Search

Actualment, la mort encara és tractada com un tema que la societat el considera tabú. És per això, que no se’n tenen prou coneixements ni s’aborda de forma eficaç, tot vulnerant els principis bioètics i drets dels pacients. Malauradament, també presenten dificultats els professionals sanitaris, encara que són els que conviuen diàriament amb ella. No estan preparats, no presenten coneixements, actituds i habilitats, ja que manquen de preparació a les universitats i de programes d’educació emocional en el procés de final de vida a les mateixes institucions sanitàries. Els sanitaris, únicament, estan preparats pel manteniment de la vida a conseqüència del gran avanç tecnològic, i la mort és considerada com el fracàs de la medicina. OBJECTIUS: L’objectiu principal és aprofundir en el coneixement del procés de final de vida; com a específics es troben descriure la gran rellevància de les CP, definir el paper dels professionals d’infermeria davant del procés de final de vida, explorar el significat de dignitat i mort digna, indagar sobre els drets humans i els principis bioètics dels pacients, i analitzar la possible vulneració dels principis bioètics i drets dels pacients en el procés de final de vida. MATERIAL I MÈTODE: Es realitza una revisió bibliogràfica i una anàlisi de la literatura científica general i específica sobre el procés de final de vida, concretament sobre la vulnerabilitat dels principis bioètics i els drets humans. S’utilitzen i analitzen fonts amb un rang temporal de 10 anys. La recerca ha estat realitzada en bases de dades de ciències de la salut com SCIELO, PUBMED i MEDLINE, MHMEDICAL; i bases de dades d’altres disciplines, en aquest cas jurídica, com NOTÍCIAS JURÍDICAS. També s’han consultat pàgines web d’associacions científiques nacionals i internacionals, revistes, diaris i Google acadèmic. Per últim, s’ha utilitzat informació aportada de llibres que es troben a la Biblioteca de les Escoles Universitàries Gimbernat del Campus de Sant Cugat del Vallès. CONCLUSIONS: És necessari impartir formació bàsica sobre atenció pal·liativa als professionals sanitaris, ja que sovint acostuma a arribar massa tard i de forma inadequada. L’enfocament actual ha de passar de ser curatiu a pal·liatiu; és a dir, la finalitat no ha de ser remetre una malaltia, sinó aconseguir el màxim benestar possible. Així doncs, s’ha de basar en les CP, on es considera i es cuida a la persona de forma holística, en les seves quatre dimensions (física, psicològica, social i espiritual). Per així, col·laborar en el procés d’aconseguir una bona mort, acceptada i amb companyia; on es respectin les decisions i desitjos dels pacients, sense vulnerar els principis bioètics (autonomia, beneficència, no-maleficència, justícia) i els drets humans; i reconèixer la mort com un procés natural i digne de viure’s. Per últim, és important la realització d’un DVA o d’un PAC, ja que aquest ajudarà als professionals a conèixer els desitjos i necessitats dels pacients, així com les seves últimes voluntats, tot respectant el principi fonamental d’autonomia. PARAULES CLAUS: Mort, Procés de Final de Vida, Cures Pal·liatives, Patiment, Agonia, Professionals sanitaris, Bioètica, Principis Bioètics, Vulnerabilitat dels Principis Bioètics, Dignitat, Vida digna, Mort digna, Drets Humans, Drets dels pacients, Vulnerabilitat dels Drets dels pacients, Autonomia, Consentiment Informat, Pla Anticipat de Cures, Document de Voluntats Anticipades, Testament Vital, Decisions Clíniques Bàsiques, Rebuig del malalt, Obstinament terapèutic, Limitació de l’actuació, Futilitat, Sedació pal·liativa, Eutanàsia, Suïcidi assistit, Comitès d’Ètica Assistencial. Currently, the death is still treated as an issue that society considers taboo. For this reason, you don’t have enough knowledge or is addressed effectively, all in violation of the principles of bioethics and rights of patients. Unfortunately, they also present difficulties are health professionals, although those who live daily with her. They aran’t ready, son’t have knowledge, attitudes and skills, because they lack training in universities and emotional education programs in the process of the end of life in the same health institutions. The professionals, only, are ready for the maintenance of life as a result of great technological advancement, and death is considered to be the failure of the medicine. OBJECTIVES: The main objective is to deepen the knowledge of the process of the end of life; as they are specific to describe the great relevance of the CP, define the role of nursing professionals in front of end of life process, explore the meaning of dignity and dignified death, probe on human rights and the principles of bioethics patients, and analyze the possible violation of bioethical principles and the rights of patients in the end of life process. MATERIAL AND METHOD: A literature review and analysis of the scoentific literature on the general ans specific process of end of life, specifically about the vulnerability of bioethical principles and human rights. Are used and analyzed sources with a temporary rank of 10 years. The research has benn carried out in the Health Sciences databases such as SCIELO, PUBMED, MEDLINE, MHMEDICAL; nd databases of other disciplines, in this case legal, as NOTÍCIAS JURÍDICAS. It is also viewed web pages of national and international scientific associations, magazines, newspapers and Google Scholar. Finally, it has been used information provided by books that ara in library of the Gimbernat University School of Sant Cugat del Vallès. CONCLUSIONS: It is necessary to provide basic training on palliative care to health professionals, as they often tend to arrive too late and improperly. The current approach has to be healing in palliative; that is to say, the aim should not be to send a disease, but to get the highest possible welfare. Thus, it must be based on the CP, which is considered and will take care of the person of holistic form, in its four dimensions (physical, psychological, social and spiritual). So, to collaborate in the process of getting a good death, accepted and company; where will respect the decisions and wishes of patients, without infringing the bioethical principles (autonomy, charity, non-maleficència, Justice) and human rights; and acknowledge the death as a natural process and worthy of living's. Finally, it is important to the realization of a DVA or a PAC, since this will help professionals to understand the wants and needs of patients as well as their last wills, while respecting the fundamental principle of autonomy. KEY WORDS: Death, Process of End of Life, Palliative Care, Suffering, Agony, Healthcare Professionals, Bioethics, Bioethical Principles, Vulnerability of Bioethical Principles, Dignity, Decent Life, Dignified Death, Human Rights, Rights of patients, Vulnerability of Patients Rights, autonomy, informed consent, Anticipated Plan of care, Advanced care Document, Testament Vital, Basic Clinical Decisions, Rejection of Sick, Therapeutic Obstinament, Limitation of the performance, Futility, Palliative Sedation, Euthanasia, Assisted Suicide, Medical Ethics committees. Grau en Infermeria

Objectives Patients who are no longer eligible for curative treatment often suffer from multiple complaints and require a multidisciplinary treatment approach. We incorporated two pharmacists in the palliative team, one hospital pharmacist and one pharmacist who were trained as a community pharmacist. The objective of our study was to evaluate their contribution to the palliative team. Methods During 13 months, the two pharmacists participated in all regular patient reviews and rounds and were available for individual consultation by all members of the palliative team on a daily basis. Each intervention (consults at request or during the patient rounds) was logged and categorised. Key findings During the study period, 115 patients were under the care of the palliative treatment team. The pharmacists were actively involved in 107 of these (93%). Pharmacists interventions occurred in 76% of patients, with an average of 1.5 interventions per patient. The most common intervention types were giving general therapeutic advice, starting of a drug for an uncontrolled symptom and stopping a drug that was given as prophylaxis. When comparing the contribution of the hospital pharmacist and the outpatient pharmacist, their interventions overlapped with regard to starting drugs, choice of drugs and side-effect management. However, interventions on parenteral drugs or optimising the route of administration mostly came from the hospital pharmacist, whereas the outpatient pharmacist more often intervened in increasing adherence and stopping drugs. Conclusion The palliative pharmacist team adds expertise to the palliative treatment team, with an active contribution in 76% of patients.

Electrochemotherapy is a new therapeutic option for patients with locally spread melanoma. It is based on the phenomenon of reversible electroporation, i.e. a transient increase in permeability of cell membranes under the influence of an appropriately modulated electric field. This allows multiplication of toxicity of a cytostatic agent entering the tumour cell. It is highly effective, especially in the palliative treatment of cancers located in the integument of the human body (skin and subcutaneous tissue). Available literature provides a mandate both for the application of this method in the aforementioned cases as well as for further work on its development. This paper focuses on reviewing the literature concerning the use of electrochemotherapy in the treatment of melanoma.

// In-Hye Jung 1 , Sang Min Yoon 1 , Jungwon Kwak 1 , Jin-Hong Park 1 , Si Yeol Song 1 , Sang-Wook Lee 1 , Seung Do Ahn 1 , Eun Kyung Choi 1 , Jong Hoon Kim 1 1 Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea Correspondence to: Sang Min Yoon, email: drsmyoon@amc.seoul.kr Keywords: hepatocellular carcinoma, bone metastasis, palliative treatment, radiotherapy, dose-response relationship Received: June 15, 2016 Accepted: January 16, 2017 Published: January 27, 2017 ABSTRACT We evaluated the pain and radiologic response, time to progression, and dose-response relationship after palliative radiotherapy for bone metastasis from hepatocellular carcinoma. We retrospectively reviewed the medical records of 91 patients between January 2004 and August 2012. The reviewed medical records included data on changes in pain, local tumor progression, and radiologic response evaluated via follow-up images. The radiologic response was assessed based on the Response Evaluation Criteria In Solid Tumors. The pain response was defined according to the International Bone Metastases Consensus Working Party palliative radiotherapy endpoints. Median radiation dose was 40 Gy (range, 20–66 Gy), with various fraction sizes (range, 2.0–6.0 Gy). Pain response rate was 81.4%. During the follow-up periods, radiologic local tumor progression was found in 42 patients (46.2%). The median time to progression was 14.1 months. When the patients were divided into two groups according to their radiation dose (< 55 Gy 10 vs. ≥ 55 Gy 10 ), the pain response rates of the high- and low-dose groups did not differ significantly ( p = 0.728). However, the radiologic response rate and the time to progression showed significant differences between the two groups ( p = 0.009 and p = 0.018, respectively). With dose escalation, higher radiologic response rates and a longer time to progression were achieved in patients with mass-forming bone metastases from hepatocellular carcinoma.

