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Biomedical subjects

C F von Gunten

Publications and source records attributed to C F von Gunten.

16 recordsLinked to original sources
PubMed1996

Characterization of an acute inpatient hospice palliative care unit in a U.S. teaching hospital.

An existing hospice palliative care inpatient unit was studied from September 1993 to November 1993 to characterize it for two qualities: demographics of admitted patients and family satisfaction after discharge. The purpose of this study was to identify current uses of the unit and determine whether the high level of satisfaction among family members, as perceived by the staff, was accurate. To characterize demographics, 100 consecutive admissions to the unit were assessed prospectively beginning in September 1993. To characterize family satisfaction, a survey was sent to the families of 240 patients who had been cared for on the inpatient unit. Since this study, it has been identified that care on the hospice palliative care unit is provided at a 50% reduction in daily hospital charges. The hospital has benefited from establishing and maintaining an acute care inpatient hospice palliative care unit. Other academic medical centers in the United States should consider a designated unit for symptom management and terminal care as part of their comprehensive range of healthcare services.

Adult↗
PubMed1996

Terminal care for noncancer patients.

The hospice approach to terminal care will benefit patients with advanced chronic illnesses other than cancer. This article describes general criteria that will help clinicians assess when patients may be appropriately referred for hospice care. Common illnesses, such as dementia, heart disease, lung disease, and renal failure for which terminal care in advanced stages is appropriate, are discussed. Specific palliative management issues regarding these advanced disease states also are addressed.

Dementia↗
PubMed1996

Hospice and palliative care: program needs and academic issues.

With the renaissance of interest in how best to care for patients with terminal illness comes the need to recognize palliative care and hospice programs as the completion of comprehensive cancer care, not as its antithesis. In practical terms, admission to a hospice program is appropriate when efforts to control the biologic disease have ceased to be helpful and the primary medical focus is on symptom control and quality of life. In this article, the authors explore the goals of palliative care, review the transition to a hospice program, and assess the Medicare Hospice Benefit. Furthermore, they reflect on the importance of and barriers to the appropriate adoption of palliative care programs as well as palliative care education in oncology.

Comprehensive Health Care↗
PubMed1995

AIDS and palliative medicine: medical treatment issues.

Caring for patients with AIDS in hospice programs presents numerous challenges. These go beyond the strictly medical decisions discussed in this article to include unique problems with social support, emotional support, and bereavement. This discussion centers on medical issues as they are commonly encountered. They can be stumbling blocks, or even surrogates, for addressing the other important issues at the end of life. Communication between all people involved in the multidisciplinary treatment of these patients is essential. Common goals should be identified and general approaches agreed upon among the physicians, nurses (clinic, hospice, home care), therapists, clergy, and volunteers. In this way we feel that the principles of hospice and palliative care can be effectively applied to most patients with endstage AIDS.

AIDS-Related Opportunistic Infections↗
PubMed1995

Housestaff training in cancer pain education.

A program for improving housestaff education in cancer pain control was piloted on an inpatient oncology unit during academic year 1992-93. Housestaff (four or five first-year residents and two more senior residents per month) received a three-day lecture series each month. A total of 32 housestaff participated. A questionnaire (Test A) about cancer pain was administered before the series. The subjects scored 58% correct (range 49-69). When Test A was repeated at the end of each rotation, the subjects scored 83% correct (range 82-86, p < 0.0001). A quiz on analgesic dosing (Test B) was also administered. The subjects scored 38% (range 20-56) before the lectures, 81% (range 72-93) immediately after the lectures, and 57% (range 44-67) at the end of the rotation. The authors conclude that this pilot project improves knowledge about cancer pain, but sustained reinforcement is needed if analgesic dosing skills are to be maintained.

Education, Medical, Graduate↗
PubMed1993

Raynaud phenomenon in three patients with acquired immune deficiency syndrome-related Kaposi sarcoma treated with bleomycin.

The authors report three cases of Raynaud phenomenon that developed during doxorubicin, bleomycin, and vincristine (ABV) therapy for acquired immune deficiency syndrome (AIDS)-related Kaposi sarcoma. Although Raynaud phenomenon is well documented as a side effect of bleomycin, vinblastine, and cisplatin chemotherapy for germ cell neoplasms, it has not been widely documented in patients with AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Treatment of advanced, aggressive non-Hodgkin's lymphoma.

Although advanced, aggressive non-Hodgkin's lymphoma is highly responsive to chemotherapy, only approximately 30% of patients will have long-term disease-free survival and cure. Complex multiple-drug regimens have been claimed to be superior to standard regimens, eg, cyclophosphamide, doxorubicin, vincristine, and prednisone. However, several studies comparing this regimen with various multiple-drug regimens showed equivalent results with a more favorable toxicity profile for the standard regimen. Central nervous system lymphoma continues to carry a grim prognosis, but new approaches combining chemotherapy with radiation may lead to improved treatment. The availability of hematopoietic growth factors may help determine the role of dose intensity in the treatment of advanced, aggressive non-Hodgkin's lymphoma.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1992

Clinical aspects of human immunodeficiency virus-related lymphoma.

