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To examine the relationship between worsening physical function and depression and preferences for life-sustaining treatment. Mailed survey of older physicians. Longitudinal cohort study of medical students in the graduating classes from 1948 to 1964 at Johns Hopkins University. Physicians who completed the life-sustaining treatment questionnaire in 1998 and provided information about health status in 1992 and 1998 (n=645, 83% of respondents to the 1998 questionnaire; mean age 68). Preferences for life-sustaining treatment, assessed using a checklist questionnaire in response to a standard vignette. Of 645 physicians, 11% experienced clinically significant decline in physical functioning, and 18% experienced worsening depression over the 6-year period. Physicians with clinically significant functional decline were more likely (adjusted odds ratio (AOR)=2.14, 95% confidence interval (CI)=1.18–3.88) to prefer high-burden life-sustaining treatment. Worsening depression substantially modified the association between declining functioning and treatment preferences. Physicians with declining functioning and worsening depression were more likely (AOR=5.33, 95% CI=1.60–17.8) to prefer high-burden treatment than respondents without declining function or worsening depression. This study calls attention to the need for clinical reassessment of preferences for potentially life-sustaining treatment when health has declined to prevent underestimating the preferences of older patients. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To assess whether older physicians have discussed their preferences for medical care at the end of life with their physicians, whether they have established an advance directive, and what life-sustaining treatment they wish in the event of incapacity to make these decisions for themselves. DESIGN: Mailed survey to a cohort of physicians. SETTING: Physicians who were medical students at the Johns Hopkins University in graduating classes from 1946 to 1964. PARTICIPANTS: Physicians who completed the advance directive questionnaire (mean age 68). MEASUREMENTS: Questionnaires were sent out to known surviving physicians of the Precursors Study, an on-going study that began in 1946, asking physicians about their preferences for life-sustaining treatments. RESULTS: Of 999 physicians who were sent the survey, 765 (77%) responded. Forty-six percent of the physicians felt that their own doctors were unaware of their treatment preferences or were not sure, and of these respondents, 59% had no intention of discussing their wishes with their doctors within the next year. In contrast, 89% thought their families were probably or definitely aware of their preferences. Sixty-four percent reported that they had established an advance directive. Compared with physicians without advance directives, physicians who established an advance directive were more likely to believe that their doctors (odds ratio (OR) = 3.42, 95% confidence interval (CI) = 2.49-4.69) or family members (OR = 9.58, 95% CI = 5.33-17.23) were aware of their preferences for end-of-life care and were more likely to refuse treatments than those without advance directives. CONCLUSION: This survey of physicians calls attention to the gap between preferences for medical care at the end of life and expressing wishes to others through discussion and advance directives, even among physicians. [ABSTRACT FROM AUTHOR]

The article offers information on the proper care and treatment of patients with tracheostomy. It highlights the need for medical professionals to have a working knowledge on the basic equipment and handling procedures to improve patients' conditions and avoid further complications. In addition, careful decisions with terminally ill patients and their families about options and preferences with regards to tracheostomy complications are also emphasized.

The article presents a study that evaluates the role of breast self-examination in the reduction of breast cancer-related mortality. The study was conducted among women in Shanghai, China recruited through the factories' health care facilities who were not provided with breast self-examination instructions and mammography. The women in the intervention arm were given thorough breast self-examination instructions by physicians including breast inspection in front of a mirror and breast palpation in standing and supine positions. The study revealed that the rates of breast cancer mortality in the intervention and control groups were identical at 0.10%.

The article discusses research being done on the efficacy of paroxetine, fluoxetine, and sertraline in treating depression. It references a study by S. L. West et al published in a 2001 issue of the "Journal of the American Medical Association." The study of selective seratonin reuptake inhibitors for depression in primary care settings found that paroxetine, fluoxetine and sertraline were equally effective for treating mental depression. Using low-cost selective seratonin reuptake inhibitor is considered an ethical and reasonable approach in treating depression.