Cancer incidence and mortality depend on a number of factors, including age, socio-economic status and geographical location, and its prevalence is growing around the world. Most of cancer treatments include external beam radiotherapy or brachytherapy. Brachytherapy, a type of radiotherapy with energy from radionuclides inserted directly into the tumor, is increasingly used in cancer treatment. For cervical and skin cancers, it has become a standard therapy for more than 100 years as well as an important part of the treatment guidelines for other malignancies, including head and neck, skin, breast, and prostate cancers. Compared to external beam radiotherapy, brachytherapy has the potential to deliver an ablative radiation dose over a short period of time directly to the altered tissue area with the advantage of a rapid fall-off in dose, and consequently, sparing of adjacent organs. As a result, the patient is able to complete the treatment earlier, and the risks of occurrence of another cancer are lower than in conventional radiotherapy treatment. Brachytherapy has increased its use as a radical or palliative treatment, and become more advanced with the spread of pulsed-dose-rate and high-dose-rate afterloading machines; the use of new 3D/4D planning systems has additionally improved the quality of the treatment. The aim of the present study was to present short summaries of current studies on brachytherapy for the most frequently diagnosed tumors. Data presented in this manuscript should help especially young physicians or physicists to explore and introduce brachytherapy in cancer treatments.

Background: Lymphocytes were reported to play a significant part in host anticancer immune responses and influence tumour prognosis. Few studies have focused on the prognostic values of aspartate aminotransferase (AST) to lymphocyte ratio (ALRI), aspartate aminotransferase to platelet count ratio index (APRI) and systemic immune-inflammation index (SII) in hepatocellular carcinoma (HCC) treated with palliative treatments. Methods: Five hundred and ninety-eight HCC patients treated with palliative therapies were retrospectively analysed. We randomly assigned patients into the training cohort (429 patients) and the validation cohort I (169 patients). Receiver operating characteristic (ROC) curves were used to identify the best cut-off values for the ALRI, APRI and SII in the training cohort and the values were further validated in the validation cohort I. Correlations between ALRI and other clinicopathological factors were also analysed. A prognostic nomogram including ALRI was established. We validated the prognostic value of the ALRI, SII and APRI with two independent cohorts, the validation cohort II of 82 HCC patients treated with TACE and the validation cohort III of 150 HCC patients treated with curative resection. In the training cohort and all the validation cohorts, univariate analyses by the method of Kaplan-Meier and multivariate analysis by Cox proportional hazards regression model were carried out to identify the independent prognostic factors. Results: The threshold values of ALRI, APRI and SII were 86.3, 1.37 and 376.4 respectively identified by ROC curve analysis in the training cohort. Correlation analysis showed that ALRI>86.3 was greatly associated with higher rates of Child-Pugh B&C, portal vein tumor thrombosis (PVTT) and ascites (P < 0.05). Correspondingly, ALRI level of HCC patients with Child-Pugh B&C, PVTT and ascites was evidently higher than that of HCC patients with Child-Pugh A, without PVTT and without ascites (P < 0.001). In the training cohort and the validation cohort I, II, III, the OS of patients with ALRI >86.3 was obviously shorter than patients with ALRI ≤86.3 (P

Pancreatic cancer is one of the most aggressive and deadly malignancies. Despite better understanding of its biology and pathogenesis, contemporary treatment regimens are still insufficient. Along with the introduction of new treatment agents and combination therapy, the response rates are increasing, but these scores do not go with overall survival, and results are frequently conflicting. Therefore, contemporary medicine faces the challenge of expanding the knowledge base and practice on all grounds - pathology, factor risk, diagnosis, and finally surgical and palliative treatment of this disease. This paper provides a review of current adjuvant and neoadjuvant regimens and the role of experimental therapies in pancreatic ductal adenocarcinoma.

Advanced squamous cell carcinoma of the oesophagus and gastroesophageal junction usually requires palliative treatment, and the method of choice is stenting. There are several types of stents currently available, including: self-expandable metallic stents (fully or partially covered); self-expandable plastic stents; biodegradable stents. Each of the mentioned stents has its advantages and limitations, and requires a proper, patient-tailored selection. Due to the close anatomical relationship between the oesophagus and bronchial tree, some patients may require bilateral stenting. Oesophageal stenting may not only be considered as a palliative procedure, but can also be implemented to alleviate dysphagia during preoperative chemotherapy and/or radiotherapy.

WOS: 000391457100008, PubMed ID: 27780164, Objective: To investigate the symptoms of lung cancer in Turkey and to evaluate approaches to alleviate these symptoms. Subjects and Methods: This study included 1,245 lung cancer patients from 26 centers in Turkey. Demographic characteristics as well as information regarding the disease and treatments were obtained from medical records and patient interviews. Symptoms were evaluated using the Edmonton Symptom Assessment Scale (ESAS) and were graded on a scale between 0 and 10 points. Data were compared using the. 2, Student t, and Mann-Whitney U tests. Potential predictors of symptoms were analyzed using logistic regression analysis. Results: The most common symptom was tiredness (n = 1,002; 82.1%), followed by dyspnea (n = 845; 69.3%), appetite loss (n = 801; 65.7%), pain (n = 798; 65.4%), drowsiness (n = 742; 60.8%), anxiety (n = 704; 57.7%), depression (n = 623; 51.1%), and nausea (n = 557; 45.5%). Of the 1,245 patients, 590 (48.4%) had difficulty in initiating or maintaining sleep. The symptoms were more severe in stages III and IV. Logistic regression analysis indicated a clear association between demographic characteristics and symptom distress, as well as between symptom distress (except nausea) and well-being. Overall, 804 (65.4%) patients used analgesics, 630 (51.5%) received treatment for dyspnea, 242 (19.8%) used enteral/parenteral nutrition, 132 (10.8%) used appetite stimulants, and 129 (10.6%) used anxiolytics/antidepressants. Of the 799 patients who received analgesics, 173 (21.7%) reported that their symptoms were under control, and also those on other various treatment modalities (dyspnea: 78/627 [12.4%], appetite stimulant: 25/132 [18.9%], and anxiolytics/antidepressants: 25/129 [19.4%]) reported that their symptoms were controlled. Conclusion: In this study, the symptoms progressed and became more severe in the advanced stages of lung cancer, and palliative treatment was insufficient in most of the patients in Turkey. (C) 2016 S. Karger AG, Basel

Intraluminal brachytherapy plays an important role in the treatment of oesophageal tumours. This article aims to define this role in the curative as well as in the palliative treatment settings drawing on data from the literature, and also emphasizing its potential for harm when used inexpertly. It also provides a short introduction to practical aspects of the treatment procedure and treatment planning.

Assessment of parenchymal blood volume (PBV) of primary and secondary pulmonary malignancies by using a C-arm CT, regarding its role in detecting early functional response to transpulmonary chemoembolization (TPCE) and clinical practicability.21 patients with a mean age of 56.77 years, who were assigned to TPCE during their palliative treatment, were included. PBV and the diameter of tumours were analyzed. PBV maps were calculated from three-dimensional CT-angiographic (3D-CTA) data sets. Imaging was performed on a flat detector, C-arm CT. Groups of response were classified according to the criteria of the response evaluation criteria in solid tumours. Statistically significant differences were determined and Pearson's regression analysis correlated PBV and diameter as parameters of response to treatment.During 4.91 sessions, median diameter increased 18.18% (p 0.05) and PBV reduced 39.62% (p 0.05). Functional and imaging response per tumour was statistical significantly different (p ≤ 0.05). Correlation coefficient was r = 0.058. 2/41 tumours showed partial response; 31/41 tumours showed stable disease; and 8/41 tumours showed progressive disease. The highest pre-treatment PBV values were measured in decreasing tumours (206.93 ml l(-1)), and the lowest values were measured in increasing tumours (60.17 ml l(-1); p 0.05). The lowest values were also measured in lung cancer (53.02 ml l(-1)) that was significantly different to uterine leiomyosarcoma (103.31 ml l(-1)) and renal cell cancer (113.14 ml l(-1); p ≤ 0.05).Assessment of PBV maps by using 3D-CTA image data is feasible in the clinical routine. PBV shows a stronger response to TPCE treatment than measurement in diameter and should be considered as a response parameter for early detection.Assessment of PBV using C-arm CT during TPCE is a feasible technique. Assessment of PBV might be useful in assessing response to treatment.

