bluuebunny/crossref_metadata_2025_split huggingface dataset:
Challenges in palliative care research; recruitment, attrition and compliance: experience from a randomized controlled trial
Authors: Jordhøy M S , Kaasa S , Fayers P , Underland G , Ahlner-Elmqvist M 
Published: May 2003

Randomized controlled trials (RCTs) in palliative cancer care often experience methodological problems. In this paper we discuss issues of major concern, including recruitment, patient attrition and compliance, arising from an RCT that compared comprehensive palliative care to conventional care. The main criteria for trial entry were incurable malignant disease and a survival expectancy of between 2 and 9 months. Patients' health-related quality of life (HRQL), self-assessed by multi-item questionnaires, was a defined endpoint. The planned number of patients was successfully recruited, although the patients were referred late in the course of their disease so that follow-up tended to be short. Compliance in completing HRQL questionnaires was good up to 1 month before the patient's death; but in the final weeks it was found to drop substantially. Based on our experience, recommendations are given for those planning similar research. Procedures for improving patient recruitment are suggested, stressing the need for local data management, repeated information to referral sources, extensive screening for potentially eligible patients and simple referral routines. Precise inclusion criteria, including prognostic factors other than physicians' estimates of life expectancy, should be used to ensure a sufficient follow-up period. For HRQL assessment, multi-item questionnaires can achieve excellent compliance up to 1 month before patients' death, but in order to evaluate the very final weeks of life we recommend the use of simpler methods.
Quality of life as a parameter determining therapeutic choices in cancer care in a Greek sample
Authors: Mystakidou Kyriaki , Tsilika Eleni , Befon Sofia , Kululias Vasilios , Vlahos Lambros 
Published: May 2003

Health-related quality of life (HRQL) is difficult to define and measure. It is a generic term that includes concepts such as physical health, life satisfaction, psychological well-being and self-integrity. Realizing and appreciating the importance of HRQL is crucial for physicians if they are to be in a position to offer appropriate suggestions in assisting patients and their families in the decision-making process regarding cancer treatment and terminal care. In order to determine whether Greek physicians take into consideration HRQL when assessing different therapeutic options, we conducted a postal survey. A total of 1500 Greek physicians (internists, oncologists and anaesthesiologists) were asked to complete a questionnaire. We received replies from 1280 (85%). In summary, we found that Greek physicians: (1) have already started taking HRQL into consideration when reviewing their therapeutic options; (2) increasingly include HRQL in research studies as an outcome measure; (3) do not yet have thoroughly sufficient training in the holistic care of cancer patients and their families; (4) mostly do not have the opportunity to work in interdisciplinary therapeutic teams where they can exchange ideas and consider different aspects of alternative therapeutic methods. It is concluded that HRQL has already been introduced as an important determinant of therapeutic choices in cancer care in Greece. However, efforts need to be made to allow HRQL to enjoy its appropriate place in cancer care.
Screening for psychiatric illness in the palliative care inpatient setting: a comparison between the Hospital Anxiety and Depression Scale and the General Health Questionnaire-12
Authors: Le Fevre Peter , Devereux Joan , Smith Stephen , Lawrie Stephen M , Cornbleet Michael 
Published: May 2003

The objective of this study was to compare the performance of the Hospital Anxiety and Depression Scale (HADS) with the 12-item General Health Questionnaire (GHQ-12) as a screening instrument for the detection of psychiatric disorders in a palliative care inpatient setting. The results from the HADS and GHQ were compared to diagnoses generated from a semistructured psychiatric interview (Revised Clinical Interview Schedule) using standard receiver operating characteristic analysis. The study was conducted at the Marie Curie Centre, Edinburgh, a 37-bedded palliative care inpatient facility. Out of a total of 282 admissions during the study period, 79 took part in the study. The remainder of patients either refused (69) or were too unwell to participate (134). The HADS was found to be an effective screening tool for identifying depression, with an area under the receiver operating characteristic curve of 0.92. A suggested cut-off of 20 would have a sensitivity of 0.77, a specificity of 0.85 and a positive predictive value (PPV) of 0.48. There was no significant difference between the two subscales in their ability to detect depressive illnesses, although there was a trend for the anxiety subscale to perform better (P < 0.15). The GHQ did not perform as well as the HADS in this type of population. In view of this, it can be concluded that the HADS is a valid screening tool for psychiatric disorders, particularly depression, in a palliative care setting.
Descriptive epidemiological survey on a given day in all palliative care patients hospitalized in a French university hospital
Authors: Morize Véronique , Nguyen Duc Tinh , Lorente Christine , Desfosses Gilbert 
Published: May 2003

