bluuebunny/crossref_metadata_2025 huggingface dataset:
Fragile histidine triad protein expression in nonsmall cell lung cancer and correlation with Ki-67 and with p53
Authors: Mascaux C. , Martin B. , Verdebout J.M. , Meert A.P. , Ninane V. , Sculier J.P.
Published: May 2003

Fragile histidine triad (FHIT) is a tumour suppressor gene, which is altered in a variety of epithelial tumours, including lung cancer. Biochemical and functional pathways of its tumourigenicity are not yet understood. Its role in tumour proliferation is particularly controversial. The purpose of this study was to correlate the expression of FHIT protein in nonsmall cell lung cancer (NSCLC) with tumour proliferation as estimated by Ki-67 antigen and with p53, a suppressor gene.

FHIT, Ki-67 and p53 expression were evaluated by immunohistochemistry in 119 resected NSCLC.

Altogether, 58 tumours were negative (expression <10%) for FHIT. The median expression in tumours was 15% positive cells, in comparison with 100% in normal matched lung tissue. The expression was as strong as in normal tissue in only 19 cases. FHIT expression was significantly lower in squamous cell carcinoma (SCC) (5%) than in adenocarcinoma (ADC) (64%). The median expression of Ki-67 was 20% and 69% of tumours were positives (expression >10%). Ki-67 expression was significantly higher in SCC (33.3%) than in ADC (10%). The loss of FHIT protein was not correlated with the expression of p53 (median: 7.5%, 58% of positive tumours for a cut-off of 10% of positive cells) or Ki-67. But percentage of labelled cells for p53 and Ki-67 were significantly correlated.

The results suggest that for fragile histidine triad, the pathway of tumourigenesis is independent of p53 and of tumoural proliferation, as reported previouslyin vitro.
Chlamydiaspecies as a cause of community-acquired pneumonia in Canada
Authors: Marrie T.J. , Peeling R.W. , Reid T. , De Carolis E. ,   the Canadian Community-Acquired Pneumonia Investigators
Published: May 2003

Chlamydia pneumoniaehas been implicated as a cause of community-acquired pneumonia (CAP) in several studies. However, there has been no comprehensive study of the role ofChlamydiaspecies (C. pneumoniae,C. psittaci(avian and feline strains) andC. pecorum) as a cause of CAP. The aim of the present study was to determine the role ofC. pneumoniae,C. psittaciandC. pecorumas causes of CAP.

A prospective cohort observational study of CAP was conducted at 15 teaching centres in eight Canadian provinces between January 1996–October 1997. Acute (n=539) and convalescent (n=272) serum samples were obtained for determination of antibody titres toC. pneumoniae,C. psittaci,C. pecorum,C. trachomatis,Mycoplasma pneumoniae,Legionella pneumophilaserogroups I–VI,Streptococcus pneumoniaeand various respiratory viruses.

Twelve of 539 (2.2%) patients had acuteC. pneumoniaepneumonia and an additional 32 (5.9%) had possible acute infection.C. pneumoniaewas the sole pathogen in 16 of 42 (38.1%) of these patients. The most common copathogens wereS. pneumoniae, respiratory syncytial virus and influenza virus type A.C. pneumoniaepneumonia patients were older and more likely to show congestive heart failure compared to bacteraemicS. pneumoniaepatients. The latter had a lower mean diastolic blood pressure, a higher white blood cell count and a lower arterial carbon dioxide tension. Two patients had antibody titres suggestive of recent infection with the feline strain ofC. psittaci.

Although numericallyChlamydia pneumoniaeis an important cause of community-acquired pneumonia, no distinctive clinical features associated with this pathogen were detected in the present study. FelineChlamydia psittacimay cause a few cases of community-acquired pneumonia. AvianChlamydia psittacishould be considered only if there is a compatible epidemiological history.
Varicella pneumonia in adults
Authors: Mohsen A.H. , McKendrick M.
Published: May 2003

Varicella is a common contagious infection in childhood with increasing incidence in adults. Pneumonia, although rare, is the most serious complication that commonly affects adults. Over the last two decades there have been major advances in the understanding of Varicella infections, management and prevention. This review discusses the epidemiology, pathogenesis, pulmonary manifestation, morbidity, long-term clinical consequences and current state of management of Varicella pneumonia in adults. Prevention and other disease-modifying therapy are also discussed.
Pulmonary hypertension in chronic obstructive pulmonary disease
Authors: Barberà J.A. , Peinado V.I. , Santos S.
Published: May 2003

Pulmonary hypertension is a common complication of chronic obstructive pulmonary disease (COPD). Its presence is associated with shorter survival and worse clinical evolution. In COPD, pulmonary hypertension tends to be of moderate severity and progresses slowly. However, transitory increases of pulmonary artery pressure may occur during exacerbations, exercise and sleep. Right ventricular function is only mildly impaired with preservation of the cardiac output.

Structural and functional changes of pulmonary circulation are apparent at the initial stages of COPD. Recent investigations have shown endothelial dysfunction and changes in the expression of endothelium-derived mediators that regulate vascular tone and cell growth in the pulmonary arteries of patients with mild disease. Some of these changes are also present in smokers with normal lung function. Accordingly, it has been postulated that the initial event in the natural history of pulmonary hypertension in COPD could be the lesion of pulmonary endothelium by cigarette-smoke products.