Introduction: Pancreatic tumours are a crucial medical issue. The majority of patients report sick in the late stage of carcinoma clinical advancement, which considerably limits the possibility of surgical treatment. Pancreatic cancer patients with no other alternative but palliative treatment constitute a large group. Aim: To assess pain intensity levels and quality of life of pancreatic cancer patients after videothoracoscopic splanchnicectomy. Material and methods: Between 2001 January and 2010 November in the Department of Thorax, General Surgery and Oncology of the Medical University of Lodz 262 patients with pancreatic tumours were hospitalized. In 121 cases grade 3 and grade 4 tumours were observed. Hundred and twenty-one videothoracoscopic procedures of sympathetic trunk and ganglion excision were performed in 89 patients. Results: Before the procedure the pain intensity level according to VAS was 5.66 (3.9-7.2; SD 1.24) in the trial group and 5.46 (4.1-7.1; SD 1.15) in the control group. The quality of life average assessment in both groups did not differ statistically (p = 1.07) and was 46.3 (32-66; SD 0.92) in patients before the operation and in the control group 50.3 (41-63; SD 0.75). On the 7 th postoperative day the pain intensity on average was 2.33 (1.2-3.9; SD 0.78) and 4.57 (3.6-5.5; SD 0.69) respectively. One week after the procedure the quality of patients’ life was estimated at 64.1 (39-83; SD 1.38) and in the control group at 52.2 (42-65; SD 0.71); the differences are significant (p < 0.05). Thirty days after the procedure 12 patients did not t ake any painkillers (13.5%), and in the others a considerable decrease of the taken drugs was observed. On average, the pain intensity was estimated at 1.78 (0.6-3.6; SD 0.68). The quality of life, on the other hand, improved considerably in relation to the state prior to the procedure, but increased insignificantly in relation to the state on the 7 th postoperative day to 70.9 (52-88; SD 1.14). Conclusions: Splanchnicectomy is a safe method of cancer pain treatment in patients with advanced pancreatic tumours. Videothoracoscopic excision of visceral nerve thoracic section contributes to the statistically significant decrease of cancer pain intensity and considerably improves the quality of patients’ lives.

Preparation of site of radiation delivery is an important process in radiation treatment planning and plays a crucial role during a course of radiotherapy to achieve reproducibility of set-up and accuracy of treatment delivery. The preparation of treatment area is done by markings of field center, field edge or other reference point of planned field. Both non-invasive (marker pen, henna) and invasive methods (tattoo) are available for marking with limitations of each. Tattoo with a needle pricked at angle of 30° to 1-2 mm depth to create tattoo 2-3 mm diameter in size is an ideal procedure. Visibility, permanent nature, social-religious belief, and mobility of skin are one of the main concerns about tattoo. Tattoo removal can be done performed if desirable by patients by various modern ways, which will be esthetically available. Dermabrasion, cryotherapy, surgery, QSRL (Q-switched ruby laser) are common methods of tattoo removal. Esthetic dissatisfaction, allergy, dermatoses, keloids, infection, fanning/fading of tattoo are associated problems. In IMRT and IGRT treatment, delivery dependence on tattoo in reduced and use of surrogate markers including particularly for bony set-up and implanted markers (e.g. gold seeds) for tumor localization and treatment verification is increasing. However, these are complex procedures and require an expertise. Ease of set-up and less time required for tattooing are one of the main advantages of tattoo as compared to external or internal marker set-up. Tattoo still remains a crucial method of positioning, especially in developing countries and in palliative treatment settings.

In the examination of the several modes of treating urinary concretions, the question of their indications and contraindications is worthy of special attention, since adherence to a single procedure belongs to the medicine of a remote past. Modern medicine demands that preventive measures be taken in threatened calculous affection at the first sign of coming of hyperlithaemia; that when hyperlithuria exists, medicinal treatment be resorted to; that when calculi are formed, mechanical means be promptly applied for their removal; that when the calculi have been removed, the cure be accomplished by suitable after-treatment; and that when mechanical treatment is contraindicated, a judicious course of palliative treatment be adopted. Therefore the treatment of urinary concretions is now arranged into the preventive, medicinal, palliative, mechanical and post-mechanical treatment. The preventive treatment embraces hygienic, medicinal and mechanical means. The needed hygienic observances comprise diet, exercise, ablutions and raiment. The medicinal means of prevention

Background The European Society for Medical Oncology (ESMO) 2021 conference provided a high number of randomized phase III trial reports, many of which were claimed to be practice changing. Given the short time available for conference presentations, results and conclusions tend to have greatest priority with less time remaining for study background and study methodology. Purpose On behalf of the ESMO Practicing Oncologists Working Group, 11 potentially practice-changing reports were selected and screened for three main questions: (i) Did the investigators provide sufficient details with regard to Patients and Methods to make the results comprehensible? (ii) Were there any reasons to consider bias? (iii) To which extent did the results presented translate to clinical benefit? Results In 2 out of 11 trials, the study design presented differed considerably from the study design described at ClinicalTrials.gov. Allocation concealment was not carried out in 6 out of 11 trials. In none of the trials reporting progression-free survival was informative censoring considered an issue. In none of the trials reporting overall survival was desirable crossover considered an issue. Defined trial outcome measures depicted at ClinicalTrials.gov, which could boost or weaken the ESMO-Magnitude of Clinical Benefit Scale score, were often lacking in the presentation. Study success was claimed in a heterogeneous manner, which was often not clearly linked to overall clinical benefit. Conclusion ESMO conference presentations can inform the scientific community and catalyze further research but cannot replace the full papers in peer-reviewed journals, which are needed to estimate the thoroughness of the results, the overall impact on clinical benefit and the consequences for future treatment guidelines., Highlights • An oncological peer-reviewed paper is lengthy and well structured. • An oncological conference presentation is short and less structured, but its impact can be high. • ESMO 2021 conference encompassed many possibly practice-shaping phase III trial reports. • A survey of 11 selected reports to ascertain if the conclusions made were adequately underlined by the provided information.

Background/aim Electrochemotherapy (ECT) is a predominately palliative treatment for cutaneous metastases where an electric field is used to increase the intracellular accumulation of a chemotherapeutic drug (bleomycin or cisplatin). ECT induces a strong anti-vascular effect and endothelial cells seem especially vulnerable. To date, almost no neurological and/or cerebrovascular complications after ECT treatment have been published. In this paper two such cases are reported. Case report A seizure in a man treated with ECT for a basal cell carcinoma in the temporal region and a fatal ischemic stroke in a woman treated for cutaneous metastases in the neck are reported. In both cases a causal relationship to ECT treatment was strongly suspected. Conclusion ECT in the head and neck can potentially cause severe neurological complications. Ultrasound is recommended for ECT treatment in the neck.

Background: Palliative care and dignity at patients’ end-of-life are nursing competences. Many therapies and guides have been developed to assure the preservation of dignity in patients with life-threatening illnesses and in the last stages of these ones. In 2002, Harvey Max Chochinov developed the Dignity Therapy with the aim of promoting end-of-life dignity. Aim: Analyse the effectiveness of Dignity Therapy on the improvement of patients with advanced life-threatening diseases and establish if its use in the clinical practice should be recommended. The specific objectives are: analyse the effectiveness of Dignity Therapy to improve psychological distress, anxiety, depression and psychological fatigue; analyse its effectiveness in improving physical distress and symptomatology; know the effectiveness of Dignity Therapy to increase the palliative patient’s sense of dignity; analyse the benefits of Dignity therapy in the treatment of psychosocial and existential distress; and assess the feasibility of Dignity Therapy focusing on both patients and family relatives acceptability and satisfaction. Methodology: Conduction of a bibliographic review. PUBMED, COCHRANE, CINAHL and CUIDEN databases were queried during the first half month of March 2019. The selection of articles was limited to the use of Dignity Therapy in adult patients admitted to palliative care units with the sufficient physical and mental capacity to undergo the intervention. Data extracted was synthesised and analysed following the study objectives. Results: Fourteen papers encountered the selection criteria and were assessed for eligibility. The results obtained demonstrate that the Dignity Therapy is an effective instrument for the treatment and improvement of patients with life-limiting illnesses especially in the last stages of it. Therefore, its use in palliative care is recommended. Results on psychological distress lead to controversial conclusions. Four studies suggested benefits on physical distress. The overall light turns out to be positive in terms of sense of dignity, psychosocial distress and existential distress. Finally, in terms of feasibility, both patient and family’s opinion in relation to acceptability and satisfaction have been found to be positive. Conclusion: The results found throughout this review conclude firmly and affirm Dignity Therapy’s effectiveness in terms of patients’ dignity and consequently overall status. In palliative care settings, where de defence and preservation of patients’ dignity is an undeniable obligation, patients could clearly benefit from Dignity Therapy. Dignity Therapy has demonstrate to be a useful instrument for patients to solve, close or clear out their personal believes and questionable issues before leaving. This paper emerges a positive light for future research and the application of the Dignity Therapy in palliative care settings

Liver metastases development in colon rectal cancer has a strong impact on patient overall survival, with a 5-years survival of 5% with palliative treatment. Surgical resection combined with pharmacological treatment can achieve a 5-year overall survival of 31–58%. However, in only 20% of patients with colon rectal liver metastases (CRLM) liver resection is feasible. In highly selected patients, recent trials and studies proved that liver transplantation for non-resectable CRLM is a surgical option with an excellent long term overall survival. The aim of this paper is to review the indications and outcome of liver transplantation for CRLMs, with a special focus on the immunosopressive therapy and the management of local and extra hepatic recurrence after liver transplantation.

