End-stage head and neck cancer: coping mechanism

Coping mechanisms are patients’ means of adapting to stressful situations and involve psychological and physical changes in behavior. Patients adapt to head and neck cancer in a variety of ways. Head and neck cancers are extremely debilitating, especially in advanced stages of the disease or in end-of-life situations. While an oncology team needs to address the needs of all oncology patients, the advanced terminal patients require special attention. Most of these patients do not cope well with their situation and have a tendency to cease social interactions. Pain is the most frequentlyexperienced medical disability in patients having an end-stage illness experience, and thus an important medical endeavor is to afford dignity to the dying patient facingan incurable disease. In such cases, the medical community should never refuse therapy or to assist a dying patient.In some instances, the patient and family may derive benefit from their religious beliefs

TRANSFER PRICE REGULATIONS BETWEEN THEORY AND PRACTICE

In the actual economical context, the transfer prices are a major preoccupation for both multinationals and fiscal authorities. Because nowadays almost 60% from the world wide commerce is represented by transactions between multinationals, the national fiscal authorities are very careful when taking into account the tax levels paid by these companies in each jurisdiction the scope being avoiding the artificial profit transfer though transactions between affiliated persons. National fiscal authorities are trying to make sure that companies are respecting in intra-group transactions the Arm’s Length Principle as defined by OECD. In this context, the multinationals have to prove that the transfer prices used in transactions are reflecting the market prices. From the taxpayer point of view the transfer prices are a major preoccupation for multinationals both for avoiding fiscal risks (double taxation risk) and for fiscal planning (in order to avoid a fiscal adjustment for prices used in transactions). In the present paper we will present the importance of establishing the transfer prices according to the pure competition principle, methods for establishing the transfer prices and the European Union tendencies regarding the transfer pricesArm’s length Principle, cross-border transactions, multinational companies, transfer prices.

Differences Between Men and Women with Total Laryngectomy

The larynx is one of the organs that is usually involved in the tumor growth in the head and neck region and it is the second site of malignant neoplasia of the respiratory tract after the lungs. It is a well-known fact that larynx cancer is more often present in male population, with a ratio of 3:1 male/female because of the higher rate of tobacco and alcohol use. The issues related to total laryngectomy are the loss of voice, swallowing rehabilitation, reeducation of breathing through the tracheostomy, psychological alterations and social pressure. Women tend to be more affected by the presence of the tracheostomy, since general physical aspect is a major concern for modern women. Also, the emotional status of women is a plays a major role for the adherence to the therapy plan. The response to total laryngectomy by men and women is similar with slight differences in physical aspect and social reinsertion

Assessing Labour Migration Policies From the Incorporation Perspective. The Case of Romania

Migrants play an important role in shaping today’s EU, both in terms of the labour market, and society as a whole. The analyses of the migration policies, including the labour sector, are generally focused on the control and, respectively, on the security dimension, while a third branch includes the researches on the broader term of incorporation of migrants into the fabric of the host societies. This paper starts from the questions “why does the EU labour market need migrants?” and “what role can migrants play in community development?”, and it argues that using an incorporation approach in public policies concerning migrants could provide a theoretical and actional solution to overcome challenges posed by various other policy and political positions aimed against migrants. An assessment of labour-connected incorporation policies and practices is presented as a study case, using evidence-based policies and practices from Romania. The main findings of the paper indicate that there is a huge gap between stated aims of written strategies, actions being implemented and the perception of intended target groups. The article argues that this deviation is due, at least in the case of Romania, to a weak administrative capacity to manage migrant flows and the challenges they bring to traditional and rigid legal and administrative systems. The gap is also due to poor operationalisation of the concept of incorporation in policy practice, with contradictory simultaneously policy narratives of adaptation, assimilation, inclusion, or integration, and without a clear goal that should shape a national labour migration policy