Long-term oxygen administration is the only treatment that slows down the progression of pulmonary hypertension in chronic obstructive pulmonary disease. Nevertheless, with this treatment pulmonary artery pressure rarely returns to normal values and the structural abnormalities of pulmonary vessels remain unaltered. Vasodilators are not recommended on the basis of their minimal clinical efficacy and because they impair pulmonary gas exchange. Recognition of the role of endothelial dysfunction in the physiopathology of pulmonary hypertension in chronic obstructive pulmonary disease opens new perspectives for the treatment of this complication.
Increased eNO and pulmonary iNOS expression in eNOS null mice
Authors: Cook S. , Vollenweider P. , Ménard B. , Egli M. , Nicod P. , Scherrer U.
Published: May 2003

Nitric oxide (NO) is a major regulatory molecule of the cardiovascular system; however, measurement of vascular NO synthesisin vivorepresents a major challenge. NO stemming from the lower respiratory tract has been used as a marker of vascular endothelial function. Experimental evidence for this concept is lacking. Therefore, the aim of the present study was to investigate this relationship.

Lower respiratory tract exhaled NO concentration, together with systemic and pulmonary artery pressure, was measured in endothelial nitric oxide synthase (NOS) (eNOS) null mice (eNOS-/-). Similar studies were performed in inducible NOS (iNOS) null mice (iNOS-/-).

Defective endothelial NO synthesis in eNOS-/- mice (evidenced by systemic and pulmonary hypertension) was associated with augmented exhaled NO levels (12.5±1.9versus9.8±1.2 parts per billion (ppb), eNOS-/-versuswild type), whereas normal endothelial NO synthesis in iNOS-/- mice was associated with decreased exhaled NO levels (4.3±1.5 ppb). Augmented exhaled NO levels in eNOS-/- mice were associated with upregulation of iNOS expression in the lung.

These results indicate that inducible nitric oxide synthase is a major determinant of gaseous nitric oxide production in the lung, and lower respiratory tract exhaled nitric oxide does not always represent a marker of vascular endothelial nitric oxide synthesis.
Tidal expiratory flow limitation, dyspnoea and exercise capacity in patients with bilateral bronchiectasis
Authors: Koulouris N.G. , Retsou S. , Kosmas E. , Dimakou K. , Malagari K. , Mantzikopoulos G. , Koutsoukou A. , Milic-Emili J. , Jordanoglou J.
Published: May 2003

In this study the authors investigated whether expiratory flow limitation (FL) is present during tidal breathing in patients with bilateral bronchiectasis (BB) and whether it is related to the severity of chronic dyspnoea (Medical Research Council (MRC) dyspnoea scale), exercise capacity (maximal mechanical power output (WRmax)) and severity of the disease, as assessed by high-resolution computed tomography (HRCT) scoring.

Lung function, MRC dyspnoea, HRCT score,WRmaxand FL were assessed in 23 stable caucasian patients (six males) aged 56±17 yrs. FL was assessed at rest both in seated and supine positions. To detect FL, the negative expiratory pressure (NEP) technique was used. The degree of FL was rated using a five-point FL score.WRmaxwas measured using a cyclo-ergometer.

According to the NEP technique, five patients were FL during resting breathing when supine but not seated, four were FL both seated and supine, and 14 were NFL both seated and supine. Furthermore, it was shown that: 1) in stable BB patients FL during resting breathing is common, especially in the supine position; 2) the degree of MRC dyspnoea is closely related to the five-point FL score; 3)WRmax(% pred) is more closely correlated with the MRC dyspnoea score than with the five-point FL score; and 4) HRCT score is closely related to forced expiratory volume in one second % pred but not five-point FL score.

In conclusion, flow limitation is common at rest in sitting and supine positions in patients with bilateral bronchiectasis. Flow limitation and reduced exercise capacity are both associated with more severe dyspnoea. Finally, high-resolution computed tomography scoring correlates best with forced expiratory volume in one second.
A prototype paediatric venous cannula with shape change in situ
Authors: Jegger David , Corno Antonio F , Mucciolo Antonio , Mucciolo Giuseppe , Boone Yves , Horisberger Judith , Seigneul Isabelle , Jachertz Mirka , von Segesser Ludwig K
Published: May 2003