Introduction. Synchronous metastases of gastric cancer to the liver occur in 3–14% of patients with this cancer, and metachronous lesions in 37% of patients after radical gastrectomy. Liver resections due to metastases of gastric carcinomas represent only 5–9% of resections due to metastases other than colorectal cancer. Until recently, patients with gastric carcinoma metastases to the liver were classified in the IV stage of cancer and the therapy was limited to chemotherapy or palliative treatment only. Material and methods. The paper presents a current review of literature and the authors’ own experience with liver resection due to gastric cancer metastases into this organ. During 34 months, 488 patients with liver metastases were treated in the Department of General, Transplant and Liver Surgery, of the Medical University of Warsaw, in whom 426 surgical procedures were performed (87.3%). The types of surgical procedures are as follows: minor liver resections in 204 patients (47.9%), hemihepatectomies in 102 patients (23.9%), thermoablations in 86 patients (20.2%) and laparotomies in 34 patients (8.0%). Among patients treated for liver metastases there were 4 patients with metastases from gastric cancer (0.8%), which constituted 1% of patients operated on, but 6.8% of patients with liver metastases from organs other than colorectal cancer. The postoperative course and direct results in all patients operated because of gastric cancer metastases into the liver were very good. Conclusions. In some patients (single metachronous metastasis, no extrahepatic lesions, no peritoneal lesions, with subsequent chemotherapy) liver resection due to metastases from gastric cancer provides a chance for a longer survival.

The efficiency of electroporation (EP) has made it a widely used therapeutic procedure to transfer cell killing substances effectively to the target site. A lot of researches are being done on EP-based cancer treatment techniques. Electrochemotherapy (ECT) is the first EP-based application in the field of drug administration. ECT is a local and nonthermal treatment of cancer that combines the use of a medical device with pharmaceutical agents to obtain local tumor control in solid cancers. It involves the application of eight, 100µs, pulses at 1 or 5000 Hz frequency and specified electric field (V/cm) with a median duration of 25 minutes. The efficacy of chemotherapeutic drugs increases by applying short and intense electrical pulses. Several clinical studies proposed ECT as a safe and complementary curative or palliative treatment option (curative intent of 50% to 63% in the treatment of Basal Cell Carcinoma (BCC)) to treat a number of solid tumors and skin malignancies, which are not suitable for conventional treatments. It is used currently for treatment of cutaneous and subcutaneous lesions, without consideration of their histology. On the contrary, it is also becoming a practical method for treatment of internal, deep-seated tumors and tissues. A review of this method, needed instruments, alternative image-guided procedures (IGP) approaches, and future perspectives and recommendations are discussed in this paper.

Objectives: Pain appearance is one the most common complication of spastic hip disease in children with cerebral palsy (CP). It determines child and caregiver quality of life and life priorities. Reconstruction hip surgery should be considered as a treatment of choice. Some clinical conditions give the inability to perform such a procedure. In our paper, we would like to present four palliative methods of spastic hip dislocation treatment in children with CP.Material: We analyzed four groups of patients treated because of hip pain. Inclusion criteria were pain appearance (visual analog scale-11 or numeric rating scale-11) and hip joint dislocation (migration percentage >80%). All patients were admitted to our department between 2008 and 2018. In the first group, patients were treated only by steroid injections to hip joints; in the second group, patients were recruits after hip interposition arthroplasty with shoulder spacer; in the third group, they were patients after valgus subtrochanteric osteotomy (Schanz); and in the fourth group, these were patients after proximal femoral resection (Castle procedure). The minimal follow-up time was 2 years. The first group consisted of 15 patients (15 hips) with a mean age of 15.5 (8–17) years; the second group, 20 patients (24 hips) with a mean age of 14.2 (9–22.6) years; the third group, 22 patients (24 hips) with a mean age of 13.5 (7–20.5) years; and the fourth group, 10 patients (15 hips) with a mean age of 12.9 (7–17.6) years.Methods: Radiological evaluation was based on a standardized anteroposterior X-ray of the hip joints. Pain severity before surgery and at the last follow-up time was measured by visual analog scale-11. Parents or caregivers were asked about their child's pain during sitting, perineal care, and rest. During the visit, all caregivers were asked about treatment satisfaction (no 0 to max 10) and if they would decide again for the same surgery.Results: In all groups of patients, we observed a decrease in pain complaints. The observed reduction of pain in the first group was from 7.88 (4–10) to 3.08 (0–8) (p = 0.05), but results of injection were observed only for 4 months (2–8), and it has to be repeated (average: two times). In the second group, level of pain was reduced from 4.93 (1–10) to 0.93 (0–5) (p < 0.001); in the third group, from 6.22 (3–10) to 0.59 (0–6) (p < 0.001); and in the fourth group, pain reduces from 5.43 (2–10) to 2.13 (0–5) (p < 0.001). Observed changes concerned mostly sitting position and perineal care. The complication rate was in the second group, 6 of 24 cases of extraarticular ossification; in the third group, 2 of 24 cases with extraarticular ossification, two cases of revision surgery. In the fourth group, two cases needed another femoral resection. In the first group, five patients died during follow-up time, so they were excluded from the study. In the steroid injection group, parents' treatment evaluation was 6.83 (0–10), and only in three cases that they would resign from the treatment. In the hip interposition arthroplasty group, caregivers' evaluation was 7.41 (0–10), and in five cases, parents did not accept the surgery. In the Schanz osteotomy group, parents' evaluation was 5.9 (0–10), and in eight cases, caregivers would not repeat surgery. In the proximal femoral resection group, satisfaction was the highest, 8.3 (3–10), and only two parents would not decide for surgery again.Conclusion: All procedures can be considered as palliative treatment options for pain complain in a spastic hip joint dislocation in children with CP. Steroid injections to the hip joint need to be repeated, and with the follow-up time, it becomes less effective. Steroid injection seems to be the treatment of choice for patients with general anesthesia contraindications. Interposition arthroplasty of the hip joint seems to give better final results, but the highest parents' satisfaction surprisingly was observed in the proximal femoral resection group, but differences were not statistically significant.

El objetivo del articulo es analizar la forma en que profesionales de cuidados paliativos -disciplina médica especializada en la atención de pacientes con enfermedades terminales-definen, proyectan y comunican el estatuto de "terminalidad" de pacientes con enfermedades oncológicas avanzadas. El articulo se basa en observaciones etnográficas y en entrevistas a profesionales de un servicio de cuidados paliativos de la ciudad de Buenos Aires. Se analizan las tareas de definición y proyección del proceso de morir y la forma en que los profesionales manejan la información sobre el pronóstico de la enfermedad. El análisis de estas prácticas evidencia la forma en que el "final de la vida" es construido en un doble sentido: como una etapa de preparación psicológica para pacientes y familiares -y, por ende, en un objeto de intervención profesional-, y como un proceso gradual que culmina en la muerte. The aim of this paper is to analyze how professionals of palliative care -a branch of medicine specialized in the care of dying patients- define, plan and disclose the "terminal" status of patients with advanced cancer diseases. The article is based on ethnographic observations and interviews with professionals in a palliative care service in the Buenos Aires city. The paper analyzes the tasks of definition and projection of the dying process and the way professionals disclose information about the dying prognosis. The analysis of these practices shows how the "end of life" is constructed in two ways: as a stage of psychological preparation for patients and families (and therefore an object of professional intervention), and as gradual process culminating in death. O artigo aborda a maneira em que os profissionais de cuidados paliativos -disciplina médica especializada no tratamento de doentes terminais- definen, projetan e comunican o estatuto de "terminalidade" de pacientes com doenças oncológicas avançadas. A partir de observações etnográficas e entrevistas com profissionais da saúde de um serviço de cuidados paliativos da cidade de Buenos Aires, o artigo analisa as tarefas de definição e projeção do processo de morrer e do manejo das informações sobre o prognóstico da doença por parte dos profissionais. A análise dessas práticas mostra como o "final da vida" é construído em um duplo sentido: como um estágio de preparação psicológica para pacientes e familiares (e, portanto, como um objeto de intervenção profissional), e como um processo gradual que culmina com a morte.

