The ethics of end-of-life care for patients with ESRD.

Patients with ESRD have extensive and unique palliative care needs, often for years before death. The vast majority of patients, however, dies in acute care facilities without accessing palliative care services. High mortality rates along with a substantial burden of physical, psychosocial, and spiritual symptoms and an increasing prevalence of decisions to withhold and stop dialysis all highlight the importance of integrating palliative care into the comprehensive management of ESRD patients.

The relationship between spirituality, psychosocial adjustment to illness, and health-related quality of life in patients with advanced chronic kidney disease.

Context: Spirituality may promote psychosocial adjustment to illness, and this may be a mechanism by which patients with greater existential well-being (EWB) experience better health-related quality of life (HRQL) in the context of life-limiting illness.

Objectives: This study explored the relationship between psychosocial adjustment to illness, EWB, and HRQL in patients with advanced chronic kidney disease and sought to determine whether adjustment to illness mediates the relationship between EWB and HRQL.

Methods: This was a cohort study of 253 prevalent Stage 4 or 5 chronic kidney disease and dialysis patients.

Hypoactive sexual desire disorder.

Purpose Of Review: Hypoactive sexual desire disorder (HSDD) is the most prevalent female sexual dysfunction, with estimates of prevalence approximating 10%. By definition it is a deficiency of sexual desire that causes distress. HSDD has no single cause, but physiological, psychological and socio-cultural factors underpinning female sexual desire may all be important in its development.

Benign lymphoepithelial cysts of the parotid: long-term surgical results.

Benign lymphoepithelial cysts are a widely recognized cause of parotid gland swelling in patients infected with the human immunodeficiency virus (HIV). These cysts are pathognomonic for HIV. The cysts frequently grow to be exceptionally large, causing physical deformity and gross asymmetry of facial contour.

Personality disorder and criminal behaviour: what is the nature of the relationship?

Purpose Of Review: There is a well established association between personality disorder and offending but the nature of the relationship is less well understood. We reviewed the recent literature on personality disorder and offending, picking out studies that examined the relationship between the two.

Recent Findings: Cluster A, B and C personality disorders are each associated with different types of offences.

Characterization of the sortase repertoire in Bacillus anthracis.

LPXTG proteins, present in most if not all Gram-positive bacteria, are known to be anchored by sortases to the bacterial peptidoglycan. More than one sortase gene is often encoded in a bacterial species, and each sortase is supposed to specifically anchor given LPXTG proteins, depending of the sequence of the C-terminal cell wall sorting signal (cwss), bearing an LPXTG motif or another recognition sequence. B.

Testosterone improves verbal learning and memory in postmenopausal women: Results from a pilot study.

Objective: To explore the effects of testosterone on cognitive performance in healthy postmenopausal women.

Study Design: Open-label pilot study. Nine postmenopausal women on non-oral hormone replacement therapy, aged 47-60 years received transdermal testosterone spray for 26 weeks.

Evolutionary history and functional characterization of three large genes involved in sporulation in Bacillus cereus group bacteria.

The Bacillus cereus group of bacteria is a group of closely related species that are of medical and economic relevance, including B. anthracis, B. cereus, and B.

Career evaluation and the decision process for plastic surgery graduates.

National experience shows that 50 percent of physicians change positions within the first 2 years of practice. Because of market pressures, medicine in general and plastic surgery in particular are shifting away from solo practice. The authors examine the primary reasons for turnover and discuss job search priorities for recent plastic surgery graduates and established surgeons in job transition, with a current analysis of the different job opportunities available, ranging from government to private practice.

When enough is enough: the nephrologist's responsibility in ordering dialysis treatments.

For more than 20 years, nephrologists have been reporting that they are increasingly being expected to dialyze patients whom they believe may receive little benefit from dialysis therapy. During this time, there has been substantial research about the outcomes of patients of differing ages and comorbid conditions requiring dialysis and the development of clinical practice guidelines for dialysis decision making based on research evidence, ethics, and the law. The importance of palliative medicine to the care of the patient throughout the continuum of kidney disease also has been recognized, and its application has been described.

Integrating palliative care for patients with advanced chronic kidney disease: recent advances, remaining challenges.

Patients with ESRD have extensive and unique end-of-life care considerations and needs. Despite substantial advancements in renal palliative care over the past decade, much research is still required. Identifying CKD patients whose illness trajectory has shifted and would likely benefit from a palliative approach to care should be a priority of all nephrology programs.

Analysis of rescue and drowning history from a lifeguarded waterpark environment.

The objective of this paper is to analyse rescue history from a lifeguarded waterpark environment using four characteristics: gender, age, water depth and type of aquatic attraction together with the actions taken by the guard to minimise the time needed to restore respiration in the case of loss of spontaneous respiration (LSR). Analysis of 63,800,000 guests with 56,000 rescues and 32 LSR rescues shows that children and shallow water both had relatively high levels of rescues [62.6% for children aged 1-12 years and 42% for water depth less than 1.

Scalp reconstruction with inverted myocutaneous latissimus free flap and unmeshed skin graft.

Limited skin paddle size, peripheral thinning, or lack of cerebral expansion after radiotherapy may necessitate secondary sculpting after latissimus free flap reconstruction of large scalp defects. This series presents a novel modification of the myocutaneous latissimus dorsi free flap for use in large scalp defects. After superficial artery isolation, titanium mesh is placed into the calvarial defect to recapitulate the inner table.

Serum biochemistry values, plasma mineral levels, and whole blood heavy metal measurements in wild northern goshawks (Accipiter gentilis).

Serum chemistry panels and complete mineral and heavy metal screens were performed on blood samples from eight adult northern goshawks (Accipiter gentilis) breeding in Pennsylvania. Serum chemistry panels were performed to determine the health status of each bird. Biochemical values measured included serum glucose, sodium, potassium, chloride, magnesium, uric acid, creatine kinase, and aspartate transaminase.

Is there a legitimate role for the therapeutic use of cannabinoids for symptom management in chronic kidney disease?

Chronic pain is a common and debilitating symptom experienced in the context of numerous other physical and emotional symptoms by many patients with chronic kidney disease (CKD). Management of pain with opioids in CKD can be problematic given the prominence of adverse effects of opioids in CKD, which may exacerbate symptoms, such as nausea, anorexia, pruritus, and insomnia, all of which impact negatively on patients' health-related quality of life. Novel therapeutic approaches for pain and symptom management in CKD are required.