During cardiopulmonary bypass (CPB), venous drainage may be impeded due to small vessel and cannula size or chattering, thus, blood return to the heart-lung machine is reduced. We designed a self-expandable prototype cannula, which is able to maintain the vein open and overcome this problem and analysed its performance capability. This prototype and several other cannulae were tested using an access vessel diameter of 7 mm. An in vitro circuit was set up with a 10 mm penrose latex tube simulating the patient’s vein placed between the patient preload reservoir and the cannula, encasing the cannula’s inlet(s). Maximum flow rate was determined for passive venous drainage (PVD) at preloads (P) of 2 and 4 mmHg. We compared these results to three classic single-stage venous cannulae: basket tip, thoracic drain and percutaneous tip. By comparing the other cannulae to the prototype, under PVD conditions and a central venous pressure (CVP) of 2 mmHg, the prototype cannula’s flow rate (1.329 /0.04 L/min) outperformed the basket type (the best performing comparator) (1.029 /0.08 L/min) by 23% (p B /0.005). When the preload was increased to 4 mmHg under PVD conditions, the same trend was noted with the prototype cannula (1.659 /0.05 L/min), outperforming the basket cannula’s value (1.269 /0.05 L/min) by 24% (p B /0.001). This new cannula design provides superior flow characteristics, under all test conditions, compared to the classic single-stage venous cannulae used for paediatric CPB surgery.
Perioperative perfusion strategies for optimal fluid management in liver transplant recipients with renal insufficiency
Authors: Blackwell M M , Chavin K D , Sistino J J
Published: May 2003

Renal Insufficiency (RI) is a common finding in patients suffering from end-stage liver disease. The causes of RI are reported to be multifactorial and the degree of RI can range from early functional impairment to hepatorenal syndrome (HRS). The process of liver transplantation is highly likely to exacerbate the symptoms and sequelae of renal dysfunction. RI continues to be a cause of morbidity and mortality in the intraoperative and postoperative periods. With careful evaluation and monitoring in addition to appropriate intervention, a uniformly good outcome may be possible even for these most complicated patients. This paper will describe successful perfusion interventions carried out during the three phases of liver transplantation: pre-anhepatic, anhepatic and reperfusion at our institution for a three-year period. Intraoperative plasmapheresis (n5 /3), continuous veno-venous hemofiltration (CVVH) (n 5 /7), intraoperative dialysis (n 5 /8), and intraoperative dialysis with fluid removal (n 5 /3) techniques will be presented for review.
Leucocyte depletion during cardiac surgery: a comparison of different filtration strategies
Authors: de Vries Adrianus J , Gu Y John , Post Wendy J , Vos Paulien , Stokroos Ietse , Lip Harm , van Oeveren Willem
Published: May 2003

The results of leucocyte filtration during cardiac surgery are conflicting. This may be due to timing and duration of the filtration procedure, and to flow and pressure conditions in the filter. Therefore, we prospectively compared three major leucocyte filtration strategies in cardiac surgical patients. Forty patients were randomly divided into four groups. Group I: leucofiltration of arterial blood throughout cardiopulmonary bypass (CPB) (associated with high-flow and pressure gradients), Group II: leucofiltration of a part of the venous return blood in the re-warming phase during CPB (associated with intermediate flow, but high pressure), Group III: leucofiltration of residual heart-lung machine blood during transfusion into the patient after CPB (associated with low flow and low pressure), Group IV: control group without leucofiltration. We measured circulating leucocyte counts, plasma elastase levels and arterial blood oxygenation. Filters were postoperatively examined using scanning electronmicroscopy (SEM). Leucocyte counts increased over time and oxygenation decreased in all groups, without significant differences between the groups. SEM demonstrated extensive protein deposits and damaged leucocytes in the deeper layers of the filters from Group I. This was not observed in the filters from Group III. The postoperative plasma elastase levels increased in Groups II and IV and decreased in Groups I and III. In conclusion, we could not demonstrate a clinical difference among the three leucocyte depletion strategies. However, our laboratory results suggest that leucocyte filtration at low flow and pressure conditions is associated with less leucocyte damage and less release of elastase.
Fat reduction in pericardial suction blood by spontaneous density separation: an experimental model on human liquid fat versus soya oil
Authors: Engström Karl Gunnar , Appelblad Micael
Published: May 2003

Pericardial suction blood (PSB) contains mediastinal liquid wound fat with an embolic potential to cause brain damage after cardiopulmonary bypass (CPB). The aims were to measure how fat separates spontaneously from blood by density and how temperature and fat surface adhesion affect the results under experimental conditions. Human liquid fat was heat-extracted from retrieved pericardial fat tissue of coronary artery bypass graft (CABG) patients ( n=10). Human fat or soya oil, 5% and 10%, respectively, were mixed with postoperatively shed mediastinal blood ( n=20). The mixture was loaded into a temperature-controlled (37°C, 20°C, 10°C) vertical separation column. At 1, 2.5, 5 and 10 minutes, the blood was collected in five fractions, representing layers of density separation, followed by centrifugation. Human fat solidified at 8°C. Soya oil remained liquid below 0°C. Soya oil separated fast in water, but was slower in blood. At 10 minutes and 37°C 73±6% of added soya oil was found in the top 20% fraction. Human fat at 37°C behaved similarly to soya oil, with 58-2% separation at 10 minutes. However, at lower temperatures the density separation became less efficient ( p<0.001), whereas human fat more effectively adhered to the walls of the column, which added to the removal. In total, 66%-78% of the human fat was removed, depending on temperature. In conclusion, fat in PSB can be reduced by simple density separation and surface adhesion while it is temporarily retained from the CPB circuit.
The compatibility and stability of octreotide acetate in the presence of diamorphine hydrochloride in polypropylene syringes
Authors: Fielding H , Kyaterekera N , Skellern G G , Tettey J N , McDade J R , Msuya Z , Watson D G , Urie J
Published: May 2003

