia (recombinant erythropoietin), and specialized nutritional care (oral supplements + home parenteral nutrition)] according to individual needs. Control patients received the best available palliative support according to the same principles. Health-related quality of life, food intake, resting energy expenditure, body composition, exercise capacity, metabolic efficiency during exercise, and spontaneous daily physical activity as well as blood tests were evaluated during follow-up (30-824 days) according to intention to treat. RESULTS: Patient characteristics at randomizations were almost identical in study and control groups. Insulin treatment for 193 ± 139 days (mean ± SD) significantly stimulated carbohydrate intake, decreased serum-free fatty acids, increased whole body fat, particularly in trunk and leg compartments, whereas fat-free lean tissue mass was unaffected. Insulin treatment improved metabolic efficiency during exercise, but did not increase maximum exercise capacity and spontaneous physical activity. Tumor markers in blood (CEA, CA-125, CA 19-9) did not indicate the stimulation of tumor growth by insulin; a conclusion also supported by improved survival of insulin-treated patients (P < 0.03). CONCLUSION: Insulin is a significant metabolic treatment in multimodal palliation of weight-losing cancer patients %0 Journal Article %C Centre for Research and Intervention on Suicide and Euthanasia, and Psychology Department, University of Quebec at Montreal, Montreal, QC. crise@uqam.ca %A Marcoux, Isabelle %A Mishara, Brian L %A Durand, Claire %J Can J Public Health %D 2007 May-Jun %N 3 %P 235-9 %T Confusion between euthanasia and other end-of-life decisions: influences on public opinion poll results %V 98 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17626391 %X BACKGROUND: Public opinion polls indicate that a majority of Canadians are in favour of euthanasia. However, there have been many criticisms of the validity of these findings. The objective of this study was to assess public opinion towards euthanasia while controlling for possible threats to validity indicated in the literature review. METHODS: A telephone public opinion poll was conducted in 2002 with a representative sample of the general population of Quebec (n = 991; response rate = 49.8%). Respondents were asked about their support for euthanasia and treatment withdrawal and, for comparison, were asked a previously used question on euthanasia (Gallup) which has been criticized for methodological problems. Respondents were also asked to distinguish between euthanasia and other end-of-life decisions in hypothetical scenarios. RESULTS: Eleven percent more people supported euthanasia with the Gallup question than the question developed in this study. Support for euthanasia (69.6%) was less prevalent than for treatment withdrawal (85.8%). Respondents who failed to distinguish between euthanasia and treatment withdrawal or withholding treatment in hypothetical scenarios were more likely to support euthanasia in public opinion poll questions. Furthermore, there is a significant relationship between opinions about the acceptability of euthanasia and inaccurate knowledge of the nature of euthanasia. INTERPRETATION: Public opinion polls on euthanasia must be interpreted in the light of the wording of the question. Education of the population concerning euthanasia and other end-of-life decisions may be considered to be an important prerequisite to engage in public debate concerning the legalization of euthanasia %0 Journal Article %A Markowitz, Amy J %A Rabow, Michael W %J JAMA %D 2007 Jul %N 2 %P 217 %T Palliative management of fatigue at the close of life: "it feels like my body is just worn out" %V 298 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17622603 %0 Journal Article %C Hematology-Oncology, Washington University School of Medicine, St Louis, MO 63110, USA. mmartin@im.wustl.edu %A Martin, Mike G %A Govindan, Ramaswamy %A Morgensztern, Daniel %J Expert Rev Anticancer Ther %D 2007 Jun %N 6 %P 871-6 %T Second-line therapy for esophageal cancer %V 7 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17555397 %X Esophageal cancer is a highly lethal disease, with most patients presenting with unresectable or metastatic disease. Since metastatic esophageal cancer is an incurable disease, the goals for chemotherapy are to palliate symptoms and improve survival. Although some patients may achieve symptomatic improvement with the use of standard first-line chemotherapy regimens, response rates are usually low and short lasting. Virtually all patients with metastatic esophageal cancer will develop progressive disease following front-line therapy. With the availability of several chemotherapeutic agents with more tolerable side effects, a number of patients who retain a good performance status after the initial treatment remain candidates for additional therapy. This review summarizes the recent advances in second-line therapy for esophageal cancer %0 Journal Article %C Velindre Hospital, Department of Oncology & Palliative Medicine, School of Medicine, Cardiff University, Cardiff, UK %A Mason, Malcolm D %A Sydes, Matthew R %A Glaholm, John %A Langley, Ruth E %A Huddart, Robert A %A Sokal, Michael %A Stott, Mark %A Robinson, Anne C %A James, Nicholas D %A Parmar, Mahesh K B %A Dearnaley, David P %J J Natl Cancer Inst %D 2007 May %N 10 %P 765-76 %T Oral sodium clodronate for nonmetastatic prostate cancer--results of a randomized double-blind placebo-controlled trial: Medical Research Council PR04 (ISRCTN61384873) %V 99 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17505072 %X BACKGROUND: The most frequent site of metastases from prostate cancer is bone. Adjuvant bisphosphonate treatment improves outcomes of patients with bone metastasis-negative breast cancer, but the effects of bisphosphonates on bone metastases in prostate cancer are not known. METHODS: We performed a randomized double-blind placebo-controlled trial to determine whether a first-generation bisphosphonate could improve symptomatic bone metastasis-free survival (time to symptomatic bone metastases or death from prostate cancer) in men with nonmetastatic prostate cancer who were at high risk of developing bone metastases. Between June 1, 1994, and December 31, 1997, 508 men from 26 UK sites and one New Zealand site who were within 3 years of initial prostate cancer diagnosis with no evidence of metastases from current bone scanning were randomly assigned to daily oral sodium clodronate (2080 mg/day, n = 254) or placebo (n = 254) for a maximum of 5 years. Estimates of outcome risks were compared using Kaplan-Meier analyses. RESULTS: The groups allocated to each treatment were well balanced. After a median follow-up of nearly 10 years, no evidence of benefit to the clodronate group was observed in terms of bone metastases-free survival (clodronate versus placebo, 80 events versus 68 events; hazard ratio [HR] = 1.22; 95% confidence interval [CI] = 0.88 to 1.68) or overall survival (clodronate versus placebo, 130 deaths versus 127 deaths; HR = 1.02; 95% CI = 0.80 to 1.30). Adverse events, notably gastrointestinal problems and increased lactate dehydrogenase levels, were more frequent in the clodronate group than in the placebo group; otherwise, clodronate was well tolerated. Modification of trial drug dose was more frequent in the clodronate group than the placebo group (HR = 1.63, 95% CI = 1.21 to 2.19). CONCLUSION: Adjuvant sodium clodronate does not modify the natural history of nonmetastatic prostate cancer %0 Journal Article %C Northern Ireland Hospice Care, Belfast %A Maxwell, Lesley-Ann %J Nurs Times %D 2007 May %N 22 %P 28-9 %T Therapeutic nursing for managing breathlessness %V 103 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17564360 %X Efforts to manage breathlessness have so far focused on the treatment of underlying causes or on pharmacological strategies. This article discusses broader rehabilitative goals in relation to the nurse's role to improve symptomatic relief and enhance patients' quality of life, by exploring holistic approaches. It considers the value of therapeutic nursing in the nurse-patient relationship %0 Journal Article %C Department of Health Administration, Virginia Commonwealth University, Medical College of Virginia Campus, Box 980203, Richmond, VA 23298-0203, USA. mccue@hsc.vcu.edu %A McCue, Michael J %A Thompson, Jon M %J Am J Hosp Palliat Care %D 2006 Aug-Sep %N 4 %P 259-66 %T Operational and financial performance of newly established hospices %V 23 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17060288 %X The objective of the study was to examine the financial and operating performance of newly established, free- standing hospices relative to existing, freestanding hospices. A nonparametric median test was used to compare the median values of operating and financial performance measures between newly established hospices and existing hospices. Operating and financial data were measured for the 2 groups using cost report data from the Centers for Medicare and Medicaid Services. The authors sampled 44 new, freestanding hospices and selected 312 freestanding existing hospices and analyzed their data over 2 years from 2002 to 2003. The study found that 91% of these new hospices were owned by for-profit organizations and were located in the southern region of the United States. New hospices served fewer patients; however, they had a longer length of stay compared to existing hospices. They offered fewer imaging services and radiation therapy services. New hospices generated significantly higher revenue but incurred significantly higher expenses. The results suggest that longer lengths of stay allow these newer hospices to increase revenue and improve overall profitability %0 Journal Article %C International Program of Psycho-Social Health Research, Central Queensland University, Brisbane, Queensland, Australia %A McGrath, Pam %J Aust J Rural Health %D 2007 Aug %N 4 %P 264-8 %T 'I don't want to be in that big city; this is my country here': Research findings on Aboriginal peoples' preference to die at home %V 15 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17617091 %X Objective: The present article provides findings from a two-year study on Indigenous palliative care conducted in the Northern Territory that explored and documented wishes in relation to place of death for rural and remote Aboriginal people. Design: Qualitative, open-ended interviews, audio-recorded, transcribed verbatim, and thematically analysed. Participants: There were a total of 72 interviews completed with Indigenous patients (n = 10), Indigenous caregivers (n = 19), Indigenous and non-Indigenous health care workers (n = 41), and interpreters (n = 2). Results: The findings provide a clear articulation of the wish of Aboriginal people from rural and remote areas to die at home connected to land and family. Strong cultural reasons were given for this preference, including the strong connection with land and community, a belief in 'death country', the importance of passing on sacred knowledge to the appropriate family member, the significance of ensuring that the dying individual's 'animal spirit' is able to return to the land, and the imperative that the 'right person' in the family network is available to provide the care. Conclusion: The strong wish to die at home informs the importance of building up local health and palliative care services and avoiding, where possible, the need for relocation for health care to the major metropolitan hospitals during end-of-life care %0 Journal Article %C International Program of Psycho-Social Health Research, Central Queensland University, Kenmore, Queensland 4069, Australia %A McGrath, Pam %A Phillips, Emma %J Nurs Forum %D 2007 Apr-Jun %N 2 %P 65-72 %T Making them more vulnerable: nursing insights on the irony of using questionnaires %V 42 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17474939 %X TOPIC. Nursing insights on the experience of using standardized questionnaires during hospice care. PURPOSE. To explore and describe the experience of hospice staff using questionnaires on hospice clients: whether such instruments help or hinder the holistic, compassionate hospice practice and to set this topic on the research agenda in the hope of generating critical reflection on this important aspect of hospice care. SOURCES. A cross-section of hospice staff interviewed about their experience with administering the questionnaires. (Findings from research conducted with hospice clients on their experience of questionnaires are published separately.) CONCLUSIONS. The initial findings indicate that staff perceive questionnaires as negatively impacting on their efforts to engage in holistic and compassionate hospice practice and point to a major irony that questionnaires, designed for the supportive care of the vulnerable, actually make the vulnerable more vulnerable %0 Journal Article %C Department of Clinical Oncology, S. Croce General Hospital, Cuneo, Italy. mcmerlano@tisali.it %A Merlano, M %A Garrone, O %J Int J Biol Markers %D 2007 Jan-Mar %N 1 Suppl 4 %P S71-6 %T Treatment of advanced head and neck cancer with cetuximab %V 