We conducted a descriptive study on a given day on all inpatients requiring palliative care in a French university hospital. In each department, a collaborative team made up of physicians and nurses identified and described the clinical signs, the treatment protocols, the social and family characteristics and the outcome for each patient using a standardized questionnaire. Study subjects were inpatients in the hospital and presented advanced or terminal-stage life-threatening conditions. Two-hundred-and-forty-five patients were included in the study. These patients represented 13% of the total number of inpatient beds available in the hospital on the day of the survey. Sixty-six per cent of study subjects suffered from physical discomfort and 80% suffered psychologically. Patients still received specific treatment for their condition in 45% of cases. Social problems were identified principally in medium- or long-term care department inpatientswho made up 36% of the total inpatient population. A request for transfer to another care structure had been completed for 24% of patients. Assistance from the Palliative Care Unit's support team had been requested in 25% of cases, mainly to provide psychological support for the patient and the health care providers. These results have led us to reconsider the general organization of palliative care in the health care system.
Folklore associated with dying in the west of Ireland
Authors: Donnelly Sinead 
Published: May 2003

The warm welcome for modern advances in the care of the dying should not exclude the past in which there is much to be learned from the skills of our ancestors. A bilingual two-year qualitative research project into traditions associated with dying and death was undertaken. Research began in the archives available in the internationally recognized university folklore departments of Ireland and Scotland. This was augmented by 40 indepth personal interviews with Gaelic- and English-speaking residents in rural communities of both countries, recalling local customs and practices in the care of the dying. This paper reports the Irish experience; the collection of data in Scotland continues. From this study, several main themes emerged. Death was seen and accepted as a natural continuation of life, simply a step into the spirit world. In view of people's oneness with nature and the spiritual world, death was not to be feared. Traditions were unique to each area even down to the precise number of candles used at the sickbed. People understood the signs and symptoms of dying and were skilled in alleviating the distress of both relatives and the dying; and, in this, language was important in capturing and expressing the philosophy of these people. The acceptance of death as the one truism of life was facilitated by the strong faith and prayer of people for whom, in the celebration of death, humour was never far away. In their grief, the community was supported by the loose formality of the wake (torramh), funeral procession, keening (caoineadh) and music. In all these, the men and women of the community and its leaders had distinct and respected roles to play.
How do terminally ill patients at home take their medication?
Authors: Zeppetella Giovambattista 
Published: May 2003

Compliance with prescribed medication was assessed in 111 terminally ill patients referred to a community palliative care team using semistructured interviews and pill counting. One-hundred-and-six patients were prescribed a total of 597 drugs; of these patients, 64 (60%) were noncompliant. Thirty-five patients (33%) took less medication than prescribed, usually due to experiencing, or anxieties about, adverse events; the commonest drugs involved were analgesics. Seventeen patients (16%) took additional medication, usually purchased over the counter in response to inadequate symptom control or to adverse events from other drugs; the most common preparations were vitamins and analgesics. Twelve patients (11%) both took less medication than prescribed and also purchased medication over the counter. Most patients (90%) had two or more prescribers; patients who saw their general practitioners as their main prescriber were more likely to adhere to their prescribed medication. Patients who omitted and/or reduced their medication were more likely to see the hospital as their main prescriber. Drugs prescribed four times daily were most likely to be omitted and/or reduced.
A survey of antidepressant prescribing in the terminally ill
Authors: Lloyd-Williams Mari , Friedman Trevor , Rudd Nicky 
Published: May 2003

Depression is a symptom in a quarter of patients admitted to a palliative care unit, but little is known of how depression in terminally ill patients is treated. We reviewed 1046 consecutive patient admissions, of whom 106 (10%) were prescribed antidepressant medication while under the care of a palliative care team. Of these patients, 21 were prescribed antidepressants when under the care of the home care team, but 80 patients (76%) were started on medication during the final 2 weeks of life. There was consequently insufficient time for the medication to have any therapeutic effect. Seventeen patients were discharged home on antidepressant medication. Three patients were referred for a psychiatric assessment. Patients prescribed antidepressants were significantly younger (P = 0.002) than those who were not. There were no prescriptions for psychostimulants. Although the numbers of patients prescribed antidepressant medication were low in all disease groups, it was notable that patients with breast cancer were prescribed antidepressant medication more frequently than any other patient group. We conclude that there appears to be a need for a coordinated approach to both the assessment and the treatment of depression in terminally ill patients.
An evaluation of aromatherapy massage in palliative care
Authors: Wilkinson Susie , Aldridge Judith , Salmon Irene , Cain Elizabeth , Wilson Bernadette 
Published: May 2003

