[Tasered: medical consequences of the use of electric stun guns]. / Getaserd.

The Electronic Control Device (ECD) will be used by the primary police force in the Netherlands. Hence medical personnel will be confronted with persons that have received ECD shocks more often. In light of these developments, it is important that care providers are aware of potential medical consequences resulting from the use of electric stun guns. The darts usually result in minor injury with small penetration wounds requiring minimal treatment. However, in vulnerable areas, such as the eyes, the darts can cause serious injury and specialist care is indicated. The electric shock causes muscle contractions, potentially resulting in traumatic falls, or fractures. Cardiac problems occur only in exceptional cases; risk factors include long duration of the power surge, short distance from the darts to the heart and underlying heart problems. In rare cases a pneumothorax may occur. Finally, often there are underlying medical problems requiring appropriate treatment such as drug intoxication, excited delirium or psychiatric disorders. Systematic recording of the medical problems caused by anECD is indicated.

Physicians' evaluations of patients' decisions to refuse oncological treatment.

OBJECTIVE: To gain insight into the standards of rationality that physicians use when evaluating patients' treatment refusals. DESIGN OF THE STUDY: Qualitative design with in depth interviews. PARTICIPANTS: The study sample included 30 patients with cancer and 16 physicians (oncologists and general practitioners). All patients had refused a recommended oncological treatment. RESULTS: Patients base their treatment refusals mainly on personal values and/or experience. Physicians mainly emphasise the medical perspective when evaluating patients' treatment refusals. From a medical perspective, a patient's treatment refusal based on personal values and experience is generally evaluated as irrational and difficult to accept, especially when it concerns a curative treatment. Physicians have a different attitude towards non-curative treatments and have less difficulty accepting a patient's refusal of these treatments. Thus, an important factor in the physician's evaluation of a treatment refusal is whether the treatment refused is curative or non-curative. CONCLUSION: Physicians mainly use goal oriented and patients mainly value oriented rationality, but in the case of non-curative treatment refusal, physicians give more emphasis to value oriented rationality. A consensus between the value oriented approaches of patient and physician may then emerge, leading to the patient's decision being understood and accepted by the physician. The physician's acceptance is crucial to his or her attitude towards the patient. It contributes to the patient's feeling free to decide, and being understood and respected, and thus to a better physician-patient relationship.

Clarifying the term 'palliative' in clinical oncology.

The objective of this study was to clarify the term 'palliative' in clinical oncology. A qualitative study design with in-depth interviews was applied. The study sample included 30 cancer patients and 16 physicians. In clinical oncology, the use of the term 'palliative' to describe both anticancer treatments and palliative care may cause confusion and misunderstanding. Different aspects of palliative care, as expressed by the WHO definition, are not so easily recognizable with regard to palliative oncological treatments. Furthermore, the fact that the same anticancer treatments can be given to patients with palliative or curative intention is confusing. The distinction between curative and palliative oncological treatments is of crucial importance for the treatment decision-making process. Close consideration of the use of the term 'palliative' will help to clarify the various goals of treatment and care in oncological practice.

Distinct roles of the phosphatidylinositol 3-kinase and STAT5 pathways in IL-7-mediated development of human thymocyte precursors.

Here, we define the IL-7R-activated signal that promotes survival and proliferation of T cell progenitors and demonstrate that it is distinct from the signals that induce differentiation. We show that IL-7 activates PKB and STAT5 in human thymocytes. Into T cell precursors we introduced chimeric receptors with a cytoplasmic domain of the IL-7R that is no longer able to activate PI-3K/PKB and STAT5 and tested the transduced cells in a fetal thymic organ culture. We also examined the T cell precursor activity of progenitors expressing dominant-negative forms of PI-3K or STAT5B. These experiments revealed that PI-3K/PKB activation is essential for the survival and proliferation of T cell precursors and suggest that STAT5 activated by IL-7 mediates T cell differentiation.