22 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17520584 %X Cetuximab is a monoclonal antibody targeting the transmembrane receptor HER-1 (epidermal growth factor receptor, EGFR). In theory, inhibition of EGFR may influence tumor behavior since the receptor regulates many important tumor cell activities including tumor growth, angiogenesis, and inhibition of the apoptotic response to chemotherapy and radiotherapy. Available experimental data suggest that cetuximab may enhance the activity of chemotherapy and radiotherapy, reverse resistance to some anticancer drugs, and has itself anticancer activity. Early clinical data support the experimental results. This paper reviews the published findings on cetuximab in the treatment of advanced head and neck cancer and points out the future objectives of the clinical research on this drug %0 Journal Article %A Meyers, Susan %J Trustee %D 2007 May %N 5 %P 20-4, 1 %T Care with compassion. The case for palliative care %V 60 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17539573 %X As the population ages, and complex, chronic conditions become more prevalent in the patient mix, hospitals need to take a sharper look at the advantages--and common sense--of palliative care %0 Journal Article %C Eleanor and Lou Gehrig ALS/MDA Center, College of Physicians and Surgeons, Columbia University, Neurological Institute, New York, NY 10032, USA %A Mitsumoto, Hiroshi %A Rabkin, Judith G %J JAMA %D 2007 Jul %N 2 %P 207-16 %T Palliative care for patients with amyotrophic lateral sclerosis: "prepare for the worst and hope for the best" %V 298 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17622602 %X Amyotrophic lateral sclerosis (ALS) is a devastating terminal neurodegenerative disease with a highly predictable clinical course such that palliative care should begin at or soon after diagnosis. The outcome is certain in most cases. The only medication approved for treatment in the United States, riluzole, extends life by about 2 months. Virtually all skeletal muscles eventually are affected. Multiple problems require a multidisciplinary approach including aggressive symptomatic management, rehabilitation to maintain motor function, nutritional and respiratory support, augmentative communication devices, and psychological support for both patients and families because family members so often play a central role in management and care. Social, bioethical, and financial issues as well as advance directives should be addressed long before enteral feeding or assistive ventilatory support might be considered. Goals of care should be assessed on an ongoing basis. Presenting the unusual case of a patient with ALS who is also a prominent neurologist specializing in ALS, we enumerate issues in management and palliative care applicable to ALS but also to other fatal, progressive neurologic diseases such as Huntington's chorea and late-stage Parkinson disease %0 Journal Article %C Institute of Gastroenterology, Nippon Medical School Musashi Kosugi Hospital, Kawasaki, Kanagawa, Japan. mizutani@nms.ac.jp %A Mizutani, Satoshi %A Shioya, Takeshi %A Maejima, Kentaro %A Yoshino, Masanori %A Komine, Osamu %A Bou, Hideki %A Ogata, Masao %A Watanabe, Masanori %A Shibuya, Tetsuo %A Tokunaga, Akira %A Tajiri, Takashi %J J Nippon Med Sch %D 2007 Jun %N 3 %P 241-5 %T Significance of gastrectomy as palliative surgery for gastric carcinoma with pyloric stenosis %V 74 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17625374 %X We conducted a clinicopathological study of cases of gastric carcinoma with pyloric stenosis and examined treatment outcomes and the prognosis of cases of stage IV gastric carcinoma with pyloric stenosis and the validity of gastrectomy as palliative surgery in these cases. The outcomes of 49 surgeries for gastric carcinoma with pyloric stenosis were compared with those of 671 surgeries for gastric carcinoma without pyloric stenosis. The diagnosis of pyloric stenosis was confirmed with both upper gastrointestinal endoscopy and an upper gastrointestinal barium series. The frequency of pyloric stenosis in patients with gastric carcinoma was 7.3%. Serosal invasion was observed in about 70% of all cases. Of these cases, 53.1% were classified as stage IV. The resection rate was 73.5%, and the resection was classified as curative in 44.9% of cases. The incidence of complications after surgery in cases of stage IV gastric carcinoma was 47.1%. The median survival time was significantly greater in patients undergoing resection group than in those not undergoing resection (p=0.025). Most patients with gastric cancer and pyloric stenosis can be considered to have stage IV disease, which is associated with high rates of morbidity and mortality; thus, prevention of complications, and therefore, avoidance of gastrectomy is recommended in such patients. Nonetheless, in this study, gastrectomy was shown to improve prognoses in these patients %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 Surgery, Thomas Jefferson University, 1100 Walnut Street, MOB, Suite 500, Philadelphia, PA, 19107, USA, adam.berger@jefferson.edu %A Mucci, T %A Long, W %A Witkiewicz, A %A Mastrangelo, MJ %A Rosato, EL %A Berger, AC %J J Gastrointest Surg %D 2007 Jul %T Metastatic Melanoma Causing Jejunal Intussusception %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17619936 %X The gastrointestinal (GI) tract is a common site of melanoma metastases although reports of small bowel intussusception are relatively rare. Most patients with intussusception will be symptomatic and resection will provide significant palliation. In rare instances, patients will have solitary metastases to the small intestine, and resection can provide long-term palliation and chance for cure. We describe a case of a patient with a widely metastatic melanoma who presented with crampy abdominal pain and CT findings of small bowel metastases. Exploration revealed jejunojejunal intussusception and resection provided excellent palliation %0 Journal Article %C Department of Oncology, Division of Experimental Oncology, University of Alberta, Edmonton, Alberta, Canada %A Murray, D %A McEwan, AJ %J Cancer Biother Radiopharm %D 2007 Feb %N 1 %P 1-23 %T Radiobiology of Systemic Radiation Therapy %V 22 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17627411 %X Although systemic radionuclide therapy (SRT) is effective as a palliative therapy in patients with metastatic cancer, there has been limited success in expanding patterns of utilization and in bringing novel systemic radiotherapeutic agents to routine clinical use. Although there are many factors that contribute to this situation, we hypothesize that a better understanding of the radiobiology and mechanism of action of SRT will facilitate the development of future compounds and the future designs of prospective clinical trials. If these trials can be rationalized to the biological basis of the therapy, it is likely that the long-term outcome would be enhanced therapeutic efficacy. In this review, we provide perspectives of the current state of low-dose-rate (LDR) radiation research and offer linkages where appropriate with current clinical knowledge. These include the recently described phenomena of low-dose hyper-radiosensitivity-increased radioresistance (LDH-IRR), adaptive responses, and biological bystander effects. Each of these areas require a major reconsideration of existing models for radiation action and an understanding of how this knowledge will integrate into the evolution of clinical SRT practice. Validation of a role in vivo for both LDH-IRR and biological bystander effects in SRT would greatly impact the way we would assess therapeutic response to SRT, the design of clinical trials of novel SRT radiopharmaceuticals, and risk estimates for both therapeutic and diagnostic radiopharmaceuticals. We believe that the current state of research in LDR effects offers a major opportunity to the nuclear medicine community to address the basic science of clinical SRT practice, to use this new knowledge to expand the use and roles of SRT, and to facilitate the introduction of new therapeutic radiopharmaceuticals %0 Journal Article %C St. Columba's Hospice (S.A.M.), and Primary Palliative Care Research Group (S.A.M., M.K., L.G., K.B., A.S.), Division of Community Health Sciences: General Practice Section, University of Edinburgh, Edinburgh; and General Practice and Primary Care Research Unit (S.B.), Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom %A Murray, SA %A Kendall, M %A Grant, E %A Boyd, K %A Barclay, S %A Sheikh, A %J J Pain Symptom Manage %D 2007 Jul %T Patterns of Social, Psychological, and Spiritual Decline Toward the End of Life in Lung Cancer and Heart Failure %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17616334 %X Typical trajectories of physical decline have been described for people with end-stage disease. It is possible that social, psychological, and spiritual levels of distress may also follow characteristic patterns. We sought to identify and compare changes in the psychological, social, and spiritual needs of people with end-stage disease during their last year of life by synthesizing data from two longitudinal, qualitative, in-depth interview studies investigating the experiences and needs of people with advanced illnesses. The subjects were 48 patients with advanced lung cancer (n=24) and heart failure (n=24) who gave a total of 112 in-depth interviews. Data were analyzed within individual case studies and then cross-sectionally according to the stage of physical illness. Characteristic social, psychological, and spiritual end-of-life trajectories were discernible. In lung cancer, the social trajectory mirrored physical decline, while psychological and spiritual well-being decreased together at four key transitions: diagnosis, discharge after treatment, disease progression, and the terminal stage. In advanced heart failure, social and psychological decline both tended to track the physical decline, while spiritual distress exhibited background fluctuations. Holistic end-of-life care needs to encompass all these dimensions. An appreciation of common patterns of social, psychological, and spiritual well-being may assist clinicians as they discuss the likely course of events with patients and carers and try to minimize distress as the disease progresses %0 Journal Article %C Institute of Forensic Medicine, Stiftsplatz 12, 53111 Bonn, Germany. f.musshoff@uni-bonn.de %A Musshoff, F %A Trafkowski, J %A Kuepper, U %A Madea, B %J J Mass Spectrom %D 2006 May %N 5 %P 633-40 %T An automated and fully validated LC-MS/MS procedure for the simultaneous determination of 11 opioids used in palliative care, with 5 of their metabolites %V 41 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=16541404 %X A fully validated liquid chromatographic procedure coupled with electrospray ionization-tandem mass spectrometry (LC-ESI-MS/MS) is presented for quantitative determination of the opioids buprenorphine, codeine, fentanyl, hydromorphone, methadone, morphine, oxycodone, oxymorphone, piritramide, tilidine, and tramadol together with their metabolites bisnortilidine, morphine-glucuronides, norfentanyl, and nortilidine in blood plasma after an automatically performed solid-phase extraction (SPE). Separation was achieved in 35 min on a Phenomenex C12 MAX-RP column (4 microm, 150 x 2 mm) using a gradient of ammonium formiate buffer (pH 3.5) and acetonitrile. The validation data were within the required limits. The assay was successfully applied to authentic plasma samples, allowing confirmation of the diagnosis of overdose situations as well as monitoring of patients' compliance, especially in patients under palliative care %0 Journal Article %C Pain Relief and Palliative Care Unit, Department of Radiology, Areteion Hospital, School of Medicine, University of Athens, 27 Korinthias Street, 115 26 Athens, Greece. mistakidou@yahoo.com %A Mystakidou, Kyriaki %A Tsilika, Eleni %A Parpa, Efi %A Galanos, Antonis %A Vlahos, Lambros %J Psychooncology %D 2007 Apr %N 4 %P 352-7 %T Brief cognitive assessment of cancer patients: evaluation of the Mini-Mental State Examination (MMSE) psychometric properties %V 16 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=16991106 %X AIM: The aim of the present study was to validate the Greek version of the MMSE in advanced-cancer patients attending a palliative care unit. METHODS: The sample consisted of 103 advanced-cancer patients. The questionnaire was completed at baseline and three days later. Together with the MMSE, the patients also completed the EORTC QLQ-C30 Cognitive functioning scale, while researchers recorded data on demographic characteristics, disease status and treatment regimen. RESULTS: MMSE had overall Cronbach alpha 0.890. Validity as performed using known-group analysis showed good results. MMSE discriminated well between subgroups of patients differing in disease severity as defined by ECOG performance status. Comparison between the MMSE and the EORTC Cognitive functioning scale was statistically significant (p<0.05). CONCLUSION: These psychometric properties of the Greek version of the MMSE confirm it as a valid and reliable