Gaps in end-of-life care

End-of-life care is an important aspect of medical practice. Individual physicians and the medical community must be committed to the compassionate and competent provision of care to dying patients and their families. Patients rightfully expect their physicians to care for them and provide them with medical assistance as they are dying. To care properly for patients near the end of life, the physician must understand that palliative care entails addressing physical, psychosocial, and spiritual needs and that patients may at times require palliative treatment in an acute care context. To provide palliative care, the physician must be up to date on the proper use of opioids and the legality and propriety of using high doses of opioids as necessary to relieve suffering. Good symptom control; ongoing involvement with the patient; and physical, psychological, and spiritual support are the hallmarks of quality end-of-life care. Care of patients near the end of life, however, has a moral, psychological, and interpersonal intensity that distinguishes it from most other clinical encounters. With appropriate education, physicians can play a key role to improve care for patients and families who are living with advanced life-threatening illness. Although some issues [e.g., the role of physician- assisted death in addressing suffering] remain very controversial, there is much common ground based on the application of the four major principles of medical ethics, nonmaleficence, beneficence, autonomy, and justice

Recommandations concernant les relations entre chirurgiens et anesthesistes-reanimateurs

Surgeon and anesthesiologist work as a team. Physicians of different but complementary specialties, they work jointly in the management of the patient during the pre, per and postoperative periods, with the main objective of ensuring the best quality of care and the greatest safety. However, the unprecedented development of new technologies during the last decades, deeply modified the conditions of exercise of these two specialities. Thus, the practice of anaesthesia is not only necessary for performing the surgical act, but also for diagnostic and therapeutic techniques using high t e c hnologies. So, from a traditional partner of the surgeon, the anesthetist became the privileged collaborator of a great number of specialists. Within these teams, the anesthetist must achieve his/her task in all independence, as stated in the Lebanese Code of Ethics. I will try in this message to point out the responsibilities of each of the two partners in this joint practice. The practice of a shared activity, in the same place, for the benefit of the patient, requires a preliminary definition of roles, in the mutual respect of competencies and responsibilities of each specialist, based on the respect of the rules edicted in the Code of Ethics

[Violence against children]

The Convention of Human Rights defines violence as [all forms of physical or mental vio-lence, injury and abuse, neglect or negligent treatment, maltreatment or exploitation, including sexual abuse]. Violence against children cuts across boundaries of geography, race, class, religion and culture. It occurs in homes, schools and streets ; in places of work and entertainment, and in care and detention centers. Perpetrators include parents, family members, teachers, caretakers, law enforcement authorities and other children. Some children are particularly vulnerable because of gender, race, ethnic origin, disability or social status. And no country is immune, whether rich or poor. Although the consequences of violence for children may vary according to its nature and severity, the short- and long-term repercussions are very often grave and damaging. Violence may result in greater susceptibility to lifelong social, emotional, and cognitive impairments and to health-risk behaviors, such as substance abuse and early initiation of sexual behavior. Governments are ultimately responsible for the protection of children. It is therefore up to governments to act now, to fulfill their human rights obligations and other commitments, to ensure the protection of children from all forms of violence. Violence against children is never justifiable. Nor is it inevitable. After providing a global picture of violence against children, we propose recommendations to prevent and respond to this issue

World report on violence and health

Violence is not an intractable social problem or an inevitable part of the human condition. We can do much to address and prevent it. The world has not yet fully measured the size of the task and does not yet have all the tools to carry it out. But the global knowledge base is growing and much useful experience has already been gained The World Report on Violence and Health attempts to contribute to that knowledge base. It is hoped that the report will inspire and facilitate increased cooperation, innovation and commitment to preventing violence around the world. These are the recommendations of the World Report on Violence and Health Create, implement and monitor a national action plan for violence prevention Enhance capacity for collecting data on violence. Define priorities for, and support research on the causes, consequences, costs and prevention of violence. Promote primary prevention responses. Strengthen responses for victims of violence. Integrate violence prevention into social and educational policies, and thereby promote gender and social equality. Increase collaboration and exchange of information on violence prevention. Promote and monitor adherence to international treaties, laws and other mechanisms to protect human rights. Seek practical, internationally-agreed responses to the global drugs trade and the global arms trade

Diagnostic et traitement des kystes hydatiques du foie a propos de 87 cas ooe're's entre 1980 et 1992

Human echinococcosis is still endemic in some areas of the world, including Mediterranean countries and Lebanon because there is no effective medical therapy, surgery remains the principal mode of treatment. A consecutive series of 87 patients operated on for liver hydatid disease between January 1980 and march 1992 in the division of general surgery at saint george's hospital Beirut, were analyzed. Patients with hydatic cysts in other sites than liver were excluded from the study. There were 39 men [45%] and 48 women [55%] aged 12 to 75 years [mean 43]. the right lobe of the liver was affected in 67 cases [77%] the left lobe in 18 cases [20.6%] and both lobes in 2 cases [2.4%]. clinical symptomatology consisted of abdominal pain, fever, jaundice, urticaria and an abdominal mass preoperative diagnosis was established using imaging studies: plain abdominal films, ultrasonography computed tomography and serologic tests. Cases were classified into 3 groups: G1[n=44,50.5%] had a partial resection of the cyst followed by an external drainage, G2 [n=15,17.2%] had a partial resection of the cyst with a filling of the residual cavity, G3[n=28,32.2%] made benefit of complete resection of the cyst [perikystectomy] with or without partial hepatectomy. In this retrospective study we compared the results of these different surgical techniques: postoperative complications and mortality hospital stay of patient. We noted the better postoperative cursus of the nondrained patient [G2 and G3]. three patients died during the postoperative period because of septic complications. Conclusions and general recommendations are proposed

Protheses en silicone et cancer du sein prohleme reel ou fictif? a propos d'un cas et revue de la litterature

We present a case of breast cancer 9 years after subcutaneous mastectomy for bilateral phylloid tumor with silicone implants. The patient had a stage III adenocarcinoma [T4 N1 M0] at diagnosis; a modified radical mastectomy was done, followed by radiotherapy and chemotherapy. Later on, tamoxifen was prescribed [positive hormone receptors]. Reviewing the literature about this subject in a context of a moratorium of the food and drug Administration [FDA] in the united states recommending suspension of silicone breast implantation, we can propose several conclusions: previous and recent studies did not show any direct relation between cancer and silicone implants for augmentation mammoplasty; on the contrary, a lower incidence of breast cancer is noted. Breast cancer incidence with silicone implants seems to be higher with reconstructive mammoplasty after mastectomy for benign disease [fibrocystic disease, dysplasia, phylloid tumor], or prophylactic reason, or malignancy [carcinoma in stiu, lobular and multifocal carcinoma, early breast cancer]. This can be related to recurrence or cancer development on residual breast tissue. Breast cancer with silicone implants is of poorer prognosis because of the later diagnosis of the disease