Positive surgical margins in nephron-sparing surgery; the great unknown

There is a currently a general trend towards organ-preserving surgery, and urology is no exception. Specifically, nephron-sparing surgery (NSS) has gained general acceptance for T1a renal cell carcinoma (guidelines recommendations). Moreover T1b, T2 and even T3 stage tumors have been included on the nephron sparing list at some centers. An unresolved issue is that of positive surgical margins (PSM), not only their detection but also the implications for follow up and treatment. This paper highlights data available on risk factors for PSM, their clinical relevance, and possible therapeutic consequences. From the surgeon’s viewpoint, NSS is a daring and risky surgical procedure. Urological guidelines stress the importance of NSS, and thus the trend is moving in that direction. Unresolved, however, is the problem of PSM. Trifecta, MIC, and pentafecta are applicable concepts which attempt to define the optimal endpoint of NSS, but further elaboration is necessary. Specifically, research needs to focus less on the concept of definitive margins and more on their identification and avoidance. Although some studies suggest that PSMs do not influence overall survival rate, the basic idea of preserving tissue that is not cancerous leads to further medical, social, and psychological considerations

Alcohol Withdrawal – Therapeutical Management in Surgical Patients with Upper Intestinal Bleeding

Psychological dependence involves a desire to use a drug to avoid the unpleasant withdrawal syndrome that results from cessation of exposure to it. Alcohol withdrawal syndrome is one of the most feared complications of alcohol addiction and sometimes can be fatal if not treated properly. Withdrawal syndrome is characterized by neurological hyperexcitability, which can lead to severe psychological and neurological symptoms. A survey was conceived in order to monitor the efficiency of several drug associations (Clonidine, Midazolam, IV ethanol), which were administered at the beginning of intensive therapy admission of achohol addicts. By comparing the postoperative evolution parameters and complications incidences for these patients (such as the hospitalization duration in AIT department, the tracheobronchitis incidence, complications as sepsis, pneumonia and cardiac complications), we managed to determine which treatment is the most beneficial for these cases. Benzodiazepines are frequently used for pharmacological therapy of alcohol addicted patients. In our study Midazolam was very efficient, compared to other therapies. When administered for a maximum of 7 days, the inccidence of side effects remains minimal

Considerations on the Psychological Status of the Patients Undergoing Radical Cystectomy

The psychological impact on patients suffering radical cystectomy is twofold - (both that of the underlying neoplastic disease and that measured by the quality of life subsequent to surgery) and increases as the urinary derivation technique is less physiological and affects more the local anatomy. Although there are numerous questionnaires that assess the quality of life of patients with cancer (HRQoL - health related QoL), not many probe bladder cancer morbidity or correlate the different types of urinary diversions’ impact on QoL (quality of life). We analyzed 39 cases in our clinic who underwent radical cystectomy between August 2013 and August 2014. Different diversions were performed, as follows: for 24 patients a cutaneous ureterostomy was performed, in 10 cases a Mainz II pouch, in 3 cases a Bricker derivation and in 2 patients a Studer neobladder was performed. In these patients, QoL - Cancer Version and FACT-BL questionnaires were administered and were followed for an initial period of 2 years. According to our survey, the Bricker derivation is best tolerated, followed by neobladder and the Mainz II pouch

Assessment of country institutional factor on sustainable energy target achievement in European Union

national institutional frameworks designed to ensure higher energy efficiency and the distance to the achievement of the EU Commission targets in terms of energy consumption, using a panel of 21 EU member states. Through panel unit root tests and an estimated VAR model, our results reveal that the quality of a nation’s institutional and economic energy efficiency framework does not significantly influence the gap between annual energy consumption and related EU targets, as prescribed by the energy efficiency EU Directives. However, the results show a bi-directional causality relationship suggests that the nation’s institutional framework on energy efficiency should be improved. According to the impulse response function, this relationship is more related to a short-run perspective. Hence, a strong correlation exists between the level of achieving the reduction targets on energy consumption and the level of gas emissions. Our findings further reveal that the level of reported GHCs significantly influences national regulations and strategies for gas emission reductions. This research highlights the importance of each EU member state creating an appropriate legislative and institutional framework that promotes energy efficienc