measure when administered to patients with advanced cancer %0 Journal Article %C Internal Medicine Department, Bazzano Hospital, Azienda USL di Bologna, Italy %A Nardi, R %A Scanelli, G %A Tragnone, A %A Lolli, A %A Kalfus, P %A Baldini, A %A Ghedini, T %A Bombarda, S %A Fiadino, L %A Di, Ciommo S %J Intern Emerg Med %D 2007 Jul %T Difficult hospital discharges in internal medicine wards %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17622495 %X OBJECTIVE: Investigate the prevalence of difficult hospital discharges (DHD), describe clinical and social patients' characteristics as potential reasons for discharge delays in an internal medicine ward and implement tailored post-discharge care. METHODS: During the year 2005 we analysed, in a middle-sized country hospital, all the patients for which some delay for discharge, owing to their whole complexity, was presumable. Comprehensive multidimensional assessment, clinical-social risk score, specific needs of care, mean of stay and outcomes were evaluated. RESULTS: 68.5% of DHD patients were >/=80 years old, with 3.8 the mean number of diseases per patient; 57.5% presented a loss of autonomy (ADL) just before acute deterioration; 80% were functionally and/or cognitively impaired. Only 5% had suitable family support; 5.1% were living at a nursing home; 2% were living alone. The most frequent causes of admission were stroke, cognitive impairment-dementia, cardiovascular diseases, fractures and cancer. Mean length of stay was 12 days. Fifty-two percent of patients were discharged home, 30% were admitted to a long-term care facility, 1% to hospice and 17% died during their hospital stay. CONCLUSIONS: The aim of "coordinated care" (i.e., targeting "at-risk" patients with assessment of medical, functional, social and emotional needs; provision of optimal medical treatment, self-care education, integrated services, monitoring of progress and early signs of problems) is to improve health outcomes and reduce costs. More than 80% of DHDs patients, with specific tailored programmes, may be discharged from hospital, with satisfactory solutions for them and their families %0 Journal Article %C Lundberg Laboratory for Cancer Research, Department of Surgery at the Sahlgrenska Academy, Goteborg University, Goteborg 41345, Sweden. bengt.e.nilsson@vgregion.se %A Nilsson, B %A Sjolund, K %A Kindblom, L-G %A Meis-Kindblom, J M %A Bumming, P %A Nilsson, O %A Andersson, J %A Ahlman, H %J Br J Cancer %D 2007 Jun %N 11 %P 1656-8 %T Adjuvant imatinib treatment improves recurrence-free survival in patients with high-risk gastrointestinal stromal tumours (GIST) %V 96 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17533389 %X Palliative imatinib treatment has dramatically improved survival in patients with malignant gastrointestinal stromal tumours, particularly in patients with tumours harbouring activating KIT mutations. To evaluate the effectiveness of adjuvant imatinib after radical surgery, a consecutive series of patients with high-risk tumours (n=23) was compared with historic controls (n=48) who were treated with surgery alone. The mean follow-up period was over 3 years in both groups. Only 1 out of 23 patients (4%) in the adjuvant treatment group developed recurrent disease compared to 32 out of 48 patients (67%) in the control group. This preliminary study indicates that 1 year of adjuvant treatment with imatinib dramatically improves recurrence-free survival. Confirmation of these findings awaits the results of ongoing randomised studies %0 Journal Article %C Western Regional Research Center, United States Department of Agriculture, Albany, California, USA. bonisko@pw.usda.gov %A Onisko, Bruce %A Dynin, Irina %A Requena, Jesus R %A Silva, Christopher J %A Erickson, Melissa %A Carter, John Mark %J J Am Soc Mass Spectrom %D 2007 Jun %N 6 %P 1070-9 %T Mass spectrometric detection of attomole amounts of the prion protein by nanoLC/MS/MS %V 18 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17446085 %X Sensitive quantitation of prions in biological samples is an extremely important and challenging analytical problem. Prions are the cause of several fatal neurodegenerative diseases known as transmissible spongiform encephalopathies (TSEs). At this time, there are no methods to diagnose TSEs in live animals or to assure a prion-free blood supply for humans. Prions have been shown to be present in blood by transfusion experiments, but based on the amount of infectivity found in these types of experiments, the amount of misfolded prion protein in blood is estimated to be only 30 to 625 amol/mL. More sensitive detection of prions in brain would allow earlier detection of disease and assure a safer food supply. We studied quantitation of the prion protein by use of nanoscale liquid chromatography coupled to a tandem mass spectrometer using the multiple reaction monitoring mode of operation. We developed a method based on the detection of VVEQMCTTQYQK obtained by reduction, alkylation, and digestion with trypsin of the prion protein. Detection of VVEQMCTTQYQK was more sensitive than for the derivative with phenylisothiocyanate (PITC) because of decreased ionization efficiency of the PITC-derivatized peptides. The VVEQMCTTQYQK method has a LOD of 20 to 30 amol for pure standards. Proof of principle is demonstrated by quantitation of the amount of PrP 27-30 in the brains of terminally ill Syrian hamsters %0 Journal Article %C Pain Relief and Palliative Care Unit, Department of Radiology, Areteion Hospital, School of Medicine, University of Athens, Greece %A Parpa, Efi %A Mystakidou, Kyriaki %A Tsilika, Eleni %A Sakkas, Pavlos %A Patiraki, Elisabeth %A Pistevou-Gombaki, Kyriaki %A Galanos, Antonis %A Vlahos, Lambros %J Am J Hosp Palliat Care %D 2006 Aug-Sep %N 4 %P 297-303 %T The attitudes of Greek physicians and lay people on euthanasia and physician-assisted suicide in terminally ill cancer patients %V 23 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17060293 %X The purpose of this article is to explore the attitudes of lay people and physicians regarding euthanasia and physician-assisted suicide in terminally ill cancer patients in Greece. The sample consisted of 141 physicians and 173 lay people. A survey questionnaire was used concerning issues such as euthanasia, physician-assisted suicide, and so forth. Many physicians (42.6%) and lay people (25.4%, P = .002) reported that in the case of a cardiac and/or respiratory arrest, there would not be an effort to revive a terminally ill cancer patient. Only 8.1% of lay people and 2.1% of physicians agreed on physician-assisted suicide (P = .023). Many of the respondents, especially physicians, supported sedation but not euthanasia or physician-assisted suicide. However, many of the respondents would prefer the legalization of a terminally ill patient's hastened death %0 Journal Article %C Covenant Hospice, Incorporated, Pensacola, Florida, USA %A Patton, Julie F %J Am J Hosp Palliat Care %D 2006 Aug-Sep %N 4 %P 304-8 %T Jungian spirituality: a developmental context for late-life growth %V 23 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17060294 %X Ira Byock's "opportunities for growth" at the end of life have become defining features of the hospice and palliative care movement and create a strong moral imperative against futile and distracting treatment for the terminally ill. This article examines a larger developmental and cultural context that includes the work of Carl Jung and others who describe similar growth as characteristic of the midlife transition and the movement toward "gerotranscendence" in later life. The author suggests that in developmental terms, gerotranscendence forms a bridge between the work of Jung and that of Byock. She examines archetypal concepts and practices that facilitate psychospiritual growth and argues that these may be used with terminally ill patients to help them engage the process of "dying well." She notes that these modern findings lie within a long and cross-cultural humanistic tradition that anticipates the development of wisdom for those whose aging occurs within a spiritual framework that involves identifying with the soul rather than with the body %0 Journal Article %C University of Toronto, Toronto, Canada %A Payne, Greg %A Laporte, Audrey %A Deber, Raisa %A Coyte, Peter C %J Milbank Q %D 2007 %N 2 %P 213-57 %T Counting Backward to Health Care's Future: Using Time-to-Death Modeling to Identify Changes in End-of-Life Morbidity and the Impact of Aging on Health Care Expenditures %V 85 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17517114 %X In most developed countries, as the largest population cohorts approach the age of sixty-five, the impact of population aging on health care expenditures has become a topic of growing interest. This articles examines trends in elderly disability and end-of-life morbidity, estimations of the cost of dying, and models of expenditures as a function of both age and time-to-death and finds broad improvement in mortality and morbidity among the elderly in the developed world. Reduced mortality and low growth in the costs associated with dying could reduce forecasted expenditures, but high growth in expenditures for those not close to death and for nonhospital services could create new economic pressures on health care systems %0 Journal Article %C Seksjon for medisinsk etikk, Universitetet i Oslo, Postboks 1130 Blindern, 0318 Oslo. reidar.pedersen@medisin.uio.no %A Pedersen, Reidar %A Bahus, Marianne Klungland %A Kvisle, Erik Martinsen %J Tidsskr Nor Laegeforen %D 2007 Jun %N 12 %P 1648-50 %T [Withholding and withdrawing treatment, ethical and legal aspects] %V 127 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17571104 %X BACKGROUND: In the wake of medical progress an important ethical discussion has arisen about when to withhold and when to withdraw life-sustaining treatment. MATERIAL AND METHODS: Literature on withholding and withdrawing life-sustaining treatment was assembled and analyzed, and common norms were compared with Norwegian legal regulations. RESULTS: Withholding or withdrawing life-sustaining treatment is not unusual when the treatment is regarded as futile. As opposed to euthanasia, limiting treatment is under certain circumstances legal. Core values--such as respect for the value of human life, the duty to save lives, equality, respect for patient autonomy, dignified death and professional integrity--may be given diverging emphases and interpretations. In many cases, the patient's capacity to consent is reduced, and it can be challenging to determine what is in the patient's best interest and when the treatment is futile. Good decision making processes and communication at the end of life is demanding, but may reduce and prevent many difficulties. INTERPRETATION: Norwegian healthcare legislation provides relatively little and to some extent unclear guidance on withholding and withdrawing life-sustaining treatment. National guidelines have not been developed. More attention could be paid to systematic approaches and dialogue with patients, relatives and all healthcare professionals about these issues %0 Journal Article %C Seksjon for medisinsk etikk, Universitetet i Oslo, Postboks 1130 Blindern, 0318 Oslo. reidar.pedersen@medisin.uio.no %A Pedersen, Reidar %A Hofmann, Bjorn %A Mangset, Margrete %J Tidsskr Nor Laegeforen %D 2007 Jun %N 12 %P 1644-7 %T [Patient autonomy and informed consent in clinical practice] %V 127 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17571103 %X BACKGROUND: Patient autonomy and informed consent is increasingly emphasized in clinical practice, professional ethics and health care legislation. MATERIAL AND METHODS: Literature on patient autonomy and informed consent was assembled, analyzed, and common norms compared with Norwegian legal regulations. RESULTS: The procedure of obtaining informed consent may increase patient participation and prevent unwanted treatment and care. Such a practice is in line with the principle of patient autonomy. An act is normally considered autonomous when the following three criteria are fulfilled: Sufficient understanding, competence to consent and that the consent is given voluntarily. In clinical practice it is sometimes impossible to meet all these criteria. Furthermore, it is often demanding to tailor the information and the decision-making process to the individual patient's background and preferences. When the patient lacks competence to consent, the Norwegian health care legislation assigns an especially large responsibility to the health care personnel. Recently, health care personnel's authority to use force in such situations have been expanded. INTERPRETATION: The increased emphasis on patient autonomy and informed consent places high demands on health care personnel's moral considerations, ability to communicate, and understanding of roles and responsibilities. Assessment of competence to consent will probably become an important challenge to Norwegian health care personnel in the near future %0 Journal Article %C Pediatric Cardiology Division, Hospital do Coracao da Associacao Sanatorio Sirio, Sao Paulo, SP, Brazil %A Pedra, CA %A Neves, JR %A Pedra, SR %A