%0 Journal Article %C Sarcoma Services, The Cancer Institute at Sinai Hospital, University of Maryland, Department of Orthopaedic Surgery, Baltimore, MD 21215, USA %A Aboulafia, Albert J %A Levine, Alan M %A Schmidt, Daniel %A Aboulafia, David %J Semin Oncol %D 2007 Jun %N 3 %P 206-14 %T Surgical therapy of bone metastases %V 34 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17560982 %X The treatment of patients with cancer epitomizes the importance of using a collaborative team approach to optimize patient care. Physician team members most commonly are radiation oncologists, general surgeons, surgical oncologists, thoracic surgeons, neurosurgeons, and orthopedic surgeons. When patients are receiving chemotherapy, their medical oncologist frequently takes responsibility for coordinating care among the various team members and initiating consultations with necessary providers. When patients develop bone metastases or chemotherapy-induced bone loss (CTIBL), the orthopedic surgeon may be able to improve the patient's quality of life greatly. Procedures orthopedists perform most commonly include open reduction and internal fixations and arthroplasties (joint replacement surgery). Less invasive procedures currently being tested include stereotactic radiosurgery, radiofrequency ablation (RFA), and percutaneous cementoplasty. By understanding the options available to patients with skeletal complications of malignancy, the medical oncologist can discuss issues with patients and make appropriate referrals for diagnosis and treatment. Additionally, with a greater understanding of the surgical procedures available, the medical oncologist will be better able to assist in preparing the patient for surgery %0 Journal Article %A Adderley, U %A Smith, R %J Cochrane Database Syst Rev %D 2007 %N 2 %P CD003948 %T Topical agents and dressings for fungating wounds %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17443534 %X BACKGROUND: Fungating wounds arise from primary, secondary or recurrent malignant disease and are associated with advanced cancer. A small proportion of patients may achieve healing following surgical excision but treatment is usually palliative. Fungating wound management usually aims to slow disease progression and optimise quality of life by alleviating physical symptoms, such as copious exudate, malodour, pain and the risk of haemorrhage, through appropriate dressing and topical agent selection. OBJECTIVES: To conduct a systematic review of the evidence of the effects of dressings and topical agents on quality of life and symptoms that impact on quality of life in people with fungating malignant wounds. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) and the Wounds Group Specialised Register in August 2006. The Cochrane Breast Cancer Group and the Pain and Palliative Care Group were contacted for relevant studies. The Allied and Complementary Medicine (AMED) database was searched in January 2007. There was no restriction on language or date of publication. SELECTION CRITERIA: Randomised controlled trials (RCTs) or, in their absence, controlled clinical trials (CCTs) with a concurrent control group, both published and unpublished, and written in any language, were eligible for inclusion. DATA COLLECTION AND ANALYSIS: Data extraction was undertaken by one author and checked for accuracy by a second author. Two review authors independently assessed trial quality. MAIN RESULTS: Two trials involving 63 people were included. One RCT in women with superficial breast lesions compared 6% miltefosine solution with placebo and found that miltefosine delayed tumour progression. However, this trial had methodological limitations. A second trial compared topical metronidazole with placebo and found that metronidazole reduced malodour. However, this trial also had methodological limitations and was underpowered. AUTHORS' CONCLUSIONS: There is weak evidence from one small trial that 6% miltefosine solution applied topically to people with superficial fungating breast lesions (smaller than 1cm) who have received either previous radiotherapy, surgery, hormonal therapy or chemotherapy for their breast cancer may slow disease progression. There is insufficient evidence in this review to give a clear direction for practice with regard to improving quality of life or managing wound symptoms associated with fungating wounds. More research is needed %0 Journal Article %C Department of Anaesthesiology and Intensive Care, Skejby Sygehus, Aarhus University Hospital, Aarhus, Denmark. anne.agard@reher-langberg.dk %A Agard, Anne Sophie %A Harder, Ingegerd %J Intensive Crit Care Nurs %D 2007 Jun %N 3 %P 170-7 %T Relatives' experiences in intensive care--finding a place in a world of uncertainty %V 23 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17234418 %X The aim of the study was to explore and describe the experiences of relatives of critically ill patients in adult intensive care. A qualitative research design was chosen, using a Grounded Theory approach. In-depth interviews were conducted with four spouses and three parents in a Danish University Hospital. An overall process of fitting in was apparent, explaining how relatives tried to manoeuvre in a chaotic and scary situation. The relatives were clearly in turmoil, yet found ways of coping in the situation and developing adaptation ability. Three major strategies were identified: enduring uncertainty, putting self aside and forming personal cues. This explorative study points to relatives being vulnerable and resourceful at the same time, struggling to find a place, experiencing distance from the patient as well as from the professionals and uncertainty regarding what to expect and how to act in the ICU. The study is a contribution to understanding relatives' needs and strategies and to developing better communication and cooperation between nurses and the patients' relatives %0 Journal Article %C Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Jacksonville, FL, USA %A Al-Haddad, M %A Martin, JK %A Nguyen, J %A Pungpapong, S %A Raimondo, M %A Woodward, T %A Kim, G %A Noh, K %A Wallace, MB %J J Gastrointest Surg %D 2007 Jul %T Vascular Resection and Reconstruction for Pancreatic Malignancy: A Single Center Survival Study %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17632763 %X INTRODUCTION: Pancreatic cancer is one of the leading causes of cancer-related death in the USA. Recently, several centers have introduced portal and superior mesenteric vein resection and reconstruction during extended pancreatectomy, rendering the previously inoperable cases resectable. AIM: The aim of this study is to confirm whether patients with locally advanced pancreatic cancer and mesenteric vascular invasion can be cured with extended pancreatectomy with vascular reconstruction (VR) and to compare their survival to patients treated with pancreatectomy without VR and those treated without resection (palliation). METHODS: Survival of 22 patients who underwent pancreatectomy with VR was compared with two control groups: 54 patients who underwent pancreatectomy without the need for VR and 28 patients whose pre-operative imaging suggested resectability but whose laparotomy indicated inoperability. RESULTS: A slight survival benefit was noted in patients who did not require VR (33.5%) compared to those who did require VR [20%, p = 0.18], although not reaching statistical significance. Despite a low 15% three-year survival in patients treated palliatively, this was not statistically different compared to survival after resection with VR (P = 0.23). The presence of nodal metastasis was associated with worse survival (p = 0.006), and the use of adjuvant therapy was associated with better survival (p = 0.001). CONCLUSION: Pancreatic cancers that require VR to completely resect the tumor have a similar survival to those not requiring VR. Long-term survival was achievable in approximately 1 out 5 patients requiring VR, although we were not able to demonstrate statistically improved survival compared to palliative care %0 Journal Article %C Service de Geriatrie, CHU Lyon, Hopital Antoine Charial, Francheville, France %A Albrand, G %A Biron, E %A Boucot, I %A Couderc, L J %A Crestani, B %A Dombret, M C %A Guenard, H %A Grivaux, M %A Hervy, M P %A Housset, B %A Jougon, J %A Orvoen-Frija, E %A Piette, F %A Pignon, T %A Pinganaud, G %A Puisieux, F %A Quoix, E %A Sauty, E %A Vaylet, F %A Wary, B %A Weill-Engerer, S %A Westeel, V %A Wislez, M %J Rev Mal Respir %D 2007 Jun %N 6 %P 703-23 %T [Lung cancer in the elderly subject.] %V 24 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17632431 %X INTRODUCTION: In France, the average age for the diagnosis of bronchial carcinoma is 64. It is 76 in the population of over 70. In fact, its incidence increases with age linked intrinsic risk of developing a cancer and with general ageing of the population. Diagnosis tools are the same for elderlies than for younger patients, and positive diagnosis mainly depends on fibreoptic bronchoscopy, complications of which being comparable to those observed in younger patients.STATE OF THE ART: The assessment of dissemination has been modified in recent years by the availability of PET scanning which is increasingly becoming the examination of choice for preventing unnecessary surgical intervention, a fortiori in elderly subjects. Cerebral imaging by tomodensitometry and nuclear magnetic resonance should systematically be obtained before proposing chirurgical treatment. An assessment of the general state of health of the elderly subject is an essential step before the therapeutic decision is made. This depends on the concept of geriatric eva-luation:Geriatric Multidimensional Assessment, and the Comprehensive Geriatric Assessment which concerns overall competence of the elderly. PERSPECTIVES: This is a global approach that allows precise definition and ranking of the patient's problems and their impact on daily life and social environment... Certain geriatric variables (IADL, BADL, MMSE, IMC etc) may be predictive of survival rates after chemotherapy or the incidence of complications following thoracic surgery. The main therapeutic principles for the management of bronchial carcinoma are applicable to the elderly subject; long term survival without relapse after surgical resection is independent of age. Whether the oncological strategy is curative or palliative, the elderly patient with bronchial carcinoma should receive supportive treatments. They should be integrated into a palliative programme if such is the case. In fact, age alone is not a factor that should detract from optimal oncological management. CONCLUSIONS: The development of an individual management programme for an elderly patient suffering from bronchial carcinoma should be based on the combination of oncological investigation and comprehensive geriatric assessment %0 Journal Article %C Department of Surgery, University of Maryland Medical Center, Baltimore, MD 21201, USA. HRAlexander@smail.umaryland.edu %A Alexander, H R %A Hanna, N %A Pingpank, J F %J Cancer Treat Res %D 2007 %P 343-55 %T Clinical results of cytoreduction and HIPEC for malignant peritoneal mesothelioma %V 134 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17633065 %X Taken together, these reports provide very provocative and encouraging data that have prompted some to conclude that cytoreduction and HIPEC represents a "new standard of care" for patients with MPM [26]. Certainly, for selected patients who have good performance status (low operative risk) and in whom complete or near complete cytoreduction can be achieved, this form of therapy is associated with a very notable overall survival ranging from 67 to 92 months in 2 larger series. Patient selection remains the central criteria for successful outcome. Patients should be carefully evaluated for co-morbid illnesses that would make them an unacceptable operative risk. Subsequently, CT scan and possibly laparoscopy should be performed to assess resectability with the appreciation that patients with suboptimal resection do very poorly. Pre-operative assessment of disease resectability is difficult to ascertain but some useful information can be obtained from a careful review of the CT scan; some investigators have advocated routine laparoscopy. Technically, details of HIPEC vary from center to center to some degree with respect to type of chemotherapy, dose of chemotherapy, duration of HIPEC, degree of hyperthermia, and method of recirculating the chemotherapy using either the open or closed technique. The use of the HIPEC technique, however, is considered the optimal method of ensuring complete distribution of therapeutic agents to the peritoneal cavity. Hyperthermia is routinely used for its synergistic actions with chemotherapy and its direct tumoricidal activity in experimental models. However, the therapeutic contribution of HIPEC above the effects of successful cytoreduction cannot be determined with available data although palliation of ascites is observed with HIPEC even without cytoreduction. There are no data indicating that one intra-operative chemotherapy regimen is superior to any other. The centers that report use of prolonged induction or post-operative intraperitoneal chemotherapy do not appear to have superior outcomes to those centers that use a more simple treatment regimen. Finally, although the intensity of therapy is considerable, once recovered, the patients appear to enjoy a good HRQOL. Although not specific for patients with MPM, 2 reports have convincingly demonstrated that HRQOL is significantly improved after HIPEC %0 Journal Article %C Marshfield Clinic Research Foundation, 1000 Oak Avenue, Marshfield, WI 54449, USA; Marshfield Clinic-Thorp Center, 704 South Clark Street, Thorp, WI 54771, USA. Alisky.Joseph@marshfieldclinic.org %A Alisky, Joseph Martin %J Med Hypotheses %D 2007 %N 4 %P 910-1 %T Implantable central venous access ports for minimally invasive repetitive drainage of pleural effusions %V 68 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17234354 %X BACKGROUND: Pleurodesis can often eliminate recurrence of malignant pleural effusions and perhaps even pleural effusions from congestive heart failure. However, for patients with recurrent pleural effusions resistant to pleurodesis or patients unable or unwilling to undergo pleurodesis, thoracentesis is currently the only means for removing a pleural effusion. PRESENTATION OF THE HYPOTHESIS: Central venous access ports used for cancer chemotherapy could be implanted with the lumens placed in the pleural space, allowing on demand drainage of pleural effusions by percutaneous access to the port. TESTING THE HYPOTHESIS: Initial trials with a swine model of pleural effusions could demonstrate proof-of-principle and determine the caliber of catheter lumen optimal for pleural effusion drainage. Subsequently, there could be clinical trials in humans. SIGNIFICANCE OF THE HYPOTHESIS: This could be a useful part of palliative care of patients with cancer and end-stage heart failure and might increase heart failure survival by improving hemodynamics and respiratory function. This technique would create a non-diuretic modality for treatment of congestive heart failure volume overload. Patients could potentially drain pleural effusions at home by accessing ports placed in the anterior chest or abdomen. The proposed technique might also have application for treatment of recurrent ascites %0 Journal Article %C Gynaecological Oncologist, ErasmusMC Daniel den Hoed Oncology Centre, PO Box 5201, AE Rotterdam 3008, The Netherlands. a.ansink@erasmusmc.nl %A Ansink, Anca C %J Trop Doct %D 2007 Apr %N 2 %P 67-70 %T Cervical cancer in developing countries: how can we reduce the burden? Awareness raising, screening, treatment and palliation %V 37 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17540080 %X Cervical cancer is an important health problem in developing countries. Most women present with advanced disease, resulting in low cure rates. Screening by Visual Inspection with the Aid of Acetic Acid and optionally HPV DNA detection as a second test is technically feasible. However, the majority of women appear to be reluctant to attend a screening clinic. This is probably due to lack of knowledge and a low priority of women's health in local communities. There is an obvious need to obtain more knowledge on communities' perceptions and understanding of cervical cancer. Furthermore, we need more information on what issues should be addressed in order to perform cervical cancer screening in an acceptable manner. Treatment of cervical cancer in developing countries is highly dependent on the resources and skills available. Efforts to provide adequate palliation should be enhanced as relief of troublesome symptoms can often be achieved by relatively simple and low-cost measures %0 Journal Article %C School of Social Work, University of North Carolina at Chapel Hill, USA. earnold@wfubmc.edu %A Arnold, Elizabeth Mayfield %A Artin, Katherine Abbott %A Griffith, Devin %A Person, Judi Lund %A Graham, Kristina G %J J Soc Work End Life Palliat Care %D 2006 %N 4 %P 61-83 %T Unmet needs at the end of life: perceptions of hospice social workers %V 2 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17387095 %X Among persons at the end of life, it is important to understand whether the needs of patients are being adequately addressed. In particular, in hospice settings where the emphasis is on comfort care and quality of life, we know little about the presence of unmet needs. The purpose of this study was to examine the experiences of hospice social workers in working with hospice patients who had unmet needs at the end of life. Surveys were mailed to hospice social workers (N = 212) in two Southeastern states with a response rate of 36%. Results revealed that hospice social workers perceived patients to experience a wide variety of unmet needs-more commonly at the time of admission than during subsequent patient interactions. The most common unmet need reported at both times was a decreased ability to participate in activities that make life enjoyable. In situations where unmet needs exist, social workers reported that the most common perceived reasons were patient- related psychosocial issues and family conflict/issues. Additionally, a variety of interventions were used to address unmet needs, but a large number of barriers appear to impact outcomes in the cases. Results suggest that hospice patients experience a number of unmet needs, many of which are potentially treatable problems and concerns. Hospice professionals must continue to seek ways to assess and intervene effectively with patients who have unmet needs %0 Journal Article %C Department of Surgery, Scientific Institute San Raffaele Hospital, Milan - Italy %A Arru, M %A Aldrighetti, L %A Gremmo, F %A Ronzoni, M %A Angeli, E %A Caterini, R %A Ferla, G %J J Vasc Access %D 2000 Jul-Sep %N 3 %P 93-9 %T Arterial devices for regional hepatic chemotherapy: transaxillary versus laparotomic access %V 1 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17638234 %X Introduction. Intra-Arterial Hepatic Chemotherapy (IAHC) based on floxuridine (FUdR) infusion is an effective treatment for hepatic metastases from colorectal cancer. A percutaneously implanted intra-arterial device may overcome the surgical stress of the laparotomic placement allowing an increase in the number of patients treated by IAHC. The aim of the present study is the comparative analysis of surgical and percutaneous transaxillary approaches to implant the catheter into the hepatic artery (HA) for IAHC. Materials and Methods. Between September 1993 and February 1999, 56 patients received an implantable infu-sion system [SynchroMed(R) (Medtronic, USA) or Port-a-cath(R) (Deltec, USA) connected to an external infusion pump (CADD(R) , Deltec, USA)] for IAHC. Twenty-eight patients (LPT group) underwent laparotomy to implant the catheter into the HA, the other 28 patients (PCT group) received a percutaneous catheter into the HA through a transaxillary percutaneous access. Indications for the laparotomic placement were: 1) synchronous metastases not suitable [technically unresectable or large (>40% of liver parenchyma) or multiple (> 3) metas-tases] for hepatic resection during colorectal surgery; 2) metachronous metastases treated by radical hepatic resection and subsequent adjuvant IAHC. Indications for percutaneous placement were: 1) metachronous metastases not suitable [see above] for hepatic resection; 2) metachronous metastases suitable for hepatic resection after neoadjuvant IAHC for tumor downstaging. All patients received IAHC based on continuous infusion of FU-dR (dose escalation 0.15-0.30 mg/kg/day for 14 days every 28 days) plus dexamethasone 28 mg. For the purpose of the study, the LPT group and the PCT group were comparatively analyzed in terms of age, gender, primary diagnosis, vascular anatomy of HA, ligation/embolization of aberrant HA, previous intestinal or hepatic surgery, contextual systemic chemotherapy, concomitant diseases. Safety and efficacy of surgical and percutaneous transaxillary approaches were then comparatively analyzed in terms of number of IAHC cycles adminis-tered, device-related complications causing temporary or definitive suppression of IAHC, biological costs of the procedures (procedure-related complications, postoperative pain and hospitalization). LPT cases without concomitant surgical procedure other than catheter placement (Cath-LPT group - 10 cases) were also compared with the PCT group for the same end points of the study. Results. LPT group and PCT group were comparable (p=n.s.) when evaluated for all the above listed variables. As for the end points of the study, mean postoperative hospitalization was 8.2+/-2.2 days in the LPT group and 1.8+/-0.7 days in the PCT group (p<0.0001), while mean analgesic requirements were 9.7+/-3.2 doses in the LPT group and 2+/-0.9 doses in the PCT group (p<0.0001). Mean number of IAHC cycles administered was 6.5+/-4.2 in the LPT group and 4.3+/-3.4 in the PCT group (p=0.038). Device-related complications causing temporary or de-finitive suppression of IAHC included catheter displacement in 10 cases (35.7%), HA thrombosis in 1 case (3.5%) and catheter occlusion in 1 case (3.5%) in the PCT group, while in the LPT group 1 case (3.5%) of catheter occlusion and 1 case (3.5%) of HA thrombosis occurred. The overall incidence of device-related complications causing temporary or definitive suppression of IAHC was 42.7% in the PCT group and 7.1% in the LPT group (p=0.005). Comparison of Cath-LPT group and the PCT group showed mean postoperative hospitalization of 5.5+/-0.7 days in the Cath-LPT group and 1.8+/-0.7 days in the PCT group (p<0.0001), and mean anal-gesic requirements of 8+/-3.1 doses in the Cath-LPT group and 2+/-0.9 in the PCT group (p<0.0001). Conclusions. Surgically implanted indwelling catheters for IAHC present lower incidence of device-related complications than percutaneous transaxillary implanted catheters. In spite of its irreversibility and significant biological costs, surgical implant is still advised when laparotomy has to be performed for other contextual procedures, such as colorectal or hepatic resection, while percutaneous transaxillary catheter placement is indicated for palliative or neoadjuvant IAHC %0 Journal Article %C The Department of Anesthesiology, Family Medicine and Pharmacology, The Rush University Medical College, Rush University Medical Center, Chicago, IL %A Barkin, Robert L %J Am J Ther %D 2007 May-Jun %N 3 %P 299-305 %T Zolpidem extended-release: a single insomnia treatment option for sleep induction and sleep maintenance symptoms %V 14 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17515707 %X It is imperative that primary care clinicians have a thorough understanding of insomnia, because they are often the first point of contact for patients who seek assistance when they have difficulty sleeping. Insomnia may appear with different presentations: sleep onset, sleep maintenances, sleep offset, nonrestorative sleep, or a combination of these symptoms. Untreated symptoms result in clinically significant distress or impairment in social, occupational, or other important areas of following-day functionality. Physicians, pharmacists, and other clinicians should be aware of the conditions that contribute to, are antecedent to, and associated with insomnia. These pathophysiological conditions include advanced age; female gender; respiratory, gastrointestinal, vascular, and rheumatologic pain syndromes; and other conditions such as depression and/or anxiety. Additional health factors contributing to insomnia include chronic pain, stressors, grief reaction, pharmacotherapeutic side effects, lifestyle contributors such as social/recreational drugs, phytopharmaceuticals, and ethanol use. The pharmacotherapy focus in this article is a modified-release formulation of the BZ1 (omega1) receptor agonist zolpidem, zolpidem extended-release. Pharmacokinetic, pharmacodynamic, and safety studies that compare 12.5 mg zolpidem extended-release (Ambien CRtrade markCIV) and 10 mg original zolpidem were initially conducted in healthy volunteers to assess the potential for an improved clinical profile. Zolpidem extended-release (12.5 mg and 6.25 mg extended-release dosage forms) is indicated for the treatment of insomnia characterized by difficulties with sleep onset and/or sleep maintenance. Zolpidem extended-release is devoid of any short-term use limitation and can be prescribed for the duration of medical necessity. The modified-release zolpidem is a two-layer tablet with a biphasic release profile, releasing the first layer immediately, whereas the second layer is released at a slower rate. Plasma concentrations are maintained for a longer period of time versus the immediate-release zolpidem formulation. Pharmacokinetic analysis has also demonstrated that the time to maximum concentration (tmax) and terminal elimination half-life (t1/2) of 12.5 mg zolpidem extended-release are similar to those of 10 mg zolpidem indicating a similar rapid onset of action and an elimination profile that reduced the risk of next-day decrements in performance. Zolpidem's CYP 450 hepatic metabolism uses as a substrate CYP3A4 (major) and 1A2, 2C9, 2C19, and 2D6 as minor pathways. Zolpidem extended-release dosage forms diminish sleep latency, number of awakenings, and wakefulness after sleep onset and augments total time asleep %0 Journal Article %C Department of Anesthesia and Intensive Care, Hopital Cardio-Vasculaire et Pneumologique Louis Pradel, Hospices Civils de Lyon, Lyon-Bron, France. christian.bauer@chu-lyon.fr %A Bauer, Christian %A Hentz, Jean-Gustave %A Ducrocq, Xavier %A Nicolas, Meyer %A Oswald-Mammosser, Monique %A Steib, Annick %A Dupeyron, Jean-Pierre %J Anesth Analg %D 2007 Jul %N 1 %P 238-44 %T Lung function after lobectomy: a randomized, double-blinded trial comparing thoracic epidural ropivacaine/sufentanil and intravenous morphine for patient-controlled analgesia %V 105 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17578981 %X BACKGROUND: Although thoracic epidural analgesia (TEA) is considered superior to IV opioids for postoperative analgesia after thoracic surgery, a few studies clearly demonstrate an improvement in pulmonary function attributable to TEA using a local anesthetic in combination with an opioid. METHODS: In this prospective, randomized, double-blind study, we compared the effects of TEA with ropivacaine and sufentanil (TEA group) to IV morphine (IV group), as they affected pain and pulmonary function after lobectomy in 68 patients. Pain intensity, forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1/FVC ratio, forced expiratory flows, and sniff nasal inspiratory pressure as a marker of inspiratory muscle strength were measured from the first to the fourth postoperative day. RESULTS: Pain relief was better in the TEA group at rest and on coughing (P < 0.001). The impairment of FVC and FEV1 was less in the TEA group when compared with that in the IV group (P < 0.001 and P = 0.003, respectively). Sniff nasal inspiratory pressure, FEV1/FVC ratio, and expiratory flow values decreased similarly in both groups. In-hospital mortality, as well as postoperative pulmonary complications, was not different between groups. CONCLUSION: After lobectomy, TEA enables a significant increase in pulmonary function concomitant with better pain relief than systemic morphine, although a modest intercostal motor block may occur %0 Journal Article %C University of Washington, Seattle Cancer Care Alliance, 825 Eastlake Ave E, G4-830, Seattle, WA 98109. jbauman@fhcrc.org %A Bauman, Julie E %A Eaton, Keith D %A Martins, Renato G %J Arch Dermatol %D 2007 Jul %N 7 %P 889-92 %T Treatment of recurrent squamous cell carcinoma of the skin with cetuximab %V 143 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17638733 %X BACKGROUND: Squamous cell carcinoma of the skin (SCCS) is rarely encountered by medical oncologists owing to success of local therapies. When advanced SCCS requires systemic palliation, treatment with conventional chemotherapy, such as cisplatin, is often precluded by a patient's age or medical comorbidities. Cetuximab is a human and mouse chimeric antibody against epidermal growth factor receptor, a tyrosine kinase receptor richly expressed by SCCS cells, including lymph node metastases. This drug, approved for treatment of squamous cell carcinoma of the upper aerodigestive tract as well as colorectal cancer, is well tolerated. Toxic effects include acneiform rash and diarrhea. Preclinical data suggest that epidermal growth factor receptor is important in SCCS carcinogenesis. OBSERVATIONS: Herein, we report 2 cases of elderly patients with extensive, in-transit recurrence of SCCS who have been treated with palliative cetuximab. The drug was well tolerated, with the exception of acneiform rash requiring dose reduction in 1 patient. Both patients had excellent responses to cetuximab: the first patient had complete response by week 16 of treatment and the second a near-complete response by week 12. In both cases, initial response to cetuximab was evident by week 4 of therapy. CONCLUSIONS: To our knowledge, these are the first reported cases of cetuximab use in patients with SCCS. The encouraging responses justify the prospective study of cetuximab in SCCS %0 Journal Article %C Department of Internal Medicine II, University Hospital Freiburg, Germany. becker@medizin.ukl.uni-freiburg.de %A Becker, Gerhild %J Cancer Treat Res %D 2007 %P 459-67 %T Medical and palliative management of malignant ascites %V 134 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17633074 %0 Journal Article %C Department of Internal Medicine, University Hospital of Freiburg, Freiburg, Germany. becker@med1.ukl.uni %A Becker, Gerhild %A Xander, Carola J %A Blum, Hubert E %A Lutterbach, Johannes %A Momm, Felix %A Gysels, Marjolein %A Higginson, Irene J %J Palliat Med %D 2007 Apr %N 3 %P 207-17 %T Do religious or spiritual beliefs influence bereavement? A systematic review %V 21 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17641074 %X BACKGROUND: Responses to bereavement may be influenced by characteristics such as age or gender, but also by factors like culture and religion. AIM: A systematic review was undertaken to assess whether spiritual or religious beliefs alter the process of grief and/or bereavement. METHODS: Fifteen computerized databases were searched. Thirty-two studies met the inclusion criteria. Evidence was graded according to the standard grading system of the Clinical Outcomes Group and by the SIGNAL score. RESULTS: In total, 5715 persons were examined: 69% women, 87% white, 83% protestant. Ninety-four percent of studies show some positive effects of religious/spiritual beliefs on bereavement, but there was a great heterogeneity regarding included populations and outcome measurements. CONCLUSION: Available data do not allow for a definite answer on whether religious/spiritual beliefs effectively influence bereavement as most studies suffer from weaknesses in design and methodological flaws. Further research is needed. Recommendations for further research are given. Palliative Medicine 2007; 21: 207-217 %0 Journal Article %C Queensland University of Technology, School of Public Health, Institute of Health and Biomedical Innovation, Brisbane, Australia. vanessa.beesley@qimr.edu.au %A Beesley, Vanessa %A Janda, Monika %A Eakin, Elizabeth %A Obermair, Andreas %A Battistutta, Diana %J Cancer %D 2007 Jun %N 12 %P 2607-14 %T Lymphedema after gynecological cancer treatment : prevalence, correlates, and supportive care needs %V 109 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17474128 %X BACKGROUND: Few studies have evaluated lymphedema after gynecological cancer treatment. The aim of this research was to establish prevalence, correlates, and supportive care needs of gynecological cancer survivors who develop lymphedema. METHODS: In 2004, a population-based cross-sectional mail survey (56% response rate) was completed by 802 gynecological cancer survivors. The questionnaire included demographic questions, a validated, generic supportive care needs measure, and a supplementary, newly developed, lymphedema needs module. RESULTS: Ten percent (95% confidence interval [CI], 8%-12%) of participants reported being diagnosed with lymphedema, and a further 15% (95% CI, 13%-17%) reported undiagnosed "symptomatic" lower limb swelling. Diagnosed lymphedema was more prevalent (36%) amongst vulvar cancer survivors. For cervical cancer survivors, those who had radiotherapy or who had lymph nodes removed had higher odds of developing swelling. For uterine and ovarian cancer survivors, those who had lymph nodes removed or who were overweight or obese had higher odds of developing swelling. Gynecological cancer survivors with lymphedema had higher supportive care needs in the information and symptom management domains compared with those who had no swelling. CONCLUSIONS: This population-based study provided evidence that lymphedema is a morbidity experienced by a significant proportion of gynecological cancer survivors and that there are considerable levels of associated unmet needs. Women at risk of lymphedema would benefit from instructions about early signs and symptoms and provision of referral information %0 Journal Article %C Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, United States %A Behfar, A %A Terzic, A %J J Appl Physiol %D 2007 Jul %T Cardioprotective repair through stem cell-based cardiopoiesis %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17641218 %X Ischemic heart disease continues to progress at pandemic levels despite current preventive and therapeutic interventions. Recent advances in stem cell biology have provided the impetus for a paradigm shift in treatment options, potentially transforming palliative care into curative therapy. Although delivery of stem cells in clinical trials has resulted in a modest functional improvement of myocardial performance in the setting of infarction, ongoing efforts at the bench and bedside are taking place to increase stem cell propensity for engraftment and homing into diseased myocardium. The newest opportunity has arisen with the delivery of stem cells guided to execute the cardiac program. Here, we examine the recent application of genomic and proteomic technology to decipher the process of cardiopoiesis, and recruit cardiopoietic stem cells for cardioprotection and safe myocardial repair. Key words: Myocardial Infarction, Cardiopoiesis, Genomics, Proteomics %0 Journal Article %C Bloomington Hospital, Bloomington, IN, USA. kbennett@bloomingtonhospital.org %A Bennett, Kathryn %J Prof Case Manag %D 2007 May-Jun %N 3 %P 189-91 %T Case management--a bridge for the revenue cycle management team %V 12 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17514005 %0 Journal Article %C Christie Hospital NHS Foundation Trust %A Berman, Richard %A Campbell, Malcolm %A Makin, Wendy %A Todd, Chris %J Clin Med %D 2007 Jun %N 3 %P 235-42 %T Occupational stress in palliative medicine, medical oncology and clinical oncology specialist registrars %V 7 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17633943 %X A cross-sectional complete enumeration postal survey was conducted to compare stress levels between specialist registrars (SpRs) in palliative medicine, clinical oncology and medical oncology. Four hundred and one UK-registered SpRs responded (response rate 63.1%). Levels of psychological distress and depression were measured by GHQ-12 and SCL-D: 102/390 (26.2%, 95% confidence interval (CI) = 21.8-30.5%)) scored > 3 on GHQ-12 indicating psychological distress, 44/391 (11.3%, 95% CI = 8.1-14.4%) scored > or = 1.5 on SCL-D indicative of depression. Suicidal ideation was indicated by 15 responders. There were no significant differences between specialties. The effect of stress on personal or family life was the dominant predictor of both psychological distress and depression, although dissatisfaction with choice of specialty and feeling underutilised also contributed. One in four SpRs experience stress. These results are similar to studies of general practitioner principals and consultants from other specialties. Stress needs to be managed if doctors are to survive professional life %0 Journal Article %C Department of Pathology, Division of Anatomic Pathology, IRCCS "Casa Sollievo della Sofferenza" Hospital, I-71013 San Giovanni Rotondo (FG), Italy %A Bisceglia, Michele %A D'Angelo, Vincenzo Antonio %A Guglielmi, Giuseppe %A Dor, David Ben %A Pasquinelli, Gianandrea %J Ann Diagn Pathol %D 2007 Aug %N 4 %P 262-73 %T Dedifferentiated chordoma of the thoracic spine with rhabdomyosarcomatous differentiation. Report of a case and review of the literature %V 11 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17630110 %X A case of spinal thoracic chordoma involving the T9 vertebra in a 70-year-old male patient, destroying the vertebral body and invading the vertebral canal with compression of the spinal cord, is presented. The patient was referred to our neurosurgical unit with a history of an irradiated metastatic adenocarcinoma to the thoracic vertebra, a diagnosis that was rendered 3 years earlier at another hospital on presentation. This misdiagnosis was likely due to the absolute rarity of thoracic vertebral chordomas (2%-3% of all chordomas), the higher frequency of metastatic deposits to the vertebrae from visceral cancers in the elderly, the limited amount of biopsy material available for histologic examination, and the epithelial phenotype of the tumor (keratin/EMA positive). The patient underwent second palliative surgery with subtotal piecemeal removal of the tumor bringing relief of the neurologic symptoms. The bulk of the tumor was represented by a high-grade pleomorphic sarcoma with adjacent areas of atypical chordoma. Small foci of conventional chordoma were also found. The previous histologic slides were also reviewed, which were consistent with the areas of atypical chordoma. Small targeted tissue fragments from areas of (atypical) chordoma and from sarcomatous areas were recovered for electron microscopy. The fine features of chordoma and focal rhabdomyoblastic differentiation were found with the latter retrospectively supported by immunohistochemical detection of striated muscle markers. A final diagnosis of dedifferentiated chordoma with rhabdomyoblastic differentiation was finally established. Rhabdomyoblastic metaplasia is a novelty in dedifferentiated chordoma. The patient died after 5 months. Autopsy was not requested %0 Journal Article %C King's College, London. julie.bliss@kcl.ac.uk %A Bliss, Julie %A While, Alison %J Br J Community Nurs %D 2007 Jun %N 6 %P 268-72 %T District nursing and social work: palliative and continuing care delivery %V 12 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17577148 %X The growing number of older people has seen a concomitant increase