Factors associated with the wish to hasten death: a study of patients with terminal illness

Background. There is considerable debate regarding the clinical issues surrounding the wish to hasten death (WTHD) in the terminally ill. The clinical factors contributing to the WTHD need further investigation among the terminally ill in order to enhance understanding of the clinical assessment and treatment needs that underlie this problem. A more detailed understanding may assist with the development of appropriate therapeutic interventions. Method. A sample of terminally ill cancer patients (N=256) recruited from an in-patient hospice unit, home palliative care service and a general hospital palliative care consulting service from Brisbane Australia between 1998-2001 completed a questionnaire assessing psychological (depression and anxiety), social (family relationship, social support, level of burden on others) and the impact of physical symptoms. The association between these factors and the WTHD was investigated. Results. A high WTHD was reported by 14% of patients. A discriminant function analysis revealed that the following variables were associated with a high WTHD (P

Prospective case review of a global e-health system for doctors in developing countries

The Swinfen Charitable Trust has managed email consultations for doctors in developing countries since 1999. The process was handled manually for the first three years and then subsequently using an automatic message-handling system. We conducted a prospective review of email consultations between referring doctors and consulting specialists during six months of automatic operation (December 2003 to May 2004). During the study period 125 consultations took place. These concerned a wide range of specialties (e.g. orthopaedics 17%, dermatology 16%, obstetrics and gynaecology 11%, radiology 10%). Of these referrals, 33% (41) were for paediatric cases. Consulting specialists, who were based in five countries, were volunteers. Referring doctors were from 24 hospitals in 12 developing countries. The median time from referral to definitive reply was 1.5 days (interquartile range 0.6-4.9). There was an 85% response rate (n = 106) to a survey concerning the value of the consultation to the referring doctor. All the referring doctors who responded made positive comments about the service and half said that it improved their management of the case. The second-opinion consultation system operated by the Swinfen Charitable Trust represents an example of a global e-health system operated for altruistic, rather than commercial, reasons.

How to recognize and manage psychological distress in cancer patients

Psychological distress is common in cancer patients, however, it is often unrecognized and untreated. We aimed to identify barriers to cancer patients expressing their psychological concerns, and to recommend strategies to assist oncologists to elicit, recognize, and manage psychological distress in their patients. Medline, Psychlit, and the Cochrane databases were searched for articles relating to the detection of emotional distress in patients. Patients can provide verbal and non-verbal information about their emotional state. However, many patients may not reveal emotional issues as they believe it is not a doctor's role to help with their emotional concerns. Moreover, patients may normalize or somatize their feelings. Anxiety and depression can mimic physical symptoms of cancer or treatments, and consequently emotional distress may not be detected. Techniques such as active listening, using open questions and emotional words, responding appropriately to patients' emotional cues, and a patient-centred consulting style can assist in detection. Screening tools for psychological distress and patient question prompt sheets administered prior to the consultation can also be useful. In conclusion, the application of basic communication techniques enhances detection of patients' emotional concerns. Training oncologists in these techniques should improve the psychosocial care of cancer patients.

Do rural consumers expect a prescription from their GP visit? Investigation of patients' expectations for a prescription and doctors' prescribing decisions in rural Australia

Objective: To assess patients’ expectation for receiving a prescription and GPs’ perceptions of patient expectation for a prescription. Design: Matched questionnaire study completed by patients and GPs. Setting: Seven general practices in rural Queensland, Australia. Subjects: The subjects were 481 patients consulting 17 GPs. Main outcome measures: Patients’ expectation for receiving a prescription and GPs’ perceptions of patients’ expectation. Results: Ideal expectation (hope) for a prescription was expressed by 57% (274/481) of patients. Sixty-six per cent (313/481) thought it was likely that the doctor would actually give them a prescription. Doctors accurately predicted hope or lack of hope for a prescription in 65% (314/481) of consultations, but were inaccurate in 19% (93/481). A prescription was written in 55% of consultations. No increase in patients’ expectation, doctors’ perceptions of expectation, or decision to prescribe were detected for patients living a greater distance from the doctors. Conclusions: Rural patients demonstrated similar rates of hope for a prescription to those found in previous urban studies. Rural doctors seem to be similarly ‘accurate’ and ‘inaccurate’ in determining patients’ expectations. Rates of prescribing were comparable to urban rates. Distance was not found to increase the level of patient expectation, affect the doctors’ perception or to influence the decision to prescribe.

A new relaxation method for roll forming problems

Finite element analysis (FEA) of nonlinear problems in solid mechanics is a time consuming process, but it can deal rigorously with the problems of both geometric, contact and material nonlinearity that occur in roll forming. The simulation time limits the application of nonlinear FEA to these problems in industrial practice, so that most applications of nonlinear FEA are in theoretical studies and engineering consulting or troubleshooting. Instead, quick methods based on a global assumption of the deformed shape have been used by the roll-forming industry. These approaches are of limited accuracy. This paper proposes a new form-finding method - a relaxation method to solve the nonlinear problem of predicting the deformed shape due to plastic deformation in roll forming. This method involves applying a small perturbation to each discrete node in order to update the local displacement field, while minimizing plastic work. This is iteratively applied to update the positions of all nodes. As the method assumes a local displacement field, the strain and stress components at each node are calculated explicitly. Continued perturbation of nodes leads to optimisation of the displacement field. Another important feature of this paper is a new approach to consideration of strain history. For a stable and continuous process such as rolling and roll forming, the strain history of a point is represented spatially by the states at a row of nodes leading in the direction of rolling to the current one. Therefore the increment of the strain components and the work-increment of a point can be found without moving the object forward. Using this method we can find the solution for rolling or roll forming in just one step. This method is expected to be faster than commercial finite element packages by eliminating repeated solution of large sets of simultaneous equations and the need to update boundary conditions that represent the rolls.