Màster Oficial de Psicogerontologia, Facultat de Psicologia, Universitat de Barcelona, curs: 2019-2020, Tutora: Rosa Baeza Lanuza, Introducción: Encontrarse con la muerte es algo inseparable para las auxiliares de geriatría, dado que va asociado al desarrollo de su profesión. Su implicación en el cuidado de los residentes en situación de últimos días representa una experiencia emocional muy impactante e intensa bajo unas condiciones laborales donde escasea el tiempo y el personal y debiendo contener las propias emociones. Todos estos factores predisponen y generan síntomas del síndrome del cuidador quemado en el equipo sanitario. Objetivo: Se propone una intervención psicoeducativa desde la perspectiva de la psicología en el campo de los cuidados paliativos. El programa tiene como objetivo dotar a las auxiliares de geriatría de conocimientos y habilidades sobre el proceso de morir y estrategias para detectar y manejar sus propias emociones. Metodología: Se plantea una intervención de modalidad grupal, de 10 sesiones con una duración de 2 horas y periodicidad semanal. La estructura de cada sesión incluye una primera parte de contenidos teóricos en formatos audiovisuales y/o impresos en papel y una segunda parte donde se realizarán dinámicas y ejercicios que servirán para afianzar y aplicar lo aprendido. Resultados: Se espera que, al finalizar el programa de intervención, los participantes logren varios objetivos; por un lado, que los participantes amplíen sus competencias sobre el acompañamiento durante el proceso de morir y la agonía, y por el otro, que aumenten y desarrollen herramientas y estrategias para la detección y el manejo emocional. Conclusiones: El programa Cuidar cuando no es posible Curar espera llenar un vacío en la formación de las auxiliares de gerontología, un colectivo muchas veces olvidado. Además, este proyecto aspira a ser precursor de una nueva concepción de los cuidados en situación de últimos días sirviendo como ejemplo para psicogerontólogos y profesionales de la salud interesados en humanizar las tareas de cuidado en las personas mayores al final de la vida y dando voz a un acontecimiento vital como es la muerte., Introduction: Encountering death is inseparable for geriatric assistants, since it is associated with the development of their profession, Her involvement in care residents at the end of life, represents a very shocking and intense emotional experience under working conditions where time and staff are scarce and her own emotions must be contained. All of these factors lead professional caregivers down the path of burnout. Objective: A psychoeducational intervention is proposed from the perspective of psychology in the field of palliative care. The intervention aims to provide gerontology assistants with knowledge about the dying process and skills to detect and manage their emotions. Methods: A group modality intervention of 10 sessions with a duration of 2 hours and weekly periodicity is proposed. The structure of each session includes a first part of theoretical contents in audiovisual formats and/or printed on paper and a second part where activities and tasks will be carried out and will serve to strengthen and apply what has been learning. Results: At the end of the program is it expected that participants accomplish a set of goals. On the one hand, it is expected that they will expand their skills about the accompaniment during the process of dying and the agony, and on the other, they will increase and develop tools and strategies for detection and emotional management. Conclusions: The program Cuidar cuando no es posible Curar looks forward to filling and essential gap in the training of gerontology assistants, a group that is often forgotten. The program aspires to be a precursor of a new conception of care in last-day situations, serving as an example for psychogerontologists and health care professionals interested in humanizing care tasks in the elderly at the end of life and giving voice to a vital event such as death.

SummaryIn the early days of transplantation most organs were procured from donors after circulatory death. Later on, as a result of a wide acceptance of the concept and diagnosis criteria of brain death, donation from donors after brain death replaced donation after circulatory death, which finally became the standard (except for several countries). Renewed interest in donation after circulatory death started in the 1990s, resulting from the persistent organ shortage from donation after brain death and the need to bridge the gap between the need for transplantation and the number of available organs. Presently, in many countries donation after circulatory death accounts for even up to 30-40% of organ procurement activity. However, the lack of unified guidelines on donation after circulatory death has challenged the medical, ethical, legal and transplant community on several grounds. Issues concern problems like end-of-life palliative treatment and its withdrawal phase, or the definition of circulatory death and its irreversibility. Both legislation on and the practice of donation after circulatory death differ significantly in different countries. In parallel with the development of this type of donation, new terms, criteria and recommendations have arisen, resulting in constantly changing and unceasingly emerging terms and definitions used in the literature, at scientific conferences and symposiums, or between countries and institutions. A need has emerged for a consensus and clear guidelines to deal with the ethical, legal, organizational, and technical challenges. Te compilation of a classification of donors after circulatory death has been envisaged to serve this purpose. This paper presents and discusses different classifications of donors and donation after circulatory death.

Nuclear theranostics functions as a bridge which connects targeted diagnosis to targeted therapy, just like Turkey functions as a geographical bridge which connects Asia to Europe. This unique geographical site of the country plays an important role with regard to introduction of novel scientific and technologic improvements, which originate from one continent to another, in the era of accelerated information. The first nuclear medicine practice in Turkey started in the beginning of 1950s with the first radioiodine treatment, which actually was a debut for nuclear theranostics in Turkey, years before many other countries in the world. For the time being, along with radioiodine treatment, many other theranostic applications such as I-131 MIBG treatment, Lu-177/Y-90 DOTA peptide treatment, Lu-177 PSMA treatment, Y-90 microsphere treatment, and bone palliative treatment are being performed in many centers countrywide. As science and technology improves, novel theranostic applications are eagerly awaited to be introduced in near future. This paper summarizes the story of nuclear theranostics in Turkey and aims to give an overview on the current status of theranostic applications in Turkey.

Peritoneal carcinomatosis (PC) from colorectal cancer (CRC) is a disease with a poor prognosis, often thought to be a terminal illness with no hope except for palliative treatment. New therapeutic modalities combining cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have shown favorable outcomes and may provide a significant survival benefit in a selected group of patients. The main rational for CRS is to remove all visible tumor burden to allow for the chemotherapeutic agent (HIPEC) to eradicate any microscopic residual disease. The Amsterdam statement formulated at the 9th International Congress on Peritoneal Surface Malignancies supports the use of CRS with HIPEC as a standard of care for selected patients with small-to-moderate volume PC from CRC. Selecting appropriate patients who would benefit from CRS/ HIPEC is paramount to derive the maximum oncological outcomes while minimizing the risks of postoperative complications and mortality. In this paper, we will review the role for CRS/HIPEC in the management of PC from CRC.

Background: Patients who play musical instruments (especially wind and stringed instruments) and vocalists are prone to particular types of orofacial problems. Some problems are caused by playing and some are the result of dental treatment. This paper proposes to give an insight into these problems and practical guidance to general practice dentists. Method: Information in this paper is gathered from studies published in dental, music and occupational health journals, and from discussions with career musicians and music teachers. Results: Orthodontic problems, soft tissue trauma, focal dystonia, denture retention, herpes labialis, dry mouth and temporomandibular joint (TMJ) disorders were identified as orofacial problems of career musicians. Options available for prevention and palliative treatment as well as instrument selection are suggested to overcome these problems. Conclusions: Career musicians express reluctance to attend dentists who are not sensitive to their specific needs. General practitioner dentists who understand how the instruments impact on the orofacial structures and are aware of potential problems faced by musicians are able to offer preventive advice and supportive treatment to these patients, especially those in the early stages of their career.

Aim To describe 20 years of experience with corpus callosotomy at Great Ormond Street Hospital for Children, London and the Children's Hospital at Westmead, Sydney. Method Records of patients who underwent corpus callosotomy between January 1995 and December 2015 were reviewed. Complications of surgery and changes in seizure type and frequency, injuries, and use of antiepileptic drugs were recorded. Drop attacks were analysed using Kaplan–Meier event-free survival curves. Multivariable regression analysis was used to assess the effect of clinical characteristics on outcome at last follow-up. Results Inclusion criteria were met for 55 patients younger than 18 years of age. Median follow-up length was 36 months. At the last follow-up, 26 out of 55 patients (47%) had rare or no drop attacks. In those without a good outcome at final follow-up, 26 out of 29 (90%) had drop attacks return within 12 months of surgery. There were no preoperative predictors of developing drop attacks postoperatively. The median number of antiepileptic drugs significantly reduced from three to two. Transient neurological complications were experienced by 11 out of 55 patients (20%) and 6 out of 55 patients had surgical complications (11%). Interpretation Corpus callosotomy is a well-tolerated procedure that is effective at reducing the severity of drop attacks in paediatric patients. Drop attacks that do return are likely to do so within 12 months and the number of antiepileptic drugs can be significantly reduced. What this paper adds Corpus callosotomy is an effective palliative treatment and well tolerated in children. Good outcomes for the first 12 months after surgery were likely to continue. The number of antiepileptic drugs can be significantly reduced after corpus callosotomy. Patients with fewer than three types of seizure had better outcomes. There were fewer injuries from drop attacks after surgery.

Treballs Finals de Grau Antropologia Social i Cultural, Facultat de Geografia i Història, Universitat de Barcelona, Curs: 2016-2017, Tutor: Mariona Rosés Tubau, El present article tracta d’il·lustrar les maneres en què la musicoteràpia pot ajudar als malalts terminals de la unitat de pal·liatius del Centre-Fòrum Hospital del Mar. La recerca vol mostrar la importància de la dimensió emocional i comunicativa que envolta tota pràctica musical, imprescindible per donar peu a la socialització entre els presents durant les sessions de la teràpia. Aquestes pràctiques permeten elevar la categoria del pacient a la de protagonista del moment vital en el qual es troba. Sense aquest tipus de teràpies, que busquen fer possible la comunicació entre els participants d’aquest procés, el paper del malalt terminal quedaria relegat a un segon pla esperant la mort de forma passiva. En front de la incapacitat d’oferir ajuda als qui estan morint, de mostrar afecte en el moment del comiat, trobem alternatives com la musicoteràpia.

