Patients with advanced cancer: when, why, and how to refer to palliative care services

Palliative care (pc) is a fundamental component of the cancer care trajectory. Its primary focus is on "the quality of life of people who have a life-threatening illness, and includes pain and symptom management, skilled psychosocial, emotional and spiritual support" to patients and loved ones. Palliative care includes, but is not limited to, end-of-life care. The benefits of early introduction of pc services in the care trajectory of patients with advanced cancer are well known, as indicated by improved quality of life, satisfaction with care, and a potential for increased survival. In turn, early referral of patients with advanced cancer to pc services is strongly recommended. So when, how, and why should patients with advanced cancer be referred to pc services? In this article, we summarize evidence to address these questions about early pc referral: ▪ What are the known benefits?▪ What is the "ideal" pc referral timing?▪ What are the barriers?▪ Which strategies can optimize integration of pc into oncology care?▪ Which communication tools can facilitate skillful introduction of pc to patients?

Macrosomia and haemodynamic instability may represent risk factors for subcutaneous fat necrosis in asphyxiated newborns treated with hypothermia

AIM

To identify additional risk factors other than asphyxia and hypothermia in newborns developing subcutaneous fat necrosis (SCFN).

METHODS

We conducted a prospective cohort study of all term asphyxiated newborns treated with hypothermia from 2008 to 2015. The presence and location of SCFN were recorded at the time of discharge or at follow-up visits. To identify the risk factors for developing SCFN, we compared the perinatal characteristics of those newborns who developed SCFN with those who did not.

RESULTS

The newborns developing SCFN had significantly higher birthweights compared with those newborns who did not develop SCFN. Among the newborns with a birthweight equal or superior to the 90th percentile, those who developed SCFN had a significantly higher use of inotropic support and higher maximum troponin levels during their initial hospitalisation.

CONCLUSION

A higher birthweight represented an independent risk factor for developing SCFN in asphyxiated newborns treated with hypothermia. When macrosomia is present, other risk factors related to haemodynamic instability during the initial hospitalisation may also increase the risk of developing SCFN.

[New technic for detecting anti-double-stranded DNA antibodies. Value in disseminated lupus erythematosus in children]

Two assays for antibodies to double stranded (ds) DNA were compared in children with systemic lupus erythematosus (SLE). An indirect immunofluorescent test using Crithidia luciliae (IF-CL) was more specific but slightly less sensitive than the DNA binding assay (RIA). Detection of antibodies to ds-DNA (anti-ds-DNA) by IF on 3 different trypanosoma (T. brusei, T. equiperdum, and T. musculi) was as specific and as sensitive as IF-CL, but more difficult to read microscopically. No correlation was found between immunoglobulin (Ig) class of circulating anti-ds-DNA and severity of renal disease in SLE. A comparison of serologic and immunohistopathologic (kidney and skin) data in 12 children with SLE showed that immune-complex glomerulonephritis was more frequently encountered when anti-ds-DNA was detected in serum, and that Ig deposits were found only in the skin when anti-ds-DNA could not be detected in serum.

Limitations of the direct immunofluorescence test for antibody-coated bacteria in determining the site of urinary tract infections in children

The results of the direct immunofluorescence test for antibody-coated bacteria to determine the site of a urinary tract infection do not always correlate with the clinical data. When this test was performed on urine specimens from 282 children with significant bacteriuria, false-negative and false-positive results were observed in 20% (19/94) and 52% (19/188) of the specimens. Contamination of the specimen during collection and the presence of Fc receptors (receptors for the crystallizable fragment of the immunoglobulin molecule) on the surface of some strains of Staphylococcus aureus yielded false-positive results, and stools and vaginal secretions were shown to be potential sources of antibody-coated bacteria. It is suggested that for children this test be run on urine collected by bladder puncture. The use of conjugated anti-IgG antiserum containing only F(ab')2 (the antigen-binding fragments of the IgG molecule) is also recommended to eliminate false-positive results due to the presence of Fc receptors on the bacterial surface.