Providing Culturally Respectful Care for Seriously Ill Vietnamese Americans.

Vietnamese Americans are a heterogeneous population with a rich, shared experience and historical and cultural influences from Asia and Europe. Societal upheaval resulting from the Vietnam War and varied immigration patterns to the U.S. and levels of acculturation layer complexity to this resilient population. These experiences influence how the communities as a whole and how the family as a unit approach health care issues, their attitudes toward serious illness and care at the end of life. Challenges with caring for this population include lack of resources and training to provide culturally sensitive care, lack of appropriate advance care planning, and lack of interpreters or culture-specific care programs. All contribute to poor end-of-life care. An understanding of how these complexities interplay may help clinicians provide compassionate and patient-centric care to these patients, their families, and their supporting communities. This article provides an overview of culturally effective care for seriously ill Vietnamese American patients and makes recommendations for potential strategies for providing respectful end-of-life care.

Role of palliative low-molecular-weight heparin for treating venous thromboembolism in patients with advanced cancer.

Patients with cancer are at risk of developing venous thromboembolism ([VTE]; deep venous thrombosis, and pulmonary embolism). Although vitamin K antagonists had originally been used to treat VTE in these patients, low-molecular-weight heparins (LMWH) have been shown to be more effective and safe for patients with cancer-associated thrombosis. In cancer patients with advanced disease where curative therapy is no longer the intent of treatment, continued anticoagulation for VTE for palliative purposes continues to remain a controversial topic as no large randomized trials have been conducted to guide clinicians in this setting. This review summarizes the data available for treating VTE in cancer patients receiving palliative services.

Endoscopic ultrasound-guided celiac plexus neurolysis for pancreatic cancer pain: a single-institution experience and review of the literature.

Pancreatic cancer is a common gastrointestinal malignancy with a poor prognosis. The primary goal for caregivers is effective palliative care, especially pain control, which is routinely managed by administration of narcotic analgesics. An alternative or adjunctive modality is celiac plexus neurolysis (CPN), a safe and effective procedure. Recent advances in the use of endoscopic ultrasonography (EUS) have made it an attractive guidance technique for CPN while allowing for a simultaneous tissue diagnosis. We report our experience using EUS-guided CPN and review the available literature regarding this modality.

Clinical outcomes of intraoperative radiation therapy for extremity sarcomas.

Purpose. Radiation of extremity lesions, a key component of limb-sparing therapy, presents particular challenges, with significant risks of toxicities. We sought to explore the efficacy of intraoperative radiation therapy (IORT) in the treatment of soft tissue sarcomas of the extremities. Patients. Between 1995 and 2001, 17 patients received IORT for soft tissue sarcomas of the extremities. Indications for IORT included recurrent tumors in a previously radiated field or tumors adjacent to critical structures. Results. Gross total resections were achieved in all 17 patients. Two patients experienced locoregional relapses, six patients recurred at metastatic sites, and one patient died without recurrence. Thirty-six month estimates for locoregional control, disease free survival, and overall survival were 86%, 50%, and 78%, respectively. IORT was extremely well tolerated, with no toxicities referable to IORT. Conclusions. For patients with soft tissue sarcomas of the extremities, IORT used as a boost to EBRT provides excellent local control, with limited acute toxicities.

Biomechanics of cervical laminoplasty: kinetic studies comparing different surgical techniques, temporal effects and the degree of level involvement.

Laminoplasty is a common surgical technique used to treat cervical myelopathy. Both voids and contradictory information exist in the literature with regard to the initial and long-term biomechanical consequences of cervical laminoplasty. In order to clarify the existing literature, as well as provide clinically useful information, we identified three specific aims: (1) to measure the long-term differences in kinetics between the open door laminoplasty (ODL) and French door laminoplasty (FDL) techniques; (2) to delineate differences in primary and long-term cervical motion after laminoplasty; and (3) to determine whether inclusion of additional levels in the laminoplasty procedure results in a change in immediate cervical biomechanics. The study design involved both an animal (caprine) model and in vitro surgical simulation. We kinematically evaluated the cervical spine specimens (C2-C7) by applying pure bending moment loads to the cephalad vertebra (C2), while constraining the caudal vertebra (C7). Resultant intervertebral rotations (C3-C6) were determined via stereophotogrammetry. Overall, the data indicate that both FDL and ODL significantly reduce range of motion 6 months postoperatively, compared with the un-operated spine. There were no significant differences between the two techniques after 6 months. We also showed that ODL produces a significant reduction in motion 6 months postoperatively compared with the immediate postoperative condition. Finally, the data indicated that extending the laminoplasty from two to four levels did not significantly change range of motion. The choice of technique should be based upon the surgeon's experience with these technically demanding procedures. In addition, initial stability considerations should not affect the decision to extend the laminoplasty to adjacent levels. Finally, the data also suggest that early changes in biomechanics should not be a major factor when considering whether immobilization of the cervical spine is necessary after laminoplasty. In fact, our temporal study, as well as previously reported clinical data, indicates that one should expect significantly decreased intervertebral motion 6 months after laminoplasty. Therefore, early physical therapy should be considered to preserve a more physiologic pattern of cervical range of motion.

[Use of a self-administered quality of life questionnaire in a university preventive service]. / Utilisation d'un autoquestionnaire de qualité de vie en service de médecine préventive universitaire.

In France, the student population represents close to two million people covered by the medical and social plan of the Services de Sante Inter-Universitaires (Inter-University Health Services), of which one of the objectives is to improve students' quality of life. This is why it seemed interesting to measure this quality of life in order to identify problems and to propose possible improvements. For this, we used a generic self-administered questionnaire, the SF 36, which allowed for detecting the variations of quality of life in relation to health status. Throughout the 1995-1996 school year, 1301 questionnaires were completed by first year students seen in routine visits or scheduled appointments. The questionnaire was well received. The self-administered questionnaire is a sensitive tool that revealed, among healthy students, statistically significant differences in scores between girls and boys (with girls showing lower scores). This difference is not found in the group of students who came for an appointment for a benign pathology. The causes of these variations remain to be explored.