The use of complementary therapies, such as massage and aromatherapy massage, is rising in popularity among patients and healthcare professionals. They are increasingly being used to improve the quality of life of patients, but there is little evidence of their efficacy. This study assessed the effects of massage and aromatherapy massage on cancer patients in a palliative care setting. We studied 103 patients, who were randomly allocated to receive massage using a carrier oil (massage) or massage using a carrier oil plus the Roman chamomile essential oil (aromatherapy massage). Outcome measurements included the Rotterdam Symptom Checklist (RSCL), the State–Trait Anxiety Inventory (STAI) and a semi-structured questionnaire, administered 2 weeks postmassage, to explore patients' perceptions of massage. There was a statistically significant reduction in anxiety after each massage on the STAI (P < 0.001), and improved scores on the RSCL: psychological (P < 0.001), quality of life (P < 0.01), severe physical (P < 0.05), and severe psychological (P < 0.05) subscales for the combined aromatherapy and massage group. The aromatherapy group's scores improved on all RSCL subscales at the 1% level of significance or better, except for severely restricted activities. The massage group's scores improved on four RSCL subscales but these improvements did not reach statistical significance. Massage with or without essential oils appears to reduce levels of anxiety. The addition of an essential oil seems to enhance the effect of massage and to improve physical and psychological symptoms, as well as overall quality of life.
Documenting War and Forging Reputations: Sir Max Aitken and the Canadian War Records Office in the First World War
Authors: Cook Tim 
Published: May 2003

Although the Canadian Corps was one of the finest fighting formations on the Western Front during the First World War and earned a reputation as the shock troops of the British Expeditionary Force, the Corps had an active propaganda campaign that publicized Canadian uniqueness throughout the war. The organization behind this promotion was the Canadian War Records Office, headed by Sir Max Aitken, who nurtured a relentless campaign extolling the heroic deeds of Canadians in France. With an eye on the future, Aitken ensured that the image constructed of the Canadian soldier was not only based in battlefield accomplishments but also articulated through the legacy of war records and a barrage of media productions.
Development of a pharmacist-coordinated system of chemotherapy protocols in an integrated healthcare delivery organization
Authors: L de Lemos Mário , O’Brien Robin K 
Published: May 2003

Objectives. To develop and coordinate protocols for chemotherapy regimens in a large integrated healthcare organization; to disseminate protocols in a timely fashion; to maintain protocols for continuous quality improvement; and to promote utilization of protocol-based chemotherapy. Methods. Two interdisciplinary groups reviewed the acceptability, accessibility, and appropriateness of the existing protocols, and proposed recommendations to be implemented by the Systemic Therapy Program of the agency. Results. A standard protocol format and a pharmacist-coordinated protocol system were developed. Protocols were relocated from the Intranet to the network computer directory and Internet website for increased accessibility. To date, 172 protocols are available on the network directory and the website, with 87% (150/172) reviewed by pharmacists and physicians of an interdisciplinary review panel. Preliminary analysis shows increased healthcare professionals’ satisfaction and a protocol use in 77% of patients treated. Conclusion. A pharmacist-coordinated chemotherapy protocol system improves protocol dissemination, protocol compliance, and chemo-therapy delivery and safety. The project enhances the pharmacist profile and credibility within the organization.
New face for a familiar friend: the deGramont regimen in the treatment of metastatic colorectal cancer given as an outpatient: a feasibility study
Authors: Rowe Michelle , Valle Juan W , Swindell Ric , Fitzsimmons Lesley , James Roger D 
Published: May 2003

The use of elastomeric infusional devices to administer chemotherapy is becoming established in a number of malignancies. Historically, hospitals have admitted patients for treatments such as the deGramont regimen, used in advanced colorectal cancer. This consists of intermittent infusional 5-fluorouracil (5-FU) and folinic acid and usually requires two to three inpatient days, every two weeks. We performed a prospective, single-center, study to assess the feasibility of administering the deGramont regimen on an outpatient basis using elastomeric infusional devices. In addition, we assessed patient acceptability of this mode of administration and the effects on quality of life (using the self-completed EORTC QLQ-C30 questionnaire). Crude cost-benefit analysis was performed and we attempted to define the group of patients for whom this is a viable option. Twenty-six patients, all receiving the same regimen, were recruited into the study. Two cohorts were (nonrandomly) allocated to receive either standard inpatient (n=13) or novel out-patient (n=13) chemotherapy. Administration of the deGramont regimen using elastomeric infusional devices through an indwelling central venous catheter was found to be both feasible and highly acceptable to patients. Those patients receiving this modality of administration reported marked benefits, improved morale and did not suffer from impaired quality of life. Taking into account the costs of inpatient hospital stay, the outpatient regimen conferred considerable cost savings. Given the continued use of this popular regimen, either alone or in combination with newer, more active agents such as irinotecan and oxaliplatin, these findings have potential implications for a large number of patients and institutions. It also raises possibility of exploring this approach for other types of ambulatory infusion device chemo-therapy and may hasten the advent of home-based chemotherapy.
Chemotherapy order review and documentation: let’s put the anDROIDs to work!
Authors: Duong Cathy D 
Published: May 2003