Ferreiro, CR %A Jatene, I %A Cortez, TM %A Jatene, M %A Souza, LC %A Assad, R %A Fontes, VF %J Catheter Cardiovasc Interv %D 2007 Jul %T New transcatheter techniques for creation or enlargement of atrial septal defects in infants with complex congenital heart disease %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17621660 %X OBJECTIVES:: To describe a series of 8 consecutive infants (5 with transposition of the great arteries [TGA] and 3 with hypoplastic left heart syndrome [HLHS]) who underwent nonconventional septostomy techniques. BACKGROUND:: For some complex congenital heart defects, an unrestrictive atrial septal defect (ASD) is essential to achieve an adequate cardiac output and/or systemic saturation. In some scenarios, the use of conventional septostomy techniques may be technically difficult, hazardous, and/or ineffective. METHODS:: Use of transhepatic approach, cutting balloons, and radiofrequency perforation with stenting of the atrial septum. RESULTS:: The size of the ASD and the oxygen saturation increased in all patients with no major complications. In those with TGA, the ASDs were considered to be of good size at the arterial switch operation. Two of the 3 patients with hybrid palliation for HLHS have developed some degree of obstruction within the interatrial stent over 2-3 months. At surgery, the stents were found to be secured within the septum with one showing significant fibrous ingrowth after uneventful removal. The other had some nonobstructive ingrowth. CONCLUSIONS:: Creation or enlargement of ASDs in infants using new nonconventional transcatheter techniques is feasible, safe, and effective, at least in the short-to-mid-term follow-up. Infants with TGA seem to benefit the most because the procedure results in satisfactory clinical stability for subsequent early surgical intervention. In infants with HLHS palliated by a hybrid approach, stent implantation to the atrial septum seems to buy enough time to bring them to the phase II safely despite progressive in-stent obstruction. (c) 2007 Wiley-Liss, Inc %0 Journal Article %C Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, UK. stephen.pereira@ucl.ac.uk %A Pereira, Stephen P %A Ayaru, Lakshmana %A Rogowska, Agnieszka %A Mosse, Alexander %A Hatfield, Adrian R W %A Bown, Stephen G %J Eur J Gastroenterol Hepatol %D 2007 Jun %N 6 %P 479-85 %T Photodynamic therapy of malignant biliary strictures using meso-tetrahydroxyphenylchlorin %V 19 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17489058 %X OBJECTIVES: The palliation of patients with malignant bile duct obstruction using metal or plastic biliary stents may be limited by stent occlusion. The aim of this study was to determine the safety and efficacy of endoscopically delivered meso-tetrahydroxyphenyl chlorin photodynamic therapy in the treatment of irresectable malignant biliary strictures and recurrent stent occlusion. METHODS: Thirteen patients with malignant biliary obstruction owing to carcinoma of the biliary tract (n=9), pancreas (n=3) or stomach (n=1), were studied. All had been initially palliated with metal (n=10) or polyethylene (n=3) biliary stents, but presented with recurrent obstructive jaundice because of local tumour progression. Patients received meso-tetrahydroxyphenyl chlorin 0.15 mg/kg intravenously 72 h before endoluminal light activation with an endoscopically placed optical fibre, followed by polyethylene stent insertion. RESULTS: Before photodynamic therapy, patients had a median of three (range 0-5) stent occlusions in the preceding 11 (2-22) months, with a median patency of plastic stents placed inside metal bile duct stents for recurrent stent occlusion of 3.5 (0.5-13) months. After photodynamic treatment, tumour necrosis and/or metal stent recanalization was seen in all patients, with a median of 0 (0-3) stent occlusions during 7 (1-43) months follow-up. The median patency of plastic stents placed inside metal stents after photodynamic therapy was 5 (1-43) months. The median survival after diagnosis and photodynamic therapy administration was 21 (10-56) and 8 (1-43) months, respectively. Photodynamic therapy was generally well tolerated but two patients developed cholangitis within the first week, complicated in one by a fatal liver abscess and two developed haemobilia within 4 weeks of treatment, one of whom died with a gall bladder empyema. CONCLUSION: In patients with malignant biliary obstruction, endoscopically delivered meso-tetrahydroxyphenyl chlorin photodynamic therapy causes efficient tumour necrosis and recanalization of blocked metal stents, but there is a significant risk of complications %0 Journal Article %C Ecumenical Center for Religion and Health and Division of General Medicine, Department of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229-3900, USA %A Perkins, Henry S %J Ann Intern Med %D 2007 Jul %N 1 %P 51-7 %T Controlling death: the false promise of advance directives %V 147 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17606961 %X Advance directives promise patients a say in their future care but actually have had little effect. Many experts blame problems with completion and implementation, but the advance directive concept itself may be fundamentally flawed. Advance directives simply presuppose more control over future care than is realistic. Medical crises cannot be predicted in detail, making most prior instructions difficult to adapt, irrelevant, or even misleading. Furthermore, many proxies either do not know patients' wishes or do not pursue those wishes effectively. Thus, unexpected problems arise often to defeat advance directives, as the case in this paper illustrates. Because advance directives offer only limited benefit, advance care planning should emphasize not the completion of directives but the emotional preparation of patients and families for future crises. The existentialist Albert Camus might suggest that physicians should warn patients and families that momentous, unforeseeable decisions lie ahead. Then, when the crisis hits, physicians should provide guidance; should help make decisions despite the inevitable uncertainties; should share responsibility for those decisions; and, above all, should courageously see patients and families through the fearsome experience of dying %0 Journal Article %C Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands %A Pogany, Katalin %A van Valkengoed, Irene G M %A Prins, Jan M %A Nieuwkerk, Pythia T %A van der Ende, Ineke %A Kauffmann, Robbert H %A Kroon, Frank P %A Verbon, Annelies %A Nievaard, Marianne F %A Lange, Joep M A %A Brinkman, Kees %J J Acquir Immune Defic Syndr %D 2007 Apr %N 4 %P 395-400 %T Effects of active treatment discontinuation in patients with a CD4+ T-cell nadir greater than 350 cells/mm3: 48-week Treatment Interruption in Early Starters Netherlands Study (TRIESTAN) %V 44 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17195761 %X OBJECTIVE: To evaluate the safety and efficacy of discontinuing highly active antiretroviral therapy (HAART) in HIV-1-positive patients who initiated HAART at a CD4+ T-cell count >350 cells/mm. METHODS: Eligible patients were identified from the Dutch AIDS Therapy Evaluation, The Netherlands (ATHENA) national observational cohort. Interruption or continuation of HAART was offered to all. RESULTS: Of 71 patients enrolled, 46 (64%) interrupted HAART (STOP group) and 25 (36%) continued HAART (control group). The median CD4+ T-cell nadirs at the start of HAART were 469 (interquartile range [IQR]: 430-720) cells/mm3 and 510 (IQR: 440-637) cells/mm3, respectively. At week 48, the median plasma HIV RNA level in the STOP group had stabilized at approximately pre-HAART values (4.55 log10, IQR: 4.2-4.9 copies/mL), but the CD4+ T-cell count still exceeded the pre-HAART count (563 cells/mm3, IQR: 450-710 cells/mm3). Only 5 patients (11%) had reinitiated HAART after 48 weeks, all for personal reasons. No Centers for Disease Control and Prevention category events or death occurred after interruption. In 6 (13%) of 46 patients, mild symptoms of acute retroviral rebound syndrome (ARVS) were identified. No improvement was observed in mental or physical health scores. In 37% of patients, nonnucleoside reverse transcriptase inhibitor drug concentrations were still detectable 1 week after stopping. CONCLUSIONS: Although HAART can safely be interrupted in patients with a high CD4 T-cell nadir, no improvement in quality of life was established. Patients can experience ARVS, the risk for development of resistance after treatment interruption is realistic, and there is a potential hazard of HIV transmission to sexual partners. We would not actively advise stopping treatment in patients who started treatment too early according to current guidelines %0 Journal Article %C Paediatric Orthopaedic Department, University Childrens Hospital. Brno, Czech Republic %A Poul, Jan %J Ortop Traumatol Rehabil %D 2004 Oct %N 5 %P 604-6 %T Diagnosis of Legg-Calve-Perthes disease %V 6 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17618209 %X Despite the use in recent years of sophisticated imaging methods, the diagnosis of Legg-Calve-Perthes disease is predominantly based on clinical examination, standard x-rays in two planes, and ultrasonography. What is essential is early detection of the collapse of the femoral head, which can be very rapid, especially in older age groups. Delayed diagnosis in these cases, usually associated with developed extrusion of the femoral head, prevents the application of principles of conservative treatment, and palliative femoral extension-abduction osteotomy is necessary %0 Journal Article %C Unite mobile de soins palliatifs, Hopital Antoine-Beclere, Clamart %A Rautureau, Pascal %J Rev Infirm %D 2007 May %N 130 %P 43 %T [Promoting the clinical nurse] %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17566508 %0 Journal Article %C Department of Rhumatology, Hopital Lariboisiere, Paris, France. pascal.richette@lrb.aphp.fr %A Richette, Pascal %A Viguier, Manuelle %A Bachelez, Herve %A Bardin, Thomas %J J Rheumatol %D 2007 Feb %N 2 %P 438-9 %T Psoriasis induced by anti-tumor necrosis factor therapy: a class effect? %V 34 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17304662 %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 Ethik-Zentrum der Universitat Zurich. romau@freesurf.ch %A Rom, B %A Biller-Andorno, N %J Schweiz Rundsch Med Prax %D 2006 Nov %N 45 %P 1765-7 %T [Comment on the case: "When life benefit becomes a problem"] %V 95 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17205933 %0 Journal Article %C Department of Psychology, The Sage Colleges, 45 Ferry Street, Troy, NY 12180, USA. romanb@sage.edu %A Romanoff, Bronna D %A Thompson, Barbara E %J Am J Hosp Palliat Care %D 2006 Aug-Sep %N 4 %P 309-16 %T Meaning construction in palliative care: the use of narrative, ritual, and the expressive arts %V 23 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17060295 %X Individuals and families make sense of the world and their experiences through a process of meaning construction. Narrative is an important means of constructing meaning. The diagnosis of life-threatening or life-altering illness often forces revision in the life narrative and the reconstruction of meaning. This article discusses the process of meaning construction and highlights the use of narrative, the expressive arts, and ritual to create meaning and connection. All members of the palliative care team play an important role in helping patients and families tell the stories of their illness and their lives and find meaning and purpose at the end of life. The use of rituals is discussed along with verbal and art-based methods for eliciting patient and family narratives. The relationships among patient, family, and practitioner are seen as powerfully therapeutic and potentially transformative for all involved %0 Journal Article %C Department of Geriatric Medicine, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK %A Rosario, BH %A Hurlstone, P %A Lee, F %A Downes, T %J Age Ageing %D 2007 Jul %T Colonic stenting: an alternative to surgery in the elderly %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17626022 %X This case report describes the management of a frail older patient presenting with a rare case of an obstructing right-sided colonic lesion, combined with complex co-morbidities. The report briefly discusses use of colonic stenting in right colonic lesions as well as palliative management of colonic tumours in general %0 Journal Article %C Department of Psychiatry, University of Rochester Medical Center, USA. Ann_Russ@urmc.rochester.edu %A Russ, Ann J %A Shim, Janet K %A Kaufman, Sharon R %J Soc Sci Med %D 2007 Jun %N 11 %P 2236-47 %T The value of "life at any cost": talk about stopping kidney dialysis %V 64 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17418924 %X With the trend toward an older, sicker dialysis population in the USA, discussions of ethical issues surrounding dialysis have shifted from concerns about access to and availability of the therapy, to growing unease about non-initiation and treatment discontinuation. Recent studies report treatment withdrawal as the leading cause of death among elderly