Varying concentrations of octreotide acetate (Sandostatin®) and diamorphine hydrochloride were prepared and stored in polypropylene syringes at 37°C in the dark. The solutions were analysed for octreotide acetate content using a validated HPLC method at regular intervals over a 48-h period. The results indicate that octreotide acetate remains stable in the presence of diamorphine hydrochloride at 37°C for 24 h. In addition, the solutions prepared maintained their clarity, with no signs of precipitation upon visual examination under normal light conditions.
The level of need for palliative care: a systematic review of the literature
Authors: Franks Peter J , Salisbury Chris , Bosanquet Nick , Wilkinson Emma K , Kite Suzanne , Naysmith Anne , Higginson Irene J
Published: May 2003

Palliative care services have developed rapidly over the past 30 years, with little evaluation as to how needs have been met by these new services. As part of a systematic review of palliative care, evidence of the needs of patients and carers has been evaluated from the current literature. Of the total of 673 articles related to the 10 areas within the main review, 64 provided evidence on the need for palliative care services over the period from 1978 to 1997. A further nine articles were added in November 1998 after the end of the study to update the review with more recent research. Need can be assessed in one of two ways: either by adopting an epidemiological approach or by examining health service usage. In the former, evidence is provided on disease-specific mortality, and related to the duration of symptoms prior to the patient's death. As an example of this, it is suggested that services may need to provide pain control for 2800 patients per million (p/M) population dying from cancer each year and 3400 p/M with noncancer terminal illness. Using health service usage as an indicator of need, 700–1800 p/M with cancer and 350–1400 p/M with noncancer terminal illness would require a support team or specialist palliative home care nurse, with 400–700 cancer p/M and 200–700 noncancer p/M requiring inpatient terminal care. Studies indicate that at present usage, palliative care is being provided by 40–50 hospice beds/M. Despite this provision, there remains evidence that in certain areas of care such as pain control, there still remains a high degree of unmet need.
Risk factors for death rattle in terminally ill cancer patients: a prospective exploratory study
Authors: Morita Tatsuya , Tsunoda Junichi , Inoue Satoshi , Chihara Satoshi
Published: May 2003

Death rattle is frequently observed in cancer patients whose death is impending and may contribute to the severe distress of patients and their family members. To identify risk factors for development and persistency of death rattle, a prospective study was performed on 245 hospice inpatients.

One-hundred-and-seven patients (44%) developed death rattle, 71% of whom achieved satisfactory symptom palliation until death. A multiple regression analysis identified neoplasms of brain and lung as independent risk factors for development of death rattle, while refractory symptoms were significantly associated with pulmonary neoplasms and infection/oedema.

In conclusion, development of death rattle was influenced by both brain and lung malignancies, while its persistency was mainly determined by pulmonary pathology. A clinical classification of death rattle based on these factors would be established by a further confirmatory study.
Do pain and disability differ in depressed cancer patients?
Authors: Sze Frank Kai-hoi , Wong Eric , Lo Raymond , Woo Jean
Published: May 2003

Seventy consecutively admitted Chinese patients with advanced cancer and pain (mean age 62 years) were evaluated with the Chinese version of the Hospital Anxiety and Depression Scale (HADS), and with the Geriatric Depression Scale (GDS) Short Form (for patients 65 years old or over) in a prospective study. The HADS and GDS had good concordance (kappa = 0.53). By these depression screening tests, the prevalence of probable depression was 41–49%, and the prevalence of definite depression (HADS [.greaterequal] 11) was 29%. There was no difference in age, gender and educational level; no difference in nature and severity of pain; and no difference in the level of disability between depressed (using HADS [.greaterequal] 11) and nondepressed patients with advanced cancer. The study suggests that depression does not correlate with the severity of pain in patients with advanced cancer. It also suggests that impaired activity of daily living (ADL) in these patients is not related to depression.
Cardiopulmonary resuscitation for palliative care patients: a discussion of ethical issues
Authors: Willard Carole
Published: May 2003

Medical advances have significantly improved the prognosis and life-expectancy for many patients with life-threatening illness. However, the ability to extend and prolong life increases the complexity of clinical decision-making, and this is particularly true in the context of palliative care. During the course of their illness, many patients with palliative care needs will require hospital admission. It is in this setting that ethical dilemmas are likely to arise regarding the use of life-prolonging measures such as cardiopulmonary resuscitation (CPR). This paper considers some of the ethical issues surrounding the use of CPR for palliative care patients in the hospital setting.
Telling the diagnosis to cancer patients in Japan: attitude and perception of patients, physicians and nurses
Authors: Seo Mitsuru , Tamura Kazuo , Shijo Hiroshi , Morioka Eiji , Ikegame Chie , Hirasako Keiko
Published: May 2003

