This preliminary experience suggests that the risk of liver abscess among patients with prior biliary intervention may be lower following radioembolization than chemoembolization, which could potentially expand treatment options in this high-risk population.
Evidence shows that disparities in pain care exist, and this problem spans across all health care settings. Health care disparities are complex, and stem from the health system climate, limitations imposed by laws and regulations, and discriminatory practices that are deep seated in biases, stereotypes, and uncertainties surrounding communication and decision-making processes. A search of the Internet identified thousands of Web sites, documents, reports, and educational materials pertaining to health and pain disparities. Web sites for federal agencies, private foundations, and professional and consumer-oriented organizations provide useful information on disparities related to age, race, ethnicity, geography, socioeconomic status, and specific populations. The contents of 10 Web sites are examined for resources to assist health professionals and consumers in better understanding health and pain disparities and ways to overcome them in practice.
progressive disease in 2 (7.4%) (7 not determined). Liver function tests showed a significant reduction of mean serum albumin after SIRT (from 3.7 ± 0.53 g/dL [baseline] to 3.3 ± 0.64 g/dL [week 4, P<.001] and 3.0 ± 0.70 g/dL [week 12, P<.001]), and a significant increase in mean ALP values (from 218.0 ± 174.47 IU/L [baseline] to 244.9 ± 132.49 IU/L [week 8, P ¼ .008] and 313.9 ± 144.73 IU/L [week 12, P ¼ .002]). Mean ALT, AST, and total bilirubin were mostly within normal range during the 12-week follow-up. Most frequent SIRT-related adverse events included fatigue (26 patients), abdominal pain (20), nausea (12), weight loss (11), and abdominal disturbances (9). Most complications were grade 1-2; only 3 patients had grade 3 (abdominal distension and ascites, and abdominal pain and fatigue) or grade 4 (AST and ALT elevation) toxicities. Median survival from diagnosis was 20.8 mo. Age, sex, extrahepatic disease, and ECOG performance status were not significant predictors of survival. Conclusions: Y-90 SIRT meaningfully prolonged survival of heavily pretreated patients with liver metastases from pancreatic adenocarcinoma. Complications and liver toxicity remained acceptable and were rarely severe (grade 3).
End-of-life decisions regarding nutrition should be formed in light of available scientific information and socio-culturally sensitive aspects of patient/family centered care. An extensive internet search was performed to identify available resources concerning nutrition at the end of life and guide health professionals and consumers in the interpretation and clinical application of information. The results of this search yielded several internet sites that post content that can be useful to clinicians, consumers and both. The amount of accessible information on the World Wide Web is so extensive that considerable effort is required to appraise the accuracy and scientific value of subject matter while balancing patients and families perceived importance of nourishment during the end stages of life. Therefore, Internet-based information on nutrition at the end of life is presented and evaluated for the relative contributions that this type of information offers to clinicians, patients and families.
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