Objective To develop a process which assists pharmacists in oncology order review, patient assessment, drug therapy monitoring, and documentation and evaluate whether it is useful in practice. Methods A process called the anDROIDs (Appendix A) is discussed. The acronym represents Antineoplastic Data Collection, Review of Systems, Oncology Target, Identification of drug-related problems, and Documentation System. A tool representing the process was created and introduced to a focus group in an oncology pharmacy workshop. Participants’ responses were measured using pre- and post-workshop assessments. Results. The focus group had positive responses in the post-workshop assessment compared to pre-workshop data. Participants found the anDROIDs tool to be easy to use and planned to incorporate it into their pharmacy practice. Conclusion The anDROIDs tool may have potential application in oncology pharmacy and can be modified to other pharmacy practice settings.
Gender and anthropometrics of patients undergoing cisplatin-containing chemotherapy as determinants of acute emesis over repeat courses
Authors: Catalán-Aplandis José Luis , Jiménez-Torres Nicolás Víctor , Calpe-Maravilla Javier , Almenar-Cubells Daniel 
Published: May 2003

Objective. To characterize the anthropometric and pharmacotherapeutic variables related to acute emesis over repeat courses of cisplatin-containing regimens (≥50 mg/m survival analysis.2) by means of survival analysis. Methods. A prospective, cross-sectional non-controlled study was started to analyse acute vomiting in patients treated in a general hospital. The patients received an intravenous combination of drugs based on metoclopramide (two 3 mg/kg doses), diphenhydramine (20 mg) and dexamethasone (20 mg) as first choice antiemetic treatment. An intravenous regimen based on ondansetron (8 mg) and dexamethasone (20 mg) was given as an alternative regimen. Therapeutic failure was defined as the recording of one or more vomiting episodes on a self-evaluation sheet. Other variables included were chemotherapeutic regimen, antiemetic regimen, gender, age, weight and height. The statistical analysis was developed using the Cox proportional hazards model. Results. Eighty-eight patients were finally included in the study, 16 women (18%) and 72 men (82%). The metoclopramide-based regimen was administered to 74 patients (84%) and the ondansetron-based regimen to 14 patients (15%). The univariate analysis showed that any variable included in the study was significant. The multivariate survival analysis retained three variables: height (hazard ratio 1.22), gender (hazard ratio 2.12) and weight (hazard ratio 1.44) of the patients. It is hypothesized that gender and anthropometrics of patients could represent differences in pharmacokinetic and/or pharmacodynamic behaviour of cisplatin and/or antiemetics. The potential role of these parameters in these drugs is discussed. Conclusions. Emesis over repeat courses in cisplatin-containing regimens seems a function of the gender and anthropometrics of patients, irrespective of the antiemetic regimen and the emetogenicity of the cytostatics. Dosing individualization of cisplatin and/or antiemetics based on pharmacokinetic and/or pharmacodynamic parameters can be a valid tool to increase the effectiveness and safety of these drugs.
Standardization of body surface area calculations
Authors: T Vu Thanh 
Published: May 2003

Purpose. Antineoplastic agents have a narrow therapeutic index and therefore require the greatest degree of dose individualization. In choosing a body surface area (BSA) for‘mula, the challenge remains in obtaining consensus among prescribers. The objective of this review is to assess the various formulae available for calculating BSA and to adopt a standard formula within an institution. Methods. Retrospective review of medication orders containing the patient’s height and weight as well as BSA calculated by the outpatient clinic staff within the Cross Cancer Institute (CCI) from 7 to 15 July 1998. Four BSA calculating devices, in current use by the clinical staff, were also tested to determine the formula currently utilized by prescribers. Results. Thirty-three orders sent to the pharmacy containing the patient’s height, weight, and BSA were reviewed. Ninety-four per cent of the BSA calculated by the clinic staff differed from pharmacy’s calculations by 0% to 4%. One BSA calculation differed by 8% and another differed by 14%. With respect to the available BSA calculating devices, all appeared to be based on the Du Bois formula. Conclusion. Of the various formulae available for estimating BSA, we concluded that the Mosteller equation is the most acceptable based on both BSA calculation accuracy and ease of use. Based on this determination, the CCI approved the adoption of the Mosteller equation as the institutional standard. This equation was later standardized throughout the entire Alberta Cancer Board. Other methods of dose determination are emerging, including therapeutic drug monitoring and PMT dosing. Further investigation is required as to whether these methods will lead to better standardization of dose.