As patients with human immunodeficiency virus infection live longer because of better antiretroviral therapy and infection prophylaxis, the incidence of non-Hodgkin's lymphoma has increased. The risk increases inversely with CD4 count--the most widely used surrogate marker for progressive immune suppression. Zidovudine itself does not appear to be a risk factor. Patients frequently present with extranodal advanced disease. The central nervous system is the primary site in 10% to 20% of cases. Important prognostic factors are performance status, a prior history of acquired immunodeficiency syndrome, and bone marrow involvement. Therapy is complicated by underlying immunosuppression, opportunistic infection, and poor bone marrow reserve. Progress has been made using colony-stimulating factors and less intensive chemotherapy regimens in systemic non-Hodgkin's lymphoma. Treatment of primary central nervous system lymphoma with radiation therapy has not improved survival.

Adult↗
PubMed1989

Treatment of CHO-K1 cells with 25-hydroxycholesterol produces a more rapid loss of 3-hydroxy-3-methylglutaryl-coenzyme A reductase activity than can be accounted for by enzyme turnover.

A key enzyme in the regulation of mammalian cellular cholesterol biosynthesis is 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMG-CoA reductase). It is well established that treatment with the compound 25-hydroxycholesterol lowers HMG-CoA reductase activity in cultured Chinese hamster ovary (CHO-K1) cells. After brief incubation (0-4 h) with 25-hydroxycholesterol (0.5 microgram/ml), cellular HMG-CoA reductase activity is decreased to 40% of its original level. This also occurs in the presence of exogenous mevinolin, a competitive inhibitor of HMG-CoA reductase which has previously been shown to inhibit its degradation. The inhibition of HMG-CoA reductase activity by 25-hydroxycholesterol is complete after 2 h. Radio-immune precipitation analysis of the native enzyme under these conditions shows a degradation half-life which is considerably longer than that of the observed inhibition. Studies with sodium fluoride, phosphatase 2A, bacterial alkaline phosphatase and calf alkaline phosphatase indicate that the observed loss of activity is not due to phosphorylation. These data are not consistent with described mechanisms of HMG-CoA reductase activity regulation by phosphorylation or degradation but are consistent with a novel mechanism that regulates the catalytic efficiency of this enzyme.

Alkaline Phosphatase↗
PubMedDate not supplied

AIDS and hospice.

Which AIDS patients should be admitted to hospice programs? Many health care professionals feel that any anti-viral drug or treatment directed against the opportunistic infections characteristic of AIDS to be incompatible with hospice philosophy. Others argue that inclusion of AIDS patients blurs the distinction between hospice and community service programs. We argue that achieving consensus on this issue is best served by focusing on the defining characteristic of hospice programs--the care of the dying. Consensus is not served by dwelling on the specific palliative or supportive measures used to achieve the hospice goal. We suggest a framework by which AIDS patients may be accommodated in existing hospice programs while maintaining hospice program integrity. It is further suggested that these may be used for the consideration of any patient for hospice care.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Hospice and palliative care: attitudes and practices of the physician faculty of an academic hospital.

It has been suggested that physicians, particularly in academic hospitals, are resistant to the hospice approach to palliative care for terminally ill patients. It is of interest, therefore, to assess the attitudes and practices of the physician faculty of an academic hospital where a hospice program has been in existence for more than 10 years. This was assessed with two faculty surveys. All 966 physician faculty that were on staff at Northwestern Memorial Hospital in the fall of 1993 were sent a survey about their opinion of hospice care (Survey A). Then, all physicians who had referred patients to the hospice program between September 1993 and September 1994 at Northwestern Memorial Hospital received a survey letter after the death of their patient (Survey B). Seventy-seven percent of faculty physician respondents to Survey A had either referred patients, or knew of colleagues who had referred patients to a hospice program. Ninety-four percent of those who answered "yes" to the question about referrals reported satisfaction with their care. Ninety-four percent would refer patients in the future and 96 percent thought the hospice program was a valuable resource to the medical center. Of the respondents to Survey B, nearly 100 percent thought the referral had been handled in an "excellent" or "good" fashion, that communication with hospice staff was "excellent" or "good," that symptom control was "excellent" or "good," that their patients and families had received "excellent" or "good" psychosocial support, and that their patients and families were satisfied with the hospice care they received.(ABSTRACT TRUNCATED AT 250 WORDS)

Attitude of Health Personnel↗