What have I done to deserve this? Europe: so near and yet so far away

In the field of education, specifically higher education, the topic which is our central theme today, everything still must be determined; even if the bases are already established for a process which will lead us to the creation of a European Role for Higher Education, the most significant features inside each cultural reality inside each context and inside every country should not be lost but, on the contrary, these features should be added so as to enhance a diverse and culturally enriched reality This is a task bearing great responsibility which each country should embrace from every discipline.     

Angiotensin converting enzyme inhibitor intoxication: Naloxone to the rescue? Naloxone for ACE inhibitor intoxication

We report here the case of a patient with perindopril intoxication inducing severe bradycardia together with a profound hypotension. Initiation of a naloxone infusion completely resolved those symptoms. As a consequence, we could recommend as a first step the use of naloxone in order to prevent the use of more invasive therapeutic tools.     

Commentary: Public health approaches to palliative care – The progress so far

This article provides an academic and professional context for the articles written for this special issue. It discusses 4 broad questions often asked about the public health approach to palliative care: what is the evidence for the effectiveness of the approach?; will this approach embedded inside palliative care services deliver the kinds of social changes needed to address the social epidemiology of living with life-limiting illness, long term caregiving and grief and bereavement?; Is recent interest in this approach simply all about cost-savings for governments?; and will an emphasis on health promotion and community development subtract from efforts to increase or maintain clinical supports at the end of life?     

Chemotherapy in patients with advanced pancreatic cancer: too close to death?

Purpose

We evaluated the attitude in using chemotherapy near the end of life in advanced pancreatic adenocarcinoma (PAC). Clinical and laboratory parameters recorded at last chemotherapy administration were analyzed, in order to identify risk factors for imminent death.

Methods

Retrospective analysis of patients who underwent at least one line of palliative chemotherapy was made. Data concerning chemotherapy (regimens, lines, and date of last administration) were collected. Clinical and laboratory factors recorded at last chemotherapy administration were: performance status, presence of ascites, hemoglobin, white blood cell (WBC), platelets, total bilirubin, albumin, LDH, C-reactive protein (C-rp), and Ca 19.9.

Results

We analyzed 231 patients: males/females, 53/47?%; metastatic/locally advanced disease, 80/20?%; and median age, 66?years (range 32?C85). All patients died due to disease progression. Median overall survival was 6.1?months (95?% CI 5.1?C7.2). At the last chemotherapy delivery, performance status was 0?C1 in 37?% and 2 in 63?%. Fifty-nine percent of patients received one chemotherapy line, while 32, 8, and 1?% had second-, third-, and fourth line, respectively. The interval between last chemotherapy administration and death was <4?weeks in 24?%, ??4?C12 in 47?%, and >12 in 29?%. Median survival from last chemotherapy to death was 7.5?weeks (95?% CI 6.7?C8.4). In a univariate analysis, ascites, elevated WBC, bilirubin, LDH, C-rp and Ca 19.9, and reduced albumin were found to predict shorter survival; however, none of them remained significant in a multivariate analysis.

Conclusions

A significant proportion of patients with advanced PAC received chemotherapy within the last month of life. The clinical and laboratory parameters recorded at last chemotherapy delivery did not predict shorter survival.