dialysis patients. Yet, the actual activities that move patients toward stopping treatment often remain obscure, even to clinicians and patients themselves. This paper explores that paradox, drawing on anthropological research among patients over age 70, their families, and clinicians in two California renal dialysis units. It concludes that many older patients sacrifice a sense of choice about dialysis in the present to maintain "choice" as both value and possibility for the future. Even so, patients desire more information and communication, provided earlier in their illness, about prognosis, how long they can expect to be on dialysis, and what the impact of the treatment will be on their daily lives. That, with time, there is a transition to be made from dialysis as "treatment" to end of life care could be better explained and managed to alleviate patients' confusion and unneeded isolation %0 Journal Article %C Yale University School of Medicine. New Haven, CT, USA. wasif.saif@yale.edu %A Saif, Muhammad Wasif %A Shahrokni, Armin %A Cornfeld, Daniel %J JOP %D 2007 %N 4 %P 460-7 %T Gemcitabine-induced liver fibrosis in a patient with pancreatic cancer %V 8 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17625301 %X Gemcitabine is the only cytotoxic agent approved by FDA for the treatment of pancreatic carcinoma. Gemcitabine has a relatively safe profile. Major side effects include bone marrow suppression and flu-like syndrome. Transient abnormalities of liver transaminase enzymes are seen in two third of patients: elevations of alkaline phosphatase and bilirubin are less common, but severe hepatic toxicity is uncommon. Four case reports regarding severe hepatic toxicity of gemcitabine leading to rapid deterioration in patients' health status and death have been reported. We report the fifth case in which liver functions were within normal limits but liver toxicity was preceded by radiological findings on the MRI. We describe a 61-year-old male with stage T4N1M0 who initially received gemcitabine-oxaliplatin (GemOx) regimen was switched to gemcitabine-capecitabine (every two weeks schedule) after four months of therapy due to lack of response. Restaging CT scan after eight-weeks showed new multiple foci of low attenuation resembling simple cysts. MRI of the abdomen was performed which revealed early and active fibrosis. Hepatitis panel were negative. Subsequently the patient developed nausea, vomiting, abdominal pain and weight loss and was referred for palliative radiotherapy. Gemcitabine was discontinued and follow-up CT scan two months later showed stable lesions in the liver. In conclusions, four cases of gemcitabine-induced liver toxicity has been reported in the literature. Such toxicity is manifested by elevated liver transaminases and more common in the presence of liver metastasis. However, our case showed that gemcitabine-induced liver toxicity can be detected by MRI, before liver enzymes start to rise and discontinuation of gemcitabine can prevent further liver toxicity and fibrosis. Report of such cases is encouraged as it will bring awareness among clinicians caring for such patients receiving gemcitabine %0 Journal Article %C Pain and Palliative Care Service (R.S., E.O., N.C., C.I.), Memorial Sloan-Kettering Cancer Center, and Department of Pharmacology (C.I.), Weill Medical College of Cornell University, New York, New York, USA %A Sekine, R %A Obbens, EA %A Coyle, N %A Inturrisi, CE %J J Pain Symptom Manage %D 2007 Jul %T The Successful Use of Parenteral Methadone in a Patient with a Prolonged QTc Interval %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17616330 %X Recent case reports have raised concerns about the potential for methadone to prolong the QTc interval (QT corrected for heart rate) and predispose patients to torsade de pointes (TdP), a life-threatening arrhythmia. We present a case report that describes the successful use of parenteral and oral methadone in a patient with uncontrolled cancer pain and a history of QTc prolongation. We describe an approach to the use of methadone in this patient and review both case reports and recent prospective studies that have evaluated the risk of TdP and the long-term outcome with respect to the development of TdP in patients receiving methadone for chronic pain or addiction %0 Journal Article %C UnitedHealth Europe %A Smith, Richard %A Williams, Nancy %A Thomas, Keri %J Health Serv J %D 2007 May %N 6057 %P 28-9 %T The American way of death %V 117 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17580769 %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 aDivision of Medical Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania bNorthwest Cancer Specialists, Vancouver, Washington, USA %A Solti, Magdolna %A Berd, David %A Mastrangelo, Michael J %A Sato, Takami %J Melanoma Res %D 2007 Aug %N 4 %P 225-31 %T A pilot study of low-dose thalidomide and interferon alpha-2b in patients with metastatic melanoma who failed prior treatment %V 17 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17625452 %X Melanoma is a hypervascular tumor and angiogenesis plays a critical role in the development/progression of metastases. As various pathways are involved in tumor angiogenesis, a combination of agents with different antiangiogenesis activities is a reasonable approach. To determine the efficacy and toxicity of combination treatment with low-dose thalidomide and low-dose interferon (IFN) in patients with stage IV melanoma who failed prior treatment(s), fifteen patients with metastatic melanoma (nine cutaneous, six uveal) received oral thalidomide (200 mg daily) with subcutaneous interferon (IFN)-alpha2b (3 MIU, 3x/week). Stabilization or regression of metastases (as evidenced by computed tomographic measurement) was the primary endpoint of the study. Patients were evaluated monthly for toxicity and every 2 months for clinical response. At a median follow-up of 22.8 months (range, 12-32 months), one patient with metastatic cutaneous melanoma achieved partial response, three patients achieved stable disease (one uveal, two cutaneous), nine patients progressed, and two were not evaluable. The time to progression was 6 months for the patient with partial response, and 2, 5.5+ and 11 months for three patients with stable disease. The estimated median overall survival was 4.7 months (confidence interval, 2.2-9.9 months; range, 0.9-31.5 months), and median progression-free survival was 1.8 months (confidence interval, 1.5-3.0 months; range, 0.5-14 months). Grade 3 toxicities related to treatment included neutropenia (n=5), elevation of transaminases (n=2), and neuropathy (n=1). No treatment-related deaths were experienced. Thalidomide+IFN is a safe and tolerable palliative treatment for previously treated stage IV melanoma %0 Journal Article %C General Intensive Care Unit, Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, PO Box 12000, 91120, Jerusalem, Israel. sprung@cc.huji.ac.il %A Sprung, Charles L %A Carmel, Sara %A Sjokvist, Peter %A Baras, Mario %A Cohen, Simon L %A Maia, Paulo %A Beishuizen, Albertus %A Nalos, Daniel %A Novak, Ivan %A Svantesson, Mia %A Benbenishty, Julie %A Henderson, Beverly %J Intensive Care Med %D 2007 Jan %N 1 %P 104-10 %T Attitudes of European physicians, nurses, patients, and families regarding end-of-life decisions: the ETHICATT study %V 33 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17066284 %X OBJECTIVE: To evaluate attitudes of Europeans regarding end-of-life decisions. DESIGN AND SETTING: Responses to a questionnaire by physicians and nurses working in ICUs, patients who survived ICU, and families of ICU patients in six European countries were compared for attitudes regarding quality and value of life, ICU treatments, active euthanasia, and place of treatment. MEASUREMENTS AND RESULTS: Questionnaires were distributed to 4,389 individuals and completed by 1,899 (43%). Physicians (88%) and nurses (87%) found quality of life more important and value of life less important in their decisions for themselves than patients (51%) and families (63%). If diagnosed with a terminal illness, health professionals wanted fewer ICU admissions, uses of CPR, and ventilators (21%, 8%, 10%, respectively) than patients and families (58%, 49%, 44%, respectively). More physicians (79%) and nurses (61%) than patients (58%) and families (48%) preferred being home or in a hospice if they had a terminal illness with only a short time to live. CONCLUSIONS: Quality of life was more important for physicians and nurses than patients and families. More medical professionals want fewer ICU treatments and prefer being home or in a hospice for a terminal illness than patients and families %0 Journal Article %A Srivastava, Ranjana %J N Engl J Med %D 2007 Jul %N 1 %P 3-5 %T The art of letting go %V 357 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17611202 %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 %C Massachusetts General Hospital, Boston, MA 02114, USA. jtemel@partners.org %A Temel, Jennifer S %A Jackson, Vicki A %A Billings, J Andrew %A Dahlin, Constance %A Block, Susan D %A Buss, Mary K %A Ostler, Patricia %A Fidias, Panos %A Muzikansky, Alona %A Greer, Joseph A %A Pirl, William F %A Lynch, Thomas J %J J Clin Oncol %D 2007 Jun %N 17 %P 2377-82 %T Phase II study: integrated palliative care in newly diagnosed advanced non-small-cell lung cancer patients %V 25 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17557950 %X PURPOSE: To assess the feasibility of early palliative care in the ambulatory setting in patients with newly diagnosed advanced non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS: Patients were eligible if they had a performance status of 0 to 1 and were within 8 weeks of diagnosis of advanced NSCLC. Participants received integrated care from oncology and palliative care throughout the course of their disease. Participants were scheduled to meet with the palliative care team (PCT) and complete quality-of-life (QOL) and mood questionnaires monthly for 6 months. The study was deemed feasible if 64% of patients completed at least 50% of their scheduled visits and QOL assessments. RESULTS: Fifty-one patients were enrolled onto the trial. One died within 72 hours and was not assessable. Ninety percent (95% CI, 0.78 to 0.96) of study participants complied with at least 50% of the palliative care visits. Eight-six percent (95% CI, 0.73 to 0.94) of the participants met the full feasibility requirements by both meeting with the PCT and completing QOL assessments at least 50% of the time. QOL and mood analyses confirmed the high symptom burden in patients with newly diagnosed advanced NSCLC. At least 50% of participants experienced some degree of shortness of breath, cough, difficulty breathing, appetite loss, weight loss, or unclear thinking at their baseline assessment. More than one third of patients had a probable mood disorder at baseline. CONCLUSION: Integrated palliative and oncology care is feasible in ambulatory patients with advanced NSCLC %0 Journal Article %C Centre valaisan de pneumologie, 3963 Crans-Montana %A Terrettaz, Emmanuel %A Frey, Jean-Georges %A Chavaillaz, Olivier %J Rev Med Suisse %D 2007 Feb %N 99 %P 470-2, 474-6 %T [Pulmonary blastoma in adults] %V 3 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17424798 %X Pneumoblastoma (PB) is a rare, malignant, primary, pulmonary tumour, of young adults. Its discovery is fortuitous in asymptomatic patients. It is a well-delimited, homogeneous lesion in the lung periphery. Histologically, its structure looks like a normal fetal lung. The surgical resection is the treatment of choice. The radiotherapy is an empirical palliative treatment to relieve dyspnea when other treatments failed. The prognosis is bad: 16% survive 5 years and 8% beyond 10 years, all treatments included. Metastases could appear in the liver, the brain and the bone %0 Journal Article %C dagger Palliative Medicine, Barts and the London NHS Trust, London, UK %A Thompson, JC %A Wood, J %A Feuer, D %J Br Med Bull %D 2007 Jul %T Prostate cancer: palliative care and pain relief %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17628024 %X Introduction Metastatic prostate cancer is incurable and causes significant morbidity. The focus of treatment should be on improving quality of life through appropriate oncological treatment and palliative care. The National Institute for Clinical Excellence guidelines for urological cancer recommends palliative care for all patients with prostate cancer, according to need. This paper outlines the principles of modern palliative care in patients with metastatic prostate cancer within the UK. Discussion We highlight the main physical symptoms encountered in metastatic prostate cancer and their management. We also introduce the UK Department of Health's 'End-of-Life Care Programme'. This initiative intends to improve the lives and deaths of all patients with incurable disease and should be a priority for all health care professionals, within any setting. Conclusion Clearly, we have addressed the management of metastatic prostate cancer within the UK setting, though any of these government initiatives may provide a resource and framework in other