The aim of this study was to clarify patients', physicians', and nurses' perceptions with regard to the communication of diagnosis to cancer patients in Japan. Sixty-three cancer patients, 35 physicians and 21 nurses were enrolled for this study: 54 of the patients wished to be informed of the diagnosis, of whom 34 had actually been told that they had cancer. Physicians did not tell the truth to the remaining 20 patients, of whom seven were not told the diagnosis because family members objected. Twenty-one of the 35 physicians thought that telling the true diagnosis had a positive effect and 27 thought that disclosure of the diagnosis to cancer patients should be promoted. Sixteen of the 21 nurses did not experience any difficulties with patient care after the diagnosis was disclosed. The present study suggests that medical staff and family members should respect the patient's standpoint because patients have the right to know about their own condition. Physicians should first provide the details of the disease to their patients. Thereafter, family members should be informed, but only with the patient's consent.
Measuring patient outcomes in palliative care: a reliability and validity study of the Support Team Assessment Schedule
Authors: Carson M Gail , Fitch Margaret I , Vachon Mary L S
Published: May 2003

This study reports the process and results of a psychometric evaluation of a clinical audit tool, the Support Team Assessment Schedule (STAS), used to measure outcomes of palliative care. The STAS was developed in London, UK to audit community palliative care services provided by a support team. The purpose of this study was to evaluate the reliability and validity of the STAS when introduced in a different setting and with different populations from those for which it had been designed. Evaluation of the STAS was completed using multidisciplinary team members, patients and families from a palliative care unit and an oncology unit of a large urban Canadian teaching hospital. The results from the reliability tests revealed a lack of consistency in the use of the tool by team members with simulated patients in clinical scenarios. The validity analysis highlighted the differences between patients, families and health care professionals' perceptions of the same clinical situation. This study provided a valuable perspective on using a previously developed clinical audit tool in different patient populations and clinical settings. Recommendations for future use of the tool are offered.
Survival prediction in terminal cancer patients: a systematic review of the medical literature
Authors: Viganò Antonio , Dorgan Marlene , Buckingham Jeanette , Bruera Eduardo , Suarez-Almazor Maria E
Published: May 2003

The clinical significance of studies on survival predictors in terminal cancer patients is hindered by both methodological limitations and the difficulty of finding common predictors for all final events in cancer related deaths. To evaluate the published medical literature concerned with the survival of patients with terminal cancer and identify potential prognostic factors, major electronic databases including MEDLINE (1966–), CANCERLIT (1983–) and EMBASE (1988–) were searched up to September 1999. Studies were included in our review if published in English, were cohort studies, addressed the identification of clinical prognostic factors for survival and looked at samples with median survival of [.lessequal]3 months. Data extracted from selected papers included: sample size, median survival, type of study, sampling frame, cohort type, type of statistical analysis (univariate or multivariate), choice of models and underlying assumptions, predictors examined and their reported level of statistical significance. A total of 24 studies were found and reviewed. On the basis of these studies, performance status and the presence of cognitive failure, weight loss, dysphagia, anorexia and dyspnoea appear to be independent survival predictors in this population. Clinical estimation of survival by the treating physician appeared independently associated with survival but the magnitude of the association generally appeared small. Clinical predictions should be considered as one of many criteria, rather than as a unique criterion by which to choose therapeutic interventions or health care programmes for terminally ill cancer patients. The use of convenient samples as opposed to more representative inception cohorts, the inclusion of different variables in the statistical analyses and inappropriate statistical methods appear to be major limitations of the reviewed literature. Methodological improvements in the design and conduction of future studies may reduce the prognostic uncertainty in this population.
Participation in a creative arts project can foster hope in a hospice day centre
Authors: Kennett Cynthia E
Published: May 2003

This study explored the experiences of terminally ill patients taking part in an exhibition of their creative arts work. It took place in St Christopher's Hospice day centre, London, UK, which aims to facilitate an environment in which a range of social and creative opportunities is offered following the theoretical background of Maslow's and Rogers' theories of personal growth and creativity. A phenomenological study explored the views of 10 patients and eleven facilitators using in-depth, semi-structured, audiotaped interviews. A content analysis identified the main themes as enjoyment, enthusiasm, excitement, pride, achievement, satisfaction, sense of purpose, mutual support and permanence. These themes were interpreted as positive expressions of self-esteem, autonomy, social integration and hope. It is suggested that it was possible to identify hope as the essence of the phenomenon, and that this is important in palliative care where traditionally continuation of active medical intervention has been equated with provision of hope.
Identifying attitudinal barriers to family management of cancer pain in palliative care in Taiwan
Authors: Lin Chia-Chin , Wang Pein , Lai Yuen-Liang , Lin Chiung-Ling , Tsai Shing-Ling , Chen Troy T
Published: May 2003