Oesophageal cancer is the ninth leading cause of malignant cancer death and its prognosis remains poor, ranking as the sixth most frequent cause of death in the world. This research work aims to adopt an Auxetic (rotating-squares) geometry device, that had previously been examined theoretically and analysed by Grima and Evans (J Mater Sci Lett 19(17):1563-1565, 2000), to produce a novel Auxetic oesophageal stent and stent-grafts relevant to the palliative treatment of oesophageal cancer and also for the prevention of dysphagia. This paper discusses the manufacture of a small diameter Auxetic oesophageal stent and stent-graft. The oral deployment of such an Auxetic stent would be simplest if a commercial balloon dilatational catheter was used as this obviates the need for an expensive dedicated delivery system. A novel manufacturing route was employed in this research to develop both Auxetic films and Auxetic oesophageal stents, which ranged from conventional subtractive techniques to a new additive manufacturing method. Polyurethane was selected as a material for the fabrication of Auxetic films and Auxetic oesophageal stents because of its good biocompatibility and non-toxicological properties. The Auxetic films were later used for the fabrication of seamed Auxetic oesophageal stents. The flexible polyurethane tubular grafts were also attached to the inner luminal side of the seamless Auxetic oesophageal stents, in order to prevent tumour in-growth. Scanning electron microscopy was used to conduct surface morphology study by using different Auxetic specimens developed from different conventional and new additive manufacturing techniques. Tensile testing of the Auxetic films was performed to characterise their mechanical properties. The stent expansion tests of the Auxetic stents were done to analyse the longitudinal extension and radial expansion of the Auxetic stent at a range of radial pressures applied by the balloon catheter, and to also identify the pressure values where the Auxetic stent fails. Finite element models of both Auxetic film and Auxetic stent were developed, and the results were compared with experimental results with a good agreement. The tensile testing of the Auxetic polyurethane films revealed that the Poisson's ratio of the sample ranged between -0.87 and -0.963 at different uniaxial tensile load values. From the stent expansion test, it was found that the Auxetic oesophageal stent radially expanded from 0.5 to 5.73 mm and longitudinally extended from 0.15 to 1.83 mm at a range of applied pressure increments (0.5-2.7 bar) from the balloon catheter.

Les cures pal·liatives pediàtriques milloren la qualitat de vida dels infants i adolescents; i fins i tot de les famílies. D’aquesta manera, tot i estar en risc la vida del pacient, s’alleugereix el patiment i s’afavoreix la identificació dels símptomes proporcionant una mort digna. A Espanya cada any 2000 nens han de rebre cures pal·liatives, dels quals un 40% estan diagnosticats de càncer. El projecte de guia de pràctica clínica (GPC) va dirigit a les infermeres que treballen a l’àmbit hospitalari de les cures pal·liatives pediàtriques i que tracten dia rere dia amb aquets infants i adolescents, d’entre 0 i 18 anys. Per l’elaboració del projecte de guia s’ha realitzat una recerca bibliografia sobre els principals símptomes que pateixen els nens, com afecten tant psicològicament com físicament, i la millor forma d’abordar-los i el paper de la infermeria alhora de tractar-los. Seguint aquest passos es millora l’autonomia del pacient i es dóna la oportunitat de viure la vida amb plenitud fins al final. També s’ha desenvolupat la metodologia i el disseny que es requereix per elaborar la guia. L’objectiu és realitzar un projecte de GPC enfocat a la homogeneïtzació de les cures pal·liatives pediàtriques i oferir una eina als professionals per proporcionar les millors cures als nens i com a conseqüència, evitar el patiment i dignificar l’últim tram de la vida dels infants. PARAULES CLAU : Cures pal·liatives pediàtriques, oncologia, càncer, símptomes, infermeria Pediatric palliative cares improves the life quality of children and adolescents; even families’ lives too. By this way, although patient lifes are in the final part of it, the suffering will decrease and the symptoms identification will be faster providing a dignified death. In Spain, 2000 children are receiving palliative cares every year, concretely the 40% of these cases are attributed to cancer. Clinic practice guide project (GPC is the Catalan abbreviation of it) is addressed to nurses who are working in hospitals in pediatric palliative cares area and treats every day with children and adolescents between 0 and 18 years. For the elaboration, the guide project has been a research about the mainly suffered symptoms, how they affect the children, and which is the best way to address it. Following these steps, child independence will be improved and bring them the opportunity of high and full life until the last moment. It has also developed a methodology and design that is required to produce the guide The objective is to realize a GPC project focused on standardization of pediatric palliative cares and provide a new tool that will help professionals to treat children. This must alleviate children suffering and must dignify the last moments of their short life. KEY WORDS : Pediatric palliative care, oncology, cancer, symptoms, nurse Grau en Infermeria

There has been much discussion regarding the acceptable use of sedation for palliation. A particularly contentious practice concerns deep, continuous sedation given to patients who are not imminently dying and given without provision of hydration or nutrition, with the end result that death is hastened. This has been called ‘early terminal sedation’. Early terminal sedation is a practice composed of two legally and ethically accepted treatment options. Under certain conditions, patients have the right to reject hydration and nutrition, even if these are life-sustaining. Patients are also entitled to sedation as palliation for intolerable, intractable suffering. Though early terminal sedation is thought to be rare at present, the changing nature of palliative medicine suggests its use will increase. Arguments regarding early terminal sedation have failed to recognize early terminal sedation as a distinct legal and ethical entity. It can be seen as both the simple sum of treatment refusal and sedation for palliation, analogous to terminal sedation. It can also be seen as an indivisible palliative treatment, more analogous to assisted suicide or euthanasia. But ultimately, it is wholly analogous neither to terminal sedation given when death is imminent, nor to assisted suicide or euthanasia. This paper contends that early terminal sedation should be considered as a distinct entity. Such a reconception promises to provide a way forward in the debate, practice and policy regarding this contentious area of palliative medicine.

We read with great interest the paper by van Rijen et al. on the psychosocial functioning of adults with congenital heart disease,1but feel that the importance of their paper has been underplayed. It is estimated that 1% of all live births have congenital heart disease,2and that in the United States alone, there are 500000 adults with congenital heart disease.3Because medical intervention is continuously improving, the long-term outlook of these patients who have had either curative or palliative treatment is getting better, and many of these patients are followed up regularly. Nonetheless, their psychological problems and psychological functioning have …

Ofrecer Cuidados Paliativos de calidad a un paciente con un Trastorno Mental Severo es uno de los retos más difíciles para los profesionales del campo asistencial. En los últimos años, se ha detectado un incremento en el número de personas que padece una o múltiples afecciones orgánicas junto a una enfermedad mental grave. Asimismo, dentro de esta misma clasificación, se ha cuantificado otro subgrupo a destacar, el de los individuos que cuentan con un pronóstico vital irreversible. Con el fin que los profesionales puedan ofrecer unos Cuidados Paliativos adecuados a sus necesidades reales, es esencial, que éstos dispongan de nociones respecto a cuáles son las enfermedades mentales consideradas como severas, sobre los distintos síntomas psiquiátricos que podrían interferir en la atención normal al proceso de muerte y respecto a las estrategias de cuidado y comunicativas más aconsejables. Es por ello que el objetivo de este trabajo es realizar una revisión bibliográfica sobre los cuidados paliativos a personas con Trastorno Mental Severo. Providing quality palliative care to a patient with Severe Mental Disorder is one of the most difficult challenges for assistance professionals. An increase in the number of people suffering from one or multiple organic diseases with severe mental illness has been detected in the last few years. Also, within this classification, another subgroup has been highlighted, the individuals that have an irreversible prognosis. So that professionals can offer them palliative care appropriate to their actual needs, it is essential that they have notions about which are considered severe mental illnesses, on various psychiatric symptoms that may interfere with normal attention to the process of death and about the most desirable strategies of care and communication. That is why the aim of this paper is to review the literature on palliative care to people with severe mental disorder. Grau en Infermeria

Summary Backround The aim of palliative treatment of advanced malignant tumours involving the hilus of the liver is to decompress mechanical jaundice. In some cases, percutaneous drainage of biliary ducts is the only possible effective treatment. The aim of this paper is to evaluate the results of palliative percutaneous drainage of biliary ducts. Materials and methods Percutaneous drainage of biliary ducts was carried out under ultrasound and x-ray control with a picture channel. A PIGTAIL catheter (9F diameter, 45 cm length) was installed by entering its end-part into intrahepatic billiary ducts and bile diversion. In 5 patients bile was inserted in back to the gastrointestinal tract by simultaneous endoscopic microgastrostomy. In 1996–2003, 52 percutaneous drainages of biliary ducts were installed in 38 patients. All of them suffered from mechanical jaundice with the bilirubin level of 170–510 umol/l caused by neoplasm constricting biliary ducts. The neoplastic disease in all cases was histologically confirmed. The quality of life was evaluated one month after installing percutaneous drainage of biliary ducts. Regression of symptoms connected with mechanical jaundice, independence and self-service when using a catheter and the physical and mental state of patients were taken into consideration. Results In all patients a decrease in the bilirubin level below 170 umol/l was observed 14 days after the procedure. In 20 patients jaundice regressed completely 4 weeks after the drainage. In a later period increased bilirubin levels were connected with temporary impairment of catheter patency or with infection of biliary ducts. Despite the advanced neoplastic disease patients showed total independence and selfservice. However neoplastic cachexia and the necessity to take analgesics deteriorated their quality of life. Conclusions 1) Percutaneous drainage of biliary ducts decompresses mechanical jaundice and decreases ailments typical of cholestasis. 2) Percutaneous drainage of biliary ducts requires specialized long-term care and cooperation with the patient and or his or her family. 3) Deterioration in the quality of life in return for its prolongation is accepted by patients and their families.