in the number of people with chronic conditions who require continuing and palliative care increasing the need for the relevant professional groups and organizations to work together. This paper reports on a multiple case study which explores the different ways that district nurses and social workers work in delivering palliative and continuing care. Each professional group operationalized their care differently across five themes: assessment, care delivery, focus of care, place of care and funding of care. The balance between care organization and care delivery needs to be addressed within emerging primary care delivery structures as primary care nursing moves towards case management for long term conditions %0 Journal Article %C Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India %A Bodhey, Nk %A Gupta, Ak %A Neelakandhan, Ks %A Neema, Pk %A Kapilamoorthy, Tr %A Purkayastha, S %A Thomas, B %A Krishnamoorthy, T %A Kesavadas, C %J Australas Radiol %D 2007 Aug %N 4 %P 351-7 %T Fluoroscopic-guided balloon dilatation and stenting in tracheal stenosis with metallic self-expandable stents and long-term follow-up results %V 51 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17635472 %X The purpose of this study was to assess the safety and long-term efficacy of self-expandable stents in the treatment of benign tracheal stenosis. Nine patients (seven men) with tracheal stenosis (including one with fistula) of varied cause were treated by fluoroscopically guided balloon dilatation and stenting with self-expandable metallic stents. The procedure was carried out under topical spray in eight patients and under general anaesthesia in one patient. The patients were followed up for a period ranging between 13 and 60 months. In eight of the nine patients, satisfactory positioning of the stent was achieved at the first instance, with immediate relief of dyspnoea. One patient with innominate artery aneurysm died 16 days after the procedure because of renal failure. At 1 month of follow up, six out of eight (75%) of our live patients were without any respiratory embarrassment. This dyspnoea-free result reached almost 90% by the end of 1 year especially so in the fibrous strictures. Four out of the eight live patients (50%) had cough for 2 months and two (25%) had mild blood-tinged sputum treated by inhalation and mucolytic agents. Secondary intervention was required in one patient at 1 month because of recurrent symptoms. The patient with tracheo-oesophageal fistula required surgical intervention because of fracture of the stent. Fluoroscopically guided balloon dilatation and stenting of the tracheal stenosis is an effective non-surgical therapy resulting in cure of fibrous strictures and palliation in cases of malignancy %0 Journal Article %C Department of Clinical and Health Psychology, Utrecht University, P.O. Box 80140, 3508, TC, Utrecht, The Netherlands, P.Boelen@fss.uu.nl %A Boelen, PA %A Prigerson, HG %J Eur Arch Psychiatry Clin Neurosci %D 2007 Jul %T The influence of symptoms of prolonged grief disorder, depression, and anxiety on quality of life among bereaved adults : A prospective study %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17629728 %X OBJECTIVE: Research has shown that symptoms of Prolonged Grief Disorder (PGD, formerly called Complicated Grief) are distinct from those of depression and anxiety, and have incremental validity in that they predict impairments in functioning, independent of depression and anxiety. This study sought to replicate these findings using a prospective design, a heterogeneous sample of mourners, and the most recent criteria to define PGD. METHOD: Data from 346 mourners who were bereaved between 6 months and 2 years and who were recruited from professional and lay mental health care workers and the Internet, were used in a confirmatory factor analysis to determine the distinctiveness of symptoms of PGD, depression, and anxiety. Regression analyses estimated the effects of symptoms of PGD, depression, and anxiety on quality of life and mental health 6 months (T2) and 15 months (T3) after baseline, in a subgroup of 96 mourners assessed at follow-up. RESULTS: PGD, depression, and anxiety represented three distinct factors. When we controlled the influence of relevant background variables but not the shared variance between the factors, all three factors predicted quality of life and mental health outcomes at T2 and T3. When we controlled the shared variance between factors, the PGD factor at T1 predicted unique variance in four outcomes at T2 (mental health, suicidal ideation, PGD severity, and depression severity) and two outcomes at T3 (mental health and PGD severity), the depression factor in one outcome at T2 (depression severity) but none at T3, and the anxiety factor in six outcomes at T2 (mental health, energy, general health perception, sleeping problems, depression severity, and anxiety severity) and one at T3 (anxiety severity). CONCLUSIONS: We found PGD (defined according to the newest criteria) to be distinct from depression and anxiety and to be predictive of reduced quality of life and mental health. The concept of PGD is needed to detect mourners at risk for health impairments, who would go undetected with an exclusive focus on depression or anxiety %0 Journal Article %C Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY, US. gab38@columbia.edu %A Bonanno, George A %A Neria, Yuval %A Mancini, Anthony %A Coifman, Karin G %A Litz, Brett %A Insel, Beverly %J J Abnorm Psychol %D 2007 May %N 2 %P 342-51 %T Is there more to complicated grief than depression and posttraumatic stress disorder? A test of incremental validity %V 116 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17516766 %X There is growing interest in complicated grief reactions as a possible new diagnostic category for inclusion in the Diagnostic and Statistical Manual of Mental Disorders. However, no research has yet shown that complicated grief has incremental validity (i.e., predicts unique variance in functioning). The authors addressed this issue in 2 studies by comparing grief, depression, and posttraumatic stress disorder (PTSD) symptoms with different measures of functioning (interviewer ratings, friend ratings, self-report, and autonomic arousal). The 1st study (N = 73) used longitudinal data collected at 4 and 18 months postloss, and the 2nd study (N = 447) used cross-sectional data collected 2.5-3.5 years postloss. With depression and PTSD controlled, grief emerged as a unique predictor of functioning, both cross-sectionally and prospectively. The findings provide convergent support for the incremental validity of complicated grief as an independent marker of bereavement-related psychopathology. ((c) 2007 APA, all rights reserved) %0 Journal Article %C School of Nursing, Algonquin College, University of Ottawa, Canada. brajtman@uottawa.ca %A Brajtman, Susan %A Fothergill-Bourbonnais, Frances %A Casey, Alberta %A Alain, Diane %A Fiset, Valerie %J Int J Palliat Nurs %D 2007 May %N 5 %P 213-21 %T Providing direction for change: assessing Canadian nursing students learning needs %V 13 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17577173 %X AIM: To examine the current curriculum content and learning needs of graduating nursing students related to end-of-life care (EOLC). DESIGN: A survey method was employed. SAMPLE: A purposive sample of 58 Anglophone and Francophone students completed the Palliative Care Quiz for Nursing (PCQN) and Frommelt's Attitudes Toward Care of the Dying Scale (FATCOD). Students responded to open-ended questions regarding perceptions of preparedness to care for terminally ill patients, and provided suggestions for changes to the curriculum. Key informant educators identified opportunities to include EOLC content in courses and clinical placements. RESULTS: Results indicated that students held positive attitudes towards caring for dying patients, had modest knowledge levels, and that one third did not feel adequately prepared to care for dying patients. Although EOLC education tends to be threaded throughout the program, the emphasis is dependent upon the commitment of individual professors and clinical instructors with experience and/or expertise in this area. CONCLUSION: Students and educators agreed more emphasis on EOLC was needed. Recommendations include development of teaching strategies and experiential learning in EOLC throughout the curriculum %0 Journal Article %A Breitbart, William %J Palliat Support Care %D 2007 Jun %N 2 %P 105-6 %T Who needs the concept of spirituality? Human beings seem to! %V 5 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17578060 %0 Journal Article %C Department of Palliative Care, Calvary Hospital, Kogarah, NSW, Australia %A Brennan, Frank %A Carr, Daniel B %A Cousins, Michael %J Anesth Analg %D 2007 Jul %N 1 %P 205-21 %T Pain management: a fundamental human right %V 105 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17578977 %X This article surveys worldwide medical, ethical, and legal trends and initiatives related to the concept of pain management as a human right. This concept recently gained momentum with the 2004 European Federation of International Association for the Study of Pain (IASP) Chapters-, International Association for the Study of Pain- and World Health Organization-sponsored "Global Day Against Pain," where it was adopted as a central theme. We survey the scope of the problem of unrelieved pain in three areas, acute pain, chronic noncancer pain, and cancer pain, and outline the adverse physical and psychological effects and social and economic costs of untreated pain. Reasons for deficiencies in pain management include cultural, societal, religious, and political attitudes, including acceptance of torture. The biomedical model of disease, focused on pathophysiology rather than quality of life, reinforces entrenched attitudes that marginalize pain management as a priority. Strategies currently applied for improvement include framing pain management as an ethical issue; promoting pain management as a legal right, providing constitutional guarantees and statutory regulations that span negligence law, criminal law, and elder abuse; defining pain management as a fundamental human right, categorizing failure to provide pain management as professional misconduct, and issuing guidelines and standards of practice by professional bodies. The role of the World Health Organization is discussed, particularly with respect to opioid availability for pain management. We conclude that, because pain management is the subject of many initiatives within the disciplines of medicine, ethics and law, we are at an "inflection point" in which unreasonable failure to treat pain is viewed worldwide as poor medicine, unethical practice, and an abrogation of a fundamental human right %0 Journal Article %C Department of Social Work, College of Community and Public Affairs, PO Box 6000, Binghamton University, NY 13902, USA. lbronst@binghamton.edu %A Bronstein, Laura R %A Wright, Kevin %J J Soc Work End Life Palliat Care %D 2006 %N 4 %P 85-102 %T The impact of prison hospice: collaboration among social workers and other professionals in a criminal justice setting that promotes care for the dying %V 2 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17387096 %X This study reports on a qualitative national telephone survey with coordinators of 14 prison hospice programs in 11 states. The rationale behind the survey was to learn about interdisciplinary collaboration between social work and criminal justice, using prison hospice as an exemplar of this collaboration. In addition to learning that all prison hospices in the study operate using an interdisciplinary team model and that most report high quality collaboration on the hospice team, the following additional five themes emerged: administrators and wardens are very supportive while correctional staff provides mixed support to team and program; greater collaboration with those outside prison hospice is critical; collaboration through prison hospice has a positive impact on dying prisoners; collaboration through prison hospice has a positive impact on prisoner volunteers; and, collaboration through prison hospice has a positive impact on the entire culture of the prison %0 Journal Article %C Postoperative and Interventional Pain Unit, Department of Anesthesiology, Geneva University Hospital, Geneva, Switzerland. alex.cahana@hcuge.ch %A Cahana, Alex %A Arigoni, Flavia %A Robert, Laurent %J Pain Pract %D 2007 Jun %N 2 %P 103-9 %T Attitudes and beliefs regarding the role of interventional pain management at the end-of-life among caregivers: a 4-year perspective %V 7 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17559479 %X Intrathecal and epidural opioid analgesia represents a major advance in the management of cancer pain, adding a new dimension to opioid therapy by allowing prolonged analgesia through the use of significantly lower doses than those required for systemic administration. However, myths, misconceptions, and apprehension continue to serve as major barriers to effective cancer pain management, and concerns regarding safety, efficacy, and relative ease of utilization still prevail. This, in turn, results in unnecessary suffering, depression, diminished cognitive function, sleep disturbance, functional disability, and compromised quality of life. We conducted a survey to systematically explore medical and paramedical attitudes prior to and 4 years after the introduction an interventional pain program and attempted to qualitatively analyze what appeared as main facilities or difficulties following end-of-life clinical experiences. In general we found that all caregivers were satisfied from using interventional pain relief techniques at the end-of-life; more so among caregivers directly involved in patient care. Although nearly half of the responders initially found "technical manipulations" moderately difficult to difficult, after a simple hands-on instruction all found these techniques to be "helpful, simple and feasible." "When all went well," caregivers found implantable devices as a useful tool to relieve pain, to increase the ability of patients to complete personal endeavors, notably mobilization, but also noted an increased patient anxiety at the end-of-life. "When all went wrong," caregivers evoked the paradoxical attitude of patients to having a "high-tech" treatment at the end-of-life, causing them eventually to have "false hope," as well as the phenomenon of "interdisciplinary hyperactivity," creating what was referred to as therapeutic futility. In summary, this study suggests the importance on insisting to introduce novel techniques into practice despite initial apprehension, however, quality improvement by detecting and overcoming attitudinal barriers remain primordial and requires narrative research %0 Journal Article %C Department of Urology, University of Florence, Italy. ktommy@libero.it %A Cai, Tommaso %A Salvadori, Adriana %A Nesi, Gabriella %A Detti, Beatrice %A Tinacci, Galliano %A Zini, Enzo %A Bartoletti, Riccardo %J Onkologie %D 2007 May %N 5 %P 249-52 %T Penile metastasis from a T1b prostate carcinoma %V 30 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17460419 %X BACKGROUND: Penile metastasis from incidental prostate carcinoma has not been described to date. CASE REPORT: The case of a 72-year-old man affected by penile metastasis from incidental prostate carcinoma is described. In March 1998, the patient underwent prostate surgery for lower urinary tract symptoms related to benign prostatic obstruction. Histological examination revealed an incidental adenocarcinoma of the prostate. The pre-operative prostate-specific antigen (PSA) value was 3.6 ng/ml. A prostate biopsy in the peripheral prostate lobes was negative. PSA progressively rose to 8 ng/ml. The prostate biopsy was repeated and was still negative. The patient was subjected to radiotherapy, as a result of which his PSA fell to 0.7 ng/ml. 4 years after prostatectomy, the PSA rose again and the patient underwent hormonal therapy. The PSA fell to < 0.001 ng/ml. In May 2004, the patient reported a painful, erythematous nodule on his penis glans. Surgical biopsy showed a metastasis from prostate adenocarcinoma and he underwent partial penectomy. Due to disease progression, the patient underwent medical therapy. PSA and testosterone were always at minimum levels. 20 months later the patient died. CONCLUSION: We underline the uncertainty of the biological behaviour and optimal management of incidentally identified prostate carcinoma. In addition, we highlight that biological and clinical progression could be the consequence of inadequate treatment recommendations %0 Journal Article %C School of Nursing, University of Texas Health Science Center, Houston, TX, USA. amy.o.calvin@uth.tmc.edu %A Calvin, Amy O %A Kite-Powell, Dorothy M %A Hickey, Joanne V %J J Neurosci Nurs %D 2007 Jun %N 3 %P 143-50 %T The neuroscience ICU nurse's perceptions about end-of-life care %V 39 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17591410 %X The purpose of this qualitative descriptive study was to describe neuroscience intensive care unit (NICU) nurses' perceptions regarding their roles and responsibilities in the decision-making process during the change in intensity of care and end-of-life care for patients. Twelve NICU nurses agreed to a private moderately structured interview. Three major themes summarize the data: (1) providing guidance, (2) being positioned in the middle of the communication process, and (3) feeling the emotions of patients and families. The nurse caring for a patient at the end of life provides guidance from the middle or "hub" of the communication process between family members and physicians. The nurses in this study describe an array of feelings associated with this role. This research adds to the limited body of knowledge concerning critical care nurses' experiences with end-of-life care. Providing guidance and being in the middle of the communication process can be a lonely, challenging, yet rewarding position. Results of this study provide a basis for offering emotional support to NICU nurses who care for patients at the end of life %0 Journal Article %C Marie Curie Cancer Care and Thames Valley University, London, UK %A Canning, Deebs %A Rosenberg, John P %A Yates, Patsy %J Int J Palliat Nurs %D 2007 May %N 5 %P 222-9 %T Therapeutic relationships in specialist palliative care nursing practice %V 13 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17577174 %X There has been limited research into the scope or standards of specialist palliative care nursing practice in an Australian context. This study sought to develop a competency framework that described the core domains of specialist palliative care nursing. This article explores one key domain of specialist palliative care nursing practice - therapeutic relationships - that was identified as underpinning other domains of practice. A mixed method was used, involving a literature review, a survey including practice exemplars and an interview of specialist palliative care nurses. Seventy-four registered nurses working in designated specialist palliative care nursing roles from each Australian state and mainland territory were involved. The nurses represented metropolitan, regional, rural and remote communities, various inpatient facilities and community practice settings. Five core domains of specialist palliative care nursing practice were identified: complex supportive care, collaborative practice, leadership, improving practice and therapeutic relationships. Therapeutic relationships were identified as the central domain of specialist palliative care nursing practice to which all other domains were inextricably linked %0 Journal Article %C Division of Hematology, Department of Cellular Biotechnologies and Hematology, Policlinico Umberto I, University La Sapienza of Rome, Italy. cartoni@bce.uniroma1.it %A Cartoni, Claudio %A Brunetti, Gregorio Antonio %A D'Elia, Gianna Maria %A Breccia, Massimo %A Niscola, Pasquale %A Marini, Maria Giulia %A Nastri, Antonio %A Alimena, Giuliana %A Mandelli, Franco %A Foa, Robin %J Haematologica %D 2007 May %N 5 %P 666-73 %T Cost analysis of a domiciliary program of supportive and palliative care for patients with hematologic malignancies %V 92 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17488691 %X The costs of home care (HC) programs may be tailored to the specific needs of patients with hematological malignancies. The aim of this study was to analyze the use of resources and the costs of a program of HC for four different prognostic groups of patients subdivided according to disease status. Over 2 years, 144 patients with hematological malignancies were assisted at home. Patients were subdivided according to disease status and life expectancy in the following groups: (i) terminal phase, with a life expectancy of 3 months or less; (ii) advanced phase, with a life expectancy of 6 months or less; (iii) chronic phase, with a life expectancy of more than 6 months; (iv) discharged early from the hospital with curable disease, following anticancer chemotherapy. Median mean monthly costs (MMC) in Euro (x) have been compared with the costs of hospitalization (DRG). Among the 4 groups of patients, those discharged early and in terminal phase required the highest mean monthly number of home visits (27.2 and 24.1), transfusions (6.1 and 6.8) and days of care (22.8 and 19.7) respectively. MMC were affected by the following variables: disease status and transfusion requirements. MMC for terminal patients (4,232.50x) and those discharged early (3,986.40x) were higher than those for advanced (2,303.80x) and chronic patients (1,488,30x). The cost of HC was lower than the corresponding DRG charges, but exceeded the district fares for HC of cancer patients. In hematological patients, the costs of HC differ according to disease status and transfusion requirements. For some categories of patients, costs of HC are lower than those of hospitalization, although higher than the current national fares for HC programs %0 Journal Article %C Hebrew SeniorLife, Institute for Aging Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA. jhhchen@ntu.edu.tw %A Chen, Jen-Hau %A Chan, Ding-Cheng Derrick %A Kiely, Dan K %A Morris, John N %A Mitchell, Susan L %J J Gerontol A Biol Sci Med Sci %D 2007 May %N 5 %P 531-6 %T Terminal trajectories of functional decline in the long-term care setting %V 62 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17522358 %X BACKGROUND: Little is known about the terminal trajectories of functional decline among long-term care (LTC) residents dying with different diseases. METHODS: A retrospective cohort study was performed on 747 individuals aged 65 or older who died between January 1994 and December 2004 in a 675-bed LTC facility in Massachusetts. Three study groups were created: advanced dementia, n = 314 (42%); terminal cancer, n = 63 (8%); and organ failure (congestive heart failure and chronic obstructive pulmonary disease), n = 370 (50%). Quarterly scores of 7 activities of daily living (ADLs) during the last year of life derived from the Minimum Data Set were compared among the three groups. Each activity was rated from 0 to 4 (higher scores indicate more dependence; total range, 0-28). RESULTS: The mean age of all individuals at death was 91 ± 6 (standard deviation) years. Functional decline was greatest during the last 3 months of life, but this decline was most precipitous in the terminal cancer and organ failure groups compared to the advanced dementia group. The mean change in ADL scores during the last year of life differed among the three groups (p <.001), with the greatest decline in the terminal cancer group (from initial score 13 to final score 25), followed by the organ failure group (13 to 22), and finally, the advanced dementia group (24 to 27). CONCLUSIONS: The terminal trajectories of functional decline among LTC residents vary by underlying diseases. An understanding of these trajectories may be useful to clinicians and families caring for LTC residents near the end of life %0 Journal Article %C Tulane National Primate Research Center, Covington, Louisiana, USA. mrclarke@duke.edu %A Clarke, Margaret R %A Zucker, Evan L %A Ford, Randall T %A Harrison, Richard M %J Am J Primatol %D 2007 Apr %N 4 %P 477-84 %T Behavior and endocrine concentrations do not distinguish sex in monomorphic juvenile howlers (Alouatta palliata) %V 69 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17154381 %X Behavioral observations on juvenile mantled howlers are limited by visually undifferentiated genitalia; however, animals can be sexed when they are very young or if they are captured. Behavioral data and fecal samples from juveniles during month-long field studies from 1993 to 1995 were analyzed to determine whether there are developmental differences in behavior or hormone concentrations that can be used to differentiate males from females. The subjects were juveniles of known sex and age from five different social groups on Hacienda La Pacifica, Costa Rica. Based on 749.8 hr of focal-animal sampling, there were no sex differences in daily activity patterns. There were no sex differences in proximity to mothers and other group members, and age differences reflected howler life-history patterns. There were no differences in estradiol or testosterone concentration by age or sex. Juvenile monomorphy thus extends beyond morphology to behavioral and hormonal similarity as well. Most juveniles are forced out of their natal groups and remain solitary until they join new groups by supplanting all same-sex adult group members. Monomorphy may allow them to spend more time in natal groups, and thus both reduce the solitary period and allow the juveniles to improve social skills needed for later immigration. While this strategy may benefit juvenile howlers, it remains a problem for those who wish to study juvenile sex differences from a distance %0 Journal Article %A Clarkson, J E %A Worthington, H V %A Eden, O B %J Cochrane Database Syst Rev %D 2007 %N 2 %P CD001973 %T Interventions for treating oral mucositis for patients with cancer receiving treatment %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17443514 %X BACKGROUND: Treatment of cancer is increasingly effective but associated with short and long term side effects. Oral side effects, including oral mucositis (mouth ulceration), remain a major source of illness despite the use of a variety of agents to treat them. OBJECTIVES: To assess the effectiveness of interventions for treating oral mucositis or its associated pain in patients with cancer receiving chemotherapy or radiotherapy or both. SEARCH STRATEGY: Computerised searches of Cochrane Oral Health Group's Trials Register; Cochrane Pain, Palliative and Supportive Care Group's Trials Register; CENTRAL; MEDLINE and EMBASE were undertaken. Reference lists from relevant articles were searched and the authors of eligible trials were contacted to identify trials and obtain additional information.Date of the most recent searches June 2006: CENTRAL (The Cochrane Library 2006, Issue 2). SELECTION CRITERIA: All randomised controlled trials comparing agents prescribed to treat oral mucositis in people receiving chemotherapy or radiotherapy or both. Outcomes were oral mucositis, time to heal mucositis, oral pain, duration of pain control, dysphagia, systemic infection, amount of analgesia, length of hospitalisation, cost and quality of life. DATA COLLECTION AND ANALYSIS: Data were independently extracted, in duplicate, by two review authors. Authors were contacted for details of randomisation, blindness and withdrawals. Quality assessment was carried out on these three criteria. The Cochrane Oral Health Group statistical guidelines were followed and risk ratio (RR) values calculated using fixed effect models. MAIN RESULTS: Twenty-six trials involving 1353 patients satisfied the inclusion criteria. Four agents, each in single trials, were found to be effective for improving (allopurinol RR 3.33, 95% confidence interval (CI) 1.06 to 10.49; granulocyte macrophage-colony stimulating factor RR 4.23, 95% CI 1.35 to 13.24; immunoglobulin RR 1.81, 95% CI 1.24 to 2.65; human placentral extract RR 4.50, 95% CI 2.29 to 8.86) or eradicating mucositis (allopurinol RR 19.00, 95% CI 1.17 to 307.63). Three of these trials were rated as at moderate risk of bias and one as at high risk of bias. The following agents were not found to be effective: benzydamine HCl, sucralfate, tetrachlorodecaoxide, chlorhexidine and 'magic' (lidocaine solution, diphenhydramine hydrochloride and aluminum hydroxide suspension). Six trials compared the time to heal and mucositis was found to heal more quickly with two interventions: granulocyte macrophage-colony stimulating factor when compared to povidone iodine, with mean difference -3.5 days (95% CI -4.1 to -2.9) and allopurinol compared to placebo, with mean difference -4.5 days (95% CI -5.8 to -3.2).Three trials compared patient controlled analgesia (PCA) to the continuous infusion method for controlling pain. There was no evidence of a difference, however, less opiate was used per hour for PCA, and the duration of pain was shorter. One trial demonstrated that pharmacokinetically based analgesia (PKPCA) reduced pain compared with PCA: however, more opiate was used with PKPCA. AUTHORS' CONCLUSIONS: There is weak and unreliable evidence that allopurinol mouthwash, granulocyte macrophage-colony stimulating factor, immunoglobulin or human placental extract improve or eradicate mucositis. There is no evidence that patient controlled analgesia (PCA) is better than continuous infusion method for controlling pain, however, less opiate was used per hour, and duration of pain was shorter, for PCA. Further, well designed, placebo-controlled trials assessing the effectiveness of allopurinol mouthwash, granulocyte macrophage-colony stimulating factor, immunoglobulin, human placental extract, other interventions investigated in this review and new interventions for treating mucositis are needed %0 Journal Article %C Department of Science and Research, Centre for Palliative Medicine, University of Bonn, Department of Anaesthesiology, Intensive Care Medicine, Palliative Medicine and Pain Therapy, Malteser Krankenhaus Bonn, Von-Hompesch-Str. 1, 53123 Bonn-Hardtberg, Germany. katri-elina.clemens@malteser.de %A Clemens, KE %A Kumar, S %A Bruera, E %A Klaschik, E %A Jaspers, B %A De, Lima L %J Palliat Med %D 2007 Apr %N 3 %P 173-175 %T Palliative care in developing countries: what are the important issues? %V 21 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17641071 %0 Journal Article %C Department of Psychiatry at The University of Queensland, Australia. ecolucci@unimelb.edu.au %A Colucci, Erminia %A Martin, Graham %J Suicide Life Threat Behav %D 2007 Apr %N 2 %P 222-37 %T Ethnocultural aspects of suicide in young people: a systematic literature review part 2: Risk factors, precipitating agents, and attitudes toward suicide %V 37 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17521274 %X Different scholars have expressed the same regret for the lack of research on ethnocultural differences in youth suicide behavior and the need to conduct more comparative studies, necessary to develop culturally responsive prevention and intervention strategies. The authors reviewed 82 publications on youth suicide that have considered, to different degrees, the ethnicity/culture of the population studied. Part 1 of this article explored youth suicide rates and methods (SLTB, this issue), while the present paper examines risk and precipitating factors and attitudes toward suicide in young people from a cross-cultural perspective %0 Journal Article %A Cooley, Candy %J Int J Palliat Nurs %D 2007 May %N 5 %P 204 %T Equality and choice in palliative care %V 13 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17577171 %0 Journal Article %C Reference Center for Orphan Lung Disorders, Louis Pradel Hospital, Hospices Civils de Lyon, University Lyon I, Research Network on Rendu-Osler Disease, Lyon, France %A Cottin, Vincent %A Dupuis-Girod, Sophie %A Lesca, Gaetan %A Cordier, Jean-Francois %J Respiration %D 2007 %N 4 %P 361-78 %T Pulmonary vascular manifestations of hereditary hemorrhagic telangiectasia (rendu-osler disease) %V 74 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17641482 %X Hereditary hemorrhagic telangiectasia (HHT) or Rendu-Osler-Weber disease is a genetic disorder with autosomal dominance and variable penetrance, characterized by epistaxis, telangiectasia and visceral manifestations of the disease. The estimated minimal prevalence is 1/10,000 inhabitants. The diagnosis is established on clinical criteria, and may be further confirmed by the identification of causative mutations in either the ENG or the ACVRL1 gene coding for endoglin and ALK1, respectively. Pulmonary vascular manifestations of HHT include pulmonary arteriovenous malforma- tions (PAVMs; especially in patients with ENG mutations) and less frequently pulmonary hypertension (especially in patients with ACVRL1 mutations). In 15-33% of patients with HHT, PAVMs consist of abnormal communications between pulmonary arteries and pulmonary veins, causing right-to-left shunting, and thus, frequently hypoxemia and dyspnea on exertion, although PAVMs may remain asymptomatic and frequently undiagnosed unless complications occur. PAVMs result in severe and frequent complications often at a young age, which may reveal the diagnosis, e.g. transient ischemic attack and cerebral stroke (10-19% of patients), systemic severe infections and abscesses (including cerebral abscess in 5-19% of patients), and rarely massive hemoptysis or hemothorax. Infections in HHT are related to the right-to-left shunting that bypasses the pulmonary capillaries and facilitates the passage of septic or aseptic emboli into the systemic and especially cerebral circulation, and potentially to minor defects in innate immunity. Treatment of PAVMs based on transcatheter coil vaso-occlusion of the feeding artery significantly decreases right-to-left shunting, hypoxemia and dyspnea on exertion, and reduces the risk of systemic complications. Long-term follow-up is warranted after transcatheter vaso-occlusion of PAVMs due to frequent recanalization of treated PAVMs and development or growth of untreated PAVMs. Patients with HHT should be informed of the risk of PAVM and potentially severe complications occurring in heretofore asymptomatic subjects. All adult patients with HHT should be proposed systematic screening for PAVM, by contrast echocardiography (preceded by anteroposterior chest radiograph) or computed tomography of the chest. Pulmonary hypertension is rare in HHT, and may be due either to systemic arteriovenous shunting in the liver increasing cardiac output or be clinically and histologically indistinguishable from idiopathic pulmonary arterial hypertension. Pulmonary hypertension is detected by systematic examination of right cardiac cavities and tricuspid regurgitation flow at echocardiography, and the diagnosis is established by right heart catheterization. Copyright (c) 2007 S. Karger AG, Basel %0 Journal Article %C Peter MacCallum Cancer Centre, Department of Surgery, East Melbourne, Victoria 3002, Australia. adrian.dabscheck@petermac.org %A Dabscheck, Adrian %J Palliat Support Care %D 2007 Jun %N 2 %P 177-8 %T A panacea of general practice %V 5 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17578071 %0 Journal Article %C Service d'Urologie, CHU Mondor, Creteil, France %A Dahan, Mickael %A Paule, Bernard %A Vordos, Dimitri %A Larre, Stephane %A Salomon, Laurent %A Yiou, Rene %A Hoznek, Andras %A Abbou, Claude %A De La Taille, Alexandre %J Prog Urol %D 2007 Jun %N 4 %P 855-9 %T [Home hospitalisation in urological cancer: assessment of the first 5 years and a satisfaction survey] %V 17 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17634001 %X INTRODUCTION: The Cancer Plan emphasizes the importance of home hospitalisation. Over the last 5 years, our department has developed this mode of hospitalisation for patients with urological cancer in order to perform chemotherapy or palliative care. The objective of this study was to determine the growth of the number of patients hospitalised at home over the last 5 years and to evaluate the satisfaction of patients hospitalised in 2005 by means of a self-administered questionnaire. METHODS: A retrospective study was conducted to identify patients hospitalised at home between 2001 and 2005. A satisfaction questionnaire was sent to 58 patients hospitalised in 2005 to evaluate the degree of satisfaction, management and coordination of all medical and paramedical personnel and the advantages perceived by the patients. RESULTS: Between 2001 and 2005, 178 patients were hospitalised at home, for chemotherapy in 59% of cases and for palliative care in 41% of cases; 56% of patients were followed for prostate cancer. Among the 58 patients contacted, 44 questionnaires were returned (response rate: 76%) : 43 patients were globally satisfied with their management (28 very satisfied, 13 satisfied and 2 moderately satisfied) and would recommend home hospitalisation to their relatives. No difficulties contacting the nurse, the oncologist or the urologist were reported. The advantages emphasized by patients were maintenance in their usual environment (92%) allowing continuation of daily activities (85%), limitation of ambulance transfers to hospital and decreased waiting time in hospital (90%), as well as the involvement of the general practitioner, freely chosen by the patient, in follow-up (62.5%) ; 98% of patients would not have preferred to be managed by conventional hospitalisation for the treatment received. CONCLUSION: Home hospitalisation for chemotherapy or palliative care appears to be an effective alternative to conventional hospitalisation requiring good collaboration by the office-hospital network %0 Journal Article %A Davies, An %A Shorthose, K %J Cochrane Database Syst Rev %D 2007 %N 3 %P CD003782 %T Parasympathomimetic drugs for the treatment of salivary gland dysfunction due to radiotherapy %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17636736 %X BACKGROUND: Salivary gland dysfunction is a predictable side effect of radiotherapy to the head and neck region. Pilocarpine hydrochloride (a choline ester) is licensed in many countries for the treatment of radiation-induced salivary gland dysfunction. Other parasympathomimetics have also been used 'off licence' in the treatment of this condition. OBJECTIVES: To determine the efficacy and tolerability of parasympathomimetic drugs in the treatment of radiation-induced salivary gland dysfunction. SEARCH STRATEGY: A detailed search strategy was developed for MEDLINE, and adapted for other databases (Cochrane Pain, Palliative and Supportive Care Group Register; Cochrane Oral Health Group Register; The Cochrane Controlled Trials Register; EMBASE; CINAHL; SIGLE; Dissertation Abstracts). The reference lists of identified studies, review articles and radiotherapy textbooks were checked for additional studies. Relevant pharmaceutical companies, clinical investigators, and professional organizations/journals were also contacted about additional studies. SELECTION CRITERIA: The selection criteria for the review were: 1) randomised controlled trials; 2) patients suffering from radiation-induced salivary gland dysfunction; 3) patients treated with parasympathomimetic drugs; and 4) assessable data available on primary outcome measures. DATA COLLECTION AND ANALYSIS: The two review authors independently collected data from the full text version of relevant papers including: 1) citation details; 2) patients; 3) interventions; 4) assessments; 5) outcomes (i.e. efficacy, tolerability); and 6) quality issues.We were unable to perform a meta-analysis, due to a lack of appropriate data. MAIN RESULTS: Only three studies, involving a total of 