Integration of oncology and palliative care : a Lancet Oncology Commission

Full integration of oncology and palliative care relies on the specific knowledge and skills of two modes of care: the tumour-directed approach, the main focus of which is on treating the disease; and the host-directed approach, which focuses on the patient with the disease. This Commission addresses how to combine these two paradigms to achieve the best outcome of patient care. Randomised clinical trials on integration of oncology and palliative care point to health gains: improved survival and symptom control, less anxiety and depression, reduced use of futile chemotherapy at the end of life, improved family satisfaction and quality of life, and improved use of health-care resources. Early delivery of patient-directed care by specialist palliative care teams alongside tumour-directed treatment promotes patient-centred care. Systematic assessment and use of patient-reported outcomes and active patient involvement in the decisions about cancer care result in better symptom control, improved physical and mental health, and better use of health-care resources. The absence of international agreements on the content and standards of the organisation, education, and research of palliative care in oncology are major barriers to successful integration. Other barriers include the common misconception that palliative care is end-of-life care only, stigmatisation of death and dying, and insufficient infrastructure and funding. The absence of established priorities might also hinder integration more widely. This Commission proposes the use of standardised care pathways and multidisciplinary teams to promote integration of oncology and palliative care, and calls for changes at the system level to coordinate the activities of professionals, and for the development and implementation of new and improved education programmes, with the overall goal of improving patient care. Integration raises new research questions, all of which contribute to improved clinical care. When and how should palliative care be delivered? What is the optimal model for integrated care? What is the biological and clinical effect of living with advanced cancer for years after diagnosis? Successful integration must challenge the dualistic perspective of either the tumour or the host, and instead focus on a merged approach that places the patient's perspective at the centre. To succeed, integration must be anchored by management and policy makers at all levels of health care, followed by adequate resource allocation, a willingness to prioritise goals and needs, and sustained enthusiasm to help generate support for better integration. This integrated model must be reflected in international and national cancer plans, and be followed by developments of new care models, education and research programmes, all of which should be adapted to the specific cultural contexts within which they are situated. Patient-centred care should be an integrated part of oncology care independent of patient prognosis and treatment intention. To achieve this goal it must be based on changes in professional cultures and priorities in health care

Self-assembled nano structures of cationic ester-containing gemini surfactants: The surfactant structure and salt effects

The aggregation behavior of ester-containing cationic gemini surfactants, dodecyl esterquat and dodecyl betainate geminis was investigated using tensiometry, conductometry, viscometry, dynamic light scattering (DLS), transmission electron microscopy (TEM) and optical microscopy techniques in the absence and presence of NaBr electrolyte. The effect of chemical structure (i.e. the presence of ester bond in alkyl chain and the spacer length) on physicochemical properties and morphology of the surfactants was studied. The results showed that the ester-containing gemini surfactants formed spherical aggregates at dilute concentration (1.1 %wt). At higher concentration (∼3.7 %wt) the morphology is different depending on the position of ester bond in alkyl chain and the spacer length. Dodecyl betainate gemini with short spacer (s = 2) formed gel as a result of the formation of worm-like micelles in the aqueous solution. Dodecyl betainate gemini (s = 3) formed large vesicles enclosing smaller ones and dodecyl esterquat gemini (s = 3) formed both short cylindrical and spherical micelles. The salt addition induced the growth of micelles and in the case of dodecyl betainate (s = 2) gemini changed the morphology from worm-like micelles to lamellar phase

Viscosity measurements at high temperatures on a standard reference material supplied by B.C.R

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