Purpose Brachytherapy is a highly valued and effective palliative treatment for lung cancer, especially as it reduces intensity of dyspnoea and other symptoms arising from tumours inside the respiratory tract. In some cases, due to the location of the lesion brachytherapy is a treatment of choice. However, its curative role is unclear. A combination treatment of brachytherapy and an external beam irradiaton may play a significant role when the mediastinal lymph nodes are involved. The paper presents the results of treatment of advanced lung cancer patients by external beam irradiation and brachytherapy, and the role of this palliative treatment is discussed. Material and methods Between May 1999 and March 2000 at the Greatpoland Cancer Centre fifteen patients with advanced lung cancer were treated by HDR brachytherapy and palliative external beam irradiation using the method of hypofractionation. The patients’ age ranged between 39 to 80 years, mean: 54.3 years. The treatment consisted of external beam irradiation (total dose of 20–30 Gy), and a weekly high dose rate (HDR) brachytherapy (three fractions of 7.5 or 10 Gy, at 1 cm from the source). In three cases the treatment was started with external irradiation, whereas in 12 cases the first stage was brachytherapy. During the patients’ clinical and endobronchial follow-up of 1, 3 and 6 months, local remission and regression of difficulties in breathing, cough, pain and haemoptysis were assessed. Results In all our patients subjective improvement (regression of all symptoms) was found on the first check-up following treatment. In one case complete remission of the tumour lasted for over 6 months, in 9 cases partial remission and in two cases progression were found. Severe complications due to the high total local dose were not observed. Conclusions Combined palliative treatment (intraluminal brachytherapy and external beam irradiation) in advanced lung cancer was an efficient method that led to regression of symptoms and improvement of well-being in many patients.

A maioria dos pacientes com câncer de pâncreas apresenta estdios avançados e é tratada paliativamente. Dos que são submetidos exclusivamente a derivação biliar, cerca de 30%-50% vão apresentar na evolução necessidade de tratamento de obstrução duodenal. As técnicas atualmente empregadas para derivação gástrica podem acarretar vômitos pós-operatórios, principalmente quando feitas profilaticamente. Uma nova técnica foi planejada para evitar alterações no mecanismo de esvaziamento gátrico e a recirculação do conteúdo alimentar. Esta técnica consta de anastomose gastrojejunal entre o corpo gátrico e a primeira alça jejunal tipo Braun em que a alça aferente é bloqueada evitando o ciclo vicioso alimentar. A reconstituição do trânsito alimentar é feita a jusante desta anastomose, impedindo o refluxo biliar para o estômago. Dezenove pacientes foram tratados consecutivamente sem complicações. A sonda nasogástrica foi retirada em torno do terceiro dia de pós-operatório e iniciada realimentação no dia seguinte. Não se observaram vômitos no pós-operatório imediato ou tardio em decorrência de retardo do esvaziamento gátrico. Pancreatic cancer is most often diagnosed too late for curative resection. Therefore most of patients with pancreatic cancer are only submitted to palliative procedures. From those submitted to biliary bypass alone about 30 % need treatment for gastric obstruction at some point of the follow up. Surgical techniques for gastroenterostomy currently in use carry themselves delaying in the gastric emptying mechanisms and circulus vitiosus through the non obstructed duodenum. The objetive of this paper is to describe a new technique devised to avoid those problems and to improve the functional results of prophylatic gastroenterostomy. This was accomplished by a gastrojejunostomy in the upper body of the stomach and constructing the jejunal loop in a Braun fashion, whose afferent loop is blocked. The main features of this technique are the position of the gastroenterostomy with a low distubance of gastric motility and the construction of the jejunal loop in order to avoid the circulus vomiting. Nineteen patients were consecutively submitted to this procedure and no post operative complications were observed. Nasogastric tube was taken off in about three days and oral feeding resumed the next day. Vomits were not observed neither in the early post operative period nor in the long term follow up. This newly designed type of reconstruction is a effective gastric beypass and avoids the problem of food reentry.

Outreach multi-disciplinary palliative care teams have tended to duplicate hospital-based teams which historically have consisted almost exclusively of doctors and nurses. This paper outlines the role of physiotherapy in palliative care. It provides a conceptual framework for physiotherapy involvement and its potential to contribute within the palliative care team therapeutically and cost-effectively. To put physiotherapy management of the disease process into perspective, some basic data on terminal illness, and statistics of a Brisbane hospice, are included. The need for more outreach physiotherapy intervention is emphasised.

It is important that clinical studies of hyperthermia will be able to define its contribution to palliative therapy. A variety of validated methods has been developed for assessing palliative therapy but none have been used in clinical studies of hyperthermia. In the present paper some of the methods available for the assessment of palliative therapy are reviewed. The necessary criteria for assessment of instruments for palliation, as well as the choice of method, is discussed. A simple strategy is proposed: use established methods and take advice on which to choose; selectively add relevant items, should this be necessary; use assessments made by patients as well as by clinicians; use the test instruments at least three times (before, during and after treatment), and pre-test it on a small series of patients before embarking upon a major study. It is hoped that, by drawing attention to the availability of such methods for evaluating palliation, they might prove important in more accurately evaluating the role of hyperthermia in the palliative treatment of cancer.

Hilar cholangiocarcinoma has been a subject of major interest in the IHPBA ever since its founding, with many members who have emerged as leading experts in the management of this difficult tumour. This thematic issue of HPB addresses some of the current issues in the surgical treatment of hilar cholangiocarcinoma. The first contribution, from New York, deals with preoperative evaluation and assessment of resectability of hilar cholangiocarcinoma. The Bismuth–Corlette classification is based on proximal extent of the tumour into the biliary tree, but does not take into account vascular involvement. The authors therefore propose an alternative, clinical staging system based on biliary ductal involvement, vascular involvement and lobar atrophy. The paper from Paris points out the need for optimal preoperative preparation of patients with hilar cholangiocarcinoma considered for resection. Although preoperative biliary decompression is controversial, it probably is important in patients with hilar cholangiocarcinoma requiring extended liver resection in order to allow postoperative or preoperative regeneration of the liver, the latter in the setting of preoperative portal vein embolization to induce hypertrophy of the future liver remnant. Resectional strategies in the treatment of hilar cholangiocarcinoma are discussed in the contribution from Houston. Resection of the portal vein bifurcation in conjunction with hilar resection potentially increases the rate of margin-negative resections, but as the authors emphasize, is not routinely recommended in the absence of signs of portal vein invasion. The authors from Nagoya, who pioneered resection of hilar cholangiocarcinoma with extended liver resections three decades ago, show that in recent years, these major resections have been performed with a mortality rate of

Algirdas Jackevicius, Leonarda Sarakauskienė, Valerijus Ostapenko, Saulius Bružas, Juozas Kurtinaitis, Algimantas Mudėnas Vilniaus universiteto Onkologijos institutas, Santariskių g.1, LT-08660 Vilnius Kauno medicinos universiteto Onkologijos ligoninė, Volungių g. 16, LT-45434 Kaunas El pastas: algirdasj@is.lt Įvadas / tikslas Vyrų krūties vėžys yra reta onkologinė liga. Siame straipsnyje pateikiame 75 ligonių, gydytų dviejose onkologijos ligoninėse, klinikinius duomenis, tiesioginius ir vėlyvuosius gydymo rezultatus. Ligoniai ir metodai Straipsnyje nagrinėjami Vilniaus universiteto Onkologijos instituto klinikoje ir Kauno universiteto Onkologijos ligoninėje1988–2003 metais gydytų 75 vyrų, sirgusių krūties vėžiu, klinikiniai duomenys. Ligonių amžiaus vidurkis – 69,2 metų (jauniausias 41, vyriausias 90 metų). Astuoniems (10,7%) ligoniams diagnozuotas pirmos stadijos vėžys, 35 (46,7%) – antros, 22 (29,3%) – trecios, 10 (13,3%) ligonių – ketvirtos. Pagal histologinius vėžio tipus dažniausiai diagnozuota intraduktalinė karcinoma – 40 ligonių, 8 ligoniams – lobulinė karcinoma, taciau 14 ligonių vėžio histologinis tipas nenustatytas. Dažniausiai, t. y. 53 ligoniams, buvo atlikta modifikuota Maddeno mastektomija, astuoniems – paprastoji mastektomija, 8 ligoniams taikyta spindulinė terapija, 6 ligoniams dėl sunkių gretutinių ligų – simptominis gydymas. 37 ligoniai gydyti kombinuotu būdų: 30 – spinduline terapija, 5 – chemoterapija, 2 – abiem gydymo metodais. Rezultatai Vėlyvieji gydymo rezultatai nebuvo geri: is 75 gyvena 28 liginiai, 47 mirė. Penkerius metus isgyveno 83,3% (95% PI 27,3–97,5) serganciųjų pirmos stadijos krūties vėžiu, 69,6% (95% PI 49,1–83,1) – antros stadijos ir tik 6,2% (95% PI 4,2–24,2) – trecios. Nė vienas ligonis, kuriam diagnozuota ketvirta ligos stadija, neisgyveno penkerių metų. Isvados Lietuvoje vyrų sergamumas krūties vėžiu per pastaruosius metus nepakito. Nemažai vyrų buvo gydyti nuo IIIB stadijos krūties vėžio, kai navikas jau buvo lokaliai isplites ir susiformavo vėžinė opa. Vyrų, sergancių trecios stadijos krūties vėžiu, prognozė yra blogesnė negu moterų. Ligos stadija nulemia ligonių gyvenimo trukme, tai patvirtina statistinis vėlyvųjų gydymo rezultatų skaiciavimas. Reiksminiai žodžiai: vyrų krūties vėžys, diagnostika, gydymas, vėlyvieji rezultatai The diagnostics and treatment of male breast carcinoma Algirdas Jackevicius, Leonarda Sarakauskienė, Valerijus Ostapenko, Saulius Bružas, Juozas Kurtinaitis, Algimantas Mudėnas Vilnius University Institute of Oncology, Santariskių str. 1, LT-08660 Vilnius, Lithuania Kaunas Medical University Oncological Hospital, Volungių str. 16, LT-45434, Kaunas, Lithuania E-mail: algirdasj@is.lt Background / objective Male breast cancer is an uncommon oncological disease. In this paper, we have analysed the results of treatment of 75 patients treated in two oncologycal clinics. Patients and methods We analysed 75 male patients treated in 1988–2003 in the clinics of the Institute of Oncology of Vilnius University and Hospital of Oncology of Kaunas University of Medicine. The mean age of patients was 69.2 years (range, 46–90 years). The staging of disease: stage I 8 (10.7%) patients, stage II 35 (46.7%), stage III 22 (29.3%). Ten (13.3%) patients were treated in stage IV of the disease. The most common method of treatment was radical mastectomy by Madden which was performed in 53 cases. In 8 cases mastectomy simplex was performed. Eight patients received radiotherapy. The patients received this conservative treatment in late stages of the disease. In seven cases the patients were in poor health state, and only palliative treatment was applied. 37 patients received combined treatment: 30 patients were treated with radiotherapy, two patients received radiotherapy and chemotherapy, in 5 cases after mastectomy the patients were treated with chemotherapy. Results The follow-up results were not satisfactory: from 75 patients 28 patients are alive and 47 died. The 5-year survival of the patients according to the stage of disease: 83.3% (95% CI 27.3–97.5) of patients in stage I, 69.6% (95% CI 49.1–83.1) in stage II, stage III 6.2% (95% CI 4.2–24.2). In this period, all patients in stage IV of the disease died. Conclusions The incidence of male breast cancer in Lithuania is low, and over the last years has remained at the same level. Many of our patients had ulceration of tumor and were treated in stage III B of the disease. The prognosis of male breast cancer in stage III of the disease is worse than of female breast cancer of the same stage. The stage of the disease was statistically significant for the survival of patients. Keywords: male breast carcinoma, diagnosis, treatment, follow-up results

