Instability and impending instability of the thoracolumbar spine in patients with spinal metastases: a systematic review.

Metastatic disease commonly occurs in the spine and incidence is likely to increase secondary to improved survival rates in many cancer patients. Despite published research on instability in patients with metastatic disease of the thoracolumbar spine, controversy exists regarding risk factors for instability and indications for surgical stabilization. The objective of this systematic review was to determine what defines instability and impending instability in patients with metastatic disease of the thoracic and lumbar spine.

The application of change management principles to facilitate the introduction of nurse practitioners and physician assistants into six Ontario emergency departments.

In a project funded by the Ontario Ministry of Health and Long-Term Care, MedEmerg facilitated the introduction of three new providers into six emergency departments. A managed change process that included team development was carried out. Increased team awareness and a higher acceptance of the provider roles were some of the key successes.

Fostering hope in terminally ill patients.

Aim: To investigate the meaning of hope, identify strategies that terminally ill patients use in maintaining and fostering hope during the final stage of life, explore changes in hope during the dying trajectory and investigate whether the results of a North American study by Herth (1990a), that explored the meaning of hope and identified strategies to promote it, could be replicated in England.

Method: A total of 16 adults receiving palliative care took part in the study. Cross-sectional data were collected on all participants.

User involvement in care: avoiding tokenism and achieving partnership.

Public involvement in health care has increased in recent years, and patients now expect to have greater input into the care and services they receive. This paper describes an initiative in one trust in which patients with cancer were able to take a lead in improving services. The evolution of the group into a cancer patients' forum offers an example of good practice.

Holism and a health-promoting approach to palliative care.

This article draws on Illich's definition of health and explores the perspective of facing death as a process of adaptation. Research into psychoneuroimmunology is discussed. This focuses on using one's own resources, which the author sees as a central tenet of holism.

Massage and aromatherapy massage: nursing art and science.

This article begins by reviewing the place of complementary therapies in palliative care from the perspective of UK professional organizations, namely the Nursing and Midwifery Council (NMC) (formerly the United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC)) and the British Medical Association (BMA). It then reviews recent research on the use of massage and aromatherapy massage in palliative care and comments on their credibility and implications, thereby addressing nursing science. The art of nursing is explored through four case histories where massage was used intuitively when words were difficult or seemed inadequate.