RESUMO
Whether a terminally ill cancer patient should be actively fed or simply hydrated through subcutaneous or intravenous infusion of isotonic fluids is a matter of ongoing controversy among clinicians involved in the care of these patients. Under the auspices of the European Association for Palliative Care, a committee of experts developed guidelines to help clinicians make a reasonable decision on what type of nutritional support should be provided on a case-by-case basis. It was acknowledged that part of the controversy related to the definition of the terminal cancer patient, since this is a heterogeneous group of patients with different needs, expectations, and potential for a medical intervention. A major difficulty is the prediction of life expectancy and the patient's likely response to vigorous nutritional support. In an attempt to reach a decision on the type of treatment support (artificial nutrition vs. hydration) which would best meet the needs and expectations of the patient, we propose a three-step process: Step 1: define the eight key elements necessary to reach a decision; Step II: make the decision; and Step III: reevaluate the patient and the proposed treatment at specified intervals. Step I involves assessing the patient concerning the following: 1) oncological/clinical condition; 2) symptoms; 3) expected length of survival; 4) hydration and nutritional status; 5) spontaneous or voluntary nutrient intake; 6) psychological profile; 7) gut function and potential route of administration; and 8) need for special services based on type of nutritional support prescribed. Step II involves the overall assessment of pros and cons, based on information determined in Step I, in order to reach an appropriate decision based on a well-defined end point (i.e., improvement of quality of life; maintaining patient survival; attaining rehydration). Step III involves the periodic reevaluation of the decision made in Step II based on the proposed goal and the attained result.
Assuntos
Hidratação , Neoplasias/terapia , Apoio Nutricional , Assistência Terminal , Humanos , Intestinos/fisiopatologia , Neoplasias/fisiopatologia , Estado Nutricional , Assistência Terminal/psicologia , Fatores de TempoAssuntos
Ética , Saúde Pública , Síndrome da Imunodeficiência Adquirida/diagnóstico , Humanos , VacinaçãoRESUMO
The influence of food on the bioavailability of a conventional tablet and of a slow-release capsule of diltiazem was investigated in two separate groups of 24 healthy volunteers in two open crossover studies. Diltiazem, as a conventional tablet (2 x 30 mg, first group) or as a slow-release capsule (120 mg SR, second group), was administered in a fasting condition and 30 min after a breakfast of 784 kcal (23 per cent proteins, 55 per cent lipids, and 22 per cent of carbohydrates). Multiple blood samples were withdrawn during the next 24 h and diltiazem, desmethyldiltiazem, and deacetyldiltiazem were assayed by HPLC. Neither the rate of absorption, assessed by the rate constant of absorption, the peak plasma concentration, and the time required to reach the peak, nor the amount of drug reaching the systemic circulation, assessed by the area under the plasma concentration time curve (AUC infinity) were influenced by food, and that independently of the formulation. Compared to the fasting experiment, food did not affect either the rate of formation or the AUC infinity of desmethyldiltiazem or deacetyldiltiazem. The results of the present study show that the relative bioavailability of the single dose of diltiazem administered as a slow-release capsule is significantly higher (69 per cent) than that estimated after the administration of diltiazem in a conventional tablet. It was concluded that food does not influence the bioavailability of diltiazem administered as a conventional tablet or as a slow-release formulation.
Assuntos
Diltiazem/farmacocinética , Administração Oral , Adolescente , Adulto , Disponibilidade Biológica , Preparações de Ação Retardada , Diltiazem/administração & dosagem , Diltiazem/análogos & derivados , Diltiazem/sangue , Diltiazem/metabolismo , Esquema de Medicação , Alimentos , Humanos , Masculino , Pessoa de Meia-IdadeAssuntos
Etanol/sangue , Fatores Etários , Intoxicação Alcoólica/sangue , Intoxicação Alcoólica/mortalidade , Autopsia/estatística & dados numéricos , Causas de Morte , França , Homicídio/estatística & dados numéricos , Humanos , Estudos Retrospectivos , Fatores Sexuais , Suicídio/estatística & dados numéricosAssuntos
Intoxicação Alcoólica , Medicina Legal , Acidentes de Trânsito/legislação & jurisprudência , Acidentes de Trânsito/estatística & dados numéricos , Intoxicação Alcoólica/sangue , Intoxicação Alcoólica/epidemiologia , Condução de Veículo/legislação & jurisprudência , Condução de Veículo/estatística & dados numéricos , Etanol/sangue , Medicina Legal/estatística & dados numéricos , França/epidemiologia , Humanos , Fatores SocioeconômicosAssuntos
Sepultamento/métodos , Mudanças Depois da Morte , Animais , Líquidos Corporais/química , Gases , SuínosAssuntos
Sepultamento/métodos , Poluição Ambiental , Mudanças Depois da Morte , Animais , Líquidos Corporais , Gases , Patologia , SuínosAssuntos
Fascículo Atrioventricular/patologia , Morte Súbita/etiologia , Sistema de Condução Cardíaco/patologia , Prolapso da Valva Mitral/patologia , Adulto , Idoso , Cardiomiopatias/patologia , Morte Súbita/patologia , Feminino , Cardiopatias/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Prolapso da Valva Mitral/complicaçõesRESUMO
There are many interactions between alcohol and drugs. Their practical incidences have already had some medico-legal illustrations, for example in their influence on car driving. This concept of interaction raises a more general problem still, ie that of the possible effects of alcohol on the chemical, toxicologic and nutritional conditions of the body. There is plenty of need for further experiments.