298 patients, fulfilled the entry criteria for the review. All three studies involved the use of pilocarpine hydrochloride.The data suggest that pilocarpine hydrochloride was more effective than placebo, and at least as effective as artificial saliva in those participants that responded. The response rate was 42 to 51%. The time to response was up to 12 weeks. The side effect rate was high, and side effects were the main reason for withdrawal (six to 15% patients taking 5 mg tds). The side effects were usually the result of generalised parasympathomimetic stimulation (e.g. sweating, headaches, urinary frequency, vasodilatation). Response rates were not dose dependent, but side effect rates were dose dependent. AUTHORS' CONCLUSIONS: There is limited evidence to support the use of pilocarpine hydrochloride in the treatment of radiation-induced salivary gland dysfunction. Currently, there is little evidence to support the use of other parasympathomimetic drugs in the treatment of this condition. Available studies suggest approximately half of patients will respond, but side effects to responders can be problematic. Adverse effects are dose dependant therefore it is important to keep dose to 5 mg tds %0 Journal Article %A Doi, Eishi %J Seishin Shinkeigaku Zasshi %D 2007 %N 4 %P 354-60 %T [Application of electroconvulsive therapy for palliative treatment of pains] %V 109 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17561676 %0 Journal Article %C Dept of Pneumology, University Hospital Freiburg, Killianstrasse 5, D-79106 Freiburg, Germany %A Dreher, M %A Storre, J H %A Windisch, W %J Eur Respir J %D 2007 May %N 5 %P 930-6 %T Noninvasive ventilation during walking in patients with severe COPD: a randomised cross-over trial %V 29 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17331969 %X It was hypothesised that noninvasive positive-pressure ventilation (NPPV) applied during walking prevents exercise-induced hypoxaemia and improves exercise performance in severe chronic obstructive pulmonary disease (COPD) patients already receiving long-term NPPV. A total of 20 COPD patients (mean+/-sd age 65.1+/-8.7 yrs, forced expiratory volume in one second 27+/-8% predicted and total lung capacity 116+/-27% pred) reporting dyspnoea, even during mild exertion, underwent two 6-min walking tests with a rollator and supplemental oxygen (2.1+/-0.9 L.min(-1)) in a randomised cross-over design: with and without pressure-limited NPPV as used at home (inspiratory:expiratory pressure 2.9+/-0.44:0.4+/-0.1 kPa (29+/-4:4+/-1 mbar), respiratory frequency 20+/-2 breaths.min(-1)). The arterial oxygen tension significantly increased by 1.39+/-1.43 kPa (95% confidence interval (CI) 0.71-2.07 kPa) after walking with NPPV, but significantly decreased by 1.43+/-1.06 kPa (95% CI -1.92 - -0.94 kPa) without NPPV. Dyspnoea, as assessed by the Borg dyspnoea scale, significantly decreased from 6 (interquartile range (IQR) 4.5-10) to 4 (1.5-4.5) and walking distance significantly increased from 209 (IQR 178-279) to 252 (203-314) m when walking was NPPV-aided. In chronic hypercapnic chronic obstructive pulmonary disease, high-intensity noninvasive positive-pressure ventilation can also be administered during walking with unchanged ventilator settings compared with settings used at rest, thus resulting in improved oxygenation, decreased dyspnoea and increased walking distance. Therefore, noninvasive positive-pressure ventilation during walking could prevent hypoxia-induced complications and could, in future, play a role in palliative care %0 Journal Article %C Dept of Internal Medicine and Cystic Fibrosis, Adult Centre, Universite Claude Bernard and Hospices Civils de Lyon, Lyon Cedex, France. isabelle.durieu@chu-lyon.fr %A Durieu, I %A Abbas-Chorfa, F %A Drai, J %A Iwaz, J %A Steghens, J-P %A Puget, M %A Ecochard, R %A Bellon, G %J Eur Respir J %D 2007 May %N 5 %P 958-64 %T Plasma fatty acids and lipid hydroperoxides increase after antibiotic therapy in cystic fibrosis %V 29 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17301094 %X The present authors investigated whether cystic fibrosis is linked to a defect in fatty acids and assessed the impact of the main patients' characteristics on the levels of several fatty acids, mostly during respiratory exacerbation and after antibiotic therapy. Fatty acid phospholipid and cholesteryl ester levels were measured in stable-state patients and controls. No differences were found concerning either the fractions of palmitic and oleic acids or the cholesteryl esters of alpha-linolenic and arachidonic acids. However, phospholipids of alpha-linolenic and arachidonic acids, as well as cholesteryl esters and phospholipids of stearic and linoleic acids, were lower in patients than in controls, but fractions of dihomo-gamma-linolenic, docosatetraenoic, docosapentaenoic, palmitoleic and eicosatrienoic acids were higher. Fatty acid levels, oxidative stress markers, nutrients, body mass index and forced expiratory volume in one second (FEV(1)) were measured in patients before and after antibiotic courses for bronchial exacerbation. After adjustments, palmitic, stearic, alpha-linolenic, linoleic, arachidonic, palmitoleic and oleic acids generally decreased during exacerbation but almost all increased after antibiotic courses. Nearly all fractions increased along with FEV(1) and a positive relationship linked fatty acids to lipid hydroperoxides. There was no general drop in fatty acids. Patients' fatty acid profiles depended on the pulmonary function and the inflammation state %0 Journal Article %C VU University Medical Center, Institute for Research in Extramural Medicine, Department of Public and Occupational Health, Amsterdam, The Netherlands, Erasmus MC - Daniel den Hoed Cancer Center, Department of Medical Oncology, Rotterdam, The Netherlands. michael.echteld@vumc.nl %A Echteld, MA %A van, Zuylen L %A Bannink, M %A Witkamp, E %A Van, der Rijt CC %J Palliat Med %D 2007 Apr %N 3 %P 199-205 %T Changes in and correlates of individual quality of life in advanced cancer patients admitted to an academic unit for palliative care %V 21 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17641073 %X Changes in individual quality of life (IQoL) and its correlates in patients admitted to an academic palliative care unit are reported. Correlates tested were pain, fatigue, and reconceptualization (changes in content of quality of life, a measure of adaptation). IQoL was measured with a structured interview method that derives an IQoL score from evaluations of individually nominated life areas. Twenty-nine patients were included in the study and interviewed shortly after unit admission. Sixteen patients were interviewed before discharge (more than 1 week between interviews). The results show that mean IQoL scores improved notably. Pain and IQoL correlated negatively and moderately at admission, and correlations between fatigue and pain at discharge and IQoL were negative and strong. An increasing number of changes in life areas was moderately associated with worsening IQoL. Life area's most often nominated were relationships with family members and friends, symptoms and aspects related to maintaining control. Palliative Medicine 2007; 21: 199-205 %0 Journal Article %C Department of Surgery, Louis Mourier Hospital, Assistance Publique, Hopitaux de Paris, University Paris VII, 178 rue des Renouillers, 92701 Colombes Cedex, France %A Facchiano, E %A Scaringi, S %A Kianmanesh, R %A Sabate, JM %A Castel, B %A Flamant, Y %A Coffin, B %A Msika, S %J Eur J Surg Oncol %D 2007 Jul %T Laparoscopic hyperthermic intraperitoneal chemotherapy (HIPEC) for the treatment of malignant ascites secondary to unresectable peritoneal carcinomatosis from advanced gastric cancer %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17640844 %X AIMS: To review our experience of laparoscopic hyperthermic intraperitoneal chemotherapy (HIPEC) in the treatment of malignant ascites from advanced gastric cancer in order to discuss benefits, problems and possible indications. METHODS: From June 2000 to May 2003 laparoscopic approach was used to perform HIPEC on five patients affected by malignant ascites secondary to unresectable peritoneal carcinomatosis of gastric origin, in order to associate the benefits of a definitive palliation of ascites with a minimal invasiveness. All patients had ascites related symptoms requiring iterative paracenteses. Intraperitoneal perfusion of mitomycin-C and cisplatin was delivered for 60-90min with an inflow temperature of 45 degrees C. RESULTS: Complete clinical regression of ascites and related symptoms was achieved in all the five patients treated. Intraoperative course was uneventful in all cases. Mean operative time was 181min. No postoperative deaths, related to the procedure, occurred. Only a case of delayed gastric empting was recorded as a minor postoperative complication. CONCLUSIONS: Laparoscopic HIPEC appears to be a safe and effective procedure to treat debilitating malignant ascites from unresectable peritoneal carcinomatosis %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 Edmonton Palliative Medicine Program, Regional Palliative Care Consult Team, Health Services Building, Grey Nuns Hospital, 1100 Youville Drive W, Edmonton, AB, T6L 5X8, Canada, Joan.Faily@capitalhealth.ca %A Faily, J %A Oneschuk, D %J Support Care Cancer %D 2007 Jul %T Acupuncture in palliative care %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17636346 %X GOALS OF WORK: Acupuncture involves the insertion of needles into designated acupuncture points to aid in the treatment of symptoms and to improve health. MATERIALS AND METHODS: A survey was conducted in a tertiary palliative care unit where 50 patients with advanced cancer were surveyed to determine their understanding of, use of, and interest in acupuncture. MAIN RESULTS: Twenty-seven (54%) patients provided an accurate understanding of acupuncture. Although only 30% of patients had previously used acupuncture to treat noncancer medical conditions and only 10% had used it for cancer related symptoms, 80% of patients were interested in seeing an acupuncture practitioner on the care unit if one was made available. CONCLUSIONS: Although few advanced cancer patients on a tertiary palliative care unit had previously received acupuncture, many had a general understanding of this complementary therapy, and expressed an interest in seeing an acupuncture practitioner %0 Journal Article %C Hopital Charles Nicolle, Service d'Anatomie et de Cytologie Pathologiques, Boulevard 9 Avril 1938, 1006 Tunis, Tunisie. farah_faten@yahoo.fr %A Farah-Klibi, F %A Ferchichi, L %A Kooli, H %A Ferjaoui, M %A Baltagi Ben Jilani, S %A Zermani, R %J Rev Laryngol Otol Rhinol (Bord) %D 2007 %N 1-2 %P 101-4 %T [Adenoid cystic carcinoma of the trachea] %V 128 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17633678 %X Cystic adenoid carcinoma of the trachea, also called cylindroma, is a rare malignant tumor accounting for 1% of all respiratory tract cancers. OBJECTIVES: To recall through two observations and a review of the literature, various epidemiologic anatomical clinical aspects, and evolutionary of cystic glandular carcinome of the respiratory tracts. We report 2 cases of cystic glandular carcinoma of the trachea. CLINICAL CASE: They were two women of 60 and 49 year old who came with a deterioration of the general status with dyspnea, dysphonia and/or dysphagia. Radiological explorations visualized, in the first case, a tumoral process of the superior half of the trachea and, in the second case, a tumoral circumferential process budding in the sub-glottic area and reaching the first rings of the trachea. The two patients had a removal of the tumour An auxiliary radiotherapy was indicated in the first case. CONCLUSION: Cystic adenoid carcinomas of the trachea are rare tumours. Their diagnosis is based on the bronchial fibroscopy associated with the biopsy. The optimal treatment is surgical associated with the radiotherapy. The palliative treatments keep a place among inoperable patients %0 Journal Article %C Department of Oncological Sciences, Mount Sinai School of Medicine, New York, New York, USA %A Fatone, Anne M %A Moadel, Alyson B %A Foley, Frederick W %A Fleming, Megan %A Jandorf, Lina %J Palliat Support Care %D 2007 Jun %N 2 %P 115-25 %T Urban voices: the quality-of-life experience among women of color with breast cancer %V 5 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17578062 %X OBJECTIVES: Research on the health-related quality of life (HRQL) among women of color (i.e., Hispanics and African Americans) with breast cancer suggests that they may be at elevated risk for a variety of physical and psychosocial sequelae. The context in which these women perceive, experience, and respond to these HRQL challenges can provide important information for planning a culturally appropriate palliative care treatment plan. METHODS: In an effort to understand the quality of life experience after breast cancer among women of color, this study describes the nature and impact of physical, emotional, and menopausal symptoms among African American (n = 8) and Hispanic (n = 12) breast cancer survivors based on qualitative data gathered through semistructured interviews. Themes were identified and categorized into six HRQL domains: physical (e.g., pain, nausea), psychological (e.g., sadness, irritability), cognitive (e.g., memory problems), sexual (e.g., decreased desire), social/functional (e.g., financial strain, social distress), and spiritual/existential (e.g., increased faith, spiritual coping), with high interrater reliability (kappa = .81). RESULTS: For both groups, physical issues had a major impact on HRQL, with psychological issues being additionally salient for Hispanic women. Most (88%) African American women voiced positive changes in their faith after diagnosis whereas 50% of Hispanic women viewed faith as an important way of coping with breast cancer. SIGNIFICANCE OF RESULTS: This research broadens our understanding of the experience of breast cancer among ethnic minority women, and in turn, offers some key directions for guiding the development of culturally tailored HRQL interventions %0 Journal Article %C School of Law of the University of Manchester %A Ferreira, N %J Med Law %D 2007 Jun %N 2 %P 387-407 %T Latest legal and social developments in the euthanasia debate: bad moral consciences and political unrest %V 26 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17639859 %X Several events that took place during recent years, such as the French Act on the rights of patients and the end of life, the Terri Schiavo case and Lord Joffe's proposal for an Assisted Dying Bill in the United Kingdom, have triggered the debate on euthanasia more than ever. It is therefore opportune to revisit basic notions related thereto and to make a comparative analysis of the legal regime of euthanasia in several countries in Europe and elsewhere, as well as to try to see how the public awareness of the problem has of late developed. There seems to be a clear trend in many legal systems towards an increasing respect for the patient's right to self-determination. However, we are still looking at a complex social game, where legal and medical terminology are manipulated and euphemisms are invented in order to accommodate bad moral consciences and avoid political unrest %0 Journal Article %C National Center for Ethics in Health Care, U.S. Department of Veterans Affairs, Washington, DC, USA. Foxe2@comcast.net %A Fox, Ellen %A Daskal, Frona C %A Stocking, Carol %J J Clin Ethics %D 2007 Spring %N 1 %P 64-71 %T Ethics consultants' recommendations for life-prolonging treatment of patients in persistent vegetative state: a follow-up study %V 18 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17546936 %0 Journal Article %C Heinrich-Heine-University Clinics, Moorenstrasse, Dusseldorf, Germany. enno.freye@uni-duesseldorf.de %A Freye, Enno %A Anderson-Hillemacher, Astrid %A Ritzdorf, Ingrid %A Levy, Joseph Victor %J Pain Pract %D 2007 Jun %N 2 %P 123-9 %T Opioid rotation from high-dose morphine to transdermal buprenorphine (Transtec) in chronic pain patients %V 7 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17559481 %X Opioid rotation is increasingly becoming an option to improve pain management especially in long-term treatment. Because of insufficient analgesia and intolerable side effects, a total of 42 patients (23 male, 19 female; mean age 64.1 years) suffering from severe musculoskeletal (64%), cancer (21%) or neuropathic (19%) pain were converted from high-dose morphine (120 to >240 mg/day) to transdermal buprenorphine. The dose of buprenorphine necessary for conversion (at least 52.5 microg/h) was titrated individually by the treating physician. No conversion recommendations were given and the treating physician used his or her own judgment for dose adjustment. Pain relief, overall satisfaction and quality of sleep (very good, good, satisfactory, poor, or very poor), and the incidence and severity of adverse drug reactions over a period of at least 10 weeks and up to 1 year was assessed. Following rotation, patients experiencing good/very good pain relief increased from 5% to 76% (P < 0.001). Only 5% reported insufficient relief. Relief was achieved with buprenorphine alone in 77.4%, while 17% needed an additional opioid for breakthrough pain. Sleep quality (good/very good) increased from 14% to 74% (P < 0.005). Adverse effects were reported in 11.9%, mostly because of local irritation, did not result in termination of therapy. Neither tolerance nor refractory effect following rotation from morphine to buprenorphine was noted. Conversion tables with a fixed conversion ratio are of limited value in patients treated with high-dose morphine %0 Journal Article %C Medizinische Klinik und Poliklinik III, Klinikum der Universitat Munchen - Grosshadern, Munchen %A Fritsch, Susanne %A Buske, Christian %A Wormann, Bernhard %A Wedding, Ulrich %A Hiddemann, Wolfgang %A Spiekermann, Karsten %J Med Klin (Munich) %D 2007 Apr %N 4 %P 324-9 %T [Therapy of acute myeloid leukemia (AML) for medically non-fit patients] %V 102 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17426936 %X Acute myeloid leukemia (AML) has an increasing incidence with higher age, which is about 15 per 100,000 for patients > 65 years. Many older AML patients show functional restrictions and have a high comorbidity status, so that they do not seem to be qualified for a curatively intended chemotherapy. Decisive for the low cure rate of older AML patients are both patient-dependent and disease-dependent reasons such as secondary or therapy-related leukemia or adverse cytogenetics with complex chromosomal abnormalities, which are poor prognostic factors and are responsible for the low probability to achieve long-lasting complete remissions. Prognostic scores are developed for identifying "medically non-fit" patients as objectively as possible. In the future, these patients should not only be offered best supportive care but also well-tolerable concepts of therapy, which are feasible on an ambulatory basis. The main aim for this patient group must be to avoid long hospitalizations and to maintain a high quality of life %0 Journal Article %C Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan. shfuji@kuhp.kyoto-u.ac.jp %A Fujibayashi, Shunsuke %A Neo, Masashi %A Nakamura, Takashi %J J Neurosurg Spine %D 2007 Jul %N 1 %P 99-102 %T Palliative dual iliac screw fixation for lumbosacral metastasis. Technical note %V 7 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17633497 %X Spinal fixation for destructive metastatic lesions at the lumbosacral junction is challenging because of the large and unique load-bearing characteristics present. In particular, caudal fixation is difficult in cases of sacral destruction because of insufficient S-1 pedicle screw anchorage. The authors describe their surgical technique for secure iliac screw placement and the clinical results obtained in five patients with metastatic spinal disease. All patients in this study underwent palliative operations with dual iliac screw fixation between April 1999 and October 2002, and the clinical and radiological findings were assessed. In all five patients, spinal metastases extended into the sacrum. The metastases were from renal cell carcinomas in two patients, lung cancer in two, and a paraganglioma in one patient. Postoperative follow-up periods ranged from 3 months to 6 years (mean 28.4 months). Preoperatively, four patients could not walk due to severe pain or neurological compromise. Postoperatively, all patients reported a reduction in pain and regained the ability to walk. Complications included one case of early wound infection. In the patients with long survival after the operation, there was one case of iliac screw loosening and one case of rod breakage. The dual iliac screw fixation technique provided sufficient immediate stability for destructive lumbosacral metastasis %0 Journal Article %C Department of General Practice, Flinders University, Adelaide, SA, Australia. richard.reed@flinders.edu.au %A Gadzhanova, Svetla %A Reed, Richard %J Med J Aust %D 2007 Jul %N 2 %P 92-4 %T Medical services provided by general practitioners in residential aged-care facilities in Australia %V 187 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17635091 %X We conducted a literature review to assess the current status of general practitioner services in residential aged-care facilities (RACFs) in Australia and the impact of recent initiatives to enhance access by RACF residents to these services. Of 400 publications identified, 22 were selected as relevant to our study. We also analysed publicly available statistical data on GP services in RACFs. Recent initiatives to improve quality of care and facilitate access to GP services for RACF residents include the Aged Care GP Panels Initiative, the Enhanced Primary Care program, and an expanded role of palliative care. Despite these initiatives, many GPs still find RACF services unappealing due to a perceived poor level of remuneration for the effort involved. Further improvements in access to and quality of GP services to RACFs may require new models of care delivery and financing %0 Journal Article %C Division of Nephrology, Department of Medicine, Tufts University, Boston, Massachusetts, USA, and Baystate Medical Center, Springfield, Massachusetts, USA %A Germain, Michael J %A Cohen, Lewis M %A Davison, Sara N %J Semin Dial %D 2007 May-Jun %N 3 %P 195-9 %T Withholding and withdrawal from dialysis: what we know about how our patients die %V 20 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17555480 %X Withholding and withdrawal of dialysis has been a reality since dialysis was invented. Only in the past 20 years has it been formally studied, and we still have a great deal to learn. The nephrology community has slowly come to accept that, for some of our patients, not having dialysis is a better option than continuing or initiating therapy. The principles of palliative care throughout the disease trajectory and hospice care at end of life are germane to this population due to its high symptom burden and mortality rate. We review what is currently known concerning patients who choose to withhold or withdraw from dialysis, and the current barriers (and solutions) to providing them with optimal palliative care %0 Journal Article %C toni@tonigilbert.com %A Gilbert, Toni %J Beginnings %D 2007 Spring %N 2 %P 10-1 %T Inner dancer %V 27 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17494521 %0 Journal Article %C School of Health Science, Swansea University. richard.griffith@swan.ac.uk %A Griffith, Richard %J Br J Community Nurs %D 2007 Jun %N 6 %P 273-7 %T Euthanasia: is there a case for changing the law? %V 12 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17577149 %X Calls for a change in the law to allow strictly controlled forms of voluntary euthanasia and assisted dying in the United Kingdom continue following two recent cases. In this article Richard Griffith reviews the current stance of the law on euthanasia and assisted dying and discusses attempts at reform made by Lord Joffe in the Assisted Dying for the Terminally Ill Bill 2005 (HL) %0 Journal Article %C School of Health Science, Swansea University. richard.griffith@swan.ac.uk %A Griffith, Richard %J Br J Community Nurs %D 2007 May %N 5 %P 228-33 %T Do not attempt resuscitation orders: a review of the issues %V 12 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17551459 %X Controversy surrounding the use of do not resuscitate orders on patients often without their knowledge and without apparent good reason (Age Concern England, 2000) have led some to question the lawfulness of such orders. This article considers the legal basis for do not resuscitate orders and outlines best practice guidance that will assist district nurses and other health professionals in deciding whether making such an order is lawful and for the benefit of the patient concerned %0 Journal Article %C Division of Clinical Neurosciences, Institute of Neurological Sciences, University of Glasgow, Southern General Hospital, Glasgow, G51 4TF, Scotland, UK %A Grinfeld, Esther %A Goodwin, Roslyn %A Kennedy, Peter G E %J Virus Genes %D 2007 Aug %N 1 %P 29-32 %T Varicella-Zoster virus gene expression at variable periods following death in a rat model of ganglionic infection %V 35 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17039406 %X We used a rat model of Varicella-Zoster virus (VZV) ganglionic infection, which mirrors some of the features of VZV latency in humans, to determine the temporal pattern of expression of a VZV immediate-early gene (63) and a VZV late gene (40) at 0, 24 and 48 h after death of the animal. The immediate-early VZV gene 63 is known to be abundantly expressed during human ganglionic latency, while the late VZV gene 40 is not expressed during human latency. Using both RNA in situ hybridisation (ISH) and nested RT-PCR, it was found that at all time points in both thoracic and lumbar ganglia, the number of ganglia positive for VZV gene 63 was higher than for gene 40. The expression of gene 40 did not increase with time postmortem (pm) These results provide indirect support for the hypothesis that patterns of expression of VZV genes detected in human tissue at even 48 h pm reflect the pattern of expression during human ganglionic latency %0 Journal Article %C Glycation, Oxidation and Disease Laboratory, Division of Basic Medical Sciences, Touro University-California, Mare Island, Vallejo, CA, USA %A Gugliucci, A %A Lunceford, N %A Kinugasa, E %A Ogata, H %A Schulze, J %A Kimura, S %J Clin Chim Acta %D 2007 Jun %T Acrolein inactivates paraoxonase 1: changes in free acrolein levels after hemodialysis correlate with increases in paraoxonase 1 activity in chronic renal failure patients %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17632094 %X BACKGROUND: Acrolein is a very reactive aldehyde present in cigarette smoke and endogenously generated by pathways such as lipid peroxidation and threonine metabolism by phagocytes. Acrolein has been shown to affect uptake of cholesterol by HDL. We hypothesized that acrolein could also have deleterious effects on paraoxonase 1 (PON-1) activity. We also determined whether free serum acrolein levels are higher in renal failure, and assessed whether they decrease after hemodialysis (HD) and whether this change correlates with increases in PON-1 activity. METHODS: We incubated human HDL with 0-10 mmol/l acrolein for 2 h and measured PON-1 activity and structural changes. Acrolein was also measured in 40 end stage renal disease (ESRD) patients (before and after a hemodialysis session), and 40 control subjects. RESULTS: We found that acrolein inhibits PON-1 activity in HDL in a time and concentration dependent fashion. Inhibition occurred at 40% at 0.5 mmol/l and was cancelled by cysteine but not by aminoguanidine or carnosine. We confirm that free serum acrolein levels are higher in chronic renal failure patients and demonstrate that they are partially removed by HD. Decrease in acrolein levels after dialysis correlate with increases in PON-1 activity (r=0.32, p 0.01). CONCLUSION: Acrolein inactivates paraoxonase 1 in HDL, a process that is inhibited by N-acetylcysteine. We confirm that acrolein levels are higher in ESRD and show for the first time, data supporting that acrolein is partially removed by hemodialysis. Decrease in acrolein levels after dialysis correlates with increase in PON-1 activity. This could offer new insights to explain low PON-1 activities in smokers and renal failure subjects as well as pointing at thiol-conserving reducing compounds such as N-acetylcysteine, as putative therapeutic palliatives %0 Journal Article %C Institute for Cancer Care at Mercy, Baltimore, MD, USA %A Gushchin, Vadim %A Demmy, Todd L %A Kane, John M 3rd %J Semin Oncol %D 2007 Jun %N 3 %P 215-25 %T Surgical management of metastatic peritoneal or pleural disease %V 34 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17560983 %X The surgeon's role in the treatment of malignant peritoneal disease has expanded over time, stemming from a better understanding of tumor biology. For the majority of patients, carcinomatosis is a terminal process with surgical intervention being reserved for palliation of bowel obstruction or symptomatic ascites. However, for select patients with favorable tumor biologies, aggressive surgical approaches may result in long-term survival. This review describes the patterns of peritoneal tumor dissemination, surgical palliation of malignant bowel obstruction or ascites, and the principles, indications, toxicities, and overall results of cytoreductive surgery with intraperitoneal hyperthermic chemotherapy. On the other hand, long-term survival is rarely expected for malignant pleural disease unless the causal tumor is highly responsive to systemic chemotherapy. There are controversies and considerable geographic variations in the management of malignant pleural effusions. However, less invasive ambulatory palliative treatments for patients so afflicted are gaining popularity %0 Journal Article %C Department of Prosthodontics, SDM College of Dental Sciences and Hospital, Dharwad, Karnataka, India %A Guttal, S S %A Patil, N P %A Shetye, A D %J J Oral Rehabil %D 2006 Nov %N 11 %P 863-7 %T Prosthetic rehabilitation of a midfacial defect resulting from lethal midline granuloma--a clinical report %V 33 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17002746 %X Prosthetic rehabilitation of the midfacial defects has always perplexed maxillofacial prosthodontists. These midfacial defects lead to functional and cosmetic deficiencies. One of the causes of such defects is midline lethal granuloma, which is a destructive granulomatous lesion of uncertain aetiology, involving the nose, paranasal sinuses and the palate. Presented here is a clinical report of a 22-year-old male patient diagnosed to have lethal midline granuloma, who was referred to the Department of Prosthodontics, SDM College of Dental Sciences Dharwad. The patient had a severe midfacial defect involving the nose, the paranasal sinuses, the palate and the soft tissues of the face. Although the lesion was not of the rapidly progressive type at the time of rehabilitation, the non-specific inflammatory process was persisting. The patient was treated with chemotherapy and palliative therapy. The primary objective of the prosthetic rehabilitation was to provide closure of the severe defect to protect the soft tissues from environmental exposure. Secondarily the prosthesis also provided acceptable aesthetics and psychological benefit to the patient %0 Journal Article %C Luther College, University of Regina. mary.hampton@uregina.ca %A Hampton, Mary %A Smith, Fleur MacQueen %J Alta RN %D 2007 May %N 5 %P 18-9 %T Improving end of life care for Aboriginal families %V 63 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17583320 %0 Journal Article %C Office of Applied Studies, SAMHSA, U.S. Department of Health and Human Services, 1 Choke Cherry Road, Rm. 7-1010, Rockville, MD 20587, USA. Beth.Han@samhsa.hhs.gov %A Han, Beth %A Remsburg, Robin E %A McAuley, William J %A Keay, Timothy J %A Travis, Shirley S %J Inquiry %D 2007 Spring %N 1 %P 104-13 %T Length of hospice care among U.S. adults: 1992-2000 %V 44 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17583264 %X This study examined length of service use among U.S. adult hospice patients based on data from the 1992-2000 National Home and Hospice Care Surveys. With the Kaplan-Meier method, we estimated length of service use of current and discharged hospice patients simultaneously. Using a multivariate Cox proportional hazards model, we examined trends in patients' service use during the 1990s. Findings show that length of service use decreased significantly among adult patients who had Medicare as their only payment source. Although overall length of service use declined significantly in 1996, 1998, and 2000 compared to 1992, it was similar between 1996 and 2000 %0 Journal Article %C Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA. jin.h.han@vanderbilt.edu %A Han, Jin H %A Miller, Karen F %A Storrow, Alan B %J Acad Emerg Med %D 2007 Mar %N 3 %P 228-33 %T Factors affecting cardiac catheterization rates in elders with acute coronary syndromes %V 14 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17242386 %X BACKGROUND: Elder patients with acute coronary syndromes (ACS) are less likely to receive cardiac catheterization. The reasons for this are unclear. OBJECTIVES: To assess whether elder patients who had a documented history of dementia, lived in extended care facilities, or had do not intubate-do not resuscitate (DNR-DNI) advance directives were less likely to receive cardiac catheterization, despite having ACS with high-risk features. METHODS: This was a medical record review conducted at an urban teaching hospital. DNR-DNI status before hospitalization, extended care facility (nursing home or assisted living) residence, and a previous diagnosis of dementia were obtained from the medical record. Patients 65 years and older who presented to the emergency department with acute myocardial infarction or with unstable angina with ST segment deviation were included. Univariate and multivariate logistic regression were performed, and odds ratios (ORs) were reported with their 95% confidence intervals (CIs). RESULTS: Of the 201 eligible patients, 66 (32.8%) patients did not undergo cardiac catheterization. In the univariate analysis, patients who had dementia, resided in extended care facilities, or were DNR-DNI were less likely to receive cardiac catheterization. Only extended care facility residence (OR, 0.18; 95% CI = 0.04 to 0.83) and DNR-DNI status (OR, 0.19; 95% CI = 0.04 to 0.92) remained significantly associated with decreased cardiac catheterization in the multivariate analysis. CONCLUSIONS: Elder patients with ACS residing in extended care facilities or who are DNR-DNI are less likely to receive cardiac catheterization. Future studies concerning the quality of ACS care for elders should take these variables into account %0 Journal Article %C Department of Anesthesiology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands. j.hasselaar@anes.umcn.nl %A Hasselaar, Jeroen G J %A Reuzel, Rob P B %A Verhagen, Stans C A H H V M %A de Graeff, Alexander %A Vissers, Kris C P %A Crul, Ben J P %J Arch Intern Med %D 2007 Jun %N 11 %P 1166-71 %T Improving prescription in palliative sedation: compliance with dutch guidelines %V 167 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17563025 %X BACKGROUND: Two guidelines addressing palliative sedation have been published in the Netherlands in 2002 and 2003. The objective of the present study is to determine adherence to the guidelines for palliative sedation with regard to prescription. The study is restricted to the practice of continuous deep palliative sedation. METHODS: A structured retrospective questionnaire was administered to 1464 physicians concerning their last case of deep sedation during the past 12 months. Physicians included Dutch hospital specialists, general practitioners, and nursing home physicians. RESULTS: The response rate was 36%. A total of 43% (95% confidence interval [CI], 37%-49%) of the responding physicians did not adhere to the guidelines. Sources of deviation were the use of basic medication other than a benzodiazepine (30%), which mostly involved morphine, and omissions in adjuvant medication (13%). Nonsignificant positive association was found for consultation of a palliative care expert (odds ratio [OR], 3.86; 95% CI, 0.92-8.87). Significant positive association was found for the physician being a palliative care expert himself or herself (OR, 4.42; 95% CI, 1.42-13.75) and the use of guidelines (OR, 1.74; 95% CI, 1.02-2.98). Treatment of pain symptoms (OR, 2.21; 95% CI, 1.28-3.82), anxiety (OR, 2.32; 95% CI, 1.33-4.06), vomiting (OR, 6.52; 95% CI, 1.08-39.50), and loss of dignity (OR, 3.93; 95% CI, 1.80-8.58) also correlated positively. Treatment of delirium correlated negatively with adherence to the guidelines (OR, 0.22; 95% CI,0.11-0.44). CONCLUSIONS: The rate of 43% noncompliance to the guidelines was mostly owing to the omission of continued antipsychotic treatment for delirium and the use of morphine as the single therapy for the purpose of deep sedation. Future efforts, like better use and knowledge of the guidelines and a larger involvement of consultation teams, should increase adherence to the guidelines %0 Journal Article %C Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands. m.g.hazekamp@lumc.nl %A Hazekamp, Mark %A Portela, Francisco %A Bartelings, Margot %J Eur J Cardiothorac Surg %D 2007 May %N 5 %P 879-87 %T The optimal procedure for the great arteries and left ventricular outflow tract obstruction. An anatomical study %V 31 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17353131 %X OBJECTIVE: To describe the optimal surgical strategy in heart specimens with transposition of the great arteries (TGA) and left ventricular outflow tract obstruction (LVOTO). METHODS: Thirty-three specimens with LVOTO were selected: TGA with intact ventricular septum (TGA/IVS) (10), TGA/VSD (21), and Taussig-Bing (2). RESULTS: LVOTO in TGA/IVS consisted of combinations of bicuspid pulmonary valve (four), subpulmonary fibrous ridge (four), obstructive muscular conus (two) and bulging muscular septum (four). Arterial switch operation (ASO) with LVOTO resection/valvotomy was feasible in nine hearts. Obstructive anterior papillary muscle prohibited LVOTO relief in one specimen. In TGA/VSD and Taussig-Bing LVOTO consisted of combinations of bicuspid (nine) or unicommissural (one) pulmonary valve, fibrous ridge (three), obstructive muscular conus (five), malaligned outlet septum (six), accessory mitral valve tissue (two), straddling mitral valve (two) and anterior mitral valve rotation (four). VSDs were subpulmonary in 13 (9 perimembranous, 4 muscular), subaortic in 3 (2 perimembranous, 1 anterior muscular), doubly committed in 2, inlet in 3 (2 perimembranous, 1 muscular), non-committed and anterior in 1, and finally 1 VSD extended both into inlet and subpulmonary outlet septum. LVOTO resection and ASO with VSD closure was possible in 10. In six specimens, both a Rastelli and a Nikaidoh operation were feasible. For two hearts, a Nikaidoh procedure was the only option, while Rastelli was considered optimal in another specimen. Mitral valve anomalies prevented LVOTO relief in four, only permitting for Senning/VSD closure (one) or univentricular palliation (three). CONCLUSIONS: LVOTO resection and pulmonary valvotomy frequently permits an ASO. Inlet VSD, impossibility of VSD enlargement, straddling mitral valve, distant aorta and small right ventricle make the Nikaidoh procedure the best option. Mitral anomalies preventing LVOTO relief can make biventricular repair impossible %0 Journal Article %C Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh, Pittsburgh, PA 15231, USA. hebertrs@upmc.edu %A Hebert, Randy S %A Dang, Qianyu %A Schulz, Richard %J Am J Geriatr Psychiatry %D 2007 Apr %N 4 %P 292-300 %T Religious beliefs and practices are associated with better mental health in family caregivers of patients with dementia: findings from the REACH study %V 15 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17158632 %X OBJECTIVE: Providing care to a loved one with dementia and the death of that loved one are generally considered two of the most stressful human experiences. Each puts family caregivers at risk of psychologic morbidity. Although research has suggested that religious beliefs and practices are associated with better mental health, little is known about whether religion is associated with better mental health in family caregivers. Our objective, then, is to explore the relationship between religion and mental health in active and bereaved dementia caregivers. METHODS: A total of 1,229 caregivers of persons with moderate to severe dementia were recruited from six geographically diverse sites in the United States and followed prospectively for up to 18 months. Three measures of religion: 1) the frequency of attendance at religious services, meetings, and/or activities; 2) the frequency of prayer or meditation; and 3) the importance of religious faith/spirituality were collected. Mental health outcomes were caregiver depression (Center for Epidemiological Studies-Depression [CES-D] scale) and complicated grief (Inventory of Complicated Grief [ICG]). RESULTS: Religious beliefs and practices were important to the majority of caregivers. After controlling for significant covariates, the three measures of religion were associated with less depressive symptoms in current caregivers. Frequent attendance was also associated with less depression and complicated grief in the bereaved. CONCLUSIONS: Religious beliefs and practices, and religious attendance in particular, are associated with better mental health in family caregivers of persons with dementia %0 Journal Article %C Oregon Health Science University, Portland, Oregon, USA. edward.hickey@sickkids.ca %A Hickey, Edward J %A You, Xiaomang %A Kaimaktchiev, Vassil %A Ungerleider, Ross M %J Eur J Cardiothorac Surg %D 2007 May %N 5 %P 906-14 %T Hypoxemic reperfusion exacerbates the neurological injury sustained during neonatal deep hypothermic circulatory arrest: a model of cyanotic surgical repair %V 31 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17331738 %X OBJECTIVE: Deep hypothermic circulatory arrest (DHCA) is frequently used in infants undergoing the Norwood procedure. These infants are necessarily hypoxemic after separation from CPB. Considerable energy has been spent characterizing the physiological and histological consequences of DHCA, but these have largely focused on a normoxemic period of reperfusion. Furthermore, evidence has accumulated to suggest that the cerebral vascular autoregulatory mechanisms are dysfunctional following DHCA. In particular, the vasodilatation that elevates cerebral blood flow (CBF) in response to hypoxemia is absent. This study therefore aimed to investigate whether post-CPB hypoxemia exacerbates brain injury resulting from DHCA. METHODS: Twelve neonatal piglets were subjected to 2h DHCA and then separated from CPB. They were then randomized to either: Group 1, normoxic ventilation (n=5); or Group 2, hypoxemia (n=7), in which the arterial PaO(2) was reduced to 40-50 mmHg for the duration of reperfusion. Following a 20 h period of warm reperfusion, the animals were perfusion fixed and the brain analyzed for histological evidence of injury. Nine additional animals were studied in one of three control groups. RESULTS: All animals survived the protocol. Post-operative parameters - including mean arterial pressure, acid-base status, inotrope requirements and arterial PaCO(2) - were similar. None of the control animals had any evidence of ischemia. Group 1 animals had moderate injury (total score 7.4+/-1.6). In Group 2, three animals sustained irretrievable brain injury evidenced by gross edema and early liquefactive necrosis. The remaining four had severe ischemic histological changes (score 14.5+/-1.6, p<0.03). CONCLUSIONS: Hypoxemic reperfusion after prolonged DHCA results in increased neuronal loss. The use of DHCA for staged palliation may confer disproportionately greater cerebral risk than other patient groups. Alternatively, methods to augment oxygen delivery - such as by ECMO - may be of particular benefit in the early re-perfusion window %0 Journal Article %C Royal Tropical Institute, PO Box 95001, 1090 HA Amsterdam, The Netherlands. t.hilhorst@kit.nl %A Hilhorst, T %A van Liere, M J %A Ode, A V %A de Koning, K %J SAHARA J %D 2006 May %N 1 %P 382-93 %T Impact of AIDS on rural livelihoods in Benue State, Nigeria %V 3 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17601020 %X This study addresses the socio-economic impact of AIDS on rural livelihoods in Benue State, Nigeria, where HIV prevalence is 9.3% but the number of AIDS cases is still relatively low. About 6% of the study households had experienced illness and death classified as AIDS, and reported high costs in terms of expenditures and time spent on care, funerals and mourning. These demands on time affected income and productivity, while the diversion of resources had implications for investments and savings. Coping strategies varied between households, mainly as a reflection of asset levels, which were often related to the gender of the household head. Reported coping strategies also differed between ethnic groups. First-line relatives were the most important source of support for households under pressure. Erosive coping strategies that undermined the sustainability of livelihoods were used by more vulnerable households following multiple cases of illness and death. Mourning practices, rules of inheritance and stigma tended to increase a household's vulnerability. Currently, Benue State is facing growing adult morbidity and mortality because of HIV infections. A context-specific study of its possible impact in a setting with a still relatively low number of AIDS cases is therefore important for informing local policy development and for building advocacy %0 Journal Article %C Division of Nursing Research (P.S.H., J.S.G.), Departments of Biostatistics (X.T., S.N.R., K.M., D.K.S.) and Oncology (C.-H.P.), and the Palliative and End-of-Life Care Task Force (P.S.H.), St. Jude Children's Research Hospital, Memphis, Tennessee; and Texas Children's Cancer Center (M.H.), Houston, Texas, USA %A Hinds, PS %A Hockenberry, M %A Tong, X %A Rai, SN %A Gattuso, JS %A McCarthy, K %A Pui, CH %A Srivastava, DK %J J Pain Symptom Manage %D 2007 Jul %T Validity and Reliability of a New Instrument to Measure Cancer-Related Fatigue in Adolescents %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17629669 %X Adolescents undergoing treatment for cancer rate fatigue as their most prevalent and intense cancer- and treatment-related effect. Parents and staff rate it similarly. Despite its reported prevalence, intensity, and distressing effects, cancer-related fatigue in adolescents is not routinely assessed during or after cancer treatment. We contend that the insufficient clinical attention is primarily due to the lack of a reliable and valid self-report instrument with which adolescent cancer-related fatigue can be measured. Our aim was to determine the reliability and construct validity of a new instrument and its ability to measure change in fatigue over time. Initial testing involved 64 adolescents undergoing curative treatment of cancer who completed the Fatigue Scale-Adolescent (FS-A) at two to four key points in treatment in one of four studies. Internal consistency estimates ranged from 0.67 to 0.95. Validity estimates involving the FS-A with the parent version ranged from 0.13 to 0.76; estimates involving the staff version and the Reynolds Depression Scale were 0.27 and 0.87, respectively. Additional validity findings included significant fatigue differences between anemic and nonanemic patients (P=0.042) and the emergence of four factors in an exploratory factor analysis. Findings further indicate that the FS-A can be used to measure change over time (t=2.55, P<0.01). In summary, the FS-A has moderate to strong reliability and impressive validity coefficients for a new research instrument %0 Journal Article %C Division of Nursing Research, St. Jude Children's Research Hospital in Memphis, TN, USA. pam.hinds@stjude.org %A Hinds, Pamela S %A Burghen, Elizabeth A %A Haase, Joan E %A Phillips, Celeste R %J Oncol Nurs Forum %D 2006 Jan %N 1 Suppl %P 23-9 %T Advances in defining, conceptualizing, and measuring quality of life in pediatric patients with cancer %V 33 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17202086 %X PURPOSE/OBJECTIVES: To describe the notable advances in defining, conceptualizing, and measuring quality of life (QOL) in pediatric patients with cancer since the 1995 Oncology Nursing Society's State-of-the-Knowledge Conference on QOL. DATA SOURCES: Published research, clinical papers, and hospital policies. DATA SYNTHESIS: QOL ratings from children and adolescents are being solicited increasingly in research and clinical assessments during treatment and survivorship using various methods but are not solicited from terminally ill patients; qualitatively induced models of pediatric cancer-related QOL now are being tested using quantitative methods. CONCLUSIONS: Children aged five years and older are able to report their cancer-related QOL; reliable and valid QOL instruments exist for all phases of treatment except end of life. IMPLICATIONS FOR NURSING: Nurses can involve children and adolescents in rating their QOL for research and clinical purposes and can apply theory-based QOL models to direct care %0 Journal Article %C Department of Geriatrics, Nagoya University Graduate School of Medicine %A Hirakawa, Yoshihisa %A Masuda, Yuichiro %A Kuzuya, Masafumi %A Iguchi, Akihisa %A Uemura, Kazumasa %J Nippon Ronen Igakkai Zasshi %D 2007 May %N 3 %P 380-3 %T [End-of-life care in the curriculum in Japan: a national survey of senior medical students] %V 44 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17575444 %X AIM: We conducted a national survey of senior medical students' attitudes about end-of-life care teaching programs for undergraduate students of Japanese medical schools from April 2004 to May 2006. METHODS: Our questionnaire survey focused on the students' attitudes towards the following end-of-life areas: 1) end-of-life topics, 2) teaching methods, 3) putting theories into practice, and 4) overall end-of-life issue. RESULTS: Overall, 1,039 students from 16 medical schools responded to our survey. The students who took part in the program appreciated the class on communication techniques with dying patients or family members of dying patients. As for the students who did not participate in the program, they expressed the wish to join a class concerning these issues. These students also expressed an interest in visiting hospices or conducting interviews with dying patients as part of their training. Most of the students formulated good opinions toward end-of-life issues, but not toward end-of-life practices. Regardless of whether they joined the program or not, most of the students had a positive attitude towards end-of-life education programs. CONCLUSION: The survey highlighted the need to consider wider implementation and improvement of end-of-life care education in the Japanese curriculum %0 Journal Article %C Institut Bergonie 229, cours de l'Argonne 33076 Bordeaux Cedex, France. hoerni@bergonia.org %A Hoerni, B %J Rev Med Suisse %D 2007 Apr %N 106 %P 968 %T [Euthanasia continued] %V 3 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17575977 %0 Journal Article %C Division of Hematology-Oncology and the Palliative Care Service of the Department of Medicine, and of Long Island Jewish Hospital campus of the Albert Einstein College of Medicine, New Hyde Park, NY, USA. mhoffman@lij.edu %A Hoffman, Mark A %A Weiner, Joseph S %J J Clin Oncol %D 2007 Jul %N 19 %P 2853-6 %T Is Mrs S depressed? Diagnosing depression in the cancer patient %V 25 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17602092 %0 Journal Article %C Department of Surgery, Institut Paoli-Calmettes, 232 Bd Sainte Marguerite, Marseilles, France %A Houvenaeghel, G %A Lelievre, L %A Buttarelli, M %A Jacquemier, J %A Carcopino, X %A Viens, P %A Gonzague-Casabianca, L %J Eur J Surg Oncol %D 2007 May %N 4 %P 498-503 %T Contribution of surgery in patients with bulky residual disease after chemoradiation for advanced cervical carcinoma %V 33 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17156969 %X AIM: To report the outcome of 30 patients who underwent surgery after concomitant chemoradiation for locally advanced cervical cancer with residual disease > or = 2 cm. METHODS: From 1988 to 2004, 143 patients with FIGO stage IB2-IVA cervical cancer underwent surgery after concurrent chemoradiotherapy. Among them, 30 had a residual cervical tumour > or = 2 cm prior to surgery. Surgery consisted in a simple or radical hysterectomy (n=15) or in a pelvic exenteration (n=15). Endpoints were recurrence and distant metastasis rates, overall survival (OS) and disease-free survival (DFS) at 3 and 5 years. Analysis included FIGO stage, response to chemoradiation, para-aortic lymphatic status or type of surgery: palliative (remaining disease after surgery) or curative (no evidence of remaining disease after surgery). RESULTS: Surgery has been only palliative in 11 cases. Pelvic recurrences occurred in 8 patients after a median interval of 8.8 months. Distant metastases occurred in 8 patients after a median interval of 13 months. So far, 16 patients have died (53.3%). The 3-year and 5-year OS rates are 64.9% and 55.6%, respectively, for the 19 patients who had a curative surgery. The DFS rate is 50.8% at 3 and 5 years in this latter group. Overall 12 patients (40%) are alive and free of disease after a median follow-up of 32.5 months. CONCLUSIONS: Adjuvant surgery may improve the outcome of patients with bulky residual tumour after chemoradiation for locally advanced cervical cancer, allowing a 5-year OS of 55.6% after curative intervention %0 Journal Article %C University of Minnesota, Center for Animal Health and Food Safety, USA %A Hueston, William %A Klausner, Jeffrey %A Singleton, Stephan %J Minn Med %D 2007 Apr %N 4 %P 40-2 %T One medicine--today's imperative %V 90 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17494537 %0 Journal Article %C Division of Hepatogastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung Medical Center and Chang Gung University, College of Medicine, Kaohsiung, Taiwan %A Hung, Fu-Chih %A Kuo, Chung-Mou %A Chuah, Seng-Kee %A Kuo, Chung-Huang %A Chen, Yaw-Sen %A Lu, Sheng-Nan %A Chang Chien, Chi-Sin %J J Gastroenterol Hepatol %D 2007 May %N 5 %P 724-8 %T Clinical analysis of primary duodenal adenocarcinoma: an 11-year experience %V 22 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17444863 %X BACKGROUND AND AIM: The impact of obstructive jaundice (OJ) complicated by primary duodenal adenocarcinoma (PDA) on survival, and its treatment options, has rarely been mentioned in literature. The aim of the present study was to review the clinical features of PDA patients in an attempt to determine the prognostic factors and the influence of OJ on survival. METHODS: From May 1994 to February 2005, all duodenal malignancies treated at Kaohsiung Chang Gung Memorial Hospital were reviewed. Preliminary findings were made on a total of 116 duodenal adenocarcinoma (DA) cases. After excluding metastatic DA and the papilla of Vater cancer, 23 patients (19.8%), confirmed as having PDA, were enrolled. RESULTS: Among the 23 predominantly male patients with a mean age of 68 years, abdominal pain was the most common symptom. Major tumor origin was the second portion, and the predominantly cytological feature was moderate differentiation. Tumor-node-metastasis (TNM) cancer stage IV accounted for 47.8% of the patients, and cancer-directed surgeries (CDS) were performed on 11 patients. Seven patients experienced complications due to OJ, which could be a sign of grave prognosis predicting survival of less than 1 year. Four of the patients received internal or external biliary drainage before CDS or palliative surgeries. Cigarette smoking, cytology, TNM stage, aspartate aminotransferase (AST), OJ, and CDS were significant factors of overall survival in a univariate analysis. The independent predictors of long-term survival were CDS, TNM stage, cytology, cigarette smoking, and AST using the Cox proportional hazard model. CONCLUSION: PDA patients who did not smoke and who were eligible for and received CDS had better prognostic outcomes %0 Journal Article %C Department of Radiology, Tulane University Medical Center, New Orleans, USA %A Hutchins, Troy %A Friedlander, Paul %A Palacios, Enrique %J Ear Nose Throat J %D 2007 May %N 5 %P 266-7 %T Anaplastic thyroid carcinoma %V 86 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17580801 %0 Journal Article %A Ivanov, K P %J Usp Fiziol Nauk %D 2007 Apr-Jun %N 2 %P 63-74 %T [Physiological blocking of the mechanisms of the cold death] %V 38 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17578019 %X Physiological mechanisms of the cold paralyses of the main, most important functions during deep hypothermia of a homeothermic organism were studied. The reasons for the organism death upon deep cooling were revealed. The cold paralyses and the following organism death were shown to be accounted for to a great extent by the specific impairments in the ion exchange between the nervous cells of vegetative brain centers and the intercellular medium and the blood. Removing these impairments with the help of the methods developed in the authors laboratory allows the lost physiological functions of an organism to be restored for a time without rewarming the body %0 Journal Article %C WA Centre for Cancer and Palliative Care, Curtin University, Perth, WA, Australia. m.jiwa@curtin.edu.au %A Jiwa, Moyez %A Ee, Hooi C %A J Beilby, Justin %J Med J Aust %D 2007 Jul %N 2 %P 71-2 %T Will promoting general practitioners with special interests threaten access to primary care? %V 187 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17635085 %X Increasing the number of "special interest" GPs may exacerbate the current GP shortage %0 Journal Article %C School of Social Work at the University of Michigan, 1080 South University Avenue, Ann Arbor, MI 48109, USA. sjoe@umich.edu %A Joe, Sean %A Romer, Daniel %A Jamieson, Patrick E %J Suicide Life Threat Behav %D 2007 Apr %N 2 %P 165-78 %T Suicide acceptability is related to suicide planning in U.S. adolescents and young adults %V 37 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17521270 %X The association between adolescents' and young adults' attitudes toward suicide and their own suicidality across five racial-ethnic classifications was studied in a nationally representative sample of 3,301 youth ages 14 to 22 years from the National Annenberg Risk Survey of Youth. Results indicate that adolescents and young adults who most strongly believe that it is acceptable to end one's life are more than fourteen times more likely to make a plan to kill themselves as those who do not have such beliefs (p < .001). Future behavioral prevention and intervention research should take into consideration adolescents' and young adults' approval of suicide as a risk factor for taking their own lives %0 Journal Article %C Katedra Ortopediii TraumatologiiDzieciecej, Pracownia Biomechaniki Ruchu, Akademia Medyczna im. Karola Marcinkowskiego w Poznaniu %A Jozwiak, Marek %A Idzior, Maciej %A Kowalski, Ireneusz %J Chir Narzadow Ruchu Ortop Pol %D 2007 Jan-Feb %N 1 %P 43-9 %T [Talectomy for the clubfeet treatment in children with myelomeningocoele] %V 72 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17639918 %X Talectomy, despite its palliative character, seems to be a treatment of choice in many cases of severe neurogenic clubfeet. The aim of our study was to determine the value of talectomy in the treatment of equinovarus deformity in children with myelomeningocoele. MATERIAL AND METHOD: The material consists of 12 children with myelomeningocele (21 neurogenic clubfeet), treated by talectomy. The results of two post-operative follow-up examinations were included--first after 15 months (follow-up I, second after 30 months (follow-up II). The material was divided into two groups: I--consist of feet after talectomy combined with wedge resection of calcaneo-cuboid joint, and II--the feet which underwent "only" talectomy. The calcaneo-cuboid wedge osteotomy was performed to improve the forefoot position for the correction of the more severe deformity. The clinical and X-ray records concerning preoperative period were reviewed. At the follow-up the clinical, radiological and functional evaluation were performed with the special affiliation on modified Magone scale. RESULTS: Satisfactory clinical results were achieved in all feet except one which required reoperation. Walking ability in orthopaedic fit was present in 5 cases before surgery, and increased to 9 at follow-up. There were no radiological signs of the tibio-calcaneal fusion at the time of observation. During follow-up, on the basis of radiograms made in lateral position, gradual limitation of ROM in so called "tibio-calcaneal" joint was observed. At follow-up I according to modified Magone scale good clinical result was observed in 3 feet, satisfactory in 10, and unsatisfactory in the remaining 3 feet. At follow-up II 3 were defined as good, 4 were defined as satisfactory and the remaining 8 as pour results (only patients who underwent two postoperative examinations). The clinical deterioration does not correlate with the lost of feet shape correction--but mainly with the lost of the ROM in the new "tibio-calcaneal" joint. There were no statistically significant differences between the clinical outcome of feet from group I and II. The authors concluded that the additional wedge resection of calcaneo-cuboid joint improved the forefoot position and, by this way, makes the surgery correction easier %0 Journal Article %C Departement De Nephrologie, Hopital Edouard Herriot, Hospices Civils de Lyon, Lyon, France. laurent.juillard@chu-lyon.fr %A Juillard, Laurent %A Lemoine, Sandrine %A Janier, Marc F %A Barthez, Paul Y %A Bonnefoi, Frederic %A Laville, Maurice %J Hypertension %D 2007 Jul %N 1 %P 242-7 %T Validation of renal oxidative metabolism measurement by positron-emission tomography %V 50 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17502492 %X Either in research or in clinical practice, the exploration of renal oxidative metabolism is limited by the lack of noninvasive measurement. Positron-emission tomography using carbon-11 acetate may estimate tissue oxidative metabolism by measuring acetate turnover in the Krebs cycle. Although extensively studied in cardiology, this method has never been validated for renal oxidative metabolism measurement. The aim of this study is the validation of acetate turnover compared with the invasive renal oxygen consumption measurement. Renal oxygen consumption and tubular sodium reabsorption were measured invasively in 10 anesthetized pigs. Simultaneously, acetate turnover was estimated by the clearance of carbon-11 acetate in the renal cortex, after a 166-MBq injection of carbon-11 acetate. Renal oxidative metabolism was measured under various conditions induced by mechanical and pharmacological interventions. Renal oxygen consumption and acetate turnover varied on a wide range from 0.05 to 0.29 mmol min(-1) (>5-fold) and from 0.025 to 0.188 minutes(-1) (>7-fold), respectively. Acetate turnover was very significantly correlated with renal oxygen consumption (P<0.0001; R=0.82) and tubular sodium reabsorption (P=0.001; R=0.67). This study demonstrates that acetate turnover measures renal oxidative metabolism noninvasively and quantitatively, consistent with changes in tubular sodium reabsorption. This method may be applied to assess oxidative metabolism in animal models and in humans %0 Journal Article %C Queensland University of Technology, Centre for Health Research, Victoria Park Road, Kelvin Grove, Queensland, Australia. v.kain@qut.edu.au %A Kain, Victoria J %J Int J Palliat Nurs %D 2007 May %N 5 %P 243-8 %T Moral distress and providing care to dying babies in neonatal nursing %V 13 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17577177 %X Moral distress in nursing is a prevalent theme in the literature. Although this issue has been investigated in other nursing disciplines, it has not been investigated by empirical research in the emotionally and ethically sensitive area of providing care to dying babies. Moral distress occurs when nurses are prevented from translating moral choices into moral action. The response to moral distress is anger, resentment, guilt, frustration, sorrow and powerlessness. If not addressed, self-worth may be jeopardised, affecting personal and professional relationships. A review of the literature was conducted to explore moral distress in neonatal nursing when providing care to dying babies. This literature review provides a basis for the direction of further research and hypothesis testing. Further focused research is necessary in this under-theorised area of nursing practice to clarify the significance of moral distress for neonatal nurses caring for dying babies %0 Journal Article %C Department of Obstetrics and Gynaecology, College of Health Sciences, University of Nairobi, P.O. Box 1%76-00202, Nairobi, Kenya %A Kamau, R K %A Osoti, A O %A Njuguna, E M %J East Afr Med J %D 2007 Jan %N 1 %P 24-30 %T Effect of diagnosis and treatment of inoperable cervical cancer on quality of life among women receiving radiotherapy at Kenyatta National Hospital %V 84 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17633581 %X BACKGROUND: Cancer of the uterine cervix is the most common female cancer in Kenya. Despite being preventable, it is often diagnosed when it is already late. For this reason, only palliative therapy is provided. Hence, it is expected that their daily routines and that of their caregivers are severely disrupted. OBJECTIVES: To determine the extent to which diagnosis and treatment of inoperable cervical carcinoma affects quality of life (QOL). DESIGN: Cross-sectional descriptive study. Setting Radiotherapy Department at the Kenyatta National Hospital. SUBJECTS: Women undergoing radiotherapy for inoperable cervical cancer. RESULTS: There is high prevalence of profound disruptions in nearly all domains of QOL. In the social domain, between 33% and 44% had the perception that family members and friends had withdrawn social support. Reduction in various economic facets was reported by 47.4%-52.6%, with 44.7% reporting a fall in the overall living standards. There were significant changes in the sexual domain, as a result in which 28.3% reported marital discordance. In the personality domain, decreased self-esteem and self-projection in life occurred in 30.9% and 36.2% respectively. On functional outcomes (EORTC QLQ-C30), only 32%-41% reported not being affected in the various facets of emotional function. Physical functions were affected in 19%-79%, role functions in 69%-75%; symptoms in 49%-80%; cognitive functions in 46%-56%; social functions in 63%-71% and financial aspects by 63%. On global QOL, 53% and 47% respectively reported high level disruption in overall physical health and overall QOL. CONCLUSION: Severe deterioration of QOL occurs as a result of diagnosis of inoperable cervical cancer and subsequent therapies. For this reason there is need to establish severe disease and end-of-life research and management services that would ensure better coping with cancer for patients and for home-based caregivers %0 Journal Article %C Division of Respiratory Medicine, Institute of Clinical Medicine, University of Tsukuba, Tsukuba Medical Center Hospital, Tsukuba, Japan %A Kanemoto, Kouji %A Satoh, Hiroaki %A Kagohashi, Katsunori %A Kurishima, Koichi %A Ishikawa, Hiroichi %A Ohtsuka, Morio %J Tuberk Toraks %D 2007 %N 1 %P 5-10 %T Psychotropic drugs for terminally ill patients with respiratory disease %V 55 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17401788 %X Utilization of psychotropic drugs including hypnotics, sedatives, and parenteral morphine for terminally ill patients with respiratory disease has not been reported precisely. To better understand these drugs for dying patients with respiratory disease, we focused on the last month of life of them. A chart review, which was focused on symptoms and managements, in the last month of life of 337 patients who died of respiratory disease between April 2000 and March 2005 were performed. Hypnotics were prescribed in 35.8% and 23.2% of patients with malignant and non-malignant disease, respectively. Sedatives such as haloperidol and midazolam were utilized in 34.4% of patients with malignant disease, and 30.4% of those with non-malignant disease. Sixty-seven percent of patients with malignant and 22.4% of those with non-malignant disease had parenteral morphine. In patients with malignant disease, three of the main reasons for administration of morphine were pain, dyspnea, or terminal restlessness. In all of the patients with non-malignant disease, however, parenteral morphine was prescribed for the treatment of dyspnea. Our results showed that psychotropic drugs and parenteral morphine are required in some of terminally ill patients with respiratory disease. Although careful individualization of medication is appropriate, guideline for the prescribing psychotropic drugs for these patients will be required %0 Journal Article %C Service de Chirurgie Digestive, Hopital Henri Mondor, 51 av du Marechal de Lattre-de-Tassigny, 94010 Creteil CEDEX, France. mehdi.karoui@hmn.aphp.fr %A Karoui, Mehdi %A Charachon, Antoine %A Delbaldo, Catherine %A Loriau, Jerome %A Laurent, Alexis %A Sobhani, Iradj %A Tran Van Nhieu, Jeanne %A Delchier, Jean Charles %A Fagniez, Pierre-Louis %A Piedbois, Pascal %A Cherqui, Daniel %J Arch Surg %D 2007 Jul %N 7 %P 619-23 %T Stents for palliation of obstructive metastatic colon cancer: impact on management and chemotherapy administration %V 142 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17638798 %X HYPOTHESIS: The more rapid and less complicated recovery after palliative stent insertion compared with surgery may theoretically facilitate the early administration of chemotherapy. DESIGN: A retrospective study. SETTING: University tertiary care referral center. PATIENTS: From January 1, 1996, to September 15, 2005, 58 patients with obstructing colon cancer and nonresectable synchronous metastases were treated with self-expanding colonic metallic stent (SEMS) (n = 31) or surgery (n = 27). MAIN OUTCOME MEASURES: Comparison of the use of SEMS and emergency surgery as palliative measures to treat obstructing colon cancer with special reference to time to chemotherapy administration and survival. RESULTS: Mortality and morbidity were comparable between the 2 groups. Median hospital stay was shorter after SEMS insertion than after surgery (median, 8.0 vs 13.5 days, respectively; P < .01). Incidence of stoma creation was lower in patients treated with SEMS than in patients treated with surgery (6% vs 37%, respectively; P = .02). The median time to chemotherapy administration was shorter after SEMS insertion than after surgery (14.0 vs 28.5 days, respectively; P = .002). Three patients with SEMS and 0 patients in the surgical group underwent a curative colonic and hepatic resection after downstaging by chemotherapy (P = .27). Two patients (6%) with SEMS and undergoing chemotherapy had a tumor perforation requiring emergency surgery. There was no difference in survival between the 2 groups (median survival, 13.7 months for SEMS vs 11.4 months for surgery; P = .19). CONCLUSIONS: Insertion of SEMS should be the first step to treat obstructing colon cancer with nonresectable synchronous metastases because it allows chemotherapy to be administered earlier, may increase the resectability rate of metastases, and favorably impacts survival. The risk of tumor perforation while receiving chemotherapy requires attention %0 Journal Article %C Department of Radiation Oncology, Duke University Medical Center, Durham, NC 27710, USA. kasib001@mc.duke.edu %A Kasibhatla, Mohit %A Steinberg, Peter %A Meyer, Jeffrey %A Ernstoff, Marc S %A George, Daniel J %J Clin Genitourin Cancer %D 2007 Mar %N 4 %P 291-4 %T Radiation therapy and sorafenib: clinical data and rationale for the combination in metastatic renal cell carcinoma %V 5 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17553211 %X Sorafenib, an inhibitor of multiple tyrosine kinases including vascular endothelial growth factor receptor and Raf/mitogen-activated protein kinase, increases progression-free survival in metastatic renal cell carcinoma (RCC) compared with placebo. The efficacy and toxicity of combined sorafenib and radiation therapy (RT) in the treatment of RCC are unknown. This is a retrospective report of 3 consecutive patients with metastatic or locally recurrent RCC treated with palliative RT while undergoing sorafenib therapy. All 3 patients experienced disease progression on sorafenib and remained on the drug without dose reduction during the RT plus sorafenib regimen. They were followed for toxicity and response by clinical history, physical examination, and contrast-enhanced computed tomography scans. Soon after completion of palliative RT, all 3 patients experienced complete pain relief without the need for narcotic pain medication. Posttreatment imaging revealed partial response with > 50% regression of tumor in all patients. None reported significant acute or late side effects at follow-up of 3, 6, and 8 months after RT and sorafenib. In the 3 patients with recurrent or metastatic RCC in this report, the combination of RT and sorafenib was well tolerated and resulted in excellent clinical and radiologic responses. This combination is promising and requires further study %0 Journal Article %C Department of Cardiothoracic Surgery, Christchurch Public Hospital, Christchurch %A Kathiravel, Yaso %A Westwood, David %A Macemon, Jeff %A Singh, Harsh %J N Z Med J %D 2007 %N 1257 %P U2609 %T An international surgical collaboration for the management of pulmonary artery sarcoma: a New Zealand experience %V 120 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17632599 %X We present the case of a 73-year-old man with a pulmonary artery sarcoma successfully treated as a result of an international surgical collaboration. The tumour was initially deemed to be unresectable due to a lack of local expertise managing cardiac malignancies. Since the patient was unable to travel to a specialist centre in the United States, he was initially offered only palliative therapy. However, two surgeons with experience of treating malignant cardiac tumours travelled to New Zealand specifically to perform a potentially curative resection of his tumour. This case suggests that there should be an emphasis placed on the development of internationally acceptable protocols for the treatment of rare conditions and improved local access to overseas surgical expertise %0 Journal Article %C Medical Oncology Division, National Cancer Center Hospital %A Kato, Yuki %A Katsumata, Noriyuki %J Gan To Kagaku Ryoho %D 2007 Jul %N 7 %P 1017-21 %T [Ovarian cancer from the standpoint of medical oncology.] %V 34 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17637538 %X Ovarian cancer is chemosensitive. Staging surgery followed by the first line chemotherapy is recommended no matter the stage. For recurrent disease,it is difficult to prolong the survival by chemotherapy. The goal is palliation. When primary debulking surgery can not be achieved because of patients' status, neoadjuvant chemotherapy followed by interval debulking surgery should be considered,although it is still in clinical-trials %0 Journal Article %C Dept. of Surgery, Kurashiki Central Hospital %A Kawamoto, Kazuyuki %A Yamaguchi, Kazushige %A Okabe, Michio %A Tsuruta, Atsushi %A Morimoto, Yoshinori %A Niwano, Mototaka %A Sano, Kaoru %A Paku, Tebun %A Imai, Shiro %A Yoshida, Yasuo %A Ito, Tadashi %A Ogasahara, Keizo %J Gan To Kagaku Ryoho %D 2007 Jul %N 7 %P 1131-4 %T [A case of advanced pancreatic cancer successfully treated by combined chemotherapy of s-1 and gemcitabine as second-line chemotherapy.] %V 34 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17637556 %X The patient was a 63-year-old man who suffered from advanced pancreatic cancer (T 4 N 3 M 0, StageIVb). Palliative operation was performed for obstructive jaundice. He was treated with chemotherapy of gemcitabine (GEM) alone as first-line, and combined chemotherapy of GEM and S-1 as second-line. Both therapies were effective for this patient. Tumor marker (CA 19-9) decreased after chemotherapies (first-line:5,69 2 U/mL to 70U/mL, second-line:4,877 U/mL to 562 U/mL). No toxic events were observed due to these therapies, so he was treated as an outpatient for about 2 years. It was considered that he had a good quality of life %0 Journal Article %C Division of Community Health Sciences: General Practice Section, University of Edinburgh, Edinburgh EH8 9DX, UK %A Kendall, Marilyn %A Boyd, Kirsty %A Campbell, Christine %A Cormie, Paul %A Fife, Shirley %A Thomas, Keri %A Weller, David %A Murray, Scott A %J Fam Pract %D 2006 Dec %N 6 %P 644-50 %T How do people with cancer wish to be cared for in primary care? Serial discussion groups of patients and carers %V 23 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=16837479 %X BACKGROUND: In most economically developed countries, patients, their informal and professional carers and policy makers are calling for more care in the community. OBJECTIVES: To involve patients with cancer, and their carers, in designing a framework for providing effective cancer care in primary care. METHODS: Two discussion groups comprising 18 people with current cancer and carers met monthly over a year in the south of Scotland. RESULTS: Patients with cancer and their carers identified five key times in the cancer journey as being especially significant from their perspective: around diagnosis, during treatment, after discharge, at recurrence and the final weeks. At each key time, there were five major issues of concern: information, communication, equity, a holistic approach and patient-centred care. Using these, the group members developed a checklist of recommended interventions for each stage in the illness trajectory and suggested how they might be implemented in primary care. Proactive and ongoing contact, if wished by the patient, was considered the central plank of cancer care in the community. CONCLUSIONS: Patients with cancer and their carers believe that there is an important and unique role for primary care in offering continuity of care and information that is patient-centred and holistic, throughout the cancer trajectory, from first presentation. This study successfully brought patient, carer and professional perspectives to the development of a care framework for primary care %0 Journal Article %C Department of Psychiatry, University of Muenster, Albert-Schweitzer-Str. 11, 48129, Muenster, Germany, anette.kersting@ukmuenster.de %A Kersting, A %A Kroker, K %A Steinhard, J %A Ludorff, K %A Wesselmann, U %A Ohrmann, P %A Arolt, V %A Suslow, T %J Eur Arch Psychiatry Clin Neurosci %D 2007 Jul %T Complicated grief after traumatic loss : A 14-month follow up study %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17629729 %X The traumatic loss of an unborn child after TOP due to fetal malformation and/or severe chromosomal disorders in late pregnancy is a major life-event and a potential source of serious psychological problems for those women. To obtain information on the course of grief following a traumatic loss, 62 women who had undergone TOP between the 15th and 32nd gestational week were investigated in a longitudinal study design and compared with 65 women after spontaneous delivery of a full-term healthy child. Grief, posttraumatic stress, depression, anxiety and psychiatric disorders were evaluated 14 days, 6 months and 14 months after the event, implementing validated self-report and clinician rated instruments. Compared to women after spontaneous delivery, women after induced TOP were significantly more stressed regarding all psychological outcomes at all three measuring points. Especially, 14 months after TOP 13.7% of the women fulfilled all criteria of a complicated grief diagnoses following Horowitz et al. (1997, Am J Psychiat 154:7904-7910). 