Ensuring competency in end-of-life care: controlling symptoms

BACKGROUND: Palliative medicine is assuming an increasingly important role in patient care. The Education for Physicians in End-of-life Care (EPEC) Project is an ambitious program to increase core palliative care skills for all physicians. It is not intended to transmit specialty level competencies in palliative care. METHOD: The EPEC Curriculum was developed to be a comprehensive syllabus including trainer notes, multiple approaches to teaching the material, slides, and videos of clinical encounters to trigger discussion are provided. The content was developed through a combination of expert opinion, participant feedback and selected literature review. Content development was guided by the goal of teaching core competencies not included in the training of generalist and non-palliative medicine specialist physicians. RESULTS: Whole patient assessment forms the basis for good symptom control. Approaches to the medical management of pain, depression, anxiety, breathlessness (dyspnea), nausea/vomiting, constipation, fatigue/weakness and the symptoms common during the last hours of life are described. CONCLUSION: While some physicians will have specialist palliative care services upon which to call, most in the world will need to provide the initial approaches to symptom control at the end-of-life

Effect of natural pigments on the oxidative stability of sausages stored under refrigeration

The objective was to use natural pigments to replace sodium erythorbate (NaEry), a synthetic compound used as an antioxidant in sausage formulations, and to evaluate the oxidative stability of the samples. Six assays were prepared in which sodium erythorbate (ERY) at 0.05 g/100 g was substituted by norbixin (NOR), lycopene (LYC), zeaxanthin (ZEA), beta-carotene (CAR) or dextrose (used as a control (CON)). Physical, chemical, color, texture and sensory parameters were measured on the first day and after 45 days of storage at 4 degrees C. All pigments used in the sausage formulations were able to maintain the oxidative stability of the sausages (MDA equivalents \u3c0.38 mg/kg). Zeaxanthin and norbixin were the most efficient antioxidants of those tested. This antioxidant effect might be associated with the intermediate polarities of these two compounds, which would allow them to concentrate in the membrane lipids or emulsion interface, where lipid oxidation is most prevalent. Other volatile secondary products of oxidation besides MDA should be evaluated in further studies involving natural pigments and sensory oxidative stability

Protein requirement of Japanese quail (Coturnix coturnix japonica) during rearing and laying periods

Two completely randomized trials were conducted to estimate protein requirements of Japanese quails during the rearing and laying periods. In each trial, 150 quails were distributed in five treatments with five repetitions. Crude protein levels in the rearing period were 18, 20, 22, 24 and 26% (Trial 1) and during the laying period were 16, 18, 20, 22 and 24% (Trial 2). A quadratic effect of protein level was observed on weight gain from seven to 35 days (Trial 1). There were no effects of protein levels on feed intake and feed conversion. Protein levels in experimental diets during rearing had no effect on egg production up to 63 days. However, laying was delayed and variation in body weight was greater in quails fed lower protein levels. In Trial 2, a quadratic effect of protein levels was seen on egg production and feed conversion; and a linear effect was seen on mean egg weight and feed intake. Crude protein levels of 23.08% and 21.95% were estimated by regression equations for rearing and laying, respectively

Preparation and thermal decomposition of solid state lanthanide(III) and yttrium(III) chelates of ethylenediaminetetraacetic acid

Solid state chelates of general formula H[Ln(EDTA)] · nH2O (Ln = trivalent lanthanide (except for promethium) or yttrium; EDTA = ethylenediaminetetraacetate) were prepared. Thermogravimetry, differential thermal analysis. X-ray diffraction and complexometry were used to characterize and study the thermal stability and thermal decomposition of these compounds. © 1993