countries %0 Journal Article %C From the *Virology Laboratory, Croix Rousse Hospital, Lyon, France; daggerHepatogastroenterology Unit, Hotel Dieu Hospital, Hospices Civils de Lyon, Lyon, France; double daggerBioAlliancePharma, Paris, France; and section signIFR128 BioSciences, INSERM U503, Lyon, France %A Trabaud, MA %A Cotte, L %A Labernardiere, JL %A Lebel-Binay, S %A Icard, V %A Tardy, JC %A Trepo, C %A Andre, P %J J Acquir Immune Defic Syndr %D 2007 Jul %T Variants With Different Mutation Patterns Persist in the Quasispecies of Enfuvirtide-Resistant HIV-1 Population During and After Treatment In Vivo %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17621239 %X BACKGROUND:: Genotypic and phenotypic resistance in 11 HIV-1- infected patients receiving enfuvirtide (ENF), as part of a salvage regimen, has been evaluated. METHODS:: Resistance mutations were detected by sequencing the gp41 ectodomain from plasma samples. During treatment, longitudinal samples from 1 patient were sequenced after limiting dilution of complementary DNA to isolate single genomes. Phenotypic resistance was evaluated with a new recombinant virus assay (PHENOSCRIPT; VIRalliance, Paris, France), allowing the determination of coreceptor use. RESULTS:: All patients experienced ENF failure. One to 4 mutations in the 36-to-45 gp41 region appeared during ENF therapy in all patients and disappeared after ENF removal. Mixtures of wild type and mutants unexpectedly persisted under ENF treatment, however, despite continued replication, leading to discordant results between genotypic and phenotypic data. Sequencing of isolated genomes from 1 patient confirmed that a wild-type first heptad repeat region (HR1) region was still present at the end of therapy. Several mutated variants coexisted at different time points, despite a tendency toward quasispecies reduction with time. CONCLUSION:: Individual variability of the mutation pattern and persistence of strains without mutation in the region mainly targeted by ENF resistance probably reflect the fact that resistance to ENF may rely on regions of gp41 or gp120 other than residues 36 to 45 %0 Journal Article %C Department of Gastroenterology, University Hospital of Magdeburg, Germany. ingtre@uniklinik-saarland.de %A Treiber, G %A Rocken, C %A Wex, T %A Malfertheiner, P %J Z Gastroenterol %D 2007 May %N 5 %P 369-77 %T Octreotide alone or in combination with rofecoxib as palliative treatment for advanced hepatocellular cancer %V 45 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17503315 %X BACKGROUND: Median survival for advanced hepatocellular carcinoma (HCC) is around 3 months. Previous octreotide-based treatment studies revealed conflicting results. AIMS AND METHODS: To determine whether palliative treatment for HCC is beneficial in terms of survival and quality of life (primary outcome measures). Patients were prospectively randomised to receive open-label octreotide 30 mg monthly alone (n = 39) or in combination with rofecoxib (up to 50 mg bid daily, n = 32) for a minimum of six months, or until death occurred. RESULTS: Median overall survival (154 days) and time to progression (94 days) were similar for both treatments and within the range of published trials for octreotide, while adding rofecoxib to octreotide did not alter overall survival (149 vs. 155 days, p = 0.849). Treatment-associated clinical benefit was seen in 16/71 patients (3 patients with partial remissions and 13 with stable disease). Delay in tumor progression was associated with prolonged median survival (p < 0.0001) and a better quality of life (p < 0.05). Moreover, survival outcome was associated with a CLIP score < 3, extent of portal vein infiltration, well-differentiated tumor histology, prothrombin time, alkaline phosphatase, bilirubin, serum ferritin, and gamma-glutamyltransferase (p < 0.01 each). DISCUSSION: Rofecoxib added to octreotide treatment did not improve survival over octreotide treatment alone. Octreotide treatment, although without major side effects, cannot be recommended in general as monotherapy, unless the few patients responding can better be characterised. There may still be a role for combining octreotide with other emerging targeted therapies because of potentially synergistic modes of action %0 Journal Article %C Department of Anesthesia at Harvard Medical School and the Division of Critical Care Medicine at Children's Hospital Boston, Boston, USA %A Truog, Robert D %J N Engl J Med %D 2007 Jul %N 1 %P 1-3 %T Tackling medical futility in Texas %V 357 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17611201 %0 Journal Article %C DanTPMARDR@aol.com %A Tunstall Pedoe, Dan S %J Sports Med %D 2007 %N 4-5 %P 448-50 %T Marathon cardiac deaths : the london experience %V 37 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17465632 %X Data from the London Marathon, with 650,000 completed runs, show that cardiac arrests occur even in the most experienced runners. Although coronary artery disease was the commonest cause of sudden cardiac arrest (SCA) with five deaths and six resuscitations, hypertrophic cardiomyopathy or idiopathic left ventricular hypertrophy (HCM) was diagnosed at autopsy on three occasions. HCM deaths had the same average age as the runners with ischaemic heart disease who had SCA or sudden cardiac death. The cardiac arrests were at the finish in less than one-third of cases and the remainder occurred between 6 and 26 miles on the course. Only one of the eight runners who died had reported symptoms to his family or physician suggestive of cardiac disease. The runner who had reported pre-race angina pain was investigated with a negative exercise stress test prior to the marathon and despite this died with a left anterior descending coronary artery stenosis. The cardiac death rate for the London Marathon is 1 in 80,000 finishers %0 Journal Article %A Vander Leest, Robert E %J Ann Emerg Med %D 2007 Jul %N 1 %P 88 %T Early learning %V 50 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17572292 %0 Journal Article %C Health Sciences/Medical Ethics (M.V.), University of Groningen/University Medical Center, Groningen; Royal Dutch Medical Association (E.v.W., J.L.), Utrecht; Institute for Social Medicine (J.L.), Vrije Universiteit, Amsterdam; and Division of Medical Oncology (A.d.G.), Department of Internal Medicine, University Medical Center, Utrecht, the Netherlands %A Verkerk, M %A van, Wijlick E %A Legemaate, J %A de, Graeff A %J J Pain Symptom Manage %D 2007 Jul %T A National Guideline for Palliative Sedation in the Netherlands %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17618078 %X The first national guideline on palliative sedation in the Netherlands has been adopted by the General Board of the Royal Dutch Medical Association. By law, the physician is obliged to take this guideline into consideration. In this paper we present the main principles of the guideline. Palliative sedation is defined as the intentional lowering of consciousness of a patient in the last phase of his or her life. The aim of palliative sedation is to relieve suffering, and lowering consciousness is a means to achieve this. The indication for palliative sedation is the presence of one or more refractory symptoms that lead to unbearable suffering for the patient. Palliative sedation is given to improve patient comfort. It is the degree of symptom control, not the level to which consciousness is lowered, which determines the dose and the combinations of the sedatives used and duration of treatment. Palliative sedation is normal medical practice and must be clearly distinguished from the termination of life %0 Journal Article %C Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, WA, USA %A Vig, EK %A Starks, H %A Taylor, JS %A Hopley, EK %A Fryer-Edwards, K %J J Gen Intern Med %D 2007 Jul %T Surviving Surrogate Decision-Making: What Helps and Hampers the Experience of Making Medical Decisions for Others %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17619223 %X BACKGROUND: A majority of end-of-life medical decisions are made by surrogate decision-makers who have varying degrees of preparation and comfort with their role. Having a seriously ill family member is stressful for surrogates. Moreover, most clinicians have had little training in working effectively with surrogates. OBJECTIVES: To better understand the challenges of decision-making from the surrogate's perspective. DESIGN: Semistructured telephone interview study of the experience of surrogate decision-making. PARTICIPANTS: Fifty designated surrogates with previous decision-making experience. APPROACH: We asked surrogates to describe and reflect on their experience of making medical decisions for others. After coding transcripts, we conducted a content analysis to identify and categorize factors that made decision-making more or less difficult for surrogates. RESULTS: Surrogates identified four types of factors: (1) surrogate characteristics and life circumstances (such as coping strategies and competing responsibilities), (2) surrogates' social networks (such as intrafamily discord about the "right" decision), (3) surrogate-patient relationships and communication (such as difficulties with honoring known preferences), and (4) surrogate-clinician communication and relationship (such as interacting with a single physician whom the surrogate recognizes as the clinical spokesperson vs. many clinicians). CONCLUSIONS: These data provide insights into the challenges that surrogates encounter when making decisions for loved ones and indicate areas where clinicians could intervene to facilitate the process of surrogate decision-making. Clinicians may want to include surrogates in advance care planning prior to decision-making, identify and address surrogate stressors during decision-making, and designate one person to communicate information about the patient's condition, prognosis, and treatment options %0 Journal Article %C Center for Research on Minority Health (I.T.V.), Department of Health Disparities Research, Department of Symptom Research (C.S.C.), and the WHO Collaborating Center for Supportive Cancer Care (C.S.C.), University of Texas M. D. Anderson Cancer Center; University of Texas School of Public Health (L.A.A.); and International Association for Hospice and Palliative Care (L.D.L.), Houston, Texas, USA; and Latin American Association for Palliative Care (L.D.L.), Buenos Aires, Argentina %A Vigil, IT %A Aday, LA %A De, Lima L %A Cleeland, CS %J J Pain Symptom Manage %D 2007 Jul %T What Predicts the Quality of Advanced Cancer Care in Latin America? A Look at Five Countries: Argentina, Brazil, Cuba, Mexico, and Peru %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17616337 %X Cancer is now a leading cause of death among adults in most Latin American nations. Yet, until recently, there has been limited research on the quality of, and access to, advanced cancer care in developing regions such as Latin America. This landmark, cross-national study assessed the quality of advanced cancer care in five Latin American countries by surveying a convenience sample of 777 physicians and nurses, and identifying the most salient influences on their quality-of-care assessments based on multiple linear regression analyses. Strategies for disseminating this survey included mass mailings, distribution at professional meetings/conferences, collaboration with Latin American institutions, professional organizations, and the Pan American Health Organization, and online posting. Results indicate that the respondents' assessments of the quality of, access to, and affordability of advanced cancer care varied significantly across nations (P<0.001). The strongest predictor of providers' national-level assessments of the quality of care was their ratings of access to advanced cancer care (Beta=0.647). Other predictors included affordability of care, country (Cuba vs. the other four countries), income-gap quintile, and institutional availability of opioid analgesics. Low prioritization of palliative care in both health care policy formulation and provider education also predicted the quality-of-care ratings. Findings from this study suggest that providers from five different nations hold similar equitable notions of quality care that are dependent on the provision of accessible and affordable care. Measures of social equity, such as the income-gap quintile of nations, and measures of policy barriers, such as the scale developed in this study, should be replicated in future studies to enable policy makers to assess and improve advanced cancer care in their countries %0 Journal Article %C Strelitz Diabetes Institutes, Norfolk, VA 23510, USA. vinikai@evms.edu %A Vinik, Aaron %A Ullal, Jagdeesh %A Parson, Henri K %A Casellini, Carolina M %J Nat Clin Pract Endocrinol Metab %D 2006 May %N 5 %P 269-81 %T Diabetic neuropathies: clinical manifestations and current treatment options %V 2 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=16932298 %X Diabetic neuropathies are a heterogeneous group of disorders that include a wide range of abnormalities. They can be focal or diffuse, proximal or distal, affecting both peripheral and autonomic nervous systems, causing morbidity