16.7% were diagnosed as having a manifest psychiatric disorder according to DSM-IV. All in all, 25% of these women were critically affected by the traumatic loss. TOP for fetal anomaly is to be seen as a major life event, which causes complicated grief reactions and psychiatric disorders for a substantial number of women %0 Journal Article %A Khaliq, W %A Alam, S %A Puri, N %J Cochrane Database Syst Rev %D 2007 %N 2 %P CD004846 %T Topical lidocaine for the treatment of postherpetic neuralgia %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17443559 %X BACKGROUND: The cause of postherpetic neuralgia is damage to peripheral neurons, dorsal root ganglia, and the dorsal horn of the spinal cord, secondary to herpes zoster infection (shingles). In postherpetic neuralgia, peripheral neurons discharge spontaneously and have lowered activation thresholds, and exhibit an exaggerated response to stimuli. Topical lidocaine dampens peripheral nociceptor sensitisation and central nervous system hyperexcitability, and may benefit patients with postherpetic neuralgia. OBJECTIVES: To examine the efficacy and safety of topical lidocaine in the treatment of postherpetic neuralgia. SEARCH STRATEGY: We searched the Cochrane Pain, Palliative and Supportive Care Group Trials Register, The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and LILACS, SIGLE for conference proceedings, Citation Index, the reference lists of all eligible trials, key textbooks, and previous systematic reviews. We also wrote to authors of all identified trials. SELECTION CRITERIA: Randomised or quasi-randomised trials comparing all topical applications of lidocaine, including gels and patches in patients of all ages with postherpetic neuralgia (pain persisting at the site of shingles at least one month after the onset of the acute rash). DATA COLLECTION AND ANALYSIS: Two review authors extracted data, and a third checked them. We obtained some missing data from the US Food and Drugs Administration. MAIN RESULTS: Three trials involving 182 topical lidocaine treated participants and 132 control participants were included. Two trials gave data on pain relief, and the remaining study provided data on secondary outcome measures. The largest trial published as an abstract compared topical lidocaine patch to a placebo patch and accounted for 150 of the 314 patients (48%).A meta-analysis combining two of the three studies identified a significant difference between the topical lidocaine and control groups for the primary outcome measure: a mean improvement in pain relief according to a pain relief scale. Topical lidocaine relieved pain better than placebo (P = 0.003).There was a statistical difference between the groups for the secondary outcome measure of mean VAS score reduction (P = 0.03), but this was only for a single small trial. There were a similar number of adverse skin reactions in both treatment and placebo groups.The highest recorded blood lidocaine concentration varied between 59 ng/ml and 431 ng/ml between trials. The latter figure is high and the authors of the study suggest that the sample had been contaminated during the assay procedure. AUTHORS' CONCLUSIONS: There is insufficient evidence to recommend topical lidocaine as a first-line agent in the treatment of postherpetic neuralgia with allodynia. Further research should be undertaken on the efficacy of topical lidocaine for other chronic neuropathic pain disorders, and also to compare different classes of drugs (e.g. topical anaesthetics versus anti-epileptics) %0 Journal Article %C Department of Palliative Medicine (N.K., A.S., T.N., M.Y.), Tohoku University Hospital, and Division of Epidemiology (N.K., K.O., S.K., I.T.), Department of Public Health and Forensic Medicine, Tohoku University Graduate School of Medicine, Miyagi, Japan %A Kikuchi, N %A Ohmori, K %A Kuriyama, S %A Shimada, A %A Nakaho, T %A Yamamuro, M %A Tsuji, I %J J Pain Symptom Manage %D 2007 Jul %T Survival Prediction of Patients with Advanced Cancer: The Predictive Accuracy of the Model Based on Biological Markers %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17629667 %X To determine whether the addition of biological markers to performance status (PS) and physical symptoms would improve survival prediction among patients with advanced cancer, we developed two prediction models with a scoring system based on 294 consecutive patients with advanced cancer (training set), and then tested its validity on another 93 patients (testing set). We assessed the predictive accuracy of the models using receiver-operating characteristic analysis. Albumin (ALB), lactate dehydrogenase (LDH), and lymphocyte percentage (Lymp%) were significantly and independently associated with survival length. For prediction of 60-day survival, the predictive accuracy of Model 2, based on the above biological markers in addition to PS and symptoms, was significantly better than that of Model 1, based on PS and symptoms alone (area under the curve [AUC] for Model 2, 0.80+/-0.03; AUC for Model 1, 0.69+/-0.04; P<0.001). Addition of ALB, LDH, and Lymp% to PS and physical symptoms improved prediction accuracy, especially for longer survival %0 Journal Article %C Stepping Hill Hospital, Poplar Grove, Stockport, Cheshire, SK2 7JE, UK. darren.kilroy@stockport.nhs.uk %A Kilroy, Darren A %J Emerg Med J %D 2007 Jul %N 7 %P 467-70 %T Teaching the trauma teachers: an international review of the Advanced Trauma Life Support Instructor Course %V 24 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17582034 %X OBJECTIVES: To identify educational variations between Advanced Trauma Life Support (ATLS) Instructor Courses in the UK, USA and Australia, to determine the impact of any such variations, and to consider their contributory role in future course development. METHODS: Observational, participatory qualitative study of ATLS Instructor Courses held in three representative teaching centres in 2006 and 2007. RESULTS: Each international territory has developed individual approaches to the teaching of common course content. These approaches have a variable impact upon the educational efficacy of the course. CONCLUSIONS: Observation of educational practice in international course centres allows for a richer understanding of the nature and extent of variations in teaching methods and course organisation. The amalgamation of these variations will facilitate a more inclusive international common platform for the 8th edition Instructor Course %0 Journal Article %C Department of Diagnostic Radiology, Hannover Medical School, Hannover, Germany. kirchhoff.timm@mh-hannover.de %A Kirchhoff, Timm D %A Bleck, Joerg S %A Dettmer, Arne %A Chavan, Ajay %A Rosenthal, Herbert %A Merkesdal, Sonja %A Frericks, Bernd %A Zender, Lars %A Malek, Nisar P %A Greten, Tim F %A Kubicka, Stefan %A Manns, Michael P %A Galanski, Michael %J Hepatobiliary Pancreat Dis Int %D 2007 Jun %N 3 %P 259-66 %T Transarterial chemoembolization using degradable starch microspheres and iodized oil in the treatment of advanced hepatocellular carcinoma: evaluation of tumor response, toxicity, and survival %V 6 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17548248 %X BACKGROUND: In a multidisciplinary conference patients with advanced non-resectable hepatocellular carcinoma (HCC) were stratified according to their clinical status and tumor extent to different regional modalities or to best supportive care. The present study evaluated all patients who were stratified to repeated transarterial chemoembolization (TACE) from 1999 until 2003 in terms of tumor response, toxicity, and survival. A moderate embolizing approach was chosen using a combination of degradable starch microspheres (DSM) and iodized oil (Lipiodol) in order to combine anti-tumoral efficiency and low toxicity. METHODS: Fourty-seven patients were followed up prospectively. TACE treatment consisted of cisplatin (50 mg/m(2)), doxorubicin (50 mg/m(2)), 450-900 mg DSM, and 5-30 ml Lipiodol. DSM and Lipiodol were administered according to tumor vascularization. Patient characteristics, toxicity, and complications were outlined. In multivariate regression analyses of pre-treatment variables from a prospective database, predictors for tumor response and survival after TACE were determined. RESULTS: 112 TACE courses were performed (2.4+/-1.5 courses per patient). Mean maximum tumor size was 75 (+/-43) mm, in 68% there was bilobar disease. Best response to TACE treatment was: progressive disease (PD) 9%, stable disease (SD) 55%, partial remission (PR) 36%, and complete remission (CR) 0%. Multivariate regression analyses identified tumor size 30 months, R(2)=36%). Grade 3 toxicity occurred in 7.1% (n=8), and grade 4 toxicity in 3.6% (n=4) of all courses in terms of reversible leukopenia and thrombocytopenia. The incidence of major complications was 5.4% (n=6). All complications were managed conservatively. The mortality within 6 weeks after TACE was 2.1% (one patient). CONCLUSIONS: DSM and Lipiodol were combined successfully in the palliative TACE treatment of advanced HCC resulting in high rates of tumor response and survival at limited toxicity. Favourable tumor response was associated with tumor extent and vascularization. TACE using DSM and Lipiodol can be considered a suitable palliative measure in patients who might not tolerate long acting embolizing agents %0 Journal Article %C Department of Surgery A, Soroka University Medical Center, Ben-Gurion University of the Negev, P.O. Box 151, Beer-Sheva 84101, Israel. borkirsh@bgu.ac.il %A Kirshtein, B %A Ariad, S %A Mizrahi, S %A Man, S %A Walfisch, S %J Tech Coloproctol %D 2007 Jun %N 2 %P 121-6; discussion 126-7 %T Rectal bleeding and previous anticoagulant treatment in patients with colorectal cancer do not predict outcome %V 11 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17510744 %X BACKGROUND: The aim of this study was to determine whether the outcome of patients with colorectal cancer who presented with bleeding and a history of anticoagulant treatment was different from those who did not have bleeding or previous anticoagulant treatment. METHODS: This was a single institution, retrospective study of patients with colorectal cancer with and without a history of rectal bleeding and treatment with anticoagulants, assessed for age, gender, tumor site, stage, recurrence rate, and survival. RESULTS: A total of 621 consecutive patients (309 men) with a mean age of 70 years (range, 36-94 years) diagnosed with colorectal cancer between 1998 and 2004 were studied. Of these, 149 patients (24%) were referred for symptoms of rectal bleeding and 161 patients (26%) had been previously treated with anticoagulants. A total of 592 patients (95%) underwent curative or palliative surgery; endoscopic polypectomy was performed in 3 cases only and in 26 patients (4%) surgery was not performed due to advanced disease or critical illness. Patients with bleeding and a history of anticoagulant treatment presented commonly with stage I cancer. In addition, tumor stage III was less common in patients with previous anticoagulant treatment irrespective of presenting signs. Disease-free and overall survival rates were similar in all groups, irrespective of bleeding at presentation or anticoagulant treatment. CONCLUSIONS: Rectal bleeding and anticoagulant treatment do not affect the outcome of newly diagnosed patients with colorectal cancer %0 Journal Article %C Division of Colon and Rectal Surgery, Harbor-UCLA Medical Center, Torrance, California 90509, USA %A Konyalian, V R %A Rosing, D K %A Haukoos, J S %A Dixon, M R %A Sinow, R %A Bhaheetharan, S %A Stamos, M J %A Kumar, R R %J Colorectal Dis %D 2007 Jun %N 5 %P 430-7 %T The role of primary tumour resection in patients with stage IV colorectal cancer %V 9 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17504340 %X OBJECTIVE: The management of stage IV colorectal cancer is controversial. Resection of the primary tumour to prevent obstruction, bleeding or perforation is the traditional approach, although survival benefit is undetermined. Management consisting of diverting ostomy, enteric bypass, laser recanalization or endoscopic stenting is an alternative to radical resection. The purpose of this study was to determine the role of resection of the primary tumour in patients with stage IV colorectal cancer, with specific attention paid to survival benefit and safety. METHOD: This was a retrospective review of all stage IV colon and rectal cancer patients in our tumour registry between 1991 and 2002. Data collected included patient demographics, presenting symptoms, detail from the hospital course including diagnostic data and operative management, complications and survival time (days). Survival analysis was performed to assess the effect of primary tumour resection on long-term survival. RESULTS: 109 patients were studied. Sixty-two (57%) patients (group I) underwent resection of the primary tumour, whereas 47 (43%) patients (group II) were managed without resection. Median survival times for groups I and II were 375 (IQR: 179-759) and 138 (IQR: 35-262) days respectively (P < 0.0001). After controlling for age, sex, tumour location and level of liver involvement as well as liver function, patients who underwent resection still survived longer (HR = 0.34, 95% CI: 0.21-0.55). CONCLUSION: Palliative resection of the primary tumour plays an essential role in the management of stage IV colorectal cancer. Resection can offer increased survival and is indicated in certain patients with incurable disease. Limited metastatic tumour burden of the liver was associated with better survival in such patients %0 Journal Article %C 1Clinic of Cardiovascular Surgery, German Heart Center Munich, Technical University Munich, Germany %A Kostolny, M %A Hoerer, J %A Eicken, A %A Dietrich, C %A Schreiber, CF %A Lange, R %J Cardiol Young %D 2007 Jul %P 1-6 %T Impact of placing a conduit from the right ventricle to the pulmonary arteries as the first stage of further palliation in the Norwood sequence for hypoplasia of the left heart %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17637071 %X OBJECTIVE: We describe the experience from a single institution with the Norwood sequence of palliation for hypoplasia of the left heart, emphasizing complications related to placement of a conduit from the right ventricle to the pulmonary arteries and their management. METHODS: Between November, 2002 and January, 2006, we palliated 32 patients with hypoplastic left heart syndrome or its variants by placing a conduit from the right ventricle to the pulmonary arteries. We reviewed retrospectively the charts and angiograms from these patients. RESULTS: Hospital survival after construction of the conduit was 90.6%. There were 3 interstage deaths, of which 2 were likely due severe obstruction of the conduit. Stents were implanted into the proximal or medial portions of the conduits of 3 patients. Early revision of the distal anastomosis, and shortening the conduit, was performed early postoperatively in 2 patients. So far, 24 out 26 survivors of the first stage underwent a bi-directional cavopulmonary anastomosis after a mean interval of 4.3 plus or minus 1.4 months. Of these, 3 required a semi-urgent second stage of palliation because of worsening cyanosis, with one patient dying after the second stage. Completion of the Fontan circulation by insertion of an extracardiac conduit was performed in 8 patients at the mean age of 19.8 plus or minus 2.2 months. We were able to achieve biventricular repair in 1 patient, with aortic atresia, hypoplastic arch and ventricular septal defect, 4.3 months after the initial palliative procedure. Overall survival of the whole cohort of 32 patients was 78.9%, plus or minus 7.8%, at 5 months, and 74.3%, plus or minus 8.6%, up to 25 months. CONCLUSIONS: The introduction of the conduit placed from the right ventricle to the pulmonary arteries has led to an improved outcome in the complex entity of hypoplastic left heart syndrome and its variants. Stenosis of the conduit, nonetheless, may account for significant interstage morbidity, and often requires intervention or early installation of the second stage of palliation %0 Journal Article %C Department of Public Health, China Medical University, Taiwan, ROC. wukuo@mail.cmu.edu.tw %A Kuo, Hsien Wen %A Wu, Shu Jen %A Ma, Tso Ching %A Chiu, Ming-Chu %A Chou, Sze-Yuan %J J Psychosom Res %D 2007 Apr %N 4 %P 495-500 %T Posttraumatic symptoms were worst among quake victims with injuries following the Chi-chi quake in Taiwan %V 62 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17383502 %X OBJECTIVE: The aim of this study was to investigate the incidence of posttraumatic stress disorder (PTSD) and psychological health status among earthquake victims 1 year after the quake. METHOD: Two hundred and seventy-two quake victims from temporary housing units were interviewed. Posttraumatic symptoms was assessed using the Davidson Trauma Scale, Chinese version (DTS-C). Psychological health status was measured using the Chinese Health Questionnaire (CHQ). RESULTS: The percentage of posttraumatic symptoms was 16.5%. Fifty-seven percent of the victims were found to have psychological problems using the CHQ. Posttraumatic symptoms and psychological problems were more prevalent among women (22.2% and 64%), compared with men (9.2% and 47.9%). Posttraumatic symptoms and CHQ total scores were highest among 25- to 44-year-olds, and lowest in the over-60-year group. Based on linear and logistic regression models, age and injury were the only two factors that significantly affected posttraumatic symptoms and CHQ total scores. CONCLUSION: Consistent with the previous studies, it is vitally important to continue providing psychological counseling and social support for quake victims, particularly victims who sustained an injury %0 Journal Article %C The Leukemia/Bone Marrow Transplantation Program of British Columbia, Division of Hematology, Vancouver General Hospital, British Columbia Cancer Agency and the University of British Columbia, Vancouver, British Columbia, Canada %A Kuruvilla, John %A Shepherd, John D %A Sutherland, Heather J %A Nevill, Thomas J %A Nitta, Janet %A Le, Aulan %A Forrest, Donna L %A Hogge, Donna E %A Lavoie, Julye C %A Nantel, Stephen H %A Toze, Cynthia L %A Smith, Clayton A %A Barnett, Micheal J %A Song, Kevin W %J Biol Blood Marrow Transplant %D 2007 Aug %N 8 %P 925-31 %T Long-term outcome of myeloablative allogeneic stem cell transplantation for multiple myeloma %V 13 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17640596 %X Allogeneic stem cell transplantation (alloSCT) has been used in the hopes of harnessing the curative potential of the graft-versus-myeloma effect. This study examines the long-term outcomes of a large cohort of patients with myeloma who were treated with myeloablative alloSCT at a single center. Comparisons are made with those who were treated with autologous stem cell transplantation (ASCT). Between January 1989 and February 2002, 158 patients age 10 years post myeloablative alloSCT, similarly there are long-term survivors post-ASCT. Myeloablative alloSCT should not be considered standard treatment, and should only be considered in the context of a clinical trial %0 Journal Article %C From the *Department of Gastroenterology, Western Galilee Hospital, Nahariya; daggerRappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa; double daggerDepartment of Gastroenterology, Rambam Medical Center, Haifa; and section signDepartment of Pathology, Western Galilee Hospital, Nahariya, Israel %A Lachter, J %A Cooperman, JJ %A Shiller, M %A Suissa, A %A Yassin, K %A Cohen, H %A Reshef, R %J Pancreas %D 2007 Aug %N 2 %P 130-134 %T The Impact of Endoscopic Ultrasonography on the Management of Suspected Pancreatic Cancer-A Comprehensive Longitudinal Continuous Evaluation %V 35 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17632318 %X OBJECTIVES:: Between 1997 and 2001, a single-center chart review demonstrated significant impact of endoscopic ultrasonography (EUS) in evaluating suspected pancreatic cancer (PCA). Repeating and comparing this review with that from 2001 to 2004 was performed to determine whether increased use of EUS results in more patients being accurately chosen for curative versus palliative procedures, and for surgical versus nonsurgical oncotherapy. METHODS:: The complete systematic review was made up of electronic files from the gastroenterology, oncology, and pathology departments of patients presenting with suspected PCA. Results were compared with those obtained in 1997-2001. RESULTS:: From 2001 to 2004, 72 patients had PCA. Seven tumor types were identified. Forty-seven percent (34/72) of patients with suspected PCA were preoperatively staged by EUS; 24% (17/72) of all patients underwent surgery. Comparatively, from 1997 to 2001, only 32% (20/62) of patients were evaluated by EUS (P = 0.056) and 45% (28/62) of all patients underwent surgery (P < 0.01). The EUS detected a tumor in 32 of 34 cases. The EUS-guided fine-needle aspiration cytology identified PCA in 14 of 18 cases. F-18-deoxyglucose-positron emission tomography and magnetic resonance imaging were not used. Endoscopic retrograde cholangiopancreatography was performed in 29% (21/72) of patients, with 15 stents inserted. CONCLUSIONS:: Increased EUS use for diagnosing and staging PCA resulted in fewer patients undergoing futile surgery. The EUS plays a pivotal role in the management of patients with PCA %0 Journal Article %C University Medical Center Utrecht, Department of Nuclear Medicine, Utrecht, The Netherlands. M.Lam@umcutrecht.nl %A Lam, M G E H %A de Klerk, J M H %A van Rijk, P P %A Zonnenberg, B A %J Anticancer Agents Med Chem %D 2007 Jul %N 4 %P 381-97 %T Bone seeking radiopharmaceuticals for palliation of pain in cancer patients with osseous metastases %V 7 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17630915 %X Many patients with cancer develop symptomatic skeletal metastases at an advanced stage of their disease. Skeletal metastases are often complicated by pain. They cause considerable morbidity and mortality. Besides analgesics, treatment options include external beam radiotherapy, bisphosphonates, chemotherapy, surgery and bone seeking radiopharmaceuticals. Pain palliation with bone seeking radiopharmaceuticals has proved to be an effective treatment modality in patients with metastatic bone pain. Radiopharmaceuticals bind to the bone matrix in areas of increased bone turnover, due to a metastatic response. Beta rays from the specific radionuclide, bound to its carrier ligand, result in the therapeutic effect. Various radiopharmaceuticals have been developed for this purpose. All have their own characteristics. The radiopharmaceuticals Samarium-153-ethylenediaminetetramethylenephosphonic acid ((153)Sm-EDTMP) and Strontium-89-Chloride, which are approved in the USA and Europe, as well as the not universally approved Rhenium-186-hydroxyethylidenediphosphonic acid ((186)Re-HEDP), will be discussed in greater detail. Depending on the half-life and radiation energy of the specific radionuclide, they exert a different effect and toxicity profile. In most cases, bone marrow toxicity is limited and reversible, which makes repetitive treatment relatively safe. Several studies have shown encouraging clinical results of palliative therapy using bone seeking radiopharmaceuticals, with an overall reported pain response rate in the order of ± 70-80% of patients. This systemic form of radionuclide therapy is simple to administer and complements other treatment options. It has been associated with marked pain reduction, improved mobility in many patients, reduced dependence on analgesics, and improved performance status and quality of life. Additionally, new therapeutic strategies hold the promise of enhancement of the palliative and anticancer effects of this form of therapy %0 Journal Article %C Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, P.O. Box 301402, Houston, TX 77230-1402, USA %A Lang, Julie E %A Babiera, Gildy V %J Surg Clin North Am %D 2007 Apr %N 2 %P 527-38, xi-xii %T Locoregional Resection in Stage IV breast cancer: tumor biology, molecular and clinical perspectives %V 87 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17498542 %X The intact primary in patients diagnosed with Stage IV breast cancer is generally reserved for palliative indications. Haagensen and Stout's 1943 criteria of inoperability for carcinoma of the breast, including tumor fixation to the chest wall, ulceration, and peau d'orange, hold true. Surgery alone is unlikely to prolong life in such patients. Improvements in breast cancer screening and awareness mean fewer patients having inoperable breast cancer. The current problem is that imagining studies reveal some patients to have oligometastatic disease with an intact primary. This article considers surgical treatment as part of multimodal Stage IV breast cancer treatment for such patients. Several challenges to previous dogma to never operate on Stage IV breast cancer patients except with palliative intent have arisen %0 Journal Article %C Senologiezentrum Ostschweiz, Kantonsspital St. Gallen, 9007 St. Gallen, Switzerland. Thomas.Langenegger@kssg.ch %A Langenegger, T %A Wahl, P %A Schiesser, D %A Thurlimann, B %J Breast Cancer Res Treat %D 2006 Nov %N 2 %P 177-81 %T Plasma levels of tamoxifen, N-desmethyl tamoxifen and anastrozole in a patient with metastatic breast cancer and chronic hemodialysis %V 100 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=16688477 %X Endocrine therapy for hormone-sensitive breast cancer is a well-established treatment option, both in adjuvant and palliative settings. For patients undergoing chronic hemodialysis, only scant pharmacokinetic data have been published for tamoxifen, and no data have been published for anastrozole. We therefore measured plasma levels of tamoxifen, its major metabolite, N-desmethyl tamoxifen, and anastrozole in a breast cancer patient undergoing chronic hemodialysis. Clinical tolerability was good. The blood levels for tamoxifen, N-desmethyl tamoxifen and anastrozole were within the expected therapeutic ranges. From this study, we can conclude that endocrine therapy for breast cancer with tamoxifen or anastrozole seems feasible and safe for patients undergoing chronic hemodialysis %0 Journal Article %C Department of Hepatobilliary Surgery, Cancer Center and State Key Laboratory of Oncology in South China, Sun Yat-sen University, China %A Lao, Xiang-Ming %A Chen, Dong-Ying %A Zhang, Ya-Qi %A Xiang, Jin %A Guo, Rong-Ping %A Lin, Xiao-Jun %A Li, Jin-Qing %J Am J Surg Pathol %D 2007 Jun %N 6 %P 817-26 %T Primary carcinosarcoma of the liver: clinicopathologic features of 5 cases and a review of the literature %V 31 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17527068 %X Carcinosarcoma of the liver is very rare worldwide. The terminology and pathogenesis of hepatic carcinosarcoma remain controversial issues. In this article, we studied the clinicopathologic features of 5 cases of hepatic carcinosarcomas (matching the World Health Organization definition), analyzed the clinical data, histologic and immunohistochemical (IHC) results, and discussed the terminology, pathologic differential diagnoses, pathogenesis, and prognosis. The patients were 40 to 68 years old, and included 4 males and 1 female. All patients were Hepatitis B surface antigen positive with para-tumorous cirrhosis. The largest dimensions of the neoplasms ranged from 6.0 to 14.0 cm. Satellite nodules, portal vein tumor thrombi, direct invasion into local tissues (right diaphragm, right adrenal gland, and gastric wall) as well as metastatic foci in lungs and abdominal lymph nodes were identified. Pathologically, the neoplasms consisted of carcinomatous and sarcomatous components. The carcinomatous components were exclusively conventional hepatocellular carcinomas in all 5 cases, whereas the sarcomatous components exhibited complex features. Confirmed by IHC studies, the sarcomatous elements in different cases included rhabdomyosarcomas, malignant fibrous histiocytomas, fibrosarcoma, and poorly differentiated spindle cells without distinctive differentiation. Furthermore, the sarcomatous elements in these 5 neoplasms stained negative for all the epithelial markers we applied for IHC staining, which support the pathologic diagnosis of carcinosarcoma rather than sarcomatoid carcinoma. The presence of transitional zones between carcinomatous and sarcomatous components may support the transformation theory. Four patients with palliative hepatectomy died within 6 months, whereas 1 patient is still alive 21 months after radical resection. The poor prognosis of hepatic carcinosarcoma may be due to their highly invasive and metastatic features. Radical resection of early stage hepatic carcinosarcoma may contribute to a relatively optimistic prognosis %0 Journal Article %C Klinik und Poliklinik fur Urologie, Universitatsklinikum, Sigmund-Freud-Strasse 25, 53125, Bonn, Deutschland, norbert.laube@ukb.uni-bonn.de %A Laube, N %A Kleinen, L %A Bode, U %A Fisang, C %A Meissner, A %A Bradenahl, J %A Syring, I %A Busch, H %A Pinkowski, W %A Muller, SC %J Urologe A %D 2007 Jul %T [Coating with plasma-deposited functionalized diamond-like carbon to decrease encrustations on urological implants.] %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17634911 %X The double-J stents used today for palliative artificial urinary diversion very often show extreme formation of encrustations, even a short time after implantation. Despite increased scientific material development, the complication rate has not really been strongly influenced. Grant-aided by the German Federal Ministry of Education and Research, we chose a new interdisciplinary and translational approach by coating standard stent materials with plasma-deposited amorphous diamond-like carbon. These stents show clearly reduced rates of encrustation in vitro. Ongoing clinical trials demonstrate a further enhancement of this effect in vivo. The underlying mechanisms are being investigated by extending the established in vitro model, thereby pushing research in this field to a new level %0 Journal Article %C Palliative Care Unit, Centre Hospitalier Lyon Sud, 69310 Pierre Benite, France %A Laurent, A %A Mistretta, F %A Bottigioli, D %A Dahel, K %A Goujon, C %A Nicolas, JF %A Hennino, A %A Laurent, PE %J Vaccine %D 2007 Jun %T Echographic measurement of skin thickness in adults by high frequency ultrasound to assess the appropriate microneedle length for intradermal delivery of vaccines %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17640778 %X Skin thickness (epidermis-dermis) across the deltoid, suprascapular, waist and thigh as possible body sites for a new microdelivery system for intradermal (id) inoculation were evaluated using 20MHz ultrasound echography in 205 women and 137 men aged 18-70 years, in three ethnic groups: Caucasian, Asian and Black. Mean skin thickness was 2.54mm at the suprascapular, 2.02mm at the deltoid, 1.91mm at the waist and 1.55mm at the thigh. A 1.5mm microneedle length inserted perpendicularly to the skin surface would ensure the administration of the antigen into the dermal layer, irrespectively of subject gender, age, ethnicity and BMI. The deltoid, suprascapular and waist are the most appropriate body sites %0 Journal Article %C School of Social Work, Michigan State University, East Lansing, MI 48824, USA. margie.rodriguezlesage@ssc.msu.edu %A Le Sage, Margie Rodriguez %J J Soc Work End Life Palliat Care %D 2006 %N 4 %P 3-31 %T Linguistic competence/language access services (LAS) in end-of-life and palliative care: a social work leadership imperative %V 2 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17387093 %X Despite the mandated and moral imperative to advance linguistic competence in all health care contexts, leadership that addresses this area of practice and study in end-of-life and palliative care is not readily obvious. Because social work is ideally suited to lead efforts to advance linguistically-accessible end-of-life and palliative care, social workers are encouraged to assume the challenge. This article focuses on topics that are elementary yet central to discussions on language diversity and leadership initiatives to advance language access in end-of-life and palliative care contexts: importance and function of language, extent of language diversity, inequity related to language diversity, mandates and standards related to language access, and approaches and competencies that contribute positively to language access %0 Journal Article %C Royal Dutch Medical Association %A Legemaate, Johan %A Verkerk, Marian %A van Wijlick, Eric %A de Graeff, Alexander %J Eur J Health Law %D 2007 Apr %N 1 %P 61-73 %T Palliative sedation in the Netherlands: starting-points and contents of a national guideline %V 14 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17566321 %X In December 2005 the first national guideline for palliative sedation in the Netherlands was published. This guideline was developed by a committee of the Royal Dutch Medical Association, at the request of the Dutch government. The guideline defines palliative sedation as 'the intentional lowering of consciousness of a patient in the last phase of his or her life'. According to the guideline the objective of palliative sedation is to relieve suffering, and lowering consciousness is a means to achieve this. It is very important that palliative sedation is given for the right indication, proportionally, and adequately. It is the degree of symptom control, not the level to which consciousness is lowered, which determines the dose and combinations of the sedatives used and duration of treatment. The assessment and decision-making processes must focus on adequate relief of the patient's suffering, so that a peaceful and acceptable situation is created. Palliative sedation is given in the last phase of life, in the imminently dying patient. Palliative sedation raises several legal questions. In this article we describe the structure and contents of the guideline, with special attention for the main legal issues involved, like the distinction between palliative sedation and euthanasia and the process of informed consent %0 Journal Article %C CNS Office, LOROS, Groby Road, Leicester, UK. deborahann.lewis@virgin.net %A Lewis, Deborah %A Anthony, Denis %J Int J Palliat Nurs %D 2007 May %N 5 %P 230-6 %T A patient and carer survey in a community clinical nurse specialist service %V 13 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17577175 %X The community clinical nurse specialist (CNS) team provides specialist palliative care to clients with cancer and non-malignant, life-limiting diseases in clients' homes, community hospitals, and residential and nursing homes. CNSs are based in health centres, community hospitals (geographically spread around the county) or at the local hospice. There has been no systematic review of patient and carer levels of satisfaction since the conception of the CNS service in 1984. Accredited as a nursing development unit (Flint and Wright, 2001) by Leeds University, the team has been encouraged to obtain service users' views. National guidelines in the UK (National Institute for Health and Clinical Excellence (NICE), 2004) also recommend that systems be put in place to enable clients to make their voices heard in a variety of ways. The principle aim was to identify the level of patient and carer satisfaction and to highlight aspects of care that warranted alteration or improvement. The CNS team were also keen to identify the aspects of their role most helpful to patients and carers, enabling CNSs to spend their time in a way that is most beneficial to clients %0 Journal Article %C Chang Gung University, Graduate School of Nursing, Tao-Yuan, Taiwan, R.O.C.. sttang@mail.cgu.edu.tw %A Li, Chung-Yi %A Liao, Yen-Chi %J Palliat Med %D 2007 Apr %N 3 %P 249-57 %T Factors associated with depressive distress among Taiwanese family caregivers of cancer patients at the end of life %V 21 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17641079 %X Family caregivers in East Asian countries are known to have a strong sense of filial piety and a traditional caregiving ideology. They are generally presumed to be protected from psychological distress arising from caregiving. However, there is scant information regarding the impact of caregiving on Chinese/Taiwanese families. The purpose of this study was aimed at identifying those family caregivers of Taiwanese terminally ill cancer patients who are at risk of experiencing depressive distress from the following three categories of predisposing factors: 1) contextual factors; 2) stressors; and 3) appraisal of the caregiving situation.Of the 170 Taiwanese family caregivers of terminally ill cancer patients that participated in this survey, 129 (75.9%) were at an extraordinarily high risk of being distressed because of depressive symptoms (CES-D > 15). Results indicated that family caregivers were vulnerable to clinically depressive distress if they were the patient's spouse (adjusted odds ratio (AOR): 2.89; 95% confidence interval (CI): 1.19-7.01), or evaluated caregiving as imposing a greater negative impact on their own health (AOR: 1.27; 95% CI: 1.09-1.47). In contrast, if family caregivers felt very confident in their knowledge of how to take care of the patient at home (AOR: 0.35; 95% CI: 0.15-0.81), or were sufficiently aware of the patient's thoughts and feelings about disease experiences and symptoms (AOR: 0.47; 95% CI: 0.25-0.88), they were less likely to suffer from depressive distress.These finding have significant clinical implications when they are put into the context of Confucian cultures which place great emphasis on filial piety and familism. Interventions and policy should be developed to target spousal caregivers to enhance their confidence in caregiving and understanding of the patient's disease experiences. This will reduce the negative caregiving impact on the caregiver's health, which in turn may prevent the development of depressive distress among family caregivers. Palliative Medicine 2007; 21: 249-257 %0 Journal Article %C Department of Surgery, Soder Hospital, Karolinska Institute, S-118 83 Stockholm, Sweden. stefan.linder@sodersjukhuset.se %A Linder, S %A Bostrom, L %A Nilsson, B %J Eur J Surg Oncol %D 2007 Jun %N 5 %P 616-22 %T Pancreatic carcinoma incidence and survival in Sweden in 1980-2000: a population-based study of 16,758 hospitalized patients with special reference to different therapies %V 33 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17317081 %X AIMS: The purpose of this study was to analyze the incidence and survival of pancreatic carcinoma in Sweden during 1980-2000. METHODS: In this population-based study the patients were identified in the Swedish Hospital Discharge Register and Cancer Register. Data were matched with those in the Register of Causes of Death in Sweden, and 16,758 patients were identified. RESULTS: During the studied period, 1819 patients underwent pancreatic resection, 7457 were treated with palliative procedures and, in 7482, no