Prevalence and determinants of end-of-life chemotherapy use in patients with metastatic breast cancer.

Cessation of chemotherapy in the last few weeks of life could be an important quality-of-care benchmark. Proportion of metastatic breast cancer patients who receive end-of-life chemotherapy is not well described. We aimed to determine the prevalence and determinants of end-of-life chemotherapy use in patients with metastatic breast cancer. A retrospective cohort study using a prospectively collated database of patients with metastatic breast cancer who died between January 1, 2010, and September 30, 2014, was conducted. End-of-life chemotherapy (EOLC) use was defined as receipt of chemotherapy within 2 weeks of death (EOLC2) and receipt of chemotherapy within 4 weeks of death (EOLC4). Patients who did not receive any chemotherapy in the last 4 weeks before death were categorized as non-EOLC. We identified 274 patients with metastatic breast cancer, of whom 28 received EOLC2 (10.2%) and 62 received EOLC4 (22.6%). In comparison with non-EOLC, patients receiving EOLC4 were younger and had greater disease burden. Patients in EOLC4 group received more number of lines of chemotherapy. In a multivariable analysis, younger age at metastatic disease and greater number of metastatic organ systems involved were predictors of end-of-life chemotherapy use. Prevalence of the use of end-of-life chemotherapy in our cohort was higher than previously described. More end-of-life chemotherapy was used in younger women, and those with greater disease burden. Earlier initiation of end-of-life discussions may be targeted to such patients.

Odontogenic maxillofacial space infections at a tertiary care center in North India: a five-year retrospective study.

OBJECTIVE: Odontogenic infections contribute to a significant proportion of maxillofacial space infections (MSI) across the world. MSI can cause several life-threatening complications despite skillful management. The objective of this study was to review the clinical characteristics, management, and outcome of odontogenic MSI treated at a tertiary care center, and to identify the factors predisposing to life-threatening complications. METHODS: A retrospective chart review of all patients treated for MSI from January 2006 to December 2010 at the Christian Medical College Hospital in Ludhiana, North India, was conducted. RESULTS: Out of 137 patients identified, 66.4% were men. Mean patient age was 40 years, and 24.1% of the patients were diabetic. The most common origin was pulpal (70.8%), the most common space involved was the submandibular space, and the most common teeth responsible were the lower third molars. Twenty patients (14.6%) developed complications. Diabetes, multiple space involvement, and a total leukocyte count of ≥15×10(9)/l were associated with complications. CONCLUSIONS: Patients with MSI who present with multiple space involvement, a high leukocyte count, and those with diabetes are at higher risk of developing life-threatening complications and need to be closely monitored.

The effect of community based daycare on mental health and quality of life of elderly in rural south India: a community intervention study.

BACKGROUND: Sustainable cost-effective interventions to improve psychiatric morbidity and quality of life among the elderly have not been systematically evaluated in developing countries. METHOD: The most vulnerable elderly living in Pennathur, Vellore district, India, in terms of socioeconomic status and social supports, were invited to participate in a day-care program. Baseline assessments were done using the Mini Mental Status Examination, the Revised Clinical Interview Schedule and the World Health Organisation Quality of Life- Bref. Follow-up assessment was done at 3 months on subjects who took part and those who refused. RESULTS AND CONCLUSIONS: Forty-one (16.4%) were invited to take part. Twenty subjects took part in the program while 21 refused. There was a significant reduction in psychiatric morbidity and improvement in quality of life scores at 3 months for subjects who attended the program. The improvement in quality of life persisted after adjusting for gender, socioeconomic status and baseline scores. Costing of the program suggests sustainability.

A community health programme in rural Tamil Nadu, India: the need for gender justice for women.

This article highlights the efforts of the Community Health and Development (CHAD) Programme of Christian Medical College to address the issues of gender discrimination and improve the status of women in the Kaniyambadi Block, Vellore, Tamil Nadu, India. The many schemes that are specifically for women and general projects for the community from which women can also benefit represent a multi-pronged approach whose aim is the improvement of women's health, education and employment in the context of community development. However, despite five decades of work with a clear bias in favour of women, the improvement in health and the empowerment of women has lagged behind that achieved by men. We believe this is because the community, with its strong male bias, utilises the health facilities and education and employment programmes more for the benefit of men and boys than women and girls. The article argues for a change of approach, in which gender and women's issues are openly discussed and debated with the community. It would appear that nothing short of social change will bring about an improvement in the health of women and a semblance of gender equality in the region.