with significant impact on the quality of life of the person with diabetes, and can result in early death. Distal symmetric polyneuropathy, the most common form of diabetic neuropathy, usually involves small and large nerve fibers. Small-nerve-fiber neuropathy often presents with pain but without objective signs or electrophysiologic evidence of nerve damage, and is recognized as a component of the impaired glucose tolerance and metabolic syndromes. The greatest risk resulting from small-fiber neuropathy is foot ulceration and subsequent gangrene and amputation. Large-nerve-fiber neuropathies produce numbness, ataxia and uncoordination, impairing activities of daily living and causing falls and fractures. A careful history and detailed physical examination are essential for the diagnosis. Symptomatic therapy has become available and newer and better treatment modalities, based on etiologic factors, are being explored with potential for significant impact on morbidity and mortality. Preventive strategies and patient education still remain key factors in reducing complication rates and mortality %0 Journal Article %C Service de Neurologie A and EDMUS Coordinating Centre, Hopital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France. sandra.vukusic@chu-lyon.fr %A Vukusic, Sandra %A Van Bockstael, Vincent %A Gosselin, Sophie %A Confavreux, Christian %J J Neurol Neurosurg Psychiatry %D 2007 Jul %N 7 %P 707-9 %T Regional variations in the prevalence of multiple sclerosis in French farmers %V 78 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17299020 %X BACKGROUND: Studies on the prevalence of multiple sclerosis have been carried out worldwide, showing a heterogeneous distribution between countries and even between the different regions of the same country. METHODS: We estimated the regional and national prevalence of multiple sclerosis in France on 1 January 2003, based on the computerised database of the national farmer health insurance system ("Mutualite Sociale Agricole"). RESULTS: There were 2667 cases of multiple sclerosis registered on the prevalence date, out of 4,098,477 affiliates. After standardisation on age, estimates for the national prevalence of multiple sclerosis in French farmers were 65.0 per 100,000 inhabitants (95% confidence interval 62.5 to 67.5), 41.9 per 100,000 in men (39.1 to 44.7) and 96.3 per 100,000 in women (92.0 to 100.6). The prevalence of multiple sclerosis was significantly higher in the north eastern regions (approximately 100 per 100,000 inhabitants) compared with the south western regions (around 50 per 100,000 inhabitants). CONCLUSION: Our study is the first to evaluate the overall prevalence of multiple sclerosis in France and its 22 regions using the same methodology. Our results may be generalised to the whole French population as there is no convincing evidence of an increased or decreased susceptibility to multiple sclerosis among farmers or persons living in the countryside. This places France among the countries of medium to high prevalence. Confirming the uneven distribution of multiple sclerosis that correlates with latitude, raises once more the question of the role of genetic and environmental factors in the susceptibility to multiple sclerosis %0 Journal Article %C Department of Pediatrics, Division of Cardiology, The Hospital for Sick Children, University of Toronto School of Medicine, Toronto, Ontario, Canada %A Walsh, Mark A %A Lee, Kyong-Jin %A Chaturvedi, Rajiv %A Van Arsdell, Glen S %A Benson, Lee N %J Catheter Cardiovasc Interv %D 2007 Jun %N 7 %P 1015-20 %T Radiofrequency perforation of the right ventricular outflow tract as a palliative strategy for pulmonary atresia with ventricular septal defect %V 69 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17377999 %X BACKGROUND: Radiofrequency perforation (RF) of the right ventricular outflow tract (RVOT), while an effective management strategy in children with an intact ventricular septum, has not been fully detailed in those presenting with a ventricular septal defect. OBJECTIVE: To determine whether transcatheter perforation of the atretic pulmonary valve is an acceptable management strategy prior to surgical repair. RESULTS: Valve perforation was attempted in eight children seen between May 2000 and March 2006, five being infants between 1 and 9 days of age. In five children, this was the first of two procedures, the second a planned surgical correction. The RF was successful in six children with one child requiring additional stenting of the RVOT. Of these children, three attained a biventricular repair within the next year without additional palliative surgical procedures. Of the remaining three patients, one is awaiting surgical correction, one did not require further surgery, and one had this procedure as the only planned palliation. The two children in whom RF was not possible were referred for surgical augmentation of pulmonary blood flow. CONCLUSION: A treatment strategy that includes pulmonary valve perforation as initial palliation to increase pulmonary blood flow may be effective. Additional experience to better define those children who would benefit from this treatment algorithm is required %0 Journal Article %C School of Psychology, University of Adelaide, Adelaide, Australia %A Ward, L %A Mathias, JL %A Hitchings, SE %J Gerontology %D 2007 Jun %N 6 %P 124-134 %T Relationships between Bereavement and Cognitive Functioning in Older Adults %V 53 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17622731 %X Background: Bereavement is often associated with increased levels of depression, anxiety, and stress. The question of whether grief is associated with cognitive deficits in older adults remains largely unanswered. Although Xavier and coworkers (see text) found preliminary evidence that grief, in the absence of depression, impacted on memory in a sample of the oldest-old in Brazil, the impact of bereavement on cognitive functioning, independent of the effects of mood, has not been adequately examined. Objective: To replicate and expand on the work of Xavier and colleagues to examine whether there is an association between bereavement due to spousal loss and performance in a range of cognitive functioning domains in older adults, independent of the effects of depression, stress, and anxiety. Methods: Samples of bereaved (n = 25) and non-bereaved (n = 25) participants, who were aged between 65 and 80 years and who were matched for age, gender, education, premorbid intellectual functioning, and general cognitive ability, were compared on a battery of tests designed to assess attention, verbal fluency, memory, and visuospatial ability. Depression, anxiety, and stress were also assessed, as were the presence of complicated grief and the adequacy of social support in the bereaved group. Cognitive tests that differed between the groups and correlated with depression, stress, or anxiety were analyzed using hierarchical multiple regression. Results: The bereaved groups were more depressed, anxious, and stressed, and performed more poorly on tests assessing attention, information-processing speed, and verbal fluency. With the exception of the attentional switching task, the cognitive measures on which the groups differed were correlated with mood. When mood was controlled statistically, the group differences in these cognitive tests disappeared. Twenty-eight percent of the bereaved group met the criteria for a diagnosis of complicated grief. This subgroup was younger than the other bereaved participants and had higher levels of stress. Conclusion: The evidence suggests that grief associated with death of a spouse has limited associations with cognition beyond those that would be expected to occur as a result of depression, anxiety, and stress. Copyright (c) 2007 S. Karger AG, Basel %0 Journal Article %C University of California, San Francisco, and San Francisco General Hospital, San Francisco, California 94143-0903, USA. dwhite@medicine.ucsf.edu %A White, Douglas B %A Curtis, J Randall %A Wolf, Leslie E %A Prendergast, Thomas J %A Taichman, Darren B %A Kuniyoshi, Gary %A Acerra, Frank %A Lo, Bernard %A Luce, John M %J Ann Intern Med %D 2007 Jul %N 1 %P 34-40 %T Life support for patients without a surrogate decision maker: who decides? %V 147 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17606959 %X BACKGROUND: Physicians in intensive care units have withdrawn life support in incapacitated patients who lack surrogate decision makers and advance directives, yet little is known about how often this occurs or under what circumstances. OBJECTIVE: To determine the proportion of deaths in intensive care units that occur in patients who lack decision-making capacity and a surrogate and the process that physicians use to make these decisions. DESIGN: Multicenter, prospective cohort study. SETTING: Intensive care units of 7 medical centers in 2004 to 2005. PATIENTS: 3011 consecutive critically ill adults. MEASUREMENTS: Attending physicians completed a questionnaire about the decision-making process for each incapacitated patient without a surrogate or advance directive for whom they considered limiting life support. RESULTS: Overall, 5.5% (25 of 451 patients) of deaths in intensive care units occurred in incapacitated patients who lacked a surrogate decision maker and an advance directive. This percentage ranged from 0% to 27% across the 7 centers. Physicians considered limiting life support in 37 such patients or would have considered it if a surrogate had been available. In 6 patients, there was prospective hospital review of the decision, and in 1 patient, there was court review. In the remaining 30 patients, the decision was made by the intensive care unit team alone or by the intensive care unit team plus another attending physician. The authors found wide variability in hospital policies, professional society guidelines, and state laws regarding who should make life-support decisions for this patient population. Thirty-six of 37 life-support decisions were made in a manner inconsistent with American College of Physicians guidelines for judicial review. LIMITATIONS: The results are based on physicians' self-reported practices and may not match actual practices. The number of incapacitated patients without surrogates in the study is small. CONCLUSIONS: Incapacitated patients without surrogates accounted for approximately 1 in 20 deaths in intensive care units. Most life-support decisions were made by physicians without institutional or judicial review %0 Journal Article %A Whittall, Hugh %J Pediatrics %D 2007 Jun %N 6 %P 1267; author reply 1267-9 %T Noninitiation or withdrawal of intensive care for high-risk newborns %V 119 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17545411 %0 Journal Article %C Klinik fur Strahlenheilkunde, Charite, Campus Virchow Klinikum, Universitatsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany %A Wieners, Gero %A Pech, Maciej %A Rudzinska, Malgorzata %A Lehmkuhl, Lukas %A Wlodarczyk, Waldemar %A Miersch, Alexandra %A Hengst, Susanne %A Felix, Roland %A Wust, Peter %A Ricke, Jens %J Eur Radiol %D 2006 Nov %N 11 %P 2586-93 %T CT-guided interstitial brachytherapy in the local treatment of extrahepatic, extrapulmonary secondary malignancies %V 16 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=16625347 %X The purpose was to evaluate the safety and efficacy of high-dose-rate (HDR) CT-guided interstitial brachytherapy in the treatment of extrahepatic, extrapulmonary, secondary malignancies. Nineteen patients were included in this prospective study. The median age was 66 years (49-77). Underlying primaries comprised colorectal carcinomas in six, renal cell carcinoma in three, pancreatic carcinoma in three, cervical cancer in two, endometrial cancer in two and NSCLC, breast cancer and sarcoma in one patient each. All patients had undergone extensive pretreatments. CT-guided HDR brachytherapy employed a 192Iridium source. Dose planning for brachytherapy was performed using 3D CT data acquired after CT-guided percutaneous applicator positioning. MRI follow-up was performed 6 weeks and every 3 months post intervention. Primary endpoints were complications, local tumor control and progression-free survival. The median tumor diameter was 6 cm (2-15 cm). Tumor locations included the hepatoduodenal ligament, mesentery, adrenal gland, mesogastrium and local recurrences after rectal or pancreatic cancer. The minimal median dose in the target volume was 11 Gy (4-18 Gy). Minor complications comprised pain and fever (n=6, 32%). Major complications included one hospital death of unknown causes (n=1; 5%). Median follow-up was 7 months (1-16). Four patients (21%) died during the follow-up period. Local tumor control was 76.5% after 6 months and progression-free survival 47% after 6 months. Minimally invasive CT-guided HDR brachytherapy is safe and effective in the palliative treatment of extrahepatic, extrapulmonary secondary malignancies %0 Journal Article %C Institute for Rehabilitation Research and DevelopmentThe Rehabilitation Centre, The Ottawa Hospital, Ottawa, ON, Canada. kewilson@ottawahospital.on.ca %A Wilson, Keith G %A Chochinov, Harvey Max %A McPherson, Christine J %A