Treatment Decisions in Advanced Disease: A Conceptual Framework

This English translation, made by a professional translator in close cooperation with the author and kindly proofread by Dr. Phil Larkin, follows the original text as closely as possible. However, though we thought it was wise to maintain the official (but not unproblematic) Dutch/Belgian definition of euthanasia in the original text (written for Belgian readers), the English texts offers a new and clearer definition of euthanasia. From the very beginning of the Belgian euthanasia debate in 1999, the Flemish Palliative Care Federation has chosen not to stay on the sideline, but to take an active part in the discussion and formulate recommendations based on our expertise and experience. Time and again we have pointed out that the ethical issues at the end of life are not just restricted to those of euthanasia. We have found that there is still much confusion about, for example, the difference or the boundary between pain control and euthanasia or between euthanasia and withholding life-sustaining treatment. Therefore, we thought it appropriate to put the following conceptual framework with regard to treatment decisions in advanced illness forward.     

Do people who apply sunscreens,re-apply them?

Little is known about Australians' practices regarding sunscreen re-application, yet it is routinely advised and has recently been shown to increase the protective efficacy of sunscreens. A baseline survey of sunscreen application and re-application behaviour was therefore conducted in a Queensland community using a standard self-administered questionnaire. Other sun protection methods were also assessed. Of a total of 669 adult respondents, 76% reported using sunscreen and of those, 61% reported re-applying sunscreen. Significantly more women (66%) than men (55%) reported re-applying sunscreen and re-application was inversely related to age (79% of those aged less than 45, 57% of those 45-59 years old and 46% of those over 60 years). Increased rates of re-application were reported during times of increased sun exposure, as well as by those with greater knowledge of the benefits of sunscreen re-application. A recent personal history of non-melanoma skin cancer did not lead to improved rates of sunscreen application, sunscreen re-application, or most forms of physical sun protection.     

Spirituality and well‐being in cancer patients: a review

Objective: Cancer places many demands on the patient and threatens the person's sense of meaning to life. It has been shown that cancer patients use their spirituality to cope with these experiences. The present literature review summarizes the research findings on the relationship between spirituality and emotional well‐being. Special attention is given to the strength of the research findings. Methods: A literature search was performed in Pubmed and Web of Science. Spirituality does not necessarily coincide with religiosity. Therefore, studies were excluded that focused on religiosity. Forty publications met the inclusion criteria: Twenty‐seven studies that investigated the relationship between spirituality and well‐being, and 13 publications that explored the relationship between meaning in life and well‐being. Results: The majority of the cross‐sectional studies (31 of 36) found a positive association between spirituality and well‐being. The four studies with a longitudinal design showed mixed results. The significance of the findings is challenged, because most spirituality questionnaires contain several items that directly refer to emotional well‐being. Conclusions: Despite that the majority of the studies concluded that spirituality was associated with higher well‐being, no definitive conclusions on this relationship can be drawn due to major methodological shortcomings of these studies. Longitudinal research utilizing spirituality and well‐being measures that do not overlap in content is recommended. Copyright © 2009 John Wiley & Sons, Ltd.     

Lower levels of the host protective IL-10 in DCM—a feature of autoimmune pathogenesis?

Objectives: To investigate whether cytokine patterns differ with respect to heart failure (HF) etiology, and to study how cytokine concentrations relate to hemodynamic alterations.

Methods: Plasma levels of interleukin-6 (IL-6), interleukin-10 (IL-10), tumor necrosis factor alpha (TNF-α) and high sensitive-CRP (hs-CRP) were analysed with enzyme-linked-immunosorbent serologic assay and turbidimetry in 45 healthy subjects and 89 patients with HF, of whom 65 were diagnosed with dilated cardiomyopathy (DCM) and 24 had ischemic heart disease (IHD).

Results: IL-6, IL-10 and hs-CRP were significantly higher in patients with HF as compared to healthy controls. The IL-10 was significantly lower in patients with DCM as compared to IHD, also when adjusting for clinical variables. Diastolic filling pressure correlated with IL-6, IL-10 and hs-CRP while heart rate (HR) correlated with IL-6 and TNF-α.

Conclusions: Proinflammatory cytokines are elevated in patients with HF and display a positive correlation with filling pressures and HR. Most significant, the regulatory and protective cytokine IL-10 was much lower in patients with DCM as compared to IHD, indicating a differentiation in cytokine patterns with respect to HF etiology.     

Laparoscopic Evaluation Shows Deficiencies in Memory Ring Deployment During Small Ventral Hernia Repair

Background  

With the introduction of a self-expanding, memory-containing, circular hernia patch, surgeons have been enthusiastic about its use to repair ventral hernias smaller than 3 cm in diameter. The aim of this study was to evaluate the efficiency, reliability, and safety of the device laparoscopically with respect to adequate deployment of the patch.     

Exaggerated aggression and decreased anxiety in mice deficient in brain serotonin

Serotonin is a major neurotransmitter in the central nervous system (CNS). Dysregulation of serotonin transmission in the CNS is reported to be related to different psychiatric disorders in humans including depression, impulsive aggression and anxiety disorders. The most frequently prescribed antidepressants and anxiolytics target the serotonergic system. However, these drugs are not effective in 20–30% of cases. The causes of this failure as well as the molecular mechanisms involved in the origin of psychological disorders are poorly understood. Biosynthesis of serotonin in the CNS is initiated by tryptophan hydroxylase 2 (TPH2). In this study, we used Tph2-deficient (Tph2^−/−) mice to evaluate the impact of serotonin depletion in the brain on mouse behavior. Tph2^−/− mice exhibited increased depression-like behavior in the forced swim test but not in the tail suspension test. In addition, they showed decreased anxiety-like behavior in three different paradigms: elevated plus maze, marble burying and novelty-suppressed feeding tests. These phenotypes were accompanied by strong aggressiveness observed in the resident–intruder paradigm. Despite carrying only one copy of the gene, heterozygous Tph2^+/− mice showed only 10% reduction in brain serotonin, which was not sufficient to modulate behavior in the tested paradigms. Our findings provide unequivocal evidence on the pivotal role of central serotonin in anxiety and aggression.