intervention was carried out. The incidence of pancreatic carcinoma in Sweden for men dropped from 16 per 100,000 at the beginning of the period to 8 per 100,000 in the year 2000. Corresponding figures for women were 12 and 7, respectively. Patients who underwent pancreatic resection had significantly longer survival compared to the palliative procedure or no-intervention groups (p<0.001). After 12 months 49.7% of the resected patients were alive while the corresponding survival in the palliative procedure and no-intervention groups were 13.6% and 11.9%, respectively. The five-year survival rate after resection was 10.8%. In the resection group survival improved over time (p<0.001) and women survived longer than men (p<0.01), which was not the case in the palliative procedure or no-intervention groups. CONCLUSIONS: During the study period, the incidence of pancreatic carcinoma in Sweden decreased markedly. The resection rate increased and only in this group of patients an improved survival was noted over time. The survival was the same for patients who underwent palliative interventions as for those who only received supportive care %0 Journal Article %C Urban Institute, 2100 M St., N.W., Washington, DC 20037, USA. kliu@ui.urban.org %A Liu, Korbin %A Wissoker, Douglas %A Swett, Althea %J Inquiry %D 2007 Spring %N 1 %P 88-103 %T Nursing home use by dual-eligible beneficiaries in the last year of life %V 44 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17583263 %X Research on health care at the end of life has focused on Medicare-financed acute care services. Much less information has been available on nursing home use in the last year of life, particularly for individuals who are dually eligible for Medicare and Medicaid. We used Medicare and Medicaid enrollment and claims data to examine nursing home admissions, odds of dying in nursing homes versus hospitals or the community, and variations in Medicare and Medicaid service use and costs by place of death. We found that, in the last year of life, 75% of dual-eligible people use nursing home care, increasing age is associated with greater likelihood of dying in nursing homes, and dual-eligible people who die in hospitals have notably higher costs than other beneficiaries %0 Journal Article %C Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, 1001 Potrero Avenue, Room 5 K1, San Francisco, CA 94110, USA. john.luce@sfdph.org %A Luce, John M %A White, Douglas B %J Am J Respir Crit Care Med %D 2007 Jun %N 11 %P 1104-8 %T The pressure to withhold or withdraw life-sustaining therapy from critically ill patients in the United States %V 175 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17379853 %X Physicians and nurses sometimes exert pressure on the families of critically ill patients to withhold or withdraw life-sustaining therapy from them. This pressure may stem from prognostic, professional, social, and economic factors. Although the pressure to limit life support may be appropriate in some circumstances, in others it is not justified. The pressure also may damage communications and cause resentment. If communications cannot be improved, and if the pressure cannot be relieved, a due process approach to conflict resolution that involves other parties may be required %0 Journal Article %C Division of Hematology/Oncology and Palliative Medicine, Virginia Commonwealth University, Richmond, Virginia, USA %A Lyckholm, Laurie %J Oncology (Williston Park) %D 2007 Feb %N 2 %P 269 %T Avoiding stress and burnout in cancer care. Words of wisdom from fellow oncologists %V 21 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17396487 %0 Journal Article %C School of Health, Faculty of Education, Health & Professional Studies, University of New England in Armidale, NSW 2351, Australia. mmaple@une.edu.au %A Maple, Myfanwy %A Plummer, David %A Edwards, Helen %A Minichiello, Victor %J Suicide Life Threat Behav %D 2007 Apr %N 2 %P 127-34 %T The effects of preparedness for suicide following the death of a young adult child %V 37 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17521266 %X Suicide deaths are often viewed as sudden and unexpected. Research examining bereavement responses to suicide are generally set within this conceptual framework. Twenty-two parents were interviewed about their bereavement experience following the suicide death of a young adult son or daughter. Data analyzed using narrative methods revealed the concept of preparedness. Three distinct preparedness narratives were identified, termed turbulent-relief, tragedy, and reflective plots. The data presented here highlights the way in which these different situations influence the resultant grief. Understanding preparedness for suicide assists in explaining the variety of grief responses in parents bereaved in this manner %0 Journal Article %C Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA %A Mausbach, Brent T %A Aschbacher, Kirstin %A Patterson, Thomas L %A von Kanel, Roland %A Dimsdale, Joel E %A Mills, Paul J %A Ancoli-Israel, Sonia %A Grant, Igor %J J Psychosom Res %D 2007 Apr %N 4 %P 439-45 %T Effects of placement and bereavement on psychological well-being and cardiovascular risk in Alzheimer's caregivers: A longitudinal analysis %V 62 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17383495 %X OBJECTIVE: We examined the impact of Alzheimer caregiver transitions (i.e., placement and bereavement) on psychological outcomes and on plasma D-dimer levels, an end product of the coagulation cascade associated with increased cardiovascular risk. METHODS: This was a prospective study in which 126 spousal caregivers of Alzheimer's patients were assessed each year for 5 years. We used random regression models to evaluate discontinuous change in our outcomes over time, with emphasis on the impact of caregiver transitions on psychological and physical well-being. RESULTS: Caregivers experienced immediate improvement in overload and mastery following transitions, and these improvements were maintained over time. There was also a significant drop in depressive symptoms immediately following placement of spouses. D-dimer rose significantly over time but began to significantly decline at 6-months posttransitions. CONCLUSIONS: Caregiver transitions appear to produce immediate and long-term "normalization" of psychological health in caregivers. This normalization also appears related to "downstream" reductions in D-dimer %0 Journal Article %C Community and Home Detox Service, Auckland Community Alcohol and Drug Service, Auckland, New Zealand. brian.mcavoy@waitematadhb.govt.nz %A McAvoy, Brian R %J Med J Aust %D 2007 Jul %N 2 %P 115-7 %T General practitioners and cancer control %V 187 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17635097 %X Cancer is the leading cause of death among Australians, causing 28% of all deaths. The average general practitioner will only encounter about four new patients each year with a potentially fatal cancer. A GP's cancer-related workload mostly involves prevention, and dealing with patients with suspicious symptoms or concerns about possible cancer, or who may be at increased risk due to family history or lifestyle factors. GPs cover the full spectrum of cancer care from prevention to palliation, including providing psychosocial support to patients and their families and carers. GPs have a key role in early diagnosis and referral, follow-up and detection of recurrence, and survivorship. There is a developing role for GPs in cancer policy and research %0 Journal Article %C Faculty of Nursing, University of Manitoba, Research Associate, Winnipeg, Manitoba, Canada. susan.mcclement@cancercare.mb.ca %A McClement, Susan %J J Wound Ostomy Continence Nurs %D 2005 Jul-Aug %N 4 %P 264-8 %T Cancer anorexia-cachexia syndrome: psychological effect on the patient and family %V 32 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=16030467 %X The majority of patients with advanced cancer experience weight loss, reduced appetite, fatigue, and weakness. Chronic nausea and early satiety may also occur. This constellation of symptoms is known as the cancer anorexia-cachexia syndrome. Together with cancer pain, cancer anorexia-cachexia syndrome has been identified as 1 of the 2 most frequent and devastating problems affecting individuals with advanced malignancies. Research examining the issue of cancer anorexia-cachexia syndrome has been conducted; however, such work is largely biomedical in orientation. In contrast, the psychologic dimensions of the cancer anorexia-cachexia syndrome experience from the perspective of terminally ill patients and their family members is less well explored or described. The ability to provide psychosocial support to patients and families requires that caregivers appreciate the psychologic effect of cancer anorexia and cachexia on these individuals. This article examines that effect in light of existing knowledge and discusses the clinical implications arising from this work %0 Journal Article %C Wittenberg University, Springfield, Ohio, USA. amcevoy@wittenberg.edu %A McEvoy, Alan %J Am J Alzheimers Dis Other Demen %D 2007 Feb-Mar %N 1 %P 11-3 %T Dying in pieces %V 22 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17533996 %0 Journal Article %C Department of Surgery, University of Calgary, Calgary, AB, Canada %A McKay, A %A Bathe, OF %J J Gastrointest Surg %D 2007 Jul %T A Novel Technique to Relieve a Closed-Loop Obstruction Secondary to a Competent Ileocecal Valve and an Unresectable Mid-Colon Tumor %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17634765 %X A competent ileocecal valve complicates the surgical treatment of an unresectable obstructing mid-colon tumor. Specifically, it may not be feasible to bypass with a colocolotomy, especially when the sigmoid colon has limited mobility or if the ascending colon is severely distended and edematous. A technique is described in which the closedloop obstruction is relieved at its proximal extent by an ileocecal valvuloplasty. A circular stapling device is fired across the ileocecal valve. Once the ileocecal valve is rendered competent, a loop ileostomy or a colocolotomy can be constructed, providing effective palliation for this difficult situation %0 Journal Article %C School of Law, Deakin University, Melbourne, Australia. danuta.mendelson@deakin.edu.au %A Mendelson, Danuta %J Int J Law Psychiatry %D 2007 May-Jun %N 3 %P 201-12 %T Roman concept of mental capacity to make end-of-life decisions %V 30 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17428540 %X When assessing decisional competence of patients, psychiatrists have to balance the patients' right to personal autonomy, their condition and wishes against principles of medical ethics and professional discretion. This article explores the age-old legal and ethical dilemmas posed by refusal of vital medical treatment by patients and their mental capacity to make end-of-life decisions against the background of philosophical, legal and medical approaches to these issues in the time of the Younger Pliny (c62-c113 CE). Classical Roman discourse regarding mental competency and "voluntary death" formed an important theme of the vast corpus of Greco-Roman writings, which was moulded not only by legal permissibility of suicide but also by philosophical (in modern terms, moral or ethical) considerations. Indeed, the legal and ethical issues of evaluating the acceptability of end of life decisions discussed in the Letters are as pertinent today as they were 2000 years ago. We may gain valuable insights about our own methodologies and frames of reference in this area of the law and psychiatry by examining Classical Roman approaches to evaluating acceptability of death-choices as described in Pliny's Letters and the writings of some of his peers %0 Journal Article %C CHASE Hospice Care for Children, Surrey, UK. toni.menezes@chasecare.org.uk %A Menezes, Antoinette %A Esplen, Polly %A Bartlett, Paul %A Turner, Bridget %A Keel, Mike %A Etherington, Veronica %A Conisbee, Elaine %A Plant, Antonia %A Haslam, Val %A England, Julie %J Int J Palliat Nurs %D 2007 May %N 5 %P 237-42 %T A system of electronic records developed by a children's hospice %V 13 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17577176 %X This paper describes the development, implementation and dissemination of an electronic data collection system for children's hospices in the UK. In 1999, CHASE Hospice Care for Children (CHASE) began providing support for life-limited children and their families in their own homes across south-west London, Surrey and West Sussex. CHASE community team is multidisciplinary and original members of the team had to create all of the necessary administrative systems for collecting and storing information about referrals and care provided to children and their families. The community team had the foresight to record activity statistics from day one of the service. The team worked together to identify information routinely collected that could usefully be stored on a computer database and a simple solution was created for this purpose using Microsoft Access version 2. CHASE was in a privileged position because the commitment to use information technology came from people providing care to children and their families %0 Journal Article %C Pain Relief and Palliative Care Unit (S.Me., S.R., G.I.), La Maddalena Cancer Center, Palermo; Departments of Oncology (F.F.), Department of Neuroscience (A.C.), Intensive Care, and Emergency, and Palliative Medicine Teaching, (S.Me., S.Ma.), University of Palermo, Palermo; and Department of Oncology (G.P., F.A., L.V., C.F.) University of L'Aquila, L'Aquila, Italy %A Mercadante, S %A Porzio, G %A Fulfaro, F %A Aielli, F %A Verna, L %A Ficorella, C %A Casuccio, A %A Riina, S %A Intravaia, G %A Mangione, S %J J Pain Symptom Manage %D 2007 Jul %T Switching from Transdermal Drugs: An Observational "N of 1" Study of Fentanyl and Buprenorphine %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17629666 %X The aim of this study was to confirm that the concomitant presence of transdermal fentanyl (TTS FE) and buprenorphine (TTS BU) may be feasible without important consequences using doses presumed to be equianalgesic. A prospective "N of 1" study was carried out in a sample of volunteers with cancer pain receiving stable doses of TTS FE or TTS BU, with adequate pain and symptom control. In the study design, each patient provided data before and after a switch from one opioid to the other and then back to the previous one. Sixteen patients receiving daily stable doses of 0.6 or 1.2mg of TTS FE were switched to TTS BU using an FE-BU ratio of 0.6-0.8. After three days, the TTS BU patch was removed and TTS FE patch was placed for another three days. Six patients receiving TTS BU were switched to TTS FE and then rotated back to TTS BU with the same dosing considerations. No statistical differences in changes in pain and symptom intensity during switching and between the two different sequences were observed. No significant changes in rescue doses of oral morphine were reported at the same intervals. Cancer patients receiving stable doses of TTS FE or TTS BU can be safely switched to the alternative transdermal opioid. Further studies should be performed to gather data about the use of TTS BU with other opioids, at different doses, and in different clinical conditions %0 Journal Article %C Department of Anaesthesiology and Intensive Care Medicine, Uberlingen Hospital, 88662, Uberlingen/See, Germany, A.Michalsen@kh-ueberlingen.de %A Michalsen, A %J Intensive Care Med %D 2007 Jul %T Care for dying patients - German legislation %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17634924 %X Caring for dying patients appears to be one of the most difficult challenges in modern medicine. Apart from respective medical standards, such care is influenced by legal stipulations, economic resources, societal values, and ethical principles. In Germany, legal provisions prohibit actively hastening a patient's death. Although passive and indirect means of assistance to die are permitted for terminally ill patients, they appear to be implemented only with hesitation. Probably, the authority of advance directives needs further clarification. More importantly, however, physicians' deficits in knowledge as well as their conceptual and psycho-emotional barriers need comprehensive improvement in order to foster end-of-life care %0 Journal Article %C docmilphd@aol.com %A Miller, Laurence %J Int J Emerg Ment Health %D 2007 Winter %N 1 %P 13-23 %T Line-of-duty death: psychological treatment of traumatic bereavement in law enforcement %V 9 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17523372 %X A line-of-duty death (LODD) strikingly brings home the risk and vulnerability of all law enforcement officers and affects the officer's peers, the entire department, the wider police community, and the officer's family. This article will place LODD in the context of general bereavement psychology, as well as describe some of its unique features. A variety of supportive and psychotherapeutic measures will be offered for helping peer and family survivors cope with this type of tragedy. This is one important area where police psychologists and community mental health clinicians can be of tremendous service in applying their specialized training in trauma therapy and grief counseling to the special needs of law enforcement and emergency services %0 Journal Article %C Department of Cardiac Surgery, The Diana Princess of Wales, Birmingham Children's Hospital, Birmingham, United Kingdom %A Moorthy, Paneer S Krishna %A McGuirk, Simon P %A Jones, Timothy J %A Brawn, William J %A Barron, David J %J Ann Thorac Surg %D 2007 Jul %N 1 %P 142-6 %T Damus-Rastelli procedure for biventricular repair of aortic atresia and hypoplasia %V 84 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17588401 %X BACKGROUND: Biventricular repair (BVR) can be achieved in aortic atresia with ventricular septal defect (VSD) by creating a double outlet left ventricle, Damus-Kaye-Stansel procedure and placement of a right ventricular-pulmonary artery conduit. This study is a review of 15 years experience with this "Damus-Rastelli" technique to assess clinical outcomes in comparison with a standard univentricular approach. METHODS: A review of 16 patients with aortic atresia or complex left ventricular outflow tract obstruction who underwent BVR between 1990 and 2005; a comparison with outcomes for the Norwood I procedure over the same period. RESULTS: Early mortality was 19% (3 patients) with no deaths in the last 12 years (13 patients). Twelve patients had associated aortic interruption (56%) or coarctation (19%). Anatomic subtype was not a risk for early death. Late age at operation was the only risk factor identified for early death (p = 0.01). Median follow-up was 32 (range, 4 to 190) months. Actuarial survival at one and five years was 60% and 53%, respectively. This compares with an early mortality of 29% (p < 0.01) and actuarial survival of 58% and 50% in the Norwood group. Freedom from reintervention was 68% and 20% at one and five years, respectively. One patient required balloon dilatation of recurrent coarctation, all others were balloon dilatation (n = 2) or surgical (n = 4) conduit replacement. All survivors are currently in New York Heart Association class I. CONCLUSIONS: Biventricular repair of aortic atresia and VSD can be achieved with results that compare well with univentricular palliation. Despite the need for conduit change, the long-term benefit of a BVR would support this technique. Delay in performing the initial repair may increase mortality %0 Journal Article %A Moroni, A L %A Bricault, I %A Serra-Tosio, G %A Sengel, C %A Ferretti, G %J J Radiol %D 2007 Apr %N 4 %P 589-91 %T [Failure to characterize a suprarenal metastasis of hepatocarcinoma using the percentage of contrast medium washout with CT: a case study] %V 88 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17464259 %0 Journal Article %C Department of Psychiatry, University of British Columbia, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, Canada. myers@telus.net %A Myers, Michael F %A Fine, Carla %J Suicide Life Threat Behav %D 2007 Apr %N 2 %P 119-26 %T Touched by suicide: bridging the perspectives of survivors and clinicians %V 37 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17521265 %X This article is a revised version of an invited plenary address given at the 39th Annual Conference of the American Association of Suicidology. The authors, a psychiatrist and a writer survivor, outline and summarize the different ways in which professionals and survivors come to an understanding of suicide. They explain how each group often exists independently and separate from the other--by cognitive and emotional dissonance, by private language, by psychological defenses and miscommunication--and call for dialog. They argue that both perspectives are essential to advance the science of suicidology and to give hope and meaning to those bereaved by suicide %0 Journal Article %C Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Enya-cho, Izumo, Shimane, 693-8501 %A Nakamoto, Takeru %A Yoshimura, Hiroshi %A Honda, Teruko %A Nakata, Kazue %A Taniguchi, Yoshie %A Yoshida, Aya %A Uenobe, Maya %A Yoshioka, Noriko %A Yamaguchi, Takatoshi %A Inagawa, Hiroyuki %A Kohchi, Chie %A Nishizawa, Takashi %A Soma, Gen-Ichiro %J In Vivo %D 2007 Mar-Apr %N 2 %P 357-64 %T Treatments for the activating macrophages that reduces surgical stress and postoperative mortalities from bacterial infections and tumor metastases %V 21 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17436588 %X BACKGROUND: Some of the mortalities caused by infectious diseases and/or distant metastases following surgery are thought to be due to immunological suppression. For this reason, techniques that reduce immunological suppression following surgery may reduce mortalities and/or incidences of micrometastases in distant organs. MATERIALS AND METHODS: Mice were anesthetized and their peritoneal cavities were opened for 30 min. Immunological suppression was estimated by the presence of tumor necrosis factor-a (TNF) after injection with OK-432 (dead bacterial bodies). The mice were administered with either Staphylococcus aureus or cancer cells of Meth A fibrosarcoma. Survival times and lung metastastic foci were then observed at 3 weeks. Results were compared for mice with or without treatment by OK432 or TNF prior to surgery. RESULTS: While significant suppression of TNF production was observed after laparotomy, administration of a macrophage-activating agent (TNF or OK-432) 3 h prior to laparotomy prevented immune suppression after the laparotomy. Laparotomy increased mortalities from bacterial infections and promoted the number of lung metastases. By contrast, administration of TNF or OK-432 3 h prior to the laparotomy decreased mortalities and metastases after the laparotomy. CONCLUSION: These results suggest that appropriate activation of macrophages prior to surgery is a method to reduce some of the detrimental effects caused by surgical operations %0 Journal Article %C Division of Surgery, Niigata Cancer Center Hospital %A Nashimoto, Atsushi %A Yabusaki, Hiroshi %A Nakagawa, Satoru %J Gan To Kagaku Ryoho %D 2007 Jul %N 7 %P 983-7 %T [Treatment Strategy for the TypeIV Gastric Cancer - From the Standpoint of the Surgery.] %V 34 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17637531 %X From the standpoint of the surgery, the treatment strategy for the typeIV gastric cancer (GC) was studied. Recently, the resected rate of typeIV GC has been increasing, though the number of operated GC patients is decreasing. The five-year survival rate was about 20% in all and around 30% in the curatively resected pts. As a result of examination of our pts with type 4 GC,multimodality therapy including neoadjuvant chemotherapy and extended surgery is recommended for pts with P 0/CY 0 or P 0/CY 1 but without other remaining GC lesions. Palliative gastrectomy and postoperative chemotherapy are recommended if performed safely to prevent such symptoms in spite of unresectable metastasis for pts with urgent symptoms such as bleeding, stricture, pain or malnutrition. For pts with P 2/P 3 but without passage disturbance, intensive chemotherapy is selected. But the propriety for selection of reduction surgery for pts with P 2/P 3 is controversial. The results of the prospective randomized controlled study of reduction surgery in non-curative advanced gastric cancer by the Gastric Cancer Surgical Study Group in Japan Clinical Oncology Group (JCOG) are expected %0 Journal Article %A Nau, Jean-Yves %J Rev Med Suisse %D 2007 Apr %N 106 %P 961 %T [Euthanasia and physician-assisted suicide: confusion in France ] %V 3 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17575974 %0 Journal Article %C Division of Cardiology, Hyogo Prefectural Amagasaki Hospital, Higashidaimotsucho 1-1-1, Amagasaki, Hyogo %A Nishi, Kiyoto %A Sato, Yukihito %A Miyamoto, Tadashi %A Taniguchi, Ryoji %A Matsuoka, Tatsuhiko %A Kuwabara, Yasuhide %A Isoda, Kei %A Yamane, Keiichirou %A Hatakenaka, Tsutomu %A Fujinaga, Keiko %A Fujiwara, Hisayoshi %A Takatsu, Yoshiki %J J Cardiol %D 2007 May %N 5 %P 251-8 %T [Infusion therapy at outpatient clinic in chronic end-stage heart failure] %V 49 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17552290 %X OBJECTIVES: To determine whether drug infusions at ambulatory clinic in patients with end stage congestive heart failure are safe and reduce the period of hospitalization. METHODS: Between May 2000 and November 2006, 21 ambulatory patients with end stage congestive heart failure were treated with infusions of the natriuretic peptide, carperitide (6 patients, 43 infusions of mean 0.033 microg/kg/min for mean 3.7 hr), the phosphodiesterase inhibitor, olprinone (19 patients, 75 infusions of mean 0.11 microg/kg/min for mean 3.8 hr), or the catecholamines, dopamine or dobutamine(5 patients, 89 infusions of mean 3.3 microg/kg/min for mean 3.2 hr). RESULTS: Systolic and diastolic blood pressure was lower after infusion of carperitide, whereas catecholamines increased systolic blood pressure and heart rate (all differences from baseline p < 0.0001). Olprinone changed neither blood pressure nor heart rate. No adverse effect was observed, including arrhythmias or change in blood pressure requiring cessation of drug infusion. Mean urinary output per infusion was 979 ml for carperitide, 720ml for olprinone, and 594ml for catecholamines. There was no correlation between mean urinary output and dose of furosemide administered during intermittent infusion therapy. There was a close correlation between pre-infusion blood pressure and urinary output(systolic: p < 0.05; diastolic: p < 0.0001). Infusion therapy reduced the length of hospitalization (p < 0.05) in 7 patients from April 2005. CONCLUSIONS: Ambulatory, low-dose infusion therapy may not decrease the mortality of patients in end-stage congestive heart failure, but was safe and might represent an acceptable end-of-life therapeutic option %0 Journal Article %C Music Therapy Department, Rowcroft Hospice, Torquay, UK. okellyj@rowcroft-hospice.org.uk %A O'kelly, Julian %A Koffman, Jonathan %J Palliat Med %D 2007 Apr %N 3 %P 235-41 %T Multidisciplinary perspectives of music therapy in adult palliative care %V 21 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17641077 %X BACKGROUND: Music therapy aims to provide holistic support to individuals through the sensitive use of music by trained clinicians. A recent growth in music therapy posts in UK palliative care units has occurred despite a paucity of rigorous research. Study aim: To explore the role of music therapy within multidisciplinary palliative care teams, and guide the future development of the discipline. DESIGN: In-depth qualitative interviews with 20 multidisciplinary colleagues of music therapists, based in five UK hospices. RESULTS : Analysis of interview material revealed a number of themes relevant to the study aims. Music therapy was valued by most interviewees; however there exists some lack of understanding of the role of the music therapist, particularly amongst nurses. Emotional, physical, social, environmental, creative and spiritual benefits of music therapy were described, with some benefits perceived as synergistic, arising from collaborations with other disciplines. Interviewees found experiencing or witnessing music therapy is effective in developing an understanding of the discipline. CONCLUSION: Music therapy is an appropriate therapeutic intervention for meeting the holistic needs of palliative care service users. More understanding and integration of music therapy could be encouraged with collaborative work, educational workshops, and the utilization of environmentally focused techniques. The study merits further research to explore and develop these findings. Palliative Medicine 2007; 21: 235-241 %0 Journal Article %C School of Narsing, Faculty of Medicine, University of Miyazaki %A Oku, Shoko %J Nippon Ronen Igakkai Zasshi %D 2007 May %N 3 %P 351-8 %T [The effect of care of terminally ill patients' families on care of families attending patients' deathbeds in a general ward] %V 44 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17575440 %X AIM: Care of families attending patients' deathbeds is important, leading to care of the bereaved. However, we have no knowledge of a causal relationship between factors of care of terminally ill patients' families and care of families attending patients' deathbeds. The aim of this survey was to find out which factors of care nurses provide to terminally ill patients' families affect care of families attending patients' deathbeds in a general ward where many terminally ill elderly patients spend their time. METHODS: Questionnaire survey of 978 general ward chief nurses working for hospitals with over 100 beds in the Kyushu district. Data were processed through factor analysis and covariance structured analysis. RESULTS: 236 valid responses were analyzed. Four factors regarding chief nurses providing for families of terminally ill patients were identified. These factors were interpreted as first, mediating communication between families and patients; second, providing information; third, promoting cooperation and understanding among families; and fourth alleviating restrictions. The first factor correlates with the third factor. Especially, the first factor strongly affects the provision of care to families attending patients' deathbeds. The relationships of the second and fourth factors with care of families attending patients' deathbeds were not proved. CONCLUSION: Care of terminally ill patients' families in a general ward consists of four factors: mediating communication between families and patients, providing information, promoting cooperation and understanding among families, and alleviating restrictions. It was revealed that the more nurses promote cooperation and understanding among families, the more they can mediate communication between families and patients and provide care to families attending patients' deathbeds. It suggests that nurses are able to have a positive effect on the grief process of the bereaved by intervening between patients and families %0 Journal Article %C Department of Radiology, Hacettepe University School of Medicine, Sihhiye, Ankara 06100, Turkey %A Ozkan, Orhan %A Akinci, Devrim %A Gocmen, Rahsan %A Cil, Barbaros %A Ozmen, Mustafa %A Akhan, Okan %J Cardiovasc Intervent Radiol %D 2007 Mar-Apr %N 2 %P 232-6 %T Percutaneous placement of peritoneal port-catheter in patients with malignant ascites %V 30 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17206391 %X We report our experience with a radiologically placed peritoneal port-catheter in palliation of malignant ascites. Port-catheters were successfully placed under ultrasonographic and fluoroscopic guidance in seven patients (five women, two men) who had symptomatic malignant ascites. The long-term primary patency rate was 100%. The mean duration of catheter function was 148 days. Seven patients had a total of 1040 port-days. Two patients received intraperitoneal chemotherapy via the port-catheter. There were no procedure-related mortality and major complications. Minor complications such as ascitic fluid leakage from the peritoneal entry site, migration of the catheter tip to the right upper quadrant, and reversal of the port reservoir occurred in four patients. None of these complications affected the drainage and required port explantation. In patients with symptomatic malignant ascites, a peritoneal port-catheter can provide palliation and eliminate multiple hospital visits for repeated paracentesis with high patency and low complication rates %0 Journal Article %C Department of Anesthesia and Pain Medicine, Seoul National University Bundang Hospital, Gumi-dong, Bundang-gu, Seongnam-si, Korea %A Park, Hee-Pyoung %A Hwang, Jung-won %A Park, Sang-Hyun %A Jeon, Young-Tae %A Bahk, Jae-Hyon %A Oh, Yong-Seok %J Anesth Analg %D 2007 Jul %N 1 %P 267-71 %T The effects of glossopharyngeal nerve block on postoperative pain relief after tonsillectomy: the importance of the extent of obtunded gag reflex as a clinical indicator %V 105 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17578986 %X BACKGROUND: We evaluated the efficacy of glossopharyngeal nerve block (GNB) for the control of post-tonsillectomy pain in adult patients, and correlated the extent of obtunded gag reflex as a clinical indicator of GNB with the extent of pain relief. METHODS: Seventy-five patients undergoing tonsillectomy received bilateral GNB with 0.75% ropivacaine with epinephrine (Group R), 0.5% bupivacaine with epinephrine (Group B) at the end of the operation, or no intervention (Group C). To evaluate the effects of GNB, we assessed throat pain (100 mm visual analog scale) and severity of gag reflex response 0.5, 8, and 24 h after surgery. RESULTS: In the immediate postoperative period, pain scores at rest and when swallowing in Groups R and B were significantly lower than those in Group C (21 ± 17 and 23 ± 13 vs 42 ± 16, 28 ± 22 and 32 ± 19 vs 62 ± 14, P < 0.001). The analgesic effect of GNB was strongly correlated with the extent of obtunded gag reflex (P < 0.01). CONCLUSIONS: GNB is a useful method for the palliation of post-tonsillectomy pain. An obtunded gag reflex response may be a clinical indicator for analgesia from GNB %0 Journal Article %C Department of Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada %A Pauls, Merril %A Leblanc, Connie %A Campbell, Sam %J CJEM %D 2002 Jan %N 1 %P 45-8 %T Ethics in the trenches: preparing for ethical challenges in the emergency department %V 4 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17637148 %X Ethical issues can be more difficult to address in the emergency department than in other settings. We present two cases, with the goal of stimulating moral reflection and encouraging emergency physicians to gain a better understanding of two important ethical issues: advance directives and resource allocation decisions. Understanding the legal and ethical basis for advance directives allows emergency physicians to determine when the directives should be followed and when they should be questioned. Resource allocation decisions are among the toughest decisions emergency physicians make. Although patients or substitute decision-makers define the value of a treatment goal, emergency physicians must ensure that this goal does indeed represent the patient's wishes, that it is achievable, and that competing claims for the same resource are considered. Learning from others' experiences and preparing for ethical problems in advance will help physicians feel more comfortable in dealing with ethical issues %0 Journal Article %C Cork University Hospital, Cork. dannann@eircom.net %A Payne, Ann %A Barry, Sandra %A Creedon, Brian %A Stone, Carol %A Sweeney, Catherine %A O' Brien, Tony %A O' Sullivan, Kathleen %J Palliat Med %D 2007 Apr %N 3 %P 193-8 %T Sensitivity and specificity of a two-question screening tool for depression in a specialist palliative care unit %V 21 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17641072 %X OBJECTIVES: The primary objective in this study is to determine the sensitivity and specificity of a two-item screening interview for depression versus the formal psychiatric interview, in the setting of a specialist palliative in-patient unit so that we may identify those individuals suffering from depressive disorder and therefore optimise their management in this often-complex population. Methods: A prospective sample of consecutive admissions (n = 167) consented to partake in the study, and the screening interview was asked separately to the formal psychiatric interview. RESULTS: The two-item questionnaire, achieved a sensitivity of 90.7% (95% CI 76.9-97.0) but a lower specificity of 67.7% (95% CI 58.7-75.7). The false positive rate was 32.3% (95% CI 24.3-41.3), but the false negative rate was found to be a low 9.3% (95% CI 3.0-23.1). A subgroup analysis of individuals with a past experience of depressive illness, (n = 95), revealed that a significant number screened positive for depression by the screening test, 55.2% (16/29) compared to those with no background history of depression, 33.3% (22/66) (P = 0.045). CONCLUSION: The high sensitivity and low false negative rate of the two-question screening tool will aid health professionals in identifying depression in the in-patient specialist palliative care unit. Individuals, who admit to a previous experience of depressive illness, are more likely to respond positively to the two-item questionnaire than those who report no prior history of depressive illness (P = 0.045). Palliative Medicine 2007; 21: 193-198 %0 Journal Article %C Sue Ryder Care St John's Hospice, Moggerhanger and Hinchingbrooke Hospital, Huntingdon, UK. paul.perkins@suerydercare.org %A Perkins, P %A Barclay, S %A Booth, S %J Palliat Med %D 2007 Apr %N 3 %P 219-25 %T What are patients' priorities for palliative care research? Focus group study %V 21 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17641075 %X To elucidate the research priorities of palliative care patients we conducted focus groups with day therapy and hospice in-patients with cancer with an estimated prognosis of 6 months or less. Patients were positive about taking part in this research project identifying five main priorities for future research - talking with patients; help for patients and families; oncology; symptoms; medication/treatments. Patients gave great emphasis to communication issues and little to symptom control. A patient questionnaire was created with these themes which is currently being used in five hospices across East Anglia. This paper describes the qualitative component of the study. Palliative Medicine 2007; 21: 219-225 %0 Journal Article %C Departments of Neurosurgical Sciences-Neurosurgery, University La Sapienza, Rome, Italy %A Piccirilli, Manolo %A Sassun, Tanya Enny %A Brogna, Christian %A Giangaspero, Felice %A Salvati, Maurizio %J Tumori %D 2007 Mar-Apr %N 2 %P 150-4 %T Late brain metastases from breast cancer: clinical remarks on 11 patients and review of the literature %V 93 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17557561 %X AIMS AND BACKGROUND: Late brain metastases from breast cancer are a rare event. Only a few cases have been reported in the English literature. The authors describe the clinical and pathological remarks, together with treatment modalities, removal extent and overall survival, of 11 patients in whom brain metastases were detected more than 10 years from the primary tumor. PATIENTS AND METHODS: Between January 1997 and April 2001, we hospitalized 11 patients, all females, with a histologically proven diagnosis of brain metastasis from breast invasive ductal carcinoma. We defined 'late metastasis' as those metastases that appeared at least 10 years after the breast cancer diagnosis. The median