CPR: is it cruel or is it kind?

When people have a cardiac arrest, whether in hospital or the community, there is a presumption is that cardiopulmonary resuscitation should be attempted in all but exceptional circumstances. This is based on ethical, legal, political and cultural principles. However, few patients leave hospital with their faculties intact following CPR, which often simply postpones death for a short time. The authors argue that this represents a poor use of public resources and condemns many patients to severe debilitation. They suggest that the focus should move towards preventing cardiac arrest, so that scarce resources can be redirected to interventions with proven benefits.     

Rash: is it shingles?

CASE PRESENTATION: Mrs. Smith, a 56-year-old Caucasian woman, was seen in the office for complaints of a rash at her waist. She completed three cycles of dose-dense cyclophosphamide and doxorubicin chemotherapy for stage III breast cancer. The third cycle was 10 days prior. Grade III neutropenia was the only complete blood count abnormality.     

IMRT: is it Nirvana?

Abstract

Intensity modulated radiotherapy (IMRT) is a complex form of external beam radiation therapy, which is not called on commonly for palliative therapy. However, its use in day-to-day therapy is becoming more wide-spread with the increasing incorporation of new imaging and planning technologies into radiotherapy departments, together with the increasing availability of multileaf collimators and electronic portal imaging devices. In the clinical setting, IMRT is being used in a number of tumour settings where dose escalation is desirable or where there are dose-limiting organs in close proximity to the tumour. The clinical evidence and basis for treatment is discussed.     

The sick building syndrome: what is it when it is?

Sick building syndrome is a commonly applied diagnosis; often abused and misinterpreted to denote headaches, dizziness, fatigue and eye irritation associated with a building The authors have stated that they do not have a significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article.     

Abnormal blood lipids: is it environment or is it genes?

Genetic and environmental factors contribute to the development and progression of atherosclerotic coronary heart disease processes. Major independent risk factors for coronary heart disease, including adverse levels of plasma lipids and lipoproteins, are also influenced by genetic and potentially modifiable environmental factors. Recent advances in molecular biology have resulted in the identification of specific genes associated with lipid disorders. The complex gene-environment interplay that contributes to interindividual variation in components of the lipid profile is also partially clarified. This article provides an overview of available data on the genetic and environmental influences on lipids and lipoproteins with emphasis on implications for clinical practice and future research.     

Palliative care: what is it?

Palliative care developed during the hospice movement. Hospice was associated as a rest place for weary travelers in ancient times, many of whom were ill. Hospice first became associated with the dying in France in 1842; the first modern hospice, St. Christopher's Hospice, was established in London by Dame Cicely Saunders in 1967. It was the first facility founded as a "place" to care for the dying. In 1974, the first U.S. hospice was established in Connecticut based on a home care model. In 1975, Balfour Mount, MD, founded the Palliative Care Service in The Royal Victoria Hospital in Montreal; the concept of "palliative care" in North America was established (Sheehan & Forman, 1996). The traditional view of palliative care indicates that symptomatic and supportive care are generally withheld until all attempts to treat the underlying disease and other medical problems are exhausted. Many times, palliative care is offered with little time left for living. Palliative care should be considered in conjunction with active treatment, and, as death nears, palliative care becomes more important as active treatment while cure become less important.