Recommendations for bowel obstruction with peritoneal carcinomatosis.

This article reports on the clinical practice guidelines developed by a multidisciplinary group working on the indications and uses of the various available treatment options for relieving intestinal obstruction or its symptoms in patients with peritoneal carcinomatosis. These guidelines are based on a literature review and expert opinion. The recommended strategy involves a clinical and radiological evaluation, of which CT of the abdomen is a crucial component.

SALTO: a randomized, multicenter study assessing octreotide LAR in inoperable bowel obstruction.

This phase II, multicenter, randomized, double-blind, non-comparative study assessed the efficacy and safety of immediate-release octreotide and octreotide LAR, in combination with corticosteroids and standard medical care, on the symptoms of inoperable malignant bowel obstruction (MBO) due to peritoneal carcinomatosis. The primary efficacy endpoint was "success" at day 14 defined as a composite endpoint including the absence of a nasogastric tube, and vomiting less than twice per day and no use of anticholinergic agents. Patients in the octreotide arm received octreotide LAR 30 mg intramuscular (im) on days 1, 29 and 57, as well as daily immediate-release octreotide 600 μg per day plus methylprednisolone on days 1 to 6.

[Effectiveness of a supportive care form for family physicians].

To assess the effectiveness of a standardized form in altering family physicians knowledge regarding supportive care delivered to their patients. We conducted an uncontrolled before and after study involving 42 cancer patients who were provided with supportive care at hospital. During the intervention study period, a standardized form was sent to their family physician within 1 week of discharge.

[Pain management for adult patients relative to palliative care].

Pain management for a patient in palliative care requires a multi-functional approach that entails the physical, psychological, social and spiritual dimensions. It is based on a deep understanding of the pain physiopatology and its accurate assessment to optimize the treatment. This article provides guidelines to manage nociceptive and neuropathic pains, along with tips in case of refractory pains.

[Symptomatic treatments (pain management excluded) for adults in palliative care].

Patients with evolutive and terminal desease often present 4 to 5 annoying symptoms, linked to the desease and implying a rigorous assessment as well as a treatment of the cause whenever possible. When all etiologic treatments have been used, the symptomatic treatments often allow to relieve the patient. This demands allying care and medication as well as mastering the available therapeutics so as to adapt the prescriptions at best.

[April 22nd, 2005 law of patients' rights and end of life: not a well-known law due to poor communication].

The law number 2005-370 of April 22, 2005, or "Leonetti law", is a very important law for patients' rights and management of the end of life. In spite of its importance, it seems to remain largely unknown to ordinary citizen and even health professionals. In this study, we evaluated the knowledge of this law among general practitioners from Isere (France), and looked at the best communication mode to channel information about the law.

[Bacterial infections in palliative care: antibiotics and therapeutic limitations].

The benefits of antibiotics treatments are not obvious at the end of life except for the symptomatic urinary infections. The numerous antibiotics prescribed raise economic and ecological problems in terms of bacterial resistances development and also in terms of quality of life. The control of symptoms has to be the main indication to prescribe antibiotics at the end of life.

[Supplemental oxygen for dyspnea for cancer patients in end-of-life palliative care].

It is difficult to know which patients with dyspnea and terminal cancer will benefit most from supplemental oxygen. Supplemental oxygen treatment is cumbersome, can cause psychological dependence, impair the quality of life of the patient and family, and may even be dangerous for people with chronic respiratory insufficiency. It must therefore not be used routinely.

[Methylphenidate in palliative care in cancer patient: a double-blind randomised trial versus placebo].

The amphetamine, methylphenidate (Ritaline) has been proposed as being of interest in the treatment of asthenia in patients with advanced cancer. To evaluate this hypothesis a randomised controlled double-blind parallel-group national multi-centre trial is proposed versus placebo. Three previous randomised controlled studies and one open study have suggested that the administration of methylphenidate may be of interest in the palliative care of asthenic cancer patients.

[The issue of dialysis withdrawal and palliative cares. A 3-year retrospective study carried out at Grenoble university teaching hospital development of a decision-making tool].

Dialysis-related constraints encourage questioning about discontinuation of treatment. In France, the 04/22/2005 law, related to patients' rights and end-of-life issues, defines bounds to treatment withdrawal, authorizing it in specific conditions, to avoid foolish obstinacy. Shortly before the publication of this law, a study has been conducted at Grenoble University Teaching Hospital, involving 31 patients followed by the dialysis service and the palliative care service, in order to analyse the circumstances in which withdrawals from dialysis happen.

Protocol for the treatment of malignant inoperable bowel obstruction: a prospective study of 80 cases at Grenoble University Hospital Center.

A prospective protocol for treatment of malignant inoperable bowel obstruction was implemented at Grenoble University Hospital Center for 4 years. All 80 episodes of obstruction resulted from peritoneal carcinomatosis and none could expect another treatment cure. The protocol comprised three successive stages.

[What is expected of psychologists in palliative care mobile teams? Their role and missions].

The present development of palliative care structures has led to the organisation, in institutes and also in the home, of multi-disciplinary teams destined that contribute to the care and accompanying of persons at the end of their life. The multiplication of these mobile teams invites us to gain further knowledge on the respective role of each professional and in particular that of the clinical psychologist in a function that is often ignored by the institutions. This study is aimed at providing a better definition of the role and missions of a psychologist working in a mobile team.