Palliative radiotherapy: history, recent advances, and future directions.

Radiotherapy has been used to palliate cancer symptoms since shortly after the time that X rays were discovered late in the 1800's. The 20th century witnessed improvements in treatment planning and delivery that permitted radiotherapy to serve as a successful, timely, and cost-efficient palliative intervention. Palliative radiation oncology has risen to the level of its own subspecialty, as evidenced by the formation of palliative radiation oncology clinical services and dedicated palliative radiotherapy guidelines, while additional changes have begun to alter the very definition and goals of palliative radiotherapy. Local treatment may now be offered with dual goals of symptom relief and the potential for increased disease-free or overall survival. While these new directions show great promise, novel strategies must be formulated to manage the increased complexity, workload, and cost of these approaches.

CE: Nursing's Evolving Role in Patient Safety.

: Background: In its 1999 report To Err Is Human: Building a Safer Health System, the Institute of Medicine (IOM) suggested that between 44,000 and 98,000 Americans die annually as a result of medical errors. The report urged health care institutions to break the silence surrounding such errors and to implement changes that would promote a culture of safety. OBJECTIVE: Our aim in conducting this content analysis of AJN articles was to explore the nurse's historical and contemporary role in promoting patient safety. We chose to focus on AJN because, as the oldest continuously published nursing journal, it provided a unique opportunity for us to view trends in nursing practice over more than 100 years. METHODS: We reviewed all AJN tables of contents from 1900 through 2015, identifying for inclusion articles with titles that suggested a focus on nursing care, patient safety, or clinical content. We then read and analyzed each of the final 1,086 articles over a period of nine months. FINDINGS: Our content analysis indicates that the early articles (from 1900 through 1920) focused on such safety measures as asepsis and the newly understood germ theory. In the 1930s, articles proposed methods for preventing medication errors and encouraged the development of written procedures to standardize care. During World War II, nurse authors identified improved patient survival rates with the use of "shock wards" and recovery rooms. The 1950s saw the emergence of progressive patient care initiatives, through which patients were assigned to various levels of care (intensive, intermediate, self, long-term, or home care) based on patient acuity. The 1960s brought increasingly complex equipment and medication regimens, which created safety problems. Hospital-acquired infections were recognized. Unit-dose medication was instituted in the 1970s. In the next two decades, medication and nursing-procedure safety were emphasized. From 2000 to 2015, articles looked beyond human performance as causes of health care errors to systemic factors, such as poor communication, patient-nurse ratios, provider skill mix, disruptive or inappropriate provider behavior, shift work, and long working hours. CONCLUSIONS: Emphasis on patient safety increased as patient care became more complex. As nurses developed a professional identity, they often put a spotlight on safety concerns and solutions. The IOM report, which encouraged research focused on systemic solutions to errors, was instrumental in furthering the very culture of safety that the nursing profession had championed.

Proceso de atención de enfermería / The process of nursing care

La autora expone su reflexión sobre las dificultades que plantea la implementación del Proceso de Atención de Enfermería (P.A.E.) a nivel formativo y del ejercicio profesional. Subraya la necesidad y la importancia de crear núcleos de trabajo para la revisión, adaptación y aplicación del P.A.E

A short history of therapist-driven respiratory care protocols.

The literature of the TDP movement continues to grow, but a legitimate concern regarding mindless acceptance of the new paradigm is now being voiced. As this issue goes to press, it appears clear to this writer that the orderly growth of the TDP paradigm has led to its widespread acceptance. The future will determine whether our early predictions of its success are well founded.

Introducing physicians to case management in psychiatry.

All physicians sooner or later find themselves in contact with a case manager whose job is to help the noninstitutionalized psychiatric patient who is chronically ill. This paper is an attempt to orient the physician about this phase of treatment which started not many years ago. The article gives a short history of the development of case management and demonstrates the various steps the case manager takes in working with a patient. These are, assessment of the problems, plans to meet the problems, linkage with agencies, monitoring the progress, advocacy, and evaluation. These activities may bring about improvement in the kind of patient frequently considered hopeless.

[25 years of curative cancer-therapy stagnation--a change in a sight?]. / 25 Jahre Stagnation der kurativen Krebstherapie--Eine Wende in Sicht?

Two measures are urgently needed to improve curative therapy results in cancer treatment. 1. Improvements in the early recognition of specific types of tumor and in appropriate modes of preventitive treatment.--2. The introduction of a metastasis prophylaxis before each diagnostic and therapeutic operation for cancer; several possibilities are proposed. The stagnation of cancer therapy results can only be overcome by an alteration in the current concept of treatment, which in cases of early cancer is as yet directed exclusively at the primary tumor.