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Neoplasia in pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
With cervical cancer beyond stage IIA, radiation is the treatment of choice with chemosensitization now being routinely performed with radiosensitizing chemotherapy (50,51). Commencement of treatment is immediate, with the exception of late second- or third-trimester pregnancies when treatment may be delayed until after the documentation of fetal pulmonary maturity and delivery. It must be emphasized that the impact of treatment delay on maternal and fetal health is uncertain. Overall evidence suggests that some amount of delay is reasonable without greatly affecting maternal outcome (49,51–59) and allowing potential small but significant gains in fetal outcomes. The literature suggests that prognosis is unchanged over many weeks and patients can be counseled as such allowing the opportunity to delay treatment if so desired. Clearly, these patients must be closely followed for any evidence of disease progression.
Healing Language
Published in Rubin Battino, Using Guided Imagery and Hypnosis in Brief Therapy and Palliative Care, 2020
People tend to avoid the giving of what they feel is “false hope.” Perhaps they feel that they are being kind to a person who has essentially just been given a death sentence, and that it is better just to accept that and tie up the loose ends of their life and “enjoy” what is left. That is, “be realistic.” They are missing two things here: the first is that we are alive until our last breath, and that hope is a potent word in terms of marshaling healing and curing resources. Yet, it is good to be realistic. There are lots of practical things to do. At the same time, there is an important distinction between a diagnosis and a prognosis. A diagnosis is based on tests of experimentally determined statistical reliability. So, diagnoses all have “error bars” associated with them. It is important to know the magnitude of those error bars. There is a difference of “this test has a reliability of 90%” and “this other one has a reliability of 50%.” A medical doctor making a prognosis is making his/her statement based on experience, which is based on the reliability of those tests! So, you may have to believe the diagnosis, but you do not have to believe the prognosis. This is why in serious cases it is vitally important to obtain second and even third opinions. (There is a remarkable book by S. S. Schneider (2005) entitled The Patient from Hell. How I Worked with My Doctors to Get the Best of Modern Medicine and HOW YOU CAN TOO. The title tells it all!)
Medium-chain acyl CoA dehydrogenase deficiency
Published in William L. Nyhan, Georg F. Hoffmann, Aida I. Al-Aqeel, Bruce A. Barshop, Atlas of Inherited Metabolic Diseases, 2020
William L. Nyhan, Georg F. Hoffmann, Aida I. Al-Aqeel, Bruce A. Barshop
In our experience, the exceptional patient who developed hypoglycemia after shorter periods of fasting, was a young infant who developed multiple episodes during infancy. The occurrence of SIDS is of course another exception to the expected course [46–48], and fatal neonatal presentation has been reported [6] in an infant with hypoglycemia and normal levels of free carnitine who had severe lipid cardiomyopathy at autopsy. GCMS of the liver in patients with SIDS has yielded cis-4 decenoic acid (C10:1) in each of four infants found to have had MCAD deficiency [47]. The prognosis for survival appears to be particularly bad for those with a neonatal presentation, although overall mortality in the first episode may be as high as 60 percent [46]. In patients surviving to diagnosis, the prognosis is good. Physical and intellectual development may be normal, although abnormal psychometric tests of development were surprisingly frequent in the survivors reported by Iafolla et al. [19, 20]. We expect that the incidence of normality will be high in those infants detected through routine screening such tests.
The linked lives of young women with metastatic breast cancer
Published in Journal of Psychosocial Oncology, 2022
Although some aspects of participants’ descriptions are applicable to young women diagnosed with earlier stages of breast cancer (partners as caretakers; accepting help with household responsibilities), the rest of the themes may be categorized as metastatic-centered and metastatic-marginal. In the first category, participants’ descriptions were centered on what it meant to have MBC (e.g., feeling alienated from early stage breast cancer patients; communicating with partners, children, and friends about terminal illness; and connecting with other MBC patients). In the second category, the terminal prognosis was notably absent during participants’ discussions of their concerns (e.g., frustrations regarding the lack of fertility support). Several participants described being devastated that they weren’t offered a chance to preserve their fertility; most of them did not refer to their MBC status or offer that as a reason not to have pursued fertility treatment. This may speak to a larger issue about (a) how patients conceptualize their prognosis and (b) how medical teams might talk with patients.
Risk factors for the development of local recurrence in extremity soft-tissue sarcoma
Published in Expert Review of Anticancer Therapy, 2022
Fabio Tirotta, Raza Sayyed, Robin L Jones, Andrew J Hayes
It should be considered that patients’ prognosis can change after surgery. In fact, patients who experience relapse after surgery have worse outcomes than those who do not. In addition, the risk of relapse becomes lower if the follow-up period is longer. Moreover, some variables determine an effect that is type dependent and therefore may no longer be applicable at follow-up. All these factors have been considered to establish dynamic nomograms. The first dynamic nomogram for patients with high-grade STS was developed in 2018 [86] and can predict the survival chance at 5 years during the first 5 years of follow-up and upon LR or DM. One year later, another dynamic nomogram was developed to predict 5-year OS during the first 3 years of follow-up [76]. This was devised using a cohort of over 3,000 patients and was externally validated. It considers variables such as age, size, grading, histology, and LR/DM.
A Review of David Lemberg’s Ethical and Legal Issues in Healthcare (1st Edition)
Published in The American Journal of Bioethics, 2019
Chapter 8 is dedicated to end-of-life (EOL) decision making, and all of the intricacies associated therewith, ranging from advance directives (or lack thereof) to surrogate decision making and palliative care to aid-in-dying. This chapter is appropriately lengthy, as the bulk of the work in clinical ethics relates to EOL decision making. The Do-It-Yourself Ethicist case studies and exercises in this chapter are compelling and useful:2. As a member of your hospital’s biomedical ethics committee, you evaluating the case of an eighty-two year old patient with advanced dementia and congestive heart failure. The patient prognosis is poor. Recently, the patient has been shuttled back and forth between a skilled nursing facility and the hospital, owing to repeated instances of aspiration pneumonia and acute respiratory failure. Surgical placement of a feeding tube has been recommended. Discuss how you would analyze and come to recommendations. (Chapter 8, page 248)