Skirko, Merika Graham %A Allard, Pierre %A Chary, Srini %A Gagnon, Pierre R %A Macmillan, Karen %A De Luca, Marina %A O'shea, Fiona %A Kuhl, David %A Fainsinger, Robin L %A Karam, Andrea M %A Clinch, Jennifer J %J Health Psychol %D 2007 May %N 3 %P 314-23 %T Desire for euthanasia or physician-assisted suicide in palliative cancer care %V 26 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17500618 %X Objective: To investigate the attitudes of terminally ill individuals toward the legalization of euthanasia or physician-assisted suicide (PAS) and to identify those who would personally desire such a death. Design: In the Canadian National Palliative Care Survey, semistructured interviews were administered to 379 patients who were receiving palliative care for cancer. Patients who expressed a desire for physician-hastened death were followed prospectively. Main Outcome Measures: Attitudes toward the legalization of euthanasia or PAS were determined, as was the personal interest in receiving a hastened death. Demographic and clinical characteristics were also recorded, including a 22-item structured interview of symptoms and concerns. Results: There were 238 participants (62.8%) who believed that euthanasia and/or PAS should be legalized, and 151 (39.8%) who would consider making a future request for a physician-hastened death. However, only 22 (5.8%) reported that, if legally permissible, they would initiate such a request right away, in their current situations. This desire for hastened death was associated with lower religiosity (p = .010), reduced functional status (p = .024), a diagnosis of major depression (p < .001), and greater distress on 12 of 22 individual symptoms and concerns (p < .025). In follow-up interviews with 17 participants, 2 (11.8%) showed instability in their expressed desire. Conclusion: Among patients receiving palliative care for cancer, the desire to receive euthanasia or PAS is associated with religious beliefs; functional status; and physical, social, and psychological symptoms and concerns. Although this desire is sometimes transitory, once firmly established, it can be enduring. ((c) 2007 APA, all rights reserved) %0 Journal Article %C Department of Radiation Oncology, Princess Margaret Hospital, Toronto, ON, Canada %A Wilson, Paula %A Bezjak, Andrea %A Asch, Murray %A Barton, Rachael %A Wong, Rebecca %A Levin, Wilfred %A Kane, Gabrielle %A Kirkbride, Peter %J J Thorac Oncol %D 2007 Jun %N 6 %P 514-9 %T The difficulties of a randomized study in superior vena caval obstruction %V 2 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17545846 %X INTRODUCTION: Superior vena caval obstruction (SVCO) is a not uncommon complication of malignant disease. Treatment may consist of radiation (RT) to the mediastinum, systemic therapy for chemosensitive tumors, and supportive measures such as oxygen and steroids. Advances in interventional radiology have allowed the introduction of expandable stents into the superior vena cava (SVC), with the theoretical advantage of providing symptom relief within hours, rather than the days and weeks over which RT exerts its effect. Although small case series have supported the use of stents in SVCO, there are no randomized data. METHODS: We set up a randomized study at Princess Margaret Hospital, Toronto. Patients were randomized to receive palliative RT to the mediastinum or immediate stenting of the SVC and then mediastinal RT within a week. The aim of the study was to compare symptom response between the two treatment arms. A second study, a prospective longitudinal study, was also set up to obtain information on symptom response and outcome regardless of the treatment given. RESULTS: In a 12-month period, we were unable to accrue any patients in the randomized study; of the 19 patients approached, 13 have agreed to participate in the longitudinal study. CONCLUSIONS: In this report, we present the problems that we have encountered with these studies %0 Journal Article %C University of Texas, San Antonio, Department of Communication-M.B. 2.312, 6900 N. Loop 1604 W, San Antonio, TX 78249-0643, USA. elaine.wittenberg@utsa.edu %A Wittenberg-Lyles, Elaine M %A Thompson, Sharlene %J Am J Hosp Palliat Care %D 2006 Aug-Sep %N 4 %P 317-22 %T Understanding enrollment conversations: the role of the hospice admissions representative %V 23 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17060296 %X Nonparticipant observation was undertaken to understand how barriers are discussed and managed in initial hospice enrollment conversations between patients, families, and hospice admission representatives. The first author observed patient/family and hospice admission representative interactions, interviewed hospice admission representatives, and attended monthly hospice meetings for a total of 37 hours of observation. Findings indicate that patients and a primary family member take on particular roles during these initial conversations. Based on the roles adopted by the patient and the family, the hospice admission representative engaged in 1 of 3 types of talk: (1) enrollment talk, (2) reassurance talk, or (3) informative talk. When engaging in enrollment conversations with families, hospice admission representatives direct their comforting statements toward reappraising uncertainty about hospice and uncertainty about death and dying %0 Journal Article %C Emergency Department, Children's Hospital of Philadelphia, PA, USA. kwoo@nursing.upenn.edu %A Woo, Katie %A Spatz, Diane %J MCN Am J Matern Child Nurs %D 2007 May-Jun %N 3 %P 150-5; quiz 156-7 %T Human milk donation: what do you know about it? %V 32 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17479050 %X The American Academy of Pediatrics (AAP) strongly endorses that human milk is species specific and the optimal nutrition for infants, and that banked human milk is a suitable alternative. After the death of an infant, breast milk often is disposed of without consideration of donation because the public and healthcare providers are unaware of human milk banks. In the United States, 10 human milk banks operate under strict guidelines established by the Human Milk Banking Association of North America. Donors are screened, and milk is pasteurized while preserving many of the beneficial components of breast milk. It is imperative that healthcare providers become educated regarding human milk banking because of the increase in informal sharing of breast milk via the Internet. Breast milk that has not been screened and treated has the risk of transmitting infections such as hepatitis and HIV. Healthcare providers should be familiar with the selection criteria for suitable donors and how to approach families when the death of an infant is imminent. Human milk banks are able to provide human milk to adopted, preterm, or ill infants whose mothers are unable to provide their own milk %0 Journal Article %C Hospice of Muskegon-Oceana, Muskegon, Michigan and The Wege Institute for Mind, Body and Spirit, Grand Rapids, Michigan; 1241 Scenic Drive, Muskegon, MI 49445, USA. lwright@yourhospice.org %A Wright, Leonard D %J Am J Hosp Palliat Care %D 2006 Aug-Sep %N 4 %P 323-7 %T Meditation: a new role for an old friend %V 23 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17060297 %X Meditation has been a spiritual and healing tradition for centuries. In 1972, Keith Wallace and Herbert Benson published a landmark article looking at meditation from a scientific perspective. The author reviewed their article, plus selected scientific literature on meditation since that time, to see if there was enough evidence to warrant the inclusion of meditation in the treatment protocols of serious disease. This review, plus an illustrative case study, demonstrated that such inclusion is warranted and further research is necessary %0 Journal Article %C Centre for Health Economics Research and Evaluation, University of Technology, Sydney, Australia %A Zapart, Siggi %A Kenny, Patricia %A Hall, Jane %A Servis, Betty %A Wiley, Sharon %J Health Soc Care Community %D 2007 Mar %N 2 %P 97-107 %T Home-based palliative care in Sydney, Australia: the carer's perspective on the provision of informal care %V 15 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17286671 %X The provision of home-based palliative care requires a substantial unpaid contribution from family and friends (i.e. informal care). The present cross-sectional descriptive study, conducted between September 2003 and April 2004, describes this contribution and the impact it has on those providing informal care. The participants were 82 informal carers of patients registered with two community palliative care services in Sydney, Australia (40% of eligible carers). Carers were interviewed to assess the care recipient's care needs, the care provided by the informal carer and the health status of the carer (using the 36-Item Short Form Health Survey). A number of open-ended questions asked about the impact of providing care and the type of support that carers would find helpful. Most carers reported that care recipients required help with household tasks and many needed assistance with personal activities of daily living, taking medications and organisational tasks. In the majority of cases, the principal carer provided all or most of this help. Although, on average, the physical health of carers was similar to that of the Australian population, their mental health scores were lower. Many carers reported effects on social and family relationships, restrictions on their participation in work and leisure activities, and a range of emotional reactions to their caring situation. The support carers said they would like included information and advice, in-home respite, help with household tasks, and financial support. The present study supports the view that effective support for carers must recognise the pre-existing relationship between carer and recipient, and the differing needs of individual carers %0 Journal Article %A Zimmermann, Camilla %A Wennberg, Richard %J Am J Hosp Palliat Care %D 2006 Aug-Sep %N 4 %P 255-8 %T Integrating palliative care: a postmodern perspective %V 23 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17060287 %X Hospice and palliative care philosophy is becoming increasingly incorporated into medical practice, education, and research. However, this process of integration may be hindered by continued adherence to several perceived conceptual dichotomies: natural and medicalized death, research and clinical care, and acceptance and denial of dying. These dichotomies were perhaps essential for the initial development of palliative care but could undermine the continuing evolution of care for the terminally ill. In this article, the authors deconstruct these dichotomies and advocate for a fully integrated model of palliative care %0 Journal Article %C Centre de Recherche en Nutrition Humaine Rhone-Alpes, INSERM U 449, INRA 1235, Universite Claude Bernard Lyon 1, Hospices Civils de Lyon, Lyon, France %A de, Rougemont A %A Normand, S %A Nazare, JA %A Skilton, MR %A Sothier, M %A Vinoy, S %A Laville, M %J Br J Nutr %D 2007 Jul %P 1-11 %T Beneficial effects of a 5-week low-glycaemic index regimen on weight control and cardiovascular risk factors in overweight non-diabetic subjects %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17617942 %X The glycaemic index (GI) has been developed in order to classify food according to the postprandial glycaemic response. This parameter is of interest, especially for people prone to glucose intolerance; however, the effects of a low-GI (LGI) diet on body weight, carbohydrate and lipid metabolism remain controversial. We studied the effects of either a LGI or high-GI (HGI) diet on weight control and cardiovascular risk factors in overweight, non-diabetic subjects. The study was a randomized 5-week intervention trial. The thirty-eight subjects (BMI 27.3 (sem 0.2) kg/m2) followed an intervention diet in which usual starch was replaced ad libitum with either LGI or HGI starch. Mean body weight decrease was significant in the LGI group ( - 1.1 (sEM 0.3) kg, P = 0.004) and was significantly greater than in the HGI group ( - 0.3 (sEM 0.2) kg, P = 0.04 between groups). Hunger sensation scales showed a trend towards a decrease in hunger sensation before lunch and dinner in the LGI group when compared with the HGI group (P = 0.09). No significant increase in insulin sensitivity was noticed. The LGI diet also decreased total cholesterol by 9.6 % (P < 0.001), LDL-cholesterol by 8.6 % (P = 0.01) and both LDL-:HDL-cholesterol ratio (10.1 %, P = 0.003) and total:HDL-cholesterol ratio (8.5 %, P = 0.001) while no significant changes were observed in the HGI group. Lowering the GI of daily meals with simple dietary recommendations results in increased weight loss and improved lipid profile and is relatively easy to implement with few constraints. These potential benefits of consuming a LGI diet can be useful to develop practical dietetic advice %0 Journal Article %A van der Wal, Gerrit %J Ned Tijdschr Geneeskd %D 2007 Jan %N 1 %P 102-4 %T ['At the cutting edge' Interview by Jannetje Koelewijn] %V 151 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17583054