The purpose of this study was threefold: (1) to examine attitudes held by Taiwanese family caregivers of hospice inpatients with cancer that serve as barriers to cancer pain management; (2) to determine the relationship of attitudinal barriers to family caregiver hesitancy to report pain and to administer analgesics; and (3) to determine the relationship of attitudinal barriers to the adequacy of analgesics used by the patient. A total of 80 pairs of palliative care inpatients and their primary family caregivers participated in this study. Family caregivers completed the Barriers Questionnaire–Taiwan (BQT) form and a demographic questionnaire. The instruments completed by patients consisted of the Brief Pain Inventory–Chinese version and a demographic questionnaire. The data revealed that Taiwanese family caregivers of palliative care patients with advanced cancer had concerns about reporting pain and administering analgesics, particularly as they related to disease progression, side-effects and p.r.n. analgesics. Older and less-educated family caregivers scored significantly higher on the BQT than did their younger, more educated counterparts. Family caregivers‘ concerns measured by the BQT were related to family caregivers‘ reluctance to administer analgesics to their patients. Implications for a broader understanding of analgesics in the advancement of pain management in palliative care in Taiwan are discussed.
Dimensions of the role of the social worker in palliative care
Authors: Sheldon F M
Published: May 2003

There has been very little research focusing on the role of the social worker in a specialist palliative care service. A qualitative research methodology was used which sought to capture the essence of that role, as perceived by those carrying it out, rather than simply to approach it as a series of tasks. A specialist palliative care social worker was asked to describe her role in selected cases that she had worked with. The interviews were taped and transcribed. The data were then analysed for themes using the techniques of constant comparative analysis. The themes were grouped into six categories and a conceptual framework developed. This was then validated with four other experienced social workers. Integrating categories in the framework were knowing and working with limits and values and valuing. The four other categories, a family focus, being a team member, managing the environment and managing anxiety related to the everyday activities of the social worker. The results are discussed in relation to social work in other specialties and in relation to other professional roles in specialist palliative care. Further research is needed to add the perspective of the social worker's client to understanding of the role.
Inter-rater reliability of formally trained and self-trained raters using the Edmonton Functional Assessment Tool
Authors: Kaasa Terry , Wessel Jean , Darrah Johanna , Bruera Eduardo
Published: May 2003

The primary objective of this study was to determine the inter-rater reliability of the revised version of the Edmonton Functional Assessment Tool (EFAT-2). A second objective was to determine whether both formally trained and self-trained therapists had an acceptable level of inter-rater reliability. The EFAT-2 was administered to consenting palliative care patients by one of two independent physical therapist rater pairs; one pair self-trained (R1, R2) and the other formally trained (R3, R4). The intraclass correlation [ICC (1,1)] for R1, R2 was 0.97 [95% confidence interval (CI) 0.94–0.99] and for R3, R4 was 0.95 (95% CI 0.90–0.98). The standard error of measurement was 1.09 and 1.44, respectively. The Kappa statistic for the rater pairs on individual EFAT items ranged from 0.17 to 0.96. The results suggest that both formally trained and self-trained therapists obtain an acceptable level of inter-rater reliability when using the EFAT-2.
The role of volunteers in hospice bereavement support in New Zealand
Authors: Payne Sheila
Published: May 2003

The purpose of this study was to assess the role of hospice bereavement volunteers in New Zealand. Participants included 34 co-ordinators and 121 volunteers from 26 hospices. Co-ordinators and volunteers were asked about the perceived adequacy of their training, support and deployment. Findings revealed that most volunteers were recruited through personal contact and newspapers. They reported being strongly motivated to help others (88%) and most had previous bereavements (71%). Volunteers provided a wide range of bereavement support within the home and/or hospice. They listed twice as many ‘satisfying’ compared to ‘least satisfying’ (442 vs 207) aspects of their work, although 50% reported their work to be emotionally distressing and 28% had problems with ‘boundaries’. Two-thirds had generic volunteer training, but only a third had specific training in bereavement. Volunteers appeared to be largely unaware of the need for specialist training, or supervision, which raises issues about the quality of services provided.
Palliative care and nursing homes: where next?
Authors: Froggatt Katherine A
Published: May 2003

Specialist palliative care providers are seeking to transfer the principles of palliative care to more general care settings in order to meet the needs of people with diseases other than cancer. To prepare nursing home staff to provide palliative care increasing numbers of educational initiatives are now being offered. This paper explores some of the assumptions that underpin these initiatives. Recommendations are made that recognize the expertise already held within nursing homes and propose a collaborative approach to promote the appropriate integration of palliative care with nursing home practice.
Determining the decision-making capacity of a patient who refused food and water
Authors: Terman Stanley A
Published: May 2003

A terminal patient expressed the wish to hasten her death and refused nutrition. The psychiatrist asked to render an opinion relevant to her competence employed questions in a semi-structured interview derived from a new instrument originally designed to determine competence to create ‘Advance Directives’. Although the patient ultimately demonstrated her resolve by totally ceasing fluid intake, the complexity of the case–including the question of the stability of her choice–illustrates the need for specific patient safeguards.
The first year of grief and bereavement in close family members to individuals who have died of cancer
Authors: Ringdal Gerd Inger , Jordhøy Marit S , Ringdal Kristen , Kaasa Stein
Published: May 2003

