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Continuous deep sedation (CDS) is a way to reduce conscious experience of symptoms of severe suffering in terminally ill cancer patients. However, there is wide variation in the frequency of its reported. So we conducted a retrospective analysis to assess the prevalence and features of CDS in our palliative care unit (PCU).
We performed a systemic retrospective analysis of the medical and nursing records of all 1581 cancer patients who died at the PCU at Higashi Sapporo Hospital between April 2005 and August 2011. Continuous deep sedation can only be administered safely and appropriately when a multidisciplinary team is involved in the decision-making process. Prior to administration of CDS, a multidisciplinary team conference (MDTC) was held with respect to all the patients considered for CDS by an attending physician. The main outcome measures were the frequency and characteristics of CDS (patient background, all target symptoms, medications used for sedation, duration, family's satisfaction, and distress). We mailed anonymous questionnaires to bereaved families in August 2011.
Of 1581 deceased patients, 22 (1.39%) had received CDS. Physical exhaustion 8 (36.4%), dyspnea 7 (31.8%), and pain 5 (22.7%) were the most frequently mentioned indications. Continuous deep sedation had a duration of less than 1 week in 17 (77.3%). Six patients (0.38%) did not meet the appropriate criteria for CDS according to the MDTC and so did not receive it. Although bereaved families were generally comfortable with the practice of CDS, some expressed a high level of emotional distress.
Significance of results:
Our results indicate that the prevalence of CDS will be decreased when it is carried out solely for appropriate indications. Continuity of teamwork, good coordination, exchange of information, and communication between the various care providers are essential. A lack of any of these may lead to inadequate assessment, information discrepancies, and unrest.
Kα radiation from low charge chlorine is examined for cold dense plasma diagnostics. A relativistic atomic structure calculation shows that the transition energies of Kα lines are slightly shifted to a higher-energy side according to the degree of M-shell ionization. Total spectral shift from Cl+ Kα lines up to those with a fully stripped M-shell is about 10 eV. With an assumption that collisional-radiative-equilibrium is valid, spectral calculations were carried out for a C2H3Cl-plasma heated by an ion beam, and clear deformation among spectral line-shapes is found in the range of the electron temperatures of ≤~ 30 eV. Contribution to the composite spectra of Kα lines with an excited electron in the outer-shell is also briefly discussed. Cl-Kα lines with M-shell electrons can be expected to give us distinct understandings for energy deposition by an ion beam in cold dense plasma.
In this paper, potential of diagnostics with the use of
Kα radiation for an energy deposition process from an intense
ion-beam to background plasma is considered quantitatively.
Kα radiation is a good candidate for the purpose. The
wavelength of Kα radiation is varied according to the charge
state of an emitter atom, and the diagnostics spatially resolved with
radiations from various kinds of charge states can give us a profile of
plasma temperature in a target material. For the calculation of
Kα yield, an atomic population kinetics code is developed,
and the result shows that Kα radiation has potential to get
information of a plasma profile heated by an intense ion-beam.
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