Erythropoietin: Can we afford to use it? Can we afford not to?

Anaemia is a common side-effect of malignancy and cancer therapy. Both red cells and erythropoietin will improve anaemia; however, the scarcity and risks of allogeneic blood transfusion need to be carefully considered against the expense and benefits of recombinant human erythropoietin. Both treatment options have significant economic implications and the definitive evaluation from NICE must be awaited with much interest.     

Can the patient perspective contribute to quality of nutritional care?

Scand J Caring Sci; 2011; 25; 176–184
Can the patient perspective contribute to quality of nutritional care? Aim: Undernutrition has been seen in hospitalized patients at all times. Nurses have a central position in the nutritional care of the patient. Despite guidelines for nutritional practise and care, 20–55% of patients are still at risk of complications to insufficient nutrition intake. The aim of this study was to obtain knowledge of hospitalized patient’s experiences of being undernourished, to understand implications this might have to quality of nutritional nursing care. Methods: Qualitative interviews were undertaken in 12 hospitalized patients at severe nutritional risk. Findings: Pain, no appetite, bad taste and side effects to medication were among reasons for poor eating. Nurses practically did not address or question symptoms that could influence poor eating and were only to a low degree involved at patient initiative. The patients appeared to divide into two groups; One ‘Passive group’, characterized with fatigue, lack of concentration and short term memory, were found insusceptible to increase nutrition intake by motivation and guidance. The overall motivation in the other ‘Active’ group was the setting of and achievement of goals, which had to be clear, communicated and followed up by nurses and physicians. This group furthermore found self‐determination and active involvement determinant for a positive and fruitful cooperation between staff and themselves. Conclusions: Nurses were in progressive about clarifying why patients did not eat. Patients highly regarded nutrition registration when followed up, however, this was only practised to a low degree. Severely undernourished patients could be divided in two groups. The ‘Passive group’ should be attended to systematically. Artificial nutrition is often needed in this group. The ‘Active group’ should be cared for with individual, active involvement from nurses. Nurses should be able to distinct which nutritional care for which patient, and act upon it.     

Can suicide be ethical? A utilitarian perspective on the appropriateness of choosing to die

In his article in the current issue of Death Studies, "Can Suicide be a Good Death?" David Lester argues that each person should determine whether suicide is appropriate for him or her in relative isolation from the opinions of others. In the present article, I use a utilitarian ethical perspective to critique this assertion. According to utilitarianism, the "goodness" of an action is judged by its impact not only on the individual, but also upon others. As such, I review research demonstrating that suicide has harmful emotional, interpersonal, and economic effects upon individuals and society. Ultimately, the rightness or wrongness of choosing to commit suicide cannot be determined in isolation from the broader consequences of this choice.     

Can the health utilities index measure change?

BACKGROUND: The Health Utilities Index (HUI) is a multidimensional, preference-weighted measure of health status. It comprises eight health attributes, aggregated into a single utility score. OBJECTIVES: The purpose of the study was to investigate the ability of the HUI to detect changes in health status in a general population cohort. RESEARCH DESIGN: Health status changes were analyzed in the full cohort and in persons who were diagnosed with chronic conditions, hospitalized, or became restricted in daily activities. SUBJECTS: To assess responsiveness, longitudinal data was used from the National Population Health Survey conducted in Canada in 1994 - 1995 and 1996 - 1997. We used cross-sectional data from the 1996 sample to classify chronic conditions into mild, moderate, and severe. MEASURES: Two measures of responsiveness were calculated: Standardized Response Mean (SRM) and Sensitivity Coefficient (SC). The HUI was compared with a global health index-the Self-Rated Health (SRH) scale. RESULTS: HUI scores improved between the two NPHS cycles in all age-sex groups, except men 65 years of age and older. Among the respondents who remained free of chronic conditions, improvements were seen primarily in the cognitive and emotional domains. The HUI deteriorated among persons who were diagnosed between the two cycles with a severe chronic condition, were hospitalized, or became restricted in activity, but not in those diagnosed with a moderate condition. The SRMs were generally smaller for the HUI compared with the SRH. CONCLUSIONS: The HUI responds to changes in health status associated with serious chronic illnesses. However, changes in the HUI do not always coincide with changes in self-reported health. Properties of the HUI scales require further study.