Purpose: The purpose of this study was to assess patient participation in advance care planning (ACP) and the decision to enroll in hospice. Methods: One hundred sixty-five family members of patients who died in hospice between January 2004 and September 2004 returned an anonymous survey (165/380; 43% response rate). Results: Forty-nine percent of family members reported that the patient was not involved in the hospice enrollment decision. The majority of respondents (78%) reported one or more people helped make the decision to enroll in hospice. For patients reported as being involved in the decision to enroll in hospice (either independently or in a shared capacity) they were more likely to have cancer (odds ratio [OR] = 2.3, p = 0.02), die at home (OR = 3.3, p = 0.006), have a length of stay in hospice greater than 7 days (OR = 2.1, p = 0.03), and less likely to have dementia (OR = 0.43, p = 0.001). White respondents were more likely to report having ACP discussions with the patient about: feeding tubes (OR = 4.7; p = 0.001), cardiopulmonary resuscitation (CPR; OR = 3.9; p = 0.002), or mechanical ventilation (OR = 2.7; p = 0.02) than non-white respondents. White respondents were more likely than non-white respondents to report that the patient had a written advance directive (OR = 4.2, p = 0.001). Discussion: These data indicate that some patients are not actively involved in the decision to enroll in hospice and that others, often physicians and family members, are making these decisions for the patient collaboratively. These data support the need for early education and interventions that assist patients and families in discussing ACP preferences and the need for greater understanding of how involved patients want to be with the decision to enroll in hospice. [ABSTRACT FROM AUTHOR]

The article provides information on a study that identified unmet psychosocial needs of cancer survivors obtained from the Pennsylvania Cancer Registry, understand the distribution of needs across subgroups, and compared unmet needs in 2005 with those identified by P. Houts et al. in 1986. It describes methodology used in the study. It concludes that unmet psychosocial need remains high despite 20 years of effort to address psychosocial issues.

We wanted to test the psychometric reliability and validity of self-reported information on psychological and functional status gathered by computer in a sample of primary care outpatients. Persons aged 65 years and older visiting a primary care medical practice in Baltimore (n=240) were approached. Complete baseline data were obtained for 54 patients and 34 patients completed 1-week retest follow-up. Standard instruments were administered by computer and also given as paper and pencil tests. Test–retest reliability estimates were calculated and comparisons across mode of administration were made. Separately, an interviewer administered a questionnaire to gauge patient attitudes and feelings after using the computer. Most participants (72%) reported no previous computer use. Nevertheless, inter-method reliability of the GDS15 at baseline (0.719, n=47), intra-method reliability of the computer in time (0.797, n=31), inter-method reliability of the CESDR20 at baseline (0.740, n=53), and the correlation between the CESDR20 computer version at baseline and follow-up (0.849, n=34) were all excellent. The inter-method reliability of the CESDR20 at follow-up (0.615, n=37) was lower but still acceptable. Although 28% were anxious prior to using the computer testing system, that percent decreased to 19% while using the system. The efficiency and reliability in comparison to the paper instruments were good or better. Even though most participants had not ever used a computer prior to participating in the study, they had generally favorable attitudes toward the use of computers, and also reported having favorable experience with the computer testing system. [Copyright &y& Elsevier]

The article offers information on the appropriate management for carotid blowout, particularly in terminally ill patients. It notes that carotid blowout is the rupture of the extracranial carotid arteries, resulting to a devastating complications of head and neck cancer. It mentions the availability of a newer technique called endovascular stenting with fewer immediate complications.

Background: Adolescent and young adult survivors of childhood cancer are a vulnerable population. Health beliefs may be related to necessary follow-up care. Purpose: This study seeks to develop a measure of health beliefs for adolescents and young adults with and without a history of cancer. Methods: Inductive and deductive methods and focus groups were used to develop the Health Competence Beliefs Inventory. Cancer survivors ( n = 138) and comparison participants ( n = 130) completed the Health Competence Beliefs Inventory and other measures. Healthcare providers reported current medical problems. Results: A series of iterative exploratory factor analyses generated a 21-item four-factor solution: (1) Health Perceptions; (2) Satisfaction with Healthcare; (3) Cognitive Competence; and (4) Autonomy. Survivors reported significantly different Health Competence Beliefs Inventory scale scores than comparisons ( p < .05). The Health Competence Beliefs Inventory was associated with beliefs, affect, quality of life, posttraumatic stress symptoms, and medical problems. Conclusions: The Health Competence Beliefs Inventory is a promising measure of adolescent and young adult perceptions of health and well-being. [ABSTRACT FROM AUTHOR]