Tuesday, July 18, 2006

Withdrawing care in Japan; ketamine; diabetes management; anorexia-cachexia

As a new father I find myself coming home in the evening and realizing all I want is baby-time and not bloggy-time so I apologize for the sparseness of posts of late. Here are a few publications from my backlog....

The most recent Lancet has a disturbing article about physicians in Japan being criminally prosecuted for withdrawing life-prolonging treatments (ventilators). These cases, per the article, appear to cases where ventilator withdrawal was clinically appropriate as well as had the approval/assent of the families. There seems to be an extreme amount of confusion in Japan in the public, media, and law-enforcement communities about euthanasia vs 'mercy killing' vs withdrawal of life-sustaining treatment etc. (extreme meaning more even than North America). Chilling.

A recent BMJ has an editorial (seemingly out of the blue, ie--not related to a concomitantly published article) arguing for (cautiously) expanding the use of ketamine as an analgesic. There's a lot of UK-regulatory stuff in here but it's interesting to see this discussion seemingly thrown haphazardly into the middle of a BMJ. The same issue also has a brief first-person account of caring for a child dying of cancer in the UK, particularly regarding the frustrations of accessing good palliative care in the community.

The Journal of Clinical Oncology's latest issue is on imaging in cancer and includes this primer on imaging techniques in cancer. It's a nice review for those of us who take care of a lot of cancer patients.

Home Healthcare Nursing has a case-based review on glycemic management at the end of life. It would make good educational material for trainees.

Supportive Care in Cancer has an intriguing basic-science article on the role of the ubiquitin-proteosome pathway on the cancer anorexia-cachexia syndrome. It is really more of a review of the pathophysiology of anorexia-cachexia highlighting the role of ubiquitins and proposing that a treatment for the syndrome may involve ubiquitin modulation. All of this is good but it seems that the physiology research is far outpacing the clinical-therapeutic research and that insofar as no therapy has clearly & consistently shown quality of life or mortality benefit--glucocortioids, androgens, progesterones, cannabinoids, hyperalimentation, omega-3 fatty acids, etc.--I'm not holding my breath.

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