Using a systematic and standardized method this longitudinal study examines changes in grief reactions in a sample of close family members ( n=183) to individuals who had died of cancer. The respondents were followed for 1 year after the loss. The study sample originated from a cluster randomized trial evaluating comprehensive palliative care (intervention) against conventional care (control). Hence, we also compared grief reactions among close family members to the patients in the intervention and control groups. Overall, the family members' grief reactions, as measured by the second part of the Texas Revised Inventory of Grief (TRIG), showed a significant decline over the period studied. However, we found no significant differences in grief reactions between the family members to the intervention and control patients at any point in time, and the pattern of change did not differ significantly for the two groups.
Diagnosis disclosure in a Portuguese oncological centre
Authors: Gonçalves J Ferraz , Castro S
Published: May 2003

The disclosure of a diagnosis of cancer to patients is a controversial matter. There have been major differences in practice concerning this issue through time and between cultures. A questionnaire was sent to the doctors of the Oporto Centre of the Portuguese Institute of Oncology in order to assess their attitudes. We received 45 responses (40%) from the 113 questionnaires sent. Of these, 32 (71%) said that they disclose the diagnosis as a general policy or at the patients' request, and 13 (29%) disclose it rarely or not at all. The most frequent reason indicated by these 13 physicians was that the disclosure might damage the patients psychologically. Forty-four (98%) doctors inform the family of the diagnosis. Thirty-nine (87%) think that patients are satisfied with the information provided. This study was carried out in one oncological centre only, so it is inappropriate to conclude that this is what happens throughout Portugal. As far as we know, this is the first study in Portugal addressing this area of practice. This subject is a very important topic of research both in Portugal and in other countries, as many published recommendations are not research based.
Is videotaping of consultations acceptable to patients attending a hospice day centre?
Authors: Hargreaves Peter N , Peppiatt Roger
Published: May 2003

The use of a videotape recorder to analyse consultations in UK general practice is accepted, well established and has been extensively researched. The technique has potential in palliative medicine for training and the continuing assessment of communication skills as part of peer review. However, there have been no published studies on whether or not videotaping of consultations would be acceptable to a hospice population.

Using a semi-structured questionnaire, we interviewed 31 patients who had agreed to have their consultation with a doctor videotaped. Although 30 (97%) did not regret having given permission and would ‘definitely’ or ‘possibly’ agree to another recording in the future, three (10%) felt that the procedure had been inadequately explained to them, six (19%) felt that they were ‘possibly’ or ‘definitely’ not given sufficient notice of the recording and one patient felt under pressure to agree to the recording. These findings suggest that if videotaping of consultations in the hospice setting is to be undertaken, more advanced notice than that usually given in general practice is required and strict safeguards should be in place to protect vulnerable patients.
Home palliative care as a cost-saving alternative: evidence from Catalonia
Authors: Serra-Prat Mateu , Gallo Pedro , Picaza Josep M
Published: May 2003

The aim of this study was to provide a comparative assessment of the health care resources consumed during the final month of life of patients undergoing palliative treatment and who died from cancer in the town of Mataró, Spain, in 1998, with respect to whether they benefited from home care teams or not. Relevant differences in the use of health care resources were found between the groups. Patients in the standard care group presented more hospital care admissions and longer length of stay, higher use of emergency and outpatient visits, and greater use of palliative care units within nursing homes than patients in the home care group. The monetary quantification of the use of the above-mentioned resources showed a 71% increase in the cost per patient in the standard care when compared to home care. According to the results of this study, home care teams for terminal cancer patients allow for savings to the health care system. A series of policy making and health services research implications are discussed.
The concerns of patients under palliative care and a heart failure clinic are not being met
Authors: Anderson H , Ward C , Eardley A , Gomm S A , Connolly M , Coppinger T , Corgie D , Williams J L , Makin W P
Published: May 2003

Patients with a terminal illness, identified by palliative care teams working in Manchester, and patients attending a heart failure clinic, were asked to participate in a prospective survey to determine their main concerns. Data were collected from 213 palliative care (PC) patients (mostly with cancer) and 66 patients with heart failure (HF). The median ages of the two patient groups were similar, but the HF patients were more likely to be male and living with a partner; 13% of PC and 7% of HF patients reported that they had no carer. The PC patients had more district nurse, hospice, social work and physiotherapy input.

The most frequently reported troublesome problems for PC patients were pain (49%), loss of independence (30%) and difficulty walking (27%). HF patients reported dyspnoea (55%), angina (32%) and tiredness (27%) as the most troublesome problems. From a checklist of symptoms, the frequency of tiredness (PC = 77%, HF = 82%) and difficulty getting about (PC = 71%, HF = 65%) were high in each group. Psychological problems were reported by 61% of PC and 41% of HF patients. Cardiac patients reported more breathlessness and cough than PC patients (83% vs 49% and 44% vs 26%, respectively). Reduced libido was more common in cardiac patients (42% vs 21%).

Patient disclosure of troublesome problems to professional carers was high (>87% in both PC and HF patients). Documented action was greater for physical than social or psychological problems. For PC patients, documented action was recorded for 83% physical, 43% social/functional and 52% psychological problems. For HF patients documented action was recorded for 74% cardiac, 60% physical–non-cardiac, 30% social/functional and 28% psychological problems. Clearly many patients' troublesome problems were not being addressed.

