Health-related quality of life anticipated with different management strategies for febrile neutropenia in adult cancer patients

PURPOSE: To describe anticipated health-related quality of life (HRQL) for different hypothetical strategies of febrile neutropenia (FN) management in adult cancer patients. METHODS: Seventy-eight adult cancer patients were enrolled. Our study considered four different hypothetical treatment strategies for FN: (1) entire inpatient management with intravenous (IV) antibiotics; (2) oral treatment at home after an initial observation in hospital with IV antibiotics; (3) entire outpatient management with IV antibiotics; and (4) entire outpatient management with oral antibiotics. Initially, patients were asked to rank the different treatment strategies for FN based on their personal preference. Subsequently, HRQL was rated using visual analog scale (VAS), time trade-off (TTO), and willingness-to-pay (WTP). RESULTS: Seventy-five percent of all respondents preferred an outpatient strategy for FN (36% oral, 21% intravenous, 18% early discharge). Further, outpatient strategies were associated with higher mean VAS scores (possible range 0-10) (oral: 6.1 (standard deviation (SD) 3.1); intravenous: 6.2 (SD 2.2); early discharge: 5.7 (SD 2.1)) as compared to inpatient care (5.3 (SD 2.9)). On the aggregate level, patients were willing to give up between 9 and 10 weeks of their life (TTO; corresponding to <1% of remaining life expectancy) and to pay between $255 and $327 Canadian dollars (WTP) to avoid treatment in hospital. CONCLUSIONS: Our study indicates that the majority of adult cancer patients would prefer an outpatient strategy for FN. However, patients' preferences vary substantially at the individual level. Implementation of outpatient strategies into routine clinical practice should consider this variability.

Neonatal procedural pain exposure and pain management in ventilated preterm infants during the first 14 days of life

OBJECTIVES: Ventilated preterm infants are at high risk for procedural pain exposure. In Switzerland there is a lack of knowledge about the pain management in this highly vulnerable patient population. The aims of this study were to describe the type and frequency of procedures and to determine the amount of analgesia given to this patient group in two Swiss neonatal intensive care units. METHOD: A retrospective cohort study was performed examining procedural exposure and pain management of a convenience sample of 120 ventilated preterm infants (mean age = 29.7 weeks of gestation) during the first 14 days of life after delivery and born between May 1st 2004 and March 31st 2006. RESULTS: The total number of procedures all the infants underwent was 38,626 indicating a mean of 22.9 general procedures performed per child and day. Overall, 75.6% of these procedures are considered to be painful. The most frequently performed procedure is manipulation on the CPAP prongs. Pain measurements were performed four to seven times per day. In all, 99.2% of the infants received either non-pharmacological and/or pharmacological agents and 70.8% received orally administered glucose as pre-emptive analgesia. Morphine was the most commonly used pharmacological agent. DISCUSSION: The number of procedures ventilated preterm infants are exposed to is disconcerting. Iatrogenic pain is a serious problem, particularly in preterm infants of low gestational age. The fact that nurses assessed pain on average four to seven times daily per infant indicates a commitment to exploring a painful state in a highly vulnerable patient population. In general, pharmacological pain management and the administration of oral glucose as a non-pharmacological pain relieving intervention appear to be adequate, but there may be deficiencies, particularly for extremely low birth weight infants born <28 weeks of gestation.

Review of Clément Vidal, "The Beginning and the End. The Meaning of Life in a Cosmological Perspective"

No more ground control. Dissertations ideally always have been ambitious, and this one can’t claim to be too humble in these regards. Together the pieces of this work form a world view that the author confesses to finding ‘magnificent’. The story he tells is one in which intelligence and complexity are keys to unlock the universe’s mysteries. Vidal tackles questions like ‘What is philosophy?’, ‘Where does it all come from?’, Where are we going?’, ‘Are we alone in the universe?’ and even ‘What is good and what is evil?’. Questions which philosophers for ages have tried to answer.

The Road from Community Ideas to Organisational Innovation: A Life Cycle Survey of Idea Management Systems

This paper introduces a new emerging software component, the idea management system, which helps to gather, organise, select and manage the innovative ideas provided by the communities gathered around organisations or enterprises. We define the notion of the idea life cycle, which provides a framework for characterising tools and techniques that drive the evolution of community submitted data inside idea management systems. Furthermore, we show the dependencies between the community-created information and the enterprise processes that are a result of using idea management systems and point out the possible benefits.

The book of household management : comprising information for the mistress, housekeeper, cook, kitchen-maid, butler, footman, coachman, valet, upper and under house maids, lady's-maid, maid-of-all-work, laundry-maid, nurse and nurse-maid, monthly, wet, and sick nurses, etc. etc. : also, sanitary, medical, and legal memoranda : with a history of the origin, properties, and uses of all things connected with home life and comfort /

Includes index.

History of the later Roman commonwealth, from the end of the second Punic war to the death of Julius Caesar; and of the reign of Augustus; with a life of Trajan.

M. Ulpius Trajanus Crinitus from A.D. 98 to 117: vol. II, p. [409]-476.

History of the later Roman commonwealth : from the end of the second Punic war to the death of Julius Cæsar; and of the reign of Augustus: with a life of Trajan /

Republished from the "Encyclopædia Metropolitana."

Certayne notes of instruction in English verse. 1575. 2. The steele glas... 1576. 3. The complaynt of Philomene... 1576. Preceded by George Whetstone's A remembrance of the well imployed life, and godly end of George Gascoigne, esquire...

"Chronicle of some of the principal events in the life...of George Gascoigne", and bibliography prefixed.

Life in Elizabethan days, a picture of a typical English community at the end of the sixteenth century,

Mode of access: Internet.

The common pursuit : improving the quality of life for Illinois citizens with disabilities : implications for restructuring the planning and management of state services /

"February, 1991."