age at the moment of brain metastasis diagnosis was 59 years (range, 47-70), with a median latency time from breast cancer diagnosis of 16 years (range, 11-30). RESULTS: Ten patients underwent surgery followed by adjuvant radiotherapy (whole brain radiotherapy). Two of them received, after whole brain radiotherapy, stereotaxic radio surgery treatment. One patient had stereotaxic brain biopsy, performed by neuronavigator, followed by palliative corticosteroid therapy. Median survival after brain metastasis diagnosis was 28 months (range, 3 months-4 years). CONCLUSIONS: Although late brain metastases are a rare event, specific neurologic symptoms and neuroradiological evidence of a cerebral neoplasm should be correlated to the presence of a cerebral metastasis, in a patient with a previous history of breast cancer. The longer latency time from breast cancer to brain metastasis could be explained by the "clonal dominance" theory and by different genetic alterations of the metastatic cell, which could influence the clinical history of the disease %0 Journal Article %C Department of Pain Medicine and Palliative Care, Beth Israel Medical Center, New York, NY 10003, USA. RPortenoy@chpnet.org %A Portenoy, Russell K %A Farrar, John T %A Backonja, Misha-Miroslav %A Cleeland, Charles S %A Yang, Kaity %A Friedman, Michael %A Colucci, Salvatore V %A Richards, Patricia %J Clin J Pain %D 2007 May %N 4 %P 287-99 %T Long-term use of controlled-release oxycodone for noncancer pain: results of a 3-year registry study %V 23 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17449988 %X OBJECTIVE: To evaluate the outcomes associated with the use of controlled-release (CR) oxycodone for up to 3 years in the treatment of noncancer pain. METHODS: Adult patients who previously participated in controlled trials of CR oxycodone for osteoarthritis pain, diabetic neuropathy pain, or low back pain, and who continued to require opioid analgesia for moderate or severe pain, were enrolled in an open-label, uncontrolled, registry study. Data collected over time included dose, pain severity on a numeric scale, treatment acceptability, adverse events, and descriptions of problematic drug-related behavior. RESULTS: Two hundred thirty-three patients were enrolled. When the study closed, 141, 86, and 39 patients had taken CR oxycodone for at least 1, 2, and 3 years, respectively; mean duration of treatment was 541.5 days. Among the 219 intent-to-treat patients (received at least 1 dose and provided at least 1 postdose study observation), the mean (SD, range) daily dose was 52.5 (+/-38.5, 10.0 to 293.5) mg. Before the end of month 3, 44% required an increase in total daily dose; this dropped to 23% during months 4 to 6, to 17% during months 10 to 12, and remained at approximately 10% for each time interval thereafter (range 8% to 13%). Among the large majority of patients with stable or lower dose requirements after the initial 3 months of treatment, the average pain intensity ratings were unchanged or improved for approximately 70% to 80% of patients at all subsequent time points through month 33, and for 54% (7/13 patients) at month 36. A decrease in pain was initially seen by the end of month 3, and for the majority of patients, the Average Pain Intensity score remained the same, better, or minimally worse (<3 points) for the remainder of the 3-year study period. The most common adverse events were constipation and nausea, and the incidence of these events declined over time on treatment. Investigators reported 6 cases (2.6%) of possible drug misuse but no evidence of de novo addiction was observed. DISCUSSION: These registry data demonstrate that a subgroup of patients with noncancer pain experienced prolonged relief with tolerable side effects and modest need for dose escalation during long-term therapy with CR oxycodone %0 Journal Article %C Department of Large Animal Clinical Sciences, Virginia Maryland Regional College of Veterinary Medicine, Virginia Tech, Blacksburg, VA 24061, USA. purswell@vt.edu %A Purswell, B J %A Kolster, Kara A %J Theriogenology %D 2006 Aug %N 3 %P 510-3 %T Immunocontraception in companion animals %V 66 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=16837035 %X There is real need worldwide to control the population growth of companion animals. Throughout the world and particularly in the United States, overpopulation of unwanted dogs and cats is a concern for many reasons. Feral populations pose risk to native species by spread of disease and predation. That unwanted animals are humanely eradicated is of concern to many persons. The need to control population growth has led to various approaches to contraception, including immunocontraception. Concerns regarding efficacy, duration of action, harm to the individual, and species specificity are among the issues being addressed. As new technologies emerge, ethical, political, and safety issues evoke differing opinions. It is hoped that in the near future, different strategies will be developed to solve this disturbing problem %0 Journal Article %C Klinik fur Palliativmedizin, Rheinisch-Westfalische Technische Hochschule, Pauwelsstrasse 30, 52074, Aachen, Deutschland, LRadbruch@UKAachen.de %A Radbruch, L %A Schaible, HG %J Schmerz %D 2007 Jul %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17632734 %0 Journal Article %C Brazilian Cochrane Centre, Rua Pedro de Toledo, 598, Sao Paulo, SP, Brazil, 04039-001. asrama@uol.com.br %A Ramacciotti, A S %A Soares, B G O %A Atallah, A N %J Cochrane Database Syst Rev %D 2007 %N 2 %P CD004842 %T Dipyrone for acute primary headaches %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17443558 %X BACKGROUND: Dipyrone is used to treat headaches in many countries, but is not available in others (particularly the USA and UK) because of its association with potentially life-threatening blood dyscrasias such as agranulocytosis. OBJECTIVES: To determine the effectiveness and safety of dipyrone for acute primary headaches in adults and children. SEARCH STRATEGY: We searched the Cochrane Pain, Palliative & Supportive Care Group's Trials Register; the Cochrane Central Register of Controlled Trials; MEDLINE; EMBASE; LILACS, and the reference lists of included studies. SELECTION CRITERIA: Double-blind randomised controlled trials of dipyrone for the symptomatic relief of acute primary headaches in adults and children. DATA COLLECTION AND ANALYSIS: Three authors independently screened articles, extracted data, assessed trial quality and analysed results. Relative risks (RRs), risk differences (RDs), weighted mean differences (WMDs), and numbers-needed-to-treat (NNTs) were calculated as appropriate. MAIN RESULTS: Four trials involving a total of 636 adult subjects were included. Methodological quality was generally high. One study each evaluated oral and intravenous dipyrone for episodic tension-type headache (ETTH); two trials evaluated intravenous dipyrone for migraine, but only one of these described pain outcomes. No pediatric trials were identified.The largest trial (n = 356) evaluated two doses (0.5 g, 1 g) of oral dipyrone for ETTH, which were significantly better than placebo for pain relief. The 1 g dose was also significantly better than acetylsalicylic acid (ASA) 1 g . A smaller trial (n = 60) evaluated intravenous dipyrone 1 g versus placebo for ETTH. RRs were statistically significant favouring dipyrone for pain-free and headache improvement outcomes. Finally, one trial (n = 134) evaluated intravenous dipyrone 1 g versus placebo for pain outcomes in patients with migraine. RRs were again statistically significant favouring dipyrone for pain-free and headache improvement outcomes.Two of the four trials assessed adverse events. No serious adverse events were reported, and no significant differences in adverse events were detected between dipyrone and comparators (placebo and ASA). AUTHORS' CONCLUSIONS: Evidence from a small number of trials suggests that dipyrone is effective for ETTH and migraine. No serious adverse events were observed in the included trials, but agranulocytosis is rare and would probably not be observed in such a relatively small sample. A study now ongoing in Latin America may clarify the true risk of agranulocytosis associated with dipyrone use %0 Journal Article %C Fachbereich Dermatologie, Allergologie, Dermatologische Onkologie, Medizinisches Zentrum Bonn Friedensplatz, Friedensplatz 16, 53111, Bonn, Germany. info@derma-bonn.de %A Reinhold, U %J Hautarzt %D 2007 Jan %N 1 %P 77-92; quiz 93 %T [Outpatient dermatological chemotherapy] %V 58 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17096136 %X Cytostatic chemotherapy is an integral therapeutic concept in dermatological oncology. The cytostatic drugs are mostly used in palliative situations and in most cases can be applied in an outpatient setting. Special medical knowledge as well as organizational structures are necessary for managing ambulant chemotherapy. A broad spectrum of cytostatic drugs is available and their special indications and use for the treatment of different types of dermato-oncological diseases is reviewed. Specific tools have to be taken into account before, during and after the application of chemotherapy. These include prevention of nausea and emesis, safety guidelines related to the prevention of extravasation, as well as special situations related to patient age %0 Journal Article %C Liver Surgery and Portal Hypertension Service, Hospital das Clinicas, Brazil. drmribeiro@gastrocare.med.br %A Ribeiro, Marcelo A F Jr %A Rodrigues, Joaquim Jose Gama %A Habr-Gama, Angelita %A Chaib, Eleazar %A D'Ipolitto, Giuseppe %A Fonseca, Alexandre Zanchenko %A Saad, William Abrao Jr %A Saad, William Abrao %J Hepatogastroenterology %D 2007 Jun %N 76 %P 1170-5 %T Radiofrequency ablation of primary and metastatic liver tumors--4 years experience %V 54 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17629064 %X BACKGROUND/AIMS: Radiofrequency ablation of primary and metastatic liver tumors has been shown to be one of the promising new modalities to treat or to palliate liver tumors. It has been used as a bridge to liver transplantation as well as an approach to recurrent tumors after resection. METHODOLOGY: We present a series of 78 cases, 39 females and 39 males with a mean age of 61 years, the RFA has been used either by laparotomy or percutaneously to treat 117 lesions. There were 32 cases of hepatocellular carcinoma, 35 metastases of colorectal cancer and 11 cases of other tumors. RESULTS: The mean number of lesions treated were 1.5 per case with a average size of 3.6 cm per lesion. All liver segments were compromised specially IV, VII, VIII. The morbidity was 28% and the mortality was 2.5%. In 20.5% of the cases we were able to find recurrence after the procedure, with a mean time of 10.5 months. CONCLUSIONS: The RFA procedure is safe, can be performed by different ways and in the group of patients who are candidates to liver transplantation, while waiting for the organ. For the metastatic diseases it does not substitute surgery but can be used in patients who cannot be operated %0 Journal Article %C Service d'accueil des urgences adultes, hopital Jean-Minjoz, centre hospitalier universitaire de Besancon, France %A Rinckenbach, V %A Rinckenbach, S %A Thaveau, F %A Hassani, O %A Hedelin, G %A Chakfe, N %A Kretz, JG %J J Mal Vasc %D 2007 Jul %T [Mortality and morbidity of consecutive surgical carotid revascularisations in octogenarians.] %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17630242 %X AIM OF THE STUDY: Retrospective evaluation of the immediate and mid term mortality and morbidity of carotid surgical revascularisations in a population of octogenarians with severe carotid artery stenosis. MATERIAL AND METHOD: Retrospective study of all patients 80 years old and more, consecutively operated for an internal carotid artery stenosis, from January 1991 to December 2003, in the Unit of Vascular Surgery of the Civil Hospices of Strasbourg. We analyzed the perioperative death and stroke rates at 30 days and the mid term survival. RESULTS: We performed 81 carotid revascularisations on 70 patients. The mean age of the population studied was 83.5 (+/-2.8 years), (range 80-92). Twenty-four stenoses (29.6%) were symptomatic (23 transient ischemic accidents, 1 stroke), and 57 stenoses (70.4%) were asymptomatic. The mean degree of stenosis was 89.2+/-8.1% (based on NASCET evaluation). The main cardiovascular risk factor was arterial hypertension (95.7%). The overall perioperative death and stroke rate was 7.1%: 2 deaths, one of them related to a stroke, and 3 strokes (confidence interval: 2.4-15.9%). The perioperative death and stroke rate in the symptomatic stenosis group was 0%, and 8.8% in the asymptomatic stenosis group (p=0.163). No specific risk factor of neurologic events has been found except ASA 3 or higher (RR: 3.84 [1.2-12.1]). The mean follow up was 3.6 years (range 2-11.3), no patient was lost to follow-up. The Kaplan-Meier 5-year survival was 52%. The mean time to death was 3.5 years after the operation. Only 16.7% of these deaths were stroke-related. CONCLUSIONS: Multicentric prospective studies, which have determined current recommendations for carotid surgery, did not include patients aged 79 years and older. In this particular population, the good results observed in our institution in the symptomatic carotid stenosis group would support the use of surgical treatment. The perioperative death and stroke rate observed for the asymptomatic group, clearly superior to current recommendations, suggests in our experience and especially for ASA>/=3, an individual evaluation to determinate the best indication %0 Journal Article %A Rodriguez Garcia, Jose Ignacio %J Cir Esp %D 2007 Mar %N 3 %P 160; author reply 160 %T [Surgery in complicated colorectal cancer] %V 81 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17349244 %0 Journal Article %C The Institute for the Study and Treatment of Psychosocial Stress, Toronto, Ontario, Canada. arokach@yorku.ca %A Rokach, Ami %A Matalon, Raan %A Safarov, Artem %A Bercovitch, Michaela %J Palliat Support Care %D 2007 Jun %N 2 %P 153-9 %T The loneliness experience of the dying and of those who care for them %V 5 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17578066 %X OBJECTIVE: The study compared the qualitative aspects of the loneliness experience of the dying, their caregivers, and the general population. METHOD: The patients were recruited in an oncological hospice in Israel, and, despite being on their deathbed, agreed to participate in the study. Thirty-seven cancer-stricken patients, 78 caregivers, and 128 participants from the general population volunteered to partake in the study. They answered, anonymously, a 30-item questionnaire and were asked to endorse those items that described their experience of loneliness. RESULTS: Results suggested that the three populations did, indeed, differ in their experience of loneliness. More specifically, dying patients and their caregivers had significantly higher subscale scores on the Growth and Discovery and the Self-alienation subscales than the general population did. It was also found that the number of hospitalization days was significantly negatively correlated to the Emotional Distress and Self-alienation subscales. SIGNIFICANCE OF RESULTS: The present results indicate that loneliness is experienced differently in or out of the hospice and by the dying patient, his or her caregiver, and the general population. This may be the first study to examine the qualitative aspects of the loneliness experienced by the dying and by their caregivers. More research is needed to replicate the present study, using larger samples %0 Journal Article %C Harvard Medical School, Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA. Robert_Ross@dfci.harvard.edu %A Ross, Robert W %A Kantoff, Philip W %J Oncology (Williston Park) %D 2007 Feb %N 2 %P 185-93; discussion 194, 199-200 %T Hormone-refractory prostate cancer: choosing the appropriate treatment option %V 21 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17396482 %X Hormone-refractory prostate cancer (HRCaP) is both heterogeneous and lethal. Multiple treatment options exist, including secondary hormonal manipulations, chemotherapy, experimental options, and best supportive care. Choosing the appropriate therapy for an individual patient depends on several important clinical factors such as the presence or absence of symptomatic metastatic disease, age and comorbidities, and prostate-specific antigen velocity. While only docetaxel (Taxotere)-based chemotherapy has been proven to improve survival in this setting, a wide range of therapies may be effective for any individual. Palliative maneuvers, such as external-beam radiation, bisphosphonate therapy, radiopharmaceuticals, and pain management are critical for appropriate patient management. Several promising novel therapies are in late-stage testing and will hopefully provide more treatment options for these patients %0 Journal Article %C Faculty of Health, London South Bank University %A Sanders, Karen %A Fullbrook, Suzanne %J Br J Nurs %D 2007 Mar %N 6 %P 360-1 %T Autonomy and care: respecting the wishes of the deceased patient %V 16 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17505392 %X In previous articles it has been established that a duty of care is owed to all those for whom we care, a duty not to cause harm, to continuously aim to provide the best possible care and treatment, to act at all times in the best interests of those for whom we care. This includes respecting the autonomous choices made by the person regarding the treatment of their body. Autonomy is the capacity to think, decide and act on the basis of such thought and decision, freely and independently (Gillon, 1986), in other words, deliberated self-rule %0 Journal Article %C Dept. of Gastroenterology, Kitasato University East Hospital %A Sasaki, Tohru %A Koizumi, Wasaburo %A Higuchi, Katsuhiko %A Ishido, Kenji %A Ae, Takako %A Nakatani, Kento %A Katada, Chikatoshi %A Tanabe, Satoshi %A Saigenji, Katsunori %J Gan To Kagaku Ryoho %D 2007 Jul %N 7 %P 988-92 %T [Therapeutic strategy for type 4 gastric cancer from the clinical oncologist standpoint.] %V 34 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17637532 %X Type 4 gastric cancer has a poor prognosis compared with other types of advanced gastric cancer because of the high incidence of peritoneal metastasis which causes intestinal obstruction, hydronephrosis, or obstructive jaundice. Surgical treatment is often only palliative, and systematic chemotherapy is considered to be important for long survival.S-1 showed a higher response rate for undifferentiated-type adenocarcinoma,and S-1 alone or its combination regimens demonstrated greater anti-tumor effects and longer survival time for gastric linitis plastica compared with conventional 5-FU regimens in our historical control study (response rate:S-1/non S-1 57.9%/27.9%,p<0.01;MST:S-1/non S-1 402 days/213 days,p<0.01).S-1 regimens may also improve the survival in patients with type 4 gastric cancer in neoadjuvant or adjuvant settings, but further prospective studies are warranted to prove its significance. Paclitaxel also has a high response rate for undifferentiated-type adenocarcinoma, and can be expected to show high efficacy for peritoneal dissemination. Irinotecan should not be administered in case of intestinal obstruction because its toxicity may be increased. However,survival of patients with type 4 gastric cancer may improve with the availability of active agents like S-1, taxanes,irinotecan as reported in colorectal cancer. Therefore,irinotecan should be administered carefully before intestinal obstruction occurs %0 Journal Article %C Department of Surgery, Niigata Prefectural Central Hospital, and Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan %A Sato, Tomoi %A Muto, Ichiro %A Hasegawa, Masaki %A Aono, Takashi %A Okada, Takayuki %A Hasegawa, Jun %A Makino, Shigeto %A Kameyama, Hitoshi %A Tanaka, Ryo %A Sekiya, Masao %J Asian J Surg %D 2007 Jul %N 3 %P 220-3 %T Breast Signet-ring Cell Lobular Carcinoma Presenting with Duodenal Obstruction and Acute Pancreatitis %V 30 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17638643 %X We report here an extremely rare case of breast signet-ring cell carcinoma (SRCC) initially manifesting as duodenal metastasis and acute pancreatitis. A 62-year-old female presented with duodenal obstruction and swollen head of the pancreas, and the diagnosis of acute pancreatitis was initially made. Upper gastrointestinal endoscopy revealed duodenal stenosis with erosive mucosa, with signet-ring cells infiltrating the submucosal layer, suggesting duodenal metastasis of SRCC. Despite absence of a palpable mass in both breasts, computed tomography revealed diffuse enhancement of the left breast in addition to left axillary lymphadenopathy. Histological examination of mammary needle biopsy samples revealed SRCC with a non-invasive lobular carcinoma component. Primary breast SRCC with duodenal metastasis was therefore diagnosed. The patient underwent palliative surgery twice for intestinal obstruction due to peritoneal dissemination. She has remained alive without bowel obstruction for 18 months while being treated with cytotoxic chemotherapies %0 Journal Article %C Department of Internal Medicine II, University of Leipzig, Leipzig, Germany %A Schoppmeyer, K %A Golsong, J %A Schiefke, I %A Mossner, J %A Caca, K %J Dis Esophagus %D 2007 %N 2 %P 89-93 %T Antireflux stents for palliation of malignant esophagocardial stenosis %V 20 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17439590 %X Placement of self-expanding metal stents (SEMS) for palliation of malignant stenoses at the gastroesophageal junction is often associated with stent migration and reflux symptoms. SEMS with an antireflux mechanism have been developed to overcome the latter problem. The aim of this study was to evaluate the safety and efficacy of antireflux Z-stents. Patients with advanced squamous cell or adenocarcinoma of the distal esophagus or cardia suffering from dysphagia received an antireflux Z-stent. Technical success, complications of the procedure, clinical symptoms before and after stent placement, reinterventions and survival were recorded. Follow-up was accomplished by patient interviews and a standardized questionnaire for primary care physicians. Eighteen consecutive patients received an antireflux Z-stent. Seventeen of 18 stents were placed technically successful in a single endoscopic procedure. Mean dysphagia score improved from 2.2 to 0.6. Four patients (22%) had permanent reflux symptoms, an additional nine (50%) were taking proton pump inhibitors on a regular basis. In 10 patients, a re-intervention was necessary mainly due to dislocation of the stent. To ensure adequate nutrition three and two patients received a percutaneous gastrostomy and a jejunostomy, respectively. Median survival from stent insertion was 54 days (range, 3-201). Although placement of an antireflux Z-stent is technically feasible, its application is hampered by frequent stent migration and insufficient prevention of gastroesophageal reflux. Further technical improvements of stents or alternative methods like brachytherapy are required for satisfactory palliation of malignant gastroesophageal stenosis %0 Journal Article %C Family Health Center, Macon, GA 31206, USA. seale.paul@mccg.org %A Seale, J Paul %A Shellenberger, Sylvia %A Spence, John %J Am Indian Alsk Native Ment Health Res %D 2006 %N 1 %P 1-31 %T Alcohol problems in Alaska Natives: lessons from the Inuit %V 13 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17602395 %X In this Alaska Native study, cultural "insiders" analyzed problems associated with increased alcohol availability, factors which have reduced alcohol-related problems, and ideas for improving treatment in an Inuit community. Participants described frequent binging, blackouts, family violence, suicide, loss of child custody, and feelings of intergenerational grief. Helpful existing treatment approaches include alcohol ordinances, inpatient treatment programs, twelve-step groups, and religious involvement. Participants urged the development of family treatment approaches which integrate Inuit customs and values %0 Journal Article %C Department of Neurology, Pain and Palliative Care, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA %A Shaiova, Lauren %A Rim, Faye %A Friedman, Deborah %A Jahdi, Maryam %J Palliat Support Care %D 2007 Jun %N 2 %P 161-6 %T A review of methylnaltrexone, a peripheral opioid receptor antagonist, and its role in opioid-induced constipation %V 5 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17578067 %X OBJECTIVES: Opioid medications are frequently used in pain and palliative care patients with malignancy to manage symptoms such as pain and dyspnea. However, opiates are associated with various side effects. Constipation is a particularly problematic and common side effect of opioid pharmacology. Opioid antagonists have been studied in the management of opioid-induced constipation. Methylnaltrexone (MNTX) is a peripheral opioid antagonist currently under clinical investigation. It offers the potential to reverse undesirable side effects without reversing analgesia. METHODS: This article attempts to review existing clinical data, focusing on antagonism of opioid-induced adverse effects on the gastrointestinal system. RESULTS: MNTX seems to be well tolerated with limited or transient side effects. MNTX has been shown to improve oral-cecal transit times in opioid treated patients, induce laxation in chronic opioid users, and neither reverses the analgesic effects of morphine nor cause withdrawal symptoms. SIGNIFICANCE OF RESULTS: Larger clinical trials of MNTX are still necessary to support its use as a standard for treatment of opioid-induced constipation %0 Journal Article %C Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY, 10027, USA, ks2394@columbia.edu %A Shear, K %A Monk, T %A Houck, P %A Melhem, N %A Frank, E %A Reynolds, C %A Sillowash, R %J Eur Arch Psychiatry Clin Neurosci %D 2007 Jul %T An attachment-based model of complicated grief including the role of avoidance %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17629727 %X INTRODUCTION: Complicated grief is a prolonged grief disorder with elements of a stress response syndrome. We have previously proposed a biobehavioral model showing the pathway to complicated grief. Avoidance is a component that can be difficult to assess and pivotal to treatment. Therefore we developed an avoidance questionnaire to characterize avoidance among patients with CG. METHODS: We further explain our complicated grief model and provide results of a study of 128 participants in a treatment study of CG who completed a 15-item Grief-related Avoidance Questionnaire (GRAQ). RESULTS OF AVOIDANCE ASSESSMENT: Mean (SD) GRAQ score was 25. 0 ± 12.5 with a range of 0-60. Cronbach's alpha was 0.87 and test re-test correlation was 0.88. Correlation analyses showed good convergent and discriminant validity. Avoidance of reminders of the loss contributed to functional impairment after controlling for other symptoms of complicated grief. DISCUSSION: In this paper we extend our previously described attachment-based biobehavioral model of CG. We envision CG as a stress response syndrome that results from failure to integrate information about death of an attachment figure into an effectively functioning secure base schema and/or to effectively re-engage the exploratory system in a world without the deceased. Avoidance is a key element of the model %0 Journal Article %C Department of Oncology, University of Alberta, Cross Cancer Institute, 11560 University Avenue, Edmonton, Alberta, T6G 1Z2, Canada. vickie.baracos@ualberta.ca %A Shragge, Jeremy E %A Wismer, Wendy V %A Olson, Karin L %A Baracos, Vickie E %J Palliat Med %D 2007 Apr %N 3 %P 227-33 %T Shifting to conscious control: psychosocial and dietary management of anorexia by patients with advanced cancer %V 21 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17641076 %X The psychosocial strategies used by advanced cancer patients to manage anorexia are poorly described. A greater understanding of them may guide clinicians to provide appropriate interventions to patients and caregivers. METHODS: Glaserian Grounded Theory was used to recruit and analyse data from two women and seven men with advanced cancer suffering from anorexia. They were interviewed about the emotional and social impact of appetite loss and the strategies that they used to compensate for reduced food intake. RESULTS: Shifting to conscious control (overeating) was the basic social psychological process employed by participants to manage the emotional and social consequences of declining intake. Although a number of symptoms were found to contribute, nausea or the anticipation of emesis provoked by food was most commonly named as the ultimate barrier to eating. DISCUSSION: Participants retained the motivation and ability to eat without appetite, providing the intake of food did not provoke nausea or the anticipation of emesis. Nutritional interventions must be tailored around patients' eating capabilities. Counselling and education programmes that assist family members in understanding the shift to conscious control over eating are required. Palliative Medicine 2007; 21: 227-233 %0 Journal Article %C Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi 110029, India %A Shukla, Jaya %A Bandopadhyaya, G P %A Shamim, S A %A Kumar, R %J Int J Pharm %D 2007 Jun %N 1-2 %P 43-7 %T Characterization of Re-188-Sn microparticles used for synovitis treatment %V 338 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17298870 %X Rhenium-188 labeled tin (Sn) microparticles were developed for pain palliation therapy in the patients suffering from synovitis with acute pain. The rhenium tin microparticles were prepared using stannous chloride and freshly eluted (188)ReO(4)(-) from (188)W/(188)Re generator. The aggregated colloidal particles, packed in a spherical form after boiling for 90-120min were analyzed using electron microscope. The size, surface morphology and stability of microparticles were analyzed by changing temperature and volume conditions. The small colloidal particles clustered and formed spherical microparticles. The 90% of microparticles were in 5-10microm range, after 90min and 120min of boiling. The radiolabeling efficiency was improved to 98% after centrifugation for 10min at 3500rpm. The formulations were stable but the increase in volume had inverse effect on labeling efficiency. No leak was observed from knee area up to 24h with 15-20mCi injection of (188)Re-Sn microparticles. The relief in treated patients, from the pain and inflammation, was observed clinically and by (99m)Tc-MDP perfusion scan %0 Journal Article %C Oncology Med/Surg Inpatient Unit, Veteran's Administration, Kansas City, USA %A Silke-Koval, Janet %J Beginnings %D 2007 Spring %N 2 %P 30-1 %T How does one live well while dying? %V 27 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17494525 %0 Journal Article %C Zaklad Brachyterapii, I Oddzial Radioterapii Ogolnej, Wielkopolskie Centrum Onkologii, Poznan. janusko@priv6.onet.pl %A Skowronek, Janusz %A Mlynarczyk, Witold %A Piorunek, Tomasz %J Przegl Lek %D 2006 %N 8 %P 664-73 %T [Brachytherapy in the treatment of lung and tracheal cancer: current indications, methods, results] %V 63 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17441380 %X Lack of improvement in treatment results of lung cancer leads to searching for new methods. One of the most distressing symptoms for lung cancer patients is airway obstruction due to the tumor, commonly resulting in dyspnea, postobstructive pneumonia, cough, or hemoptysis. Removal of endobronchial obstruction leads to quick improvement of clinical status and Quality of Life. Brachytherapy HDR of tracheal and lung cancer is a well-established method for the local treatment of patients with inoperable tumors of the tracheobronchial system. It seems that another promising treatment method of lung cancer is interstitial brachytherapy using permanent implants. The paper presents principles of brachytherapy, indications for this treatment and treatment results of tracheal and lung cancer. Indications for radical, palliative and interstitial treatment are discussed, respectively. Selected results of brachytherapy as an independent treatment and that combined with teletherapy, radical and, palliative are presented separately. Most commonly recognized complications are discussed which include: fatal pulmonary hemorrhage and fistula formation %0 Journal Article %C Division of Pulmonary and Critical Care, Indiana University School of Medicine, Indianapolis 46202, USA %A Sohrab, Sadaf %A Mathur, Praveen N %J Clin Lung Cancer %D 2007 Mar %N 5 %P 305-12 %T Management of central airway obstruction %V 8 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17562229 %X The efficacy of interventional pulmonology for palliation of patients with central airway obstruction has been established, and its curative potential for early cancer has raised great interest in current screening programs. The success of endoscopic strategies for palliation and treatment with curative intent strongly depends on the diligent identification of the various factors in lung cancer management, including full comprehension of the limits and potential of each particular technique. In the palliative setting of alleviating central airway obstruction, laser resection, electrocautery, argon plasma coagulation, and stenting are techniques that can provide immediate relief, in contrast with cryotherapy, brachytherapy, and photodynamic therapy, which have delayed effects. With curative intent, intraluminal techniques that easily coagulate early-stage cancer lesions will increase the implementation of interventional pulmonology for benign and relatively benign diseases, as well as early cancer lesions and its precursors at their earliest stage of disease %0 Journal Article %C Rep. Analgesic and Palliative Therapy Unit, ASL Frosinone, Frosinone - Italy %A Spaziani, S %A Micheli, T %A Vincenzi, B %A Campisi, C %J J Vasc Access %D 2000 Jul-Sep %N 3 %P 108-11 %T Groshong PICC and home care: an opportunity. Clinical experience after the first 200 implants %V 1 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17638236 %X Peripherally Inserted Central Catheters (PICC) represent an alternative for critical patient care, and are safer to implant in home patients. The authors report on their experience with the first 200 4 Fr Groshong PICC implanted during the last 18 months. The procedure can be easily applied at home (98% successful implant rate), without the need for fluoroscopic or ultrasound guidance. Moreover, the authors believe that the X-ray control after implant is not strictly necessary. After 11,570 days/catheters, only 5 devices were explanted because of complications: 4 because of sepsis and peripheral phlebitis, and the last was explanted by another medical staff for unclear reasons. The complications needing no explanation were a total of 32: for 12 of them the external portion of tube was damaged during use, while for the other 20 the internal clots were resolved with forced flushing. The authors conclude that Groshong PICC can be considered the gold standard for home care management of critical patients, taking into account the quality of pure silicon, the presence of a valve and the specially-made closed-tip %0 Journal Article %C Critical Care and Pulmonary Medicine Division, University of Athens, Greece. grstrat@hotmail.com %A Stratakos, G %A Zisis, C %A Bellenis, I %A Filaditaki, V %A Liapikou, A %A Zakynthinos, S %A Roussos, C %J Monaldi Arch Chest Dis %D 2006 Dec %N 4 %P 225-7 %T Tracheoesophageal fistula managed with tracheal stent through flexible bronchoscopy without fluoroscopy %V 65 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17393669 %X Inoperable malignant tracheoesophageal fistula (TEF) is characterised by an extremely poor prognosis. Tracheal or double (tracheal-esophageal) stenting through rigid bronchoscopy has been suggested as a valuable therapeutic option. We report on a patient with a large TEF successfully sealed by deployment of a self-expandable stent through flexible bronchoscopy (FB) without fluoroscopy. Dramatically improved health status permitted him to undergo radiation, attaining further clinical improvement. Four months after stent placement no sequelae were observed. During the fifth month a new fistula developed distally to the stent finally leading to death from septic complication. Palliative management of inoperable malignant TEF by tracheal stent placement through FB without fluoroscopy, is feasible, safe and rewarding leading to important clinical improvement %0 Journal Article %C Research Institute for Psychology and Health, Faculty of Social Sciences, Utrecht University, Box 80140, 3508, TC, Utrecht, The Netherlands, m.s.stroebeharrold@fss.uu.nl %A Stroebe, M %A Boelen, PA %A van, den Hout M %A Stroebe, W %A Salemink, E %A van, den Bout J %J Eur Arch Psychiatry Clin Neurosci %D 2007 Jul %T Ruminative coping as avoidance : A reinterpretation of its function in adjustment to bereavement %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17629726 %X The paper argues for a reconceptualization of ruminative coping with the death of a loved one as an avoidant rather than a confrontational strategy. Ruminative coping has been characterized within the bereavement field as persistent, repetitive and passive focus on negative emotions and symptoms. It has been theoretically described and empirically shown to be a maladaptive process, being conceptually related to complicated/chronic/prolonged grief. Furthermore, it has been contrasted with denial and suppression processes-which, too, have been understood to be maladaptive and associated with major complications following bereavement. Here evidence is reviewed and the case made that rumination is not an opposite form of coping from suppression or denial, but that it is a similar phenomenon to these, and different from the types of confrontation that take place in so-called "grief work". Implications with respect to intervention for complicated grief are discussed %0 Journal Article %A Talbott, John A %J J Cancer Educ %D 2006 Fall %N 3 %P 118-22 %T Professionalism: why now, what is it, how do we do something? %V 21 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17371171 %X Background: The subjects of professionalism and medical humanism are of concern to all medical schools in the United States as well as the object of numerous reports and scientific papers. Method: In this contribution, I discuss the following: Why is this necessary now and at the University of Maryland? What is and is not professionalism? How do we do something about the current situation, specifically in the selection of students, teaching, and evaluation of professionalism; remediation of unprofessional behavior, and rewarding exemplary behavior? Results and Conclusion: I make specific reference to our focus on end-of-life care, pain and palliation, breaking bad news, and death and dying %0 Journal Article %C Supportive and Palliative Care Unit, Department of Oncology, City Hospital, Rimini, Italy %A Tassinari, D %A Montanari, L %A Maltoni, M %A Ballardini, M %A Piancastelli, A %A Musi, M %A Porzio, G %A Minotti, V %A Caraceni, A %A Poggi, B %A Stella, A %A Aielli, F %A Scarpi, E %J Support Care Cancer %D 2007 Jul %T The palliative prognostic score and survival in patients with advanced solid tumors receiving chemotherapy %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17629751 %X PURPOSE: To evaluate the accuracy of the Palliative Prognostic Score (PaP score) in selecting metastatic gastrointestinal or nonsmall-cell lung cancer patients candidate to palliative chemotherapy. MATERIALS AND METHODS: The PaP score was calculated in 173 patients