End-of-life care in a COPD patient awaiting lung transplantation: a case report

COPD is nowadays the main indication for lung transplantation. In appropriately selected patients with end stage COPD, lung transplantation may improve quality of life and prognosis of survival. However, patients with end stage COPD may die while waiting for lung transplantation. Palliative care is important to address the needs of patients with end stage COPD. This case report shows that in a patient with end stage COPD listed for lung transplantation offering palliative care and curative-restorative care concurrently may be problematic. If the requirements to remain a transplantation candidate need to be met, the possibilities for palliative care may be limited. Discussing the possibilities of palliative care and the patient's treatment preferences is necessary to prevent that end-of-life care needs of COPD patients dying while listed for lung transplantation are not optimally addressed. The patient's end-of-life care preferences may ask for a clear distinction between the period in which palliative and curative-restorative care are offered concurrently and the end-of-life care period. This may be necessary to allow a patient to spend the last stage of life according to his or her wishes, even when this implicates that lung transplantation is not possible anymore and the patient will die because of end stage COPD

Dynamic postural stability differences between male and female players with and without ankle sprain

Objectives: To evaluate dynamic stability index (DSI) differences between males and females for different jump directions. To examine both preseason DSI differences between players with and without a history of ankle sprain, and between players with and without an ankle sprain during the subsequent season. Design: Prospective cohort design. Setting: Laboratory. Participants: 47 male (22.9 +/- 3.9 y) and 19 female (21.5 +/- 2.9 y) sub-elite and elite team sport players. Main outcome measures: Ankle sprain history was collected using an injury history questionnaire. DSI of a single-leg hop-stabilization task measured preseason was collected using force plates and calculated using a Matlab program. Ankle sprains were reported during the subsequent season. Results: Male players demonstrated larger DSI than female players on forward medial/lateral stability index (MLSI) and vertical stability index (VSI), diagonal VSI, and lateral anterior/posterior stability index (APSI) and VSI. Forward, diagonal and lateral dynamic postural stability indices (DPSI) were larger for males (p <0.001). No significant differences were found between players with and without a previous ankle sprain nor between players with and without an ankle sprain during the subsequent season. Conclusion: Male players showed larger DSI scores than female players, indicating lower dynamic stability. Sex-specific training sessions or prevention programs should be developed. (C) 2015 Elsevier Ltd. All rights reserved