As a result of this study, specific action by health care professionals was taken in 50% of PC patients and 71% of HF patients. We plan to target specific educational events on the treatment of physical problems, psychological assessment and social service provision.
The role of disodium pamidronate in the management of bone pain due to malignancy
Authors: Groff L , Zecca E , De Conno F , Brunelli C , Boffi R , Panzeri C , Cazzaniga M , Ripamonti C
Published: May 2003

A number of controlled studies have recently demonstrated the role of disodium pamidronate in the prevention of skeletal complications in patients with metastatic bone disease due to breast cancer and multiple myeloma. They have also shown that it relieves pain and is well tolerated.

The aim of this open prospective study was to evaluate the acceptability of a new schedule of pamidronate infusion and to assess pain, analgesic consumption and the Karnofsky Performance Status (KPS) in patients with metastatic bone pain treated with pamidronate in association or not with chemotherapy, radiotherapy, and hormone therapy. Patients with different types of cancer and at least one painful bone metastasis were treated with two cycles of 60 mg intravenous (iv) pamidronate weekly for three consecutive doses, with a 3-week interval between the two cycles (six infusions over 7 weeks), followed by one infusion every 3 weeks for a total of 24 infusions. Two hundred patients were enrolled in the study, of whom 94 received at least the first six infusions; 25 patients received all 24 infusions.

Pamidronate was well tolerated in the majority of the patients both during the first six infusions and during the whole study period.

In the patients under study, pain intensity decreased compared with T0sub after the first two infusions (second week of treatment). The mean equivalent daily dose of oral morphine required ranged from 21.5 to 41.5 mg/day and was low and stable during the study. For the patients who remained in the study, the KPS remained around 70 during the whole treatment period and intrasubject analysis showed a substantial stability of the KPS within each subject.

A first fracture occurred within 321 days in 25% of the whole population under study.

Pamidronate represents a further valid therapy to add to an already consolidated list of therapies such as radiotherapy, chemotherapy, hormone therapy and orthopaedic intervention in the pain management of patients with bone metastases. Future studies are necessary to evaluate the role of pamidronate and the appropriate schedule in patients with advanced or terminal cancer who are no longer being treated with oncological therapies.
Sublingual fentanyl citrate for cancer-related breakthrough pain: a pilot study
Authors: Zeppetella Giovambattista
Published: May 2003

The effects of sublingual fentanyl citrate (SLFC) were assessed in 11 hospice inpatients with cancer-related breakthrough pain. Patients were asked to rate their pain, using a visual analogue scale, before SLFC, then after 3, 5, 10, 15, 30, 45 and 60 min. Six patients (55%) had reductions in pain scores at 10 min and nine patients (82%) at 15 min. Ratings for SLFC were very good (18%), good (36%), moderate (28%), and bad (18%). Compared to the usual breakthrough medication, SLFC was better (46%), the same (36%), or worse (18%). Advantages of SLFC included ease of use, quick onset of action and no associated drowsiness. No systemic adverse events were noted, but two patients reported dry mouth and two a bitter taste. Two patients found it difficult to retain the medication under the tongue. Seven patients (64%) said they would continue to use SLFC. Sublingual fentanyl citrate appears safe and well tolerated by these patients. Randomized placebo-controlled and dose ranging studies are required to confirm these findings.
A study comparing hyoscine hydrobromide and glycopyrrolate in the treatment of death rattle
Authors: Back Ian N , Jenkins Kathleen , Blower Anthony , Beckhelling Jill
Published: May 2003

This study looked at the efficacy of drug treatment in managing death rattle in a 30-bedded specialist palliative care unit. The study was conducted in two phases. In the first, patients received hyoscine hydrobromide as the antimuscarinic; glycopyrrolate was used in the second phase. The patients in the two phases were well matched for diagnosis, age, sex and duration of death rattle. A noise score scale of 0–3 was used, which was separately validated using a verbal rating scale and noise-meter readings. Noise scores were taken at the start; 30 min after an antimuscarinic drug was administered; an hour after the initial injection if a repeat dose was given at 30 min; and 4-hourly thereafter. Drug charts of all patients with death rattle were analysed to ascertain the amount of each drug given and the cost. The incidence of death rattle was 44% in phase I, and 36% in phase II. The percentage of patients with reduced noise scores 30 min after one injection of hyoscine was significantly greater than after one dose of glycopyrrolate (56% vs 27%, P = 0.002). The need for a second injection after 30 min was less using hyoscine (33% vs 50%, P = 0.03). There was no statistically significant difference in improvement at 1 h, or at the last recorded score before death. A comparison of the cost of drug treatment using hyoscine or glycopyrrolate was made, and the potential reduction in cost per patient in the glycopyrrolate group was largely offset by increased expenditure on other drugs, especially diamorphine, midazolam and levomepromazine. The results of this study suggest that: (1) glycopyrrolate 0.2 mg is less effective at reducing death rattle than hyoscine hydrobromide 0.4 mg when assessed at 30 min, (2) the use of glycopyrrolate may lead to an increased need for other sedative or anti-emetic medication such as diamorphine, midazolam or levomepromazine, and (3) the cost benefit of using glycopyrrolate over hyoscine hydrobromide is a small part of the total drug budget, and may be less than anticipated due to the increased need of these other drugs.