Building up research in palliative care: an historical perspective and a case for the future

Palliative care is a young discipline for research, though expert group opinions have been helpful. The lack of extended research programs addressing basic biological mechanisms of patients with advanced disease and short life expectancy nationally and internationally has created an increasingly strong call for research in palliative care. Obstacles and challenges include ethical concerns among the ill, establishment of a research agenda, the number of experienced researchers at the university level, lack of national and international leadership, and funding for palliative care research. Committed individuals have conducted important research, and if their efforts are combined with professional leadership, funding might be secured to establish the programs necessary to address palliative care research nationally and internationally.     

A 'give it a go' breast-feeding culture and early cessation among low-income mothers

OBJECTIVE: to examine cultural expectations and experiences of breast feeding amongst first time mothers from low-income areas, in order to improve understanding of why many cease breast feeding in the early days of their babies' lives. DESIGN: qualitative interviews were carried out with 16 women, who expressed an intention to breast feed, at 37 weeks in their pregnancy and again at 3-9 weeks postnatally. SETTING: women were interviewed in their own homes in low-income areas of North Tyneside, north-east England. FINDINGS: decisions about breast-feeding cessation were usually made within the first few days as women negotiated the pathways of informal cultures of feeding babies and the availability and quality of formal care. A 'give it a go' breast-feeding culture is identified, where women who intended to breast feed had a strong expectation of difficulties and even failure. Expertise and confidence with bottle feeding were more widespread among family and friends. The many influences on the mothers' decision-making were interconnected and contingent upon each other: if one aspect of breast feeding 'goes wrong', other reasons were often brought into play and the underlying pessimism that was felt antenatally was borne out. CONCLUSIONS: positive experiences of formal support could make a crucial difference in the early days of breast feeding. However non-breast-feeding cultures permeated and found expression in negative discourses. Support needs to take account of the cultural contexts in which mothers make decisions and the fact that breast feeding is affected by a multitude of factors simultaneously. Access to advice at the right time is a key issue for some low-income women.     

Family experience with palliative sedation therapy for terminally ill cancer patients

Symptomatic sedation is often required in terminally ill cancer patients, and could cause significant distress to their family. The aims of this study were to clarify the family experience during palliative sedation therapy, including their satisfaction and distress levels, and the determinants of family dissatisfaction and high-level distress. A multicenter questionnaire survey assessed 280 bereaved families of cancer patients who received sedation in 7 palliative care units in Japan. A total of 185 responses were analyzed (response rate, 73%). The families reported that 69% of the patients were considerably or very distressed before sedation. Fifty-five percent of the patients expressed an explicit wish for sedation, and 89% of families were clearly informed. Overall, 78% of the families were satisfied with the treatment, whereas 25% expressed a high level of emotional distress. The independent determinants of low levels of family satisfaction were: poor symptom palliation after sedation, insufficient information-giving, concerns that sedation might shorten the patient's life, and feelings that there might be other ways to achieve symptom relief. The independent determinants of high levels of family distress were: poor symptom palliation after sedation, feeling the burden of responsibility for the decision, feeling unprepared for changes in the patient's condition, feeling that the physicians and nurses were not sufficiently compassionate, and shorter interval to patient death. Palliative sedation therapy was principally performed to relieve severe suffering based on family and patient consent. Although the majority of families were comfortable with this practice, clinicians should minimize family distress by regular monitoring of patient distress and timely modification of sedation protocols, providing sufficient information, sharing the responsibility of the decision, facilitating grief, and providing emotional support.     