with advanced, pretreated gastrointestinal or nonsmall-cell lung cancer before starting a further line of chemotherapy with palliative aim. Symptom distress score was calculated using the Edmonton Symptom Assessment System (ESAS) before every course of chemotherapy. Univariate analysis of survival was performed using the logrank test; multivariate analysis was performed using the Cox regression model. Symptom distress scores were compared using multivariate analysis of variance test for repeated measures, and overall symptom distress score was compared using analysis of variance test for repeated measures. RESULTS: Overall median survival was 26 weeks; in PaP score class A it was 32 weeks, and in class B 8 weeks (p < 0.0001). No patient was classified in class C. The two-class PaP score resulted in an independent prognostic factor (p = 0.022), as well as Karnofsky performance status (p = 0.002) and colorectal cancer (p = 0.017). A trend towards worsening of symptom distress was observed in the entire population and in class A. The high number of missed data did not permit an adequate analysis in class B. CONCLUSIONS: The PaP score seems to discriminate patients who could benefit by palliative chemotherapy from those who could better benefit by supportive and palliative approach. However, the data are insufficient to validate the use of the PaP score in patients to be treated with palliative chemotherapy, and further trials should be planned to assess its ability to improve the quality of care in oncology and the appropriateness in the choice of palliative chemotherapy %0 Journal Article %C Research Directorate, Southern Health, 246 Clayton Rd, Clayton, Vic 3168, Australia %A Thiagarajan, Malar %A Savulescu, Julian %A Skene, Loane %J J Law Med %D 2007 May %N 4 %P 583-96 %T Deciding about life-support: a perspective on the ethical and legal framework in the United Kingdom and Australia %V 14 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17571788 %X This article is concerned with the legal right of health service providers to decide whether to provide life-prolonging treatment to patients. In particular, an examination of recent decisions by the English Court of Appeal in R (Burke) v General Medical Council (Official Solicitor and Others Intervening) [2005] EWCA Civ 1003 and the European Court of Human Rights in Burke v United Kingdom (unreported, ECHR, No 19807/06, 11 July 2006) is provided. An analysis of Australian case law is undertaken together with a consideration of the limits of a patient's legal right of autonomy in relation to choosing life-prolonging medical treatment; the basis upon which such treatment can be legally withdrawn or withheld from an incompetent patient against the patient's earlier expressed wishes that it should be continued or initiated; the concept in ethics and law of a patient's best interests; and the role of courts in adjudicating disputes about the continuation of treatment in light of the recent decisions %0 Journal Article %A Thompson, David R %J Heart %D 2007 Aug %N 8 %P 901-2 %T Improving end-of-life care for patients with chronic heart failure %V 93 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17639106 %0 Journal Article %C The Pain Treatment Center of the Bluegrass, Lexington, Kentucky, USA %A Thornberry, Thomas %A Schaeffer, Jennifer %A Wright, Peter D %A Haley, Mindi C %A Kirsh, Kenneth L %J Palliat Support Care %D 2007 Jun %N 2 %P 147-52 %T An exploration of the utility of hypnosis in pain management among rural pain patients %V 5 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17578065 %X OBJECTIVE: Hypnosis is an adjunctive, noninvasive treatment with few side effects that can be useful in the management of chronic pain. However, it has fallen into disfavor in recent years and is often perceived by physicians as simple charlatanism. We evaluated the efficacy of this treatment as used clinically in a large, mostly rural, pain management center. METHODS: We conducted a chart review of 300 pain patients from the Pain Treatment Center of the Bluegrass who had undergone hypnosis for their pain concerns. A chart audit tool was developed consisting of basic demographics, pre- and posthypnosis pain ratings, a rating of relaxation achieved posthypnosis, and scores on the Beck Depression Inventory, Perceived Disability Scale, and the Pain Anxiety Symptom Scale. RESULTS: The sample consisted of 79 men (26.3%) and 221 women (73.7%) with a mean age of 46.3 years (SD = 9.9, range = 19-78). Pain levels recorded pre- and posthypnosis revealed significant improvement as a result of the intervention (mean difference = 2.5, t (1,298) = 25.9, p < .001). Patients reported an average of 49.8% improvement in relaxation level posthypnosis (SD = 24.2%) and had a mean score of 19.0 on the Beck Depression Inventory (SD = 9.9), indicating moderate levels of depression. Also, patients saw themselves as severely disabled regarding their ability to engage in physical (8.3/10) or job-related (7.7/10) activities. Attempts to identify predictors of hypnosis success were not fruitful with one exception. "Poor" responders to hypnosis reported greater levels of perceived dysfunction in their sexual functioning compared to the "good" responders, F(1,187) = 7.2, p < .01. SIGNIFICANCE OF RESULTS: Hypnosis appears to be a viable adjunct for pain management patients, including those from rural and relatively disadvantaged backgrounds. Prospective trials are needed to examine the utility of this modality in end-of-life and palliative care patients %0 Journal Article %C Intensive Care Unit and Department of Paediatrics, Royal Children's Hospital, The University of Melbourne, Melbourne, Victoria, Australia. james.tibbals@rch.org.au %A Tibballs, James %J J Paediatr Child Health %D 2007 Apr %N 4 %P 230-6 %T Legal basis for ethical withholding and withdrawing life-sustaining medical treatment from infants and children %V 43 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17444823 %X Withholding and withdrawing life-sustaining medical treatment is common in hospitals, particularly in intensive care unit environments. Usually, decisions regarding limitation of therapy are based on ethical considerations and derived by discussion and mutual agreement between parents and clinicians. However, disputes sometimes arise. When such disputes are settled in court, the judgements constitute common law and may serve as the basis for ethical decisions. All cases have been decided in the 'best interests' of the unfortunate child. Although each case has its own circumstances, a composite view reveals three legal criteria for withholding or withdrawing treatment. These are based on the present and future 'quality of life', 'futility' of present treatment and a comparison of 'burdens versus benefits' of present and future treatment and its discontinuance. These legal principles may facilitate difficult ethical decisions. This article identifies a number of common law cases which establishes these principles %0 Journal Article %C Barrow Neurological Institute, Phoenix, Arizona 85013, USA %A Treiman, David M %J Int Rev Neurobiol %D 2007 %P 273-85 %T Treatment of convulsive status epilepticus %V 81 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17433931 %X Status epilepticus (SE) is a medical and neurological emergency requiring prompt and aggressive treatment, particularly for elderly individuals in whom comorbid conditions may increase the severity of consequences in SE. Generalized convulsive status epilepticus (GCSE) is the most common and life-threatening type of SE. It may be overt or subtle in its presentation. Most cases are overt, but as the duration of GCSE increases, its presentation may become more subtle. Progressive electroencephalographic changes also occur during GCSE. A predictable sequence of five electroencephalographic patterns has been identified: (1) discrete seizures with interictal slowing, (2) merging seizures with waxing and waning ictal discharges, (3) continuous ictal sharp or spike-wave discharges, (4) continuous ictal discharges with episodes of generalized flattening, and (5) periodic epileptiform discharges superimposed on a relatively flat background. Several factors affect the prognosis of GCSE, including etiology, age, seizure type, gender, and duration. GCSE may lead to systemic complications and neuronal damage and is often fatal if untreated or inadequately treated. Treatment of GCSE should begin with basic life support measures and monitoring. Ideally, pharmacological treatment should be easy to administer and fast acting. Analysis of data on elderly patients with overt GCSE from a Veterans Affairs cooperative study revealed that success rates of first-line treatment were 71.4% for phenobarbital, 63.0% for lorazepam, 53.3% for diazepam followed by phenytoin, and 41.5% for phenytoin alone. In elderly patients with subtle GCSE, success rates for first-line treatment were 30.8% for phenobarbital, 14.3% for lorazepam, 11.8% for phenytoin, and 5.6% for diazepam followed by phenytoin. Because each drug has advantages and disadvantages, the choice of which agent to use as first-line treatment depends on individual patient characteristics %0 Journal Article %C Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115, USA. ktuncali@partners.org %A Tuncali, Kemal %A Morrison, Paul R %A Winalski, Carl S %A Carrino, John A %A Shankar, Sridhar %A Ready, John E %A vanSonnenberg, Eric %A Silverman, Stuart G %J AJR Am J Roentgenol %D 2007 Jul %N 1 %P 232-9 %T MRI-guided percutaneous cryotherapy for soft-tissue and bone metastases: initial experience %V 189 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17579176 %X OBJECTIVE: We sought to determine the safety and feasibility of percutaneous MRI-guided cryotherapy in the care of patients with refractory or painful metastatic lesions of soft tissue and bone adjacent to critical structures. MATERIALS AND METHODS: Twenty-seven biopsy-proven metastatic lesions of soft tissue (n = 17) and bone (n = 10) in 22 patients (15 men, seven women; age range, 24-85 years) were managed with MRI-guided percutaneous cryotherapy. The mean lesion diameter was 5.2 cm. Each lesion was adjacent to or encasing one or more critical structures, including bowel, bladder, and major blood vessels. A 0.5-T open interventional MRI system was used for cryoprobe placement and ice-ball monitoring. Complications were assessed for all treatments. CT or MRI was used to determine local control of 21 tumors. Pain palliation was assessed clinically in 19 cases. The mean follow-up period was 19.5 weeks. RESULTS: Twenty-two (81%) of 27 tumors were managed without injury to adjacent critical structures. Two patients had transient lower extremity numbness, and two had both urinary retention and transient lower extremity paresthesia. One patient had chronic serous vaginal discharge, and one sustained a femoral neck fracture at the ablation site 6 weeks after treatment. Thirteen (62%) of the 21 tumors for which follow-up information was available either remained the same size as before treatment or regressed. Eight tumors progressed (mean local progression-free interval, 5.6 months; range, 3-18 months). Pain was palliated in 17 of 19 patients; six of the 17 experienced complete relief, and 11 had partial relief. CONCLUSION: MRI-guided percutaneous cryotherapy for metastatic lesions of soft tissue and bone adjacent to critical structures is safe and can provide local tumor control and pain relief in most patients %0 Journal Article %C Department of Psychiatry, University of Queensland, Brisbane, Australia. jane.turner@uq.edu.au %A Turner, Jane %A Clavarino, Alexandra %A Yates, Patsy %A Hargraves, Maryanne %A Connors, Veronica %A Hausmann, Sue %J Palliat Support Care %D 2007 Jun %N 2 %P 135-45 %T Development of a resource for parents with advanced cancer: what do parents want? %V 5 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17578064 %X OBJECTIVE: Parents coping with a diagnosis of advanced cancer experience distress and guilt about the impact of the disease on their children but report that there are few resources specific to advanced disease to guide and support them in discussions with their children. Although some resources have been developed to assist parents with advanced cancer, it appears that these are not widely disseminated. METHODS: To determine the need for a brief resource that could be given to parents at the point of diagnosis of advanced cancer, including its content, in-depth interviews were conducted with eight women with advanced breast cancer. RESULTS: Women confirmed that they had received minimal assistance from health professionals in discussing the diagnosis with their children, and even when professional counselors were accessed they were not always attuned to the specific needs of parents with advanced cancer. Women felt frustrated that information they did access focused on early disease and lacked the details women felt they needed in coping with advanced cancer. Women felt that there was a need for a brief resource that reassured parents about the impact of the cancer on their children, including practical strategies to help them cope and examples of the ways other parents had responded to difficult questions such as about parental death. A draft resource was developed, critically reviewed by the participants, and their comments incorporated into a final version. SIGNIFICANCE OF RESULTS: This article expands on the themes highlighted by women as important to assist parents with advanced cancer, including the final resource that was developed %0 Journal Article %C Asthma Care and Education Unit, Department of Pulmonary Medicine, Sapir Medical Center Meir Hospital, Kfar Sava and Sackler Faculty of Medicine, Tel Aviv University, Israel. Varsanos@clalit.org.il %A Varsano, Shabtai %J Harefuah %D 2007 Apr %N 4 %P 280-5, 317 %T [Reasons for the gap between asthma in reality and GINA guidelines] %V 146 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17476936 %X Asthma is a common chronic disease worldwide, affecting 300 million people of all ages. In spite of the existence of scientifically proven clinical guidelines for the past 15 years and efficient controller medications, the gaps between asthma management in reality and the goals of the Global Initiative for Asthma (GINA) guidelines are huge. Asthma, being a chronic disease, might be a companion from early childhood to the end of life and, as such, may impose major obstacles in disease management. These obstacles may rise from patient coping skills and style, from reasons that depend on the general practitioner himself/herself and the medical establishment and, most probably, also from lack of agreement between patients and caregivers about what constitutes well-managed asthma. This review aims to reveal and clarify the known and possible reasons for the recently proven worldwide gaps that still exist between asthma in reality and the goals of asthma clinical guidelines. Presenting and discussing the reasons for these huge gaps will hopefully help general practitioners to close these gaps in order to improve their patients asthma related quality of life and preserve lung function throughout life and decrease morbidity %0 Journal Article %C Department of Nuclear Medicine, University Medical Center Utrecht, The Netherlands. e.verburg@azu.nl %A Verburg, Frederik A %A de Keizer, Bart %A van Isselt, Johannes W %J Anticancer Agents Med Chem %D 2007 Jul %N 4 %P 399-409 %T Use of radiopharmaceuticals for diagnosis, treatment, and follow-up of differentiated thyroid carcinoma %V 7 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17630916 %X In 1942, Dr. Seidlin of the Memorial Hospital in New York was faced with a 51-year- old patient who had undergone a thyroidectomy in 1923 [1]. At the time, the histologic diagnosis was a 'malignant adenoma' of the thyroid. In 1938 the patient returned with overt signs of thyroid hyperfunction (hyperthyroidism) and lower back pain. A metastasis was found in the lower spine, and surgically removed. Over the next years the patient remained hyperthyroid and developed more bone metastases. At the time of presentation to Dr. Seidlin, the patient was in an extremely poor condition: he was in severe pain, severely hyperthyroid, and severely underweight. At this time radioiodine therapy had just reached the clinical arena. In 1937 Hertz, Roberts and Evans investigated the rabbit's thyroid function using I-128 [2]. Later they pursued therapeutic goals for e.g. Graves' disease using I-130. They used dosages that we now know would have been merely diagnostic if it were not for a probable 10% I-131 contaminant [3]. Livingood and Seaborg identified I-131 as a separate isotope. In 1942 two groups independently reported on the successful treatment of hyperthyroidism with I-131 sodium iodide [4,5]. Radioiodine was so rare that it was recovered from the urine, purified and re-administered to the patient. The patient responded favourably to the radioiodine treatment, and he received several more courses of I-131. Geiger-counter examination of the patient revealed two previously unknown metastases, thereby indicating the diagnostic capabilities of radioiodine. The patient did very well on these courses: the hyperthyroidism subsided, the body-weight kg increased from 38 to 53 kilograms, and the pains diminished. This report of a potential cure for terminally ill patients fuelled the public imagination to a degree that it hit the political agenda. Effective on August 1, 1946, the Atomic Energy Act (AEA) made radioisotopes available for medical use in the USA. This date marks the beginning of 'atomic medicine', later named nuclear medicine %0 Journal Article %C ENT Department, Victoria Hospital, Bangalore Medical College, Bangalore, Karnataka, India. drbviswanatha@yahoo.co.in %A Viswanatha, Borlingegowda %J Ear Nose Throat J %D 2007 Apr %N 4 %P 218, 220-2 %T Embryonal rhabdomyosarcoma of the temporal bone %V 86 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17500393 %X The most common soft-tissue sarcoma in infants and children is rhabdomyosarcoma. The head and neck is the most common site of involvement; temporal bone involvement has been seen in about 7% of reported cases. Multimodality therapy--surgery, multiagent chemotherapy, and radiotherapy-yields sufficiently good results. The author reports a case of embryonal rhabdomyosarcoma of the temporal bone with cranial nerve palsies and extension into the parapharyngeal space in a 4-year-old boy. Despite surgery and chemotherapy, the patient died of his disease within 3 months of presentation %0 Journal Article %C Himeji Medical Center %A Wada, Yasuo %A Otoshi, Masahiro %A Jitsuko, Akira %A Nishikawa, Hidefumi %A Takahara, Sachiko %A Tsubono, Mitsuhiko %A Imai, Shiro %J Gan To Kagaku Ryoho %D 2007 Jul %N 7 %P 1041-5 %T [A Phase II Study of Weekly Paclitaxel for Advanced or Recurrent Breast Cancer.] %V 34 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17637539 %X The present study investigated the efficacy and safety of weekly administration of paclitaxel (PTX) for 37 patients with advanced or recurrent breast cancer. PTX was administered at a dose of 60 mg/m(2), 6 times every 8 weeks. The mean number of treatment cycles was 2.1, and the mean number of administrations was 12.7.Response rate was 35.1%.Two patients achieved CR, 11 PR,13 NC (3 patients of long NC),9 PD,and 2 NE.The clinical benefit rate (CR+PR+NC) was 70.3%.Median survival time was 733 days,and median time to treatment failure was 151 days. Grade 3 or more leucopenia and neutropenia occurred in 3 of patients (8.1%), and no patients showed hypersensitivity reaction after administration of PTX. Weekly PTX (60 mg/m(2)) is one of the treatment options in advanced or recurrent breast cancer from the standpoint of palliation %0 Journal Article %A Weil, K %A Hooper, L %A Afzal, Z %A Esposito, M %A Worthington, Hv %A van Wijk, Aj %A Coulthard, P %J Cochrane Database Syst Rev %D 2007 %N 3 %P CD004487 %T Paracetamol for pain relief after surgical removal of lower wisdom teeth %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17636762 %X BACKGROUND: Paracetamol has been commonly used for the relief of postoperative pain following oral surgery. In this review we investigated the optimal dose of paracetamol and the optimal time for drug administration to provide pain relief, taking into account the side effects of different doses of the drug. This will inform dentists and their patients of the best strategy for pain relief after the surgical removal of wisdom teeth. OBJECTIVES: To assess the beneficial and harmful effects of paracetamol for pain relief after surgical removal of lower wisdom teeth, compared to placebo, at different doses and administered postoperatively. SEARCH STRATEGY: We searched the Cochrane Oral Health Group's Trials Register; the Cochrane Pain, Palliative and Supportive Care Group's Trials Register; CENTRAL; MEDLINE; EMBASE and the Current Controlled Trials Register. Handsearching included several dental journals. We checked the bibliographies of relevant clinical trials and review articles for studies outside the handsearched journals. We wrote to authors of the identified randomised controlled trials (RCTs), to manufacturers of analgesic pharmaceuticals, we searched personal references in an attempt to identify unpublished or ongoing RCTs. No language restriction was applied. The last electronic search was conducted on 24th August 2006. SELECTION CRITERIA: Randomised, parallel group, placebo controlled, double blind clinical trials of paracetamol for acute pain, following third molar surgery. DATA COLLECTION AND ANALYSIS: All trials identified were scanned independently and in duplicate by two review authors, any disagreements were resolved by discussion, or if necessary a third review author was consulted. The proportion of patients with at least 50% pain relief was calculated for both paracetamol and placebo. The number of patients experiencing adverse events, and/or the total number of adverse events reported were analysed. MAIN RESULTS: Twenty-one trials met the inclusion criteria. A total of 2048 patients were initially enrolled in the trials (1148 received paracetamol, and 892 the placebo) and of these 1968 (96%) were included in the meta-analysis (1133 received paracetamol, and 835 the placebo). Paracetamol provided a statistically significant benefit when compared with placebo for pain relief and pain intensity at both 4 and 6 hours. Most studies were found to have moderate risk of bias, with poorly reported allocation concealment being the main problem. Risk ratio values for pain relief at 4 hours 2.85 (95% confidence interval (CI) 1.89 to 4.29), and at 6 hours 3.32 (95% CI 1.88 to 5.87). A statistically significant benefit was also found between up to 1000 mg and 1000 mg doses, the higher the dose giving greater benefit for each measure at both time points. There was no statistically significant difference between the number of patients who reported adverse events, overall this being 19% in the paracetamol group and 16% in the placebo group. AUTHORS' CONCLUSIONS: Paracetamol is a safe, effective drug for the treatment of postoperative pain following the surgical removal of lower wisdom teeth %0 Journal Article %C Division of Pediatric Neurology, Duke University Medical Center, Durham, NC. weislederp@childrensdayton.org %A Weisleder, Pedro %J J Child Neurol %D 2007 Jun %N 6 %P 737-40 %T Dignified death for severely impaired infants: beyond the best-interest standard %V 22 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17641260 %X The Baby Doe rules, a set of federal regulations on the treatment of extremely ill infants, went into effect in 1985. Some scholars have argued that these rules are inappropriate given that they fail to pay attention to the patient's suffering. Instead, researchers suggest that, when dealing with a severely impaired infant, the best-interest standard be used. Other ethicists have found the best-interest standard also insufficient, deeming it to be supported by weak arguments rooted on the beholder's beliefs. In this article, alternative viewpoints that might be used to complement the best-interest standard and help support the rights of severely impaired infants to a natural and dignified death are reviewed. The use of palliative instead of intensive care for severely impaired newborns is also considered %0 Journal Article %C Faculty of Health and Social Care, The University of Hull, Hull, UK %A Wilson, Benita %J J Clin Nurs %D 2007 Jun %N 6 %P 1012-20 %T Nurses' knowledge of pain %V 16 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17518877 %X Aim. The aim of this study was to establish if postregistration education and clinical experience influence nurses' knowledge of pain. Background. Inadequacies in the pain management process may not be tied to myth and bias originating from general attitudes and beliefs, but reflect inadequate pain knowledge. Design. A pain knowledge survey of 20 true/false statements was used to measure the knowledge base of two groups of nurses. This was incorporated in a self-administered questionnaire that also addressed lifestyle factors of patients in pain, inferences of physical pain, general attitudes and beliefs about pain management. Method. One hundred questionnaires were distributed; 86 nurses returned the questionnaire giving a response rate of 86%. Following selection of the sample, 72 nurses participated in the study: 35 hospice/oncology nurses (specialist) and 37 district nurses (general). Data were analysed using SPSS. Results. The specialist nurses had a more comprehensive knowledge base than the general nurses; however, their knowledge scores did not appear to be related to their experience in terms of years within the nursing profession. Conclusion. Whilst educational programmes contribute to an increase in knowledge, it would appear that the working environment has an influence on the development and use of this knowledge. It is suggested that the clinical environment in which the specialist nurse works can induce feelings of reduced self-efficacy and low personal control. To ease tension, strategies are used that can result in nurses refusing to endorse their knowledge, which can increase patients' pain. Relevance to clinical practice. Clinical supervision will serve to increase the nurses' self-awareness; however, without power and autonomy to make decisions and affect change, feelings of helplessness, reduced self-efficacy and cognitive dissonance can increase. This may explain why, despite educational efforts to increase knowledge, a concomitant change in practice has not occurred %0 Journal Article %C , 1250 Bellflower Blvd, Long Beach, CA, 90840, stwilson@csulb.edu %A Wilson, Steve %J J Soc Work End Life Palliat Care %D 2006 %N 4 %P 33-60 %T The validation of the Texas revised inventory of grief on an older latino sample %V 2 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17387094 %X Purpose: Bereavement is considered to be one of the most profound experiences in older adulthood. However, assessments of emotional reactions to grief and loss have often been based on measures tested on primarily Anglo samples. This study examined the validity and factor structure of a commonly used bereavement measure on an older Latino sample. Design and Methods: Using convergent and discriminant validation procedures, this instrument was tested using a purposive sample of 134 older, recently bereaved Latinos. Results: While the instrument was originally designed to measure two domains of grief: Past Behaviors and Present Feelings, confirmatory and exploratory factor analysis revealed a three-factor solution for this sample which included also Disbelief of the loss. Items within this domain included anger, rejection, and a sense of injustice. Implications: This study underscores the need for improved measures in research on grief and bereavement to capture the intensity and severity of grief in a cross-cultural context. doi:10.1300/J457v02n04_03 %0 Journal Article %C Klinik fur Nieren- und Hochdruckkrankheiten, Medizinische Klinik, Universitatsklinikum Essen, Essen, Deutschland. oliver.witzke@uk-essen.de %A Witzke, Oliver %A Gerken, Guido %A Kribben, Andreas %A Philipp, Thomas %J Med Klin (Munich) %D 2007 Mar %N 3 %P 203-8 %T [Hepatorenal syndrome. What's new in 2007?] %V 102 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17345016 %X BACKGROUND: Hepatorenal syndrome (HRS) is a serious complication of end-stage liver disease that was associated with a fatal prognosis in the past. A clear definition of HRS and increased understanding of the pathogenesis have led to considerable progress in therapy outcome. PATHOGENESIS: The major pathogenetic factor is vasodilation of the mesenteric circulation with arterial underfilling and consecutive renal vasoconstriction. THERAPY AND CONCLUSION: Restoration of an effective arterial blood volume can be achieved by the combination of vasopressor therapy (terlipressin, norepinephrine), in combination with volume expansion (albumin) with a success rate of up to 75%. Restoration of the effective arterial blood volume may also be achieved by implantation of a transjugular intrahepatic portosystemic stent (TIPS). This has also been successful in up to 50% of patients in selected cohorts. Finally, extracorporeal liver support systems based on exchange or detoxification of albumin have been successfully employed in a number of patients. Liver transplantation remains the only principal therapy of HRS as this is the single measure with a curative intent. All other forms of therapy are palliative but may serve as a bridge to liver transplantation %0 Journal Article %C Katedra i Klinika Dermatologii, Collegium Medicum, Uniwersytetu Jagiellonskiego, Krakow. wojaspelca@su.krakow.pl %A Wojas-Pelc, Anna %A Rajzer, Lidia %A Jaworek, Andrzej %A Wozniak, Wioletta %J Przegl Lek %D 2006 %N 8 %P 674-80 %T [The latest diagnostical methods and therapy in melanoma] %V 63 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17441381 %X Molecular biology, immunology, diagnostic and treatment of cutaneous melanoma have been analyzed on the basis of current literature due to the increasing frequency of this cancer. Due to the increasing frequency of melanoma it is crucial to detect early the malignant lesions on the basis of physical examination and noninvasive diagnostic methods (dermatoscopy, videodermatoscopy with total body photography). Histopathological examination is conclusive. In diagnostic imaging of early stage melanoma it is very important to evaluate the regional lymph node. In clinical practice, the cross-sectional imaging modalities including computed tomography (CT), ultrasound and magnetic resonance (MR) are widely used to assess lymph nodes. Sentinel lymph node (SLN) biopsy is currenly a valuable and reliable diagnostic procedure for precise staging of patients with clinically no cutaneous melanoma. The presence of SLN metastases is the most important negative factor for clinical outcome in melanoma patients. Introduction of RT-PCR allowed to detect individual cancer cells in tested sample of blood or tissue. Surgical treatment is an essential therapeutic modality in patients with melanoma. Treatment of a primary melanoma involves local excision of the tumour with a margin of skin and subcutaneous tissue. The role of systemic therapy is still a matter of clinical trials. Today's systemic therapy modalities include the use of biological agents (e.g. interferon alfa and interleukin 2) and cytotoxic agents. The efficacy of different types of melanoma vaccines (antigenic, cellular, DNA, GMTV) has been analyzed in numerous clinical trials. Results of these trials are still unsatisfactory. Dendritic cells in melanoma therapy will be very important in the future. Dendritic cells are the most efficient stimulators of T lymphocyte response among professional antygen presenting cells (APC) and the only APC capable to prime naive T lymphocytes with the antygen. A response to weakly immunogenic and tolerogenic tumor antigens can be achived with the use of DC as APC. This review represents an attempt to discuss current evidence on the place of adjuvant and palliative systemic therapy in melanoma %0 Journal Article %C Katsuta Hospital Mito GammaHouse, Hitachi-Naka, Ibaraki, Japan. BCD06275@nifty.com %A Yamamoto, Masaaki %J Prog Neurol Surg %D 2007 %P 106-28 %T Radiosurgery for metastatic brain tumors %V 20 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17317980 %X New, not yet widely known concepts pertaining to Gamma Knife (GK) radiosurgery for brain metastases are reviewed. In the author's experience, GK is a safe and effective treatment. Though lesion size is a limitation, high tumor control rates are possible when 1-4 lesions are irradiated with or =75 was 116.9 mg/day. CONCLUSION: Elderly cancer patients required a lower amount of opioid analgesia than younger adults. The ratio for age <65, 65-74, and > or =75 was about 1:1/2:1/3 %0 Journal Article %C Department of Family Medicine (C.-A.Y., Y.-F.L., S.-Y.C., C.-Y.C., T.-Y.C.) and School of Nursing (W.-Y.H.), College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan %A Yao, CA %A Hu, WY %A Lai, YF %A Cheng, SY %A Chen, CY %A Chiu, TY %J J Pain Symptom Manage %D 2007 Jul %T Does Dying at Home Influence the Good Death of Terminal Cancer Patients? %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17629664 %X To investigate whether dying at home influences the likelihood that a terminal cancer patient will achieve a good death despite the limited medical resources available in many communities, this study investigated the relationship between the achievement of a good death and the performance of good-death services in two groups with different places of death, and explored the possible factors associated with this relationship. Three hundred and seventy-four consecutive patients with terminal cancers admitted to a palliative care unit were enrolled. Two instruments, the good-death scale and the audit scale for good-death services, were used in the study. Mean age of the 374 patients was 65.45+/-14.77 years. The total good-death score in the home-death group (n=307) was significantly higher than that in hospital-death group (n=67), both at the time of admission (t=-5.741, P<0.001) and prior to death (t=-3.027, P<0.01). However, the score of item "degree of physical comfort" assessed prior to death in the home-death group was lower than that in hospital-death group (P=0.185). As to the audit scale for good-death services, each subscale score and total scores in the home-death group were significantly higher than that in hospital-death group, with the exception of the subscale "continuity of social support" (4.72 vs. 4.61, P=0.132). Bereavement support (odds ratio=1.01, 95% confidence interval=0.62-1.39; multiple regression), alleviation of anxiety (0.81, 0.46-1.15), decision-making participation (0.61, 0.26-0.95), fulfillment of last wish (0.45, 0.08-0.82), and survival time (0.00, 0.00-0.01) were independent correlates of the good-death score (35.8% of explained variance). However, the place of death was not in the model. The study conclusively suggests the necessity for palliative home care to strengthen the competence of physical care. Moreover, earlier incorporation of palliative care into anticancer therapies can lead to better death preparation and good-death services, and thus be helpful to achieve a good death %0 Journal Article %C Universite de Lyon, Hospices Civils de Lyon, Hopital Neurologique et Neurochirurgical Pierre Wertheimer, Service de Neurologie C, Lyon, France %A Zyss, J %A Xie-Brustolin, J %A Ryvlin, P %A Peysson, S %A Beschet, A %A Sappey-Marinier, D %A Hermier, M %A Thobois, S %J Mov Disord %D 2007 Jul %T Epilepsia partialis continua with dystonic hand movement in a patient with a malformation of cortical development %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17638319 %X Malformations of cortical development (MCD) with polymicrogyria and schizencephaly are due to abnormal cortical organization and usually manifest by intractable epilepsy and mental retardation. Epileptical activity is often hard to register and focal dystonia associated with such MCD has previously been described but without any metabolic imaging. We report here a 46-year-old man presenting with late-onset atypical abnormal movements of his left hand associated with right central region MCD. To demonstrate the involvement of an epileptical focus, we performed [(18)F]FDG-PET and fMRI both before and after a single dose of clobazam and diazepam, respectively. Characteristics of the abnormal hand movements, clinical response to the medication, and the result of the [(18)F]FDG-PET and fMRI investigations all favor the diagnosis of epilepsia partialis continua. We conclude that the dystonic movement is part of the partial seizure. (c) 2007 Movement Disorder Society %0 Journal Article %C Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, The Netherlands. e.voogt@erasmusmc.nl %A de Vogel-Voogt, Elsbeth %A van der Heide, Agnes %A van Leeuwen, Anna F %A Visser, Adriaan %A van der Rijt, Carin Cd %A van der Maas, Paul J %J Palliat Med %D 2007 Apr %N 3 %P 243-8 %T Patient evaluation of end-of-life care %V 21 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17641078 %X The Dutch health care system is characterized by a strong emphasis on primary care. To get insight into the strengths and gaps in end-of-life care in the Netherlands, data are needed about use and patient evaluation of end-of-life care. We assessed the experiences of patients with end-of-life care during the last months of life. We followed 128 patients with incurable lung, breast, ovarian, colorectal or prostate cancer. At inclusion they were interviewed personally at home. During follow-up, every 6 months, we asked them to fill out a questionnaire on the end-of-life care they had received. One-hundred of them died during the research period. Eighty-seven of the deceased patients were able to fill out a questionnaire in the last 6 months of their lives. They reported that, on average, 4.2 disciplines were involved in their care. Most patients indicated to be satisfied with the care offered by their caregivers. Problems in end-of-life care concerned communication, difficulties in coordination, accessibility of end-of-life care and responding quickly to acute problems. We conclude that comprehensive and interdisciplinary end-of-life care may address patients' needs, but that it simultaneously is a challenge to optimal communication among disciplines and between caregivers and the patient. Palliative Medicine 2007; 21: 243-248 %0 Journal Article %C Oosterscheldeziekenhuis, Postbus 106, 4460 BB Goes. h.vanhalteren@zzlnd.nl %A van Halteren, H K %A Liem, A H %A Planting, A S T %J Ned Tijdschr Geneeskd %D 2007 Jun %N 26 %P 1469-73 %T [Myocardial ischaemia as a result of treatment with capecitabine] %V 151 %W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17633978 %X A 53-year-old man and a 76-year-old woman were treated with the cytotoxic drug capecitabine as palliative treatment and adjuvant treatment, respectively, because of colorectal carcinoma. Both developed myocardial ischaemia within a few days. In the man, the capecitabine dosage was reduced and metoprolol was prescribed, while in the woman the capecitabine was stopped. According to the literature, the risk of myocardial ischaemia during treatment with capecitabine is approximately 0.4%, irrespective of the patient's medical history. Except in clinical trials, a history of coronary disease is not considered a contraindication for capecitabine treatment. In case stable angina pectoris develops during treatment, continuation of treatment with a reduced dosage of capecitabine can be considered. A switch to treatment with an alternative fluoropyrimidine, such as fluorouracil or raltitrexed, also appears to be safe. However, raltitrexed is no longer available in The Netherlands