Preferences for Aggressive End-of-life Care and Their Determinants Among Taiwanese Terminally Ill Cancer Patients.

BACKGROUND: Studies on factors influencing preferences for aggressive end-of-life (EOL) care have focused predominantly on preferred goals of EOL and seldom comprehensively incorporate patients' predisposing, enabling, and need factors into their analyses. OBJECTIVE: The aim of this study was to investigate the determinants of preferences for a wide range of aggressive EOL care from the aforementioned factors. METHODS: A cross-sectional survey was conducted using a convenience sample of 2329 terminally ill cancer patients recruited from 23 hospitals throughout Taiwan. RESULTS: Among these Taiwanese terminally ill cancer patients, 8.2% preferred prolonging life as their goal for EOL care. When combining those who wanted and those who were undecided as wanting that specific treatment, 27.9% preferred cardiopulmonary resuscitation when their life was in danger, and 36.0%, 27.3%, 24.3%, and 26.7% preferred to receive care at intensive care unit, cardiac massage, intubation, and mechanical ventilation support, respectively. Those at risk of preferring aggressive EOL care were men, younger than 45 years, married, diagnosed within 6 months, and with comorbidity and their physician had not accurately disclosed their prognosis or discussed EOL care issues to/with them. CONCLUSIONS: Few Taiwanese terminally ill cancer patients preferred to prolong life as their goal for EOL care, cardiopulmonary resuscitation when their life was in danger, and life-sustaining treatments at EOL. Preferences for aggressive EOL care are determined by patients' predisposing, enabling, and need factors. IMPLICATIONS FOR PRACTICE: Terminally ill cancer patients at risk of preferring aggressive EOL care should receive interventions to help them appropriately weigh the burdens and benefits of such aggressive treatments.

Metastatic Lung Cancer Presenting as Thoracic Empyema in an Old Patient.

An 83-year old male presented to the emergency department with productive cough and acute shortness of breath. Imaging, biochemical and microbiological studies of the pleural fluid indicated empyema. After antibiotic treatment and tube drainage, symptoms of the patient persisted and he received thoracoscopic decortication. His condition improved gradually, but histopathological examination showed metastatic adenocarcinoma of the lung. Clinicians are alerted to the possible association of malignant tumours and empyema in older patients.

Sorption of estrogens estrone, 17ß-estradiol, estriol, 17α-ethinylestradiol, and diethylstilbestrol on sediment affected by different origins.

The sorption coefficients of estrone (E1), 17ß-estradiol (E2), and estriol (E3), 17α-ethinylestradiol (EE2), and diethylstilbestrol (DES) on four sediments (BS1-4) collected downstream of agricultural, domestic, and industrial discharges were determined. The objective was to investigate the effect of sediment origin on the sorption affinity of natural and synthetic estrogens on sediments. Experimental results indicate that the sediment samples from different origins had differing estrogen sorption affinities. Organic materials in sediment samples collected from downstream of agricultural and domestic discharge, i.e., BS1 and BS2, respectively, were readily biodegraded and biotransformed during sediment diagenesis, which enhanced the sorption capacity for estrogens. Sediment samples BS3 and BS4, which were obtained downstream of domestic and industrial discharges, respectively, may contain complex compositions, including hydrophilic substances that resulted in lower log K(oc) values. The estrogen sorption on sediments was reasonably regressive with linear models. The log K(oc) values for individual estrogens in individual sediments showed variation: 2.82-4.21 for E1; 2.73-4.14 for E2; 2.19-3.76 for E3; 3.24-3.94 for EE2; and, 4.07-5.25 for DES. Nevertheless, the relationship between log K(ow) and log K(oc) of individual estrogens in individual sediments was linear. The mean log K(oc) values for target estrogens followed the trend of DES (4.68) > EE2 (3.71) > E2 (3.52) > E1 (3.44) > E3 (2.99), corresponding to the trend of log K(ow) values. These analytical results suggest that sorption of estrogens on sediments varied with sample origin. Therefore, evaluations of the fate and transport of estrogens in river environments must consider surrounding agricultural, domestic, and industrial sources.