Normal values and within-subject variability of cardiac I-123 MIBG scintigraphy in healthy individuals: Implications for clinical studies

BACKGROUND: Although several myocardial iodine 123 metaiodobenzylguanidine (MIBG) indices are increasingly used to detect alterations in myocardial sympathetic activity in various forms of cardiac pathology, published measurements of normal values and within-subject variability are lacking. METHODS AND RESULTS: Twenty-five healthy volunteers underwent planar and single photon emission computed tomography (SPECT) imaging. Heart-mediastinum ratio (H/M) and myocardial washout were calculated from planar images comparing three different methods for the assessment of myocardial activity: (1) global region over the myocardium (cavity included), (2) global region over the myocardium (cavity excluded), and (3) fixed small myocardial region. Segmental (relative) uptake and washout were assessed by SPECT. For all MIBG indices, the interindividual variation was the lowest for methods 1 and 2. In SPECT this variation was low for relative segmental uptake compared with washout. In 9 subjects a second MIBG scintigraphy was performed after 3 months. The within-subject variability of H/M and washout assessed by planar methods 1 and 2 was 5%, whereas it was approximately 9% for planar method 3. For relative segmental uptake from SPECT, this variability was 5%. CONCLUSION: MIBG H/M (planar) and relative segmental uptake (SPECT) show a low interindividual and within-subject variability. This enables the detection of small (regional) variations in myocardial sympathetic nervous function, especially to monitor the effect of therapeutic interventions in patients with various cardiac diseases.     

Distinct roles for two N-terminal cleaved domains in mitochondrial import of the yeast frataxin homolog, Yfh1p

The yeast frataxin homolog (Yfh1p) participates in mitochondrial iron homeostasis. The phenotypic defects of the Delta yfh1 mutant include drastic accumulation of iron in mitochondria and slow growth. The Yfh1p precursor protein contains two N-terminal domains that are sequentially cleaved by the matrix processing peptidase on import into mitochondria, generating the mature protein. We have precisely mapped these two cleavage sites. Mutations blocking the first or the second cleavage of Yfh1p do not interfere with its in vitro import or with its ability to complement phenotypes of the Delta yfh1 mutant strain. Distinct roles have been ascertained for the two cleaved domains of Yfh1p. The first cleaved domain (domain I) is sufficient for in vitro mitochondrial import of a non-mitochondrial passenger protein. However, neither domain I nor other matrix-targeting signals alone can support efficient in vitro import of mature Yfh1p. The second cleaved domain (domain II) is required as a spacer between a targeting signal and mature Yfh1p. Likewise, when Yfh1p constructs lacking domain I or II are expressed in vivo, they fail to attain appreciable steady-state amounts in mitochondria and cannot complement phenotypes of the Delta yfh1 mutant.     

Geographies of infant feeding and access to primary health-care

Although the benefits of breastfeeding to mother and infant are now well established, within Britain initiation rates are low and have changed little since 1980. This is despite many health promotion initiatives aiming to increase breastfeeding. In this paper we discuss some of the findings of an exploratory qualitative research study of infant feeding decisions in Newcastle upon Tyne, England, where health professionals are actively seeking to increase local breastfeeding initiation and duration rates. Our findings suggest that for health promotion initiatives to be effective across all social groups, there needs to be (i) a socio-cultural understanding of different social groups' access to and interpretation of pre- and postnatal formal breastfeeding support health services, and (ii) more appreciation of how mothers' informal support networks impact on their access to, interpretation and use of formal breastfeeding support.     

急性淋巴细胞白血病最新治疗策略(上)

利用目前的治疗手段,80%的急性淋巴细胞白血病(acute lymphoblastic leukem ia,ALL)患儿均能得到治愈,尚有部分患者需接受强化治疗,但治疗的副作用也带来了急性或远期的严重并发症。此外,成人ALL病人的生存率依然低于40%。因此,本病需要既可以提高治愈率又能改善生活质量的新治疗方案。本文讨论了新出现的可能会改善ALL病人预后的治疗方法,包括现有常规化疗药物的新剂型、新的抗代谢药和核苷衍生物、白血病相关抗原的单克隆抗体,针对白血病细胞的基因异常及相关信号通路的分子治疗。1常规化疗药物的新剂型化疗药物的脂质体剂型是将药物…