To assess the real utility of orthotopic liver transplantation (OLT) in patients with cholangiocarcinoma, we need series with large numbers of cases and long follow-ups. The aim of this paper is to review the Spanish experience in OLT for hilar and peripheral cholangiocarcinoma and to try to identify the prognostic factors that could influence survival.Palliative treatment of nondisseminated irresectable cholangiocarcinoma carries a zero 5-year survival rate. The role of OLT in these patients is controversial, due to the fact that the survival rate is lower than with other indications for transplantation and due to the lack of organs.We retrospectively reviewed 59 patients undergoing OLT in Spain for cholangiocarcinoma (36 hilar and 23 peripheral) over a period of 13 years. We present the results and prognostic factors that influence survival.The actuarial survival rate for hilar cholangiocarcinoma at 1, 3, and 5 years was 82%, 53%, and 30%, and for peripheral cholangiocarcinoma 77%, 65%, and 42%. The main cause of death, with both types of cholangiocarcinoma, was tumor recurrence (present in 53% and 35% of patients, respectively). Poor prognosis factors were vascular invasion (P0.01) and IUAC classification stages III-IVA (P0.01) for hilar cholangiocarcinoma and perineural invasion (P0.05) and stages III-IVA (P0.05) for peripheral cholangiocarcinoma.OLT for nondisseminated irresectable cholangiocarcinoma has higher survival rates at 3 and 5 years than palliative treatments, especially with tumors in their initial stages, which means that more information is needed to help better select cholangiocarcinoma patients for transplantation.

Colorectal peritoneal carcinomatosis was considered a terminal condition with a merely palliative treatment that included only supportive care, palliative surgery and the best systemic chemotherapy. Since the birth of a new approach, cytoreductive surgery with peritonectomy procedures together with hyperthermic intraperitoneal chemotherapy and/or early postoperative intraperitoneal chemotherapy to treat peritoneal carcinomatosis, many research groups contributed with promising results using this procedure being up to date this strategy the only one that has shown curative benefits on colorectal peritoneal carcinomatosis achieving reported overall survival rates up to 64 mo and five-year survival rates up to 51%. The aim of this paper is to expose an updated overview of the therapeutic possibilities of these procedures in colorectal peritoneal metastases in the same way that our Unit of Oncologic Surgery has performed since 1997 with more than four hundred procedures.

This paper examines unusual eighteenth and nineteenth century dental treatment and its consequences, in a nobleman excavated from beneath St. Nicholas' Church, Sevenoaks, Kent, UK in the early 1990s. This rare archaeological case exhibits erosion of dental enamel on the labial surface of all the anterior dentition. A programme of historical research suggests that this might be attributed to the application of an acid-based dental tincture or the use of an abrasive substance to whiten the teeth. Palliative treatment for the consequence of this application was prescribed by Dr Robert Blake of Dublin. Further, it bears witness to three dental restorations, two of gold and one tin. The two gold (foil) fillings are an occlusal in the upper-right second molar and a cervical on the labial surface of the upper left canine. The tin filling is an occlusal in the upper left second molar. Excavation of the carious tissue appears to have been undertaken using a spoon shaped implement.

At present, time during which people suffer from illnesses has been increasing and doctors more frequently encounter patients with lethal diseases and have to provide more prolonged treatment care for these patients. These facts have led to new concepts like care for terminally ill patients, palliative care and mourning. Palliative care is the care which relaxes patients and improves the quality of life in the terminal stage of their disease when cure is impossible. Hospice care systems have to be established for palliative care. In Turkey where these systems are not available, terminally ill patients occupy beds in hospitals or they die at home without provision of sufficient support for both patients and their relatives. Keeping pain, nausea, vomiting, cachexia, prostration and dyspnea under control is the prominent element of palliative treatment of terminally ill patients. When a physician thinks there is no point in offering treatment alternatives for a disease except for palliative care, withdrawal or discontinuation of these treatments is considered ethical in some countries. However, euthanasia is not considered legal and there is an ongoing debate over ethical aspects of euthanasia in Turkey and some other countries. Time after death is a mourning period during which relatives of people who die have to be given support for about one year. In this paper, some of the definitions, concepts and approaches aimed to raise awareness about end of life care will be reviewed.

• A partir del analisis etnografico del proceso de implementacion de un proyecto que proponia la conformacion de un coro de ensambles vocales de personas en situacion de calle, indago en este articulo la ruptura que este proyecto propuso respecto del clasico esquema de asistencia paliativa que caracteriza al circuito asistencial en el que se ubican las politicas sociales dirigidas a la atencion de la situacion de calle en la Ciudad de Buenos Aires. Este proyecto, lejos de apuntar a la ayuda material en la supervivencia, otorgo una opcion cultural que a partir del placer (no de la necesidad) motivo la participacion. Sin embargo, diferentes aspectos oscurecieron este logro imprevisto: desde la mirada de los agentes gubernamentales que lo implementaron, el Resumen proyecto no logro su objetivo de ser un nexo entre la calle marginal y el mercado laboral formal. Los tecnicos asociaban a las personas en situacion de calle con una identidad y una localizacion especifica, como si estuvieran desvinculadas de la sociedad. Sin embargo los modos en que las personas vivieron, sintieron y percibieron esta politica, nos permiten cuestionar la existencia de aquella desvinculacion. Las diversas expectativas en torno al proyecto desnaturalizan miradas y representaciones asociadas a las personas en situacion de calle, quienes en esta experiencia se apropiaron de un proyecto del que participaron activamente y defendieron en forma colectiva. • In this paper, taking as my starting point the ethnographic analysis of the process of implementing a project proposing the formation of a choir of vocal ensembles for the homeless, I investigate the break this project brought about with the classic set-up of palliative treatment commonly used by the caring network, embracing the social policies addressing care issues for the homeless in the City of Buenos Aires. Far from addressing material aid with regard to survival, instead this project offered a cultural option, which encouraged people to take part out of pleasure (rather than out of need). Nevertheless, various aspects contrived to obscure this unexpected outcome: In the eyes of the government agents who brought it into being, the project did not achieve its aim of serving as a bridge between the city’s down and outs and the formal labour market. The technicians associated the homeless with a specific location and identity, as if they were cut off from society. However, the ways in which these people lived, felt and perceived this policy enables us to question whether these ties were in fact really severed. The various expectations revolving around the project distort the views and representations associated with the homeless, who, in this experiment, embraced a project in which they played an active part and which they defended as a group.

O presente artigo foi produzido na tentativa de subsidiar os estudantes perante a situação da morte. Trata-se de conceitos e conflitos relacionados com a morte e fase terminal, atitudes que exigem envolvimento profissional nesta situação e outras informações complementares. The present paper was produced in order to help students, to deal with the death situation. It focus on conceps and conflicts related to terminal stage, death and post-death period, which demands attitudes of involvement of the professional in this situation, and other complementary informations about the whole issue.