srijeda, 13.04.2011.
TERMINAL CANCER.
The role of nutritional support as an
adjunct to managing cancer patients, not just those with
incurable disease, has long been a subject of discussion and
opinion. Ten years ago,Casinň Online italiani a review of the status of nutritional
support in cancer patients concluded that with the possible
exception of bone marrow transplantation, no benefit had
been documented for any outcome parameter, including
survival. In 1997 Samuel Klein summarized a conference
sponsored by the National Institutes of Health (NIH) and
two nutrition societies, which concluded that at least shortterm
enteral or parenteral support does not decrease mortality
or complications in cancer patients receiving cancer
therapy; no good trials of long-term support were available
to analyze. The conference further noted that while one
might expect nutritional support to improve quality of life,
no data existed that demonstrated this. Although no trials
have specifically addressed terminal cancer patients there is
consensus that artificial nutrition would not be beneficial.
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četvrtak, 17.03.2011.
What Is Tolerance?
For an addict, drug use becomes an acquired drive state
that permeates all aspects of life. Withdrawal from drug use
activates separate neural pathways that cause withdrawal
events to be perceived as life threatening, and the subsequent
physiological and psychological reactions often lead to renewed
drug consumption. The treatment research consensus
is that time in treatment and/or abstinence is the greatest
predictor of treatment success and may reflect the time
required to reinstate predrug neural homeostasis, fading
of memory of euphoria and conditioned cues, and the
reemergence of endogenous reinforcement for work, friends,
shelter, food, water, and sex.
Drug reinforcement is so powerful that even when it is
eliminated by pharmacological blockade (e.g., naltrexone),
humans quickly identify themselves as opiate available or
unavailable and change their behavior without changing
their attachment to the drug and its effects. Once pharmacological
intervention is discontinued, the addict will often
resume self-administration.
Moods and other mental states, such as drug craving
and anxiety, can become conditioned stimuli that may lead
to drug use. Clinicians have used relaxation training, in
which patients are taught relaxation and breathing techniques,
to use in the presence of drug-related stimuli or the
mental states they would normally associate with the need to
use drugs.
Clearly, relapse prevention and successful treatment of
addiction require much more than the alleviation of withdrawal
symptoms. It is well known that patients with higher
pretreatment levels of social support, employment, and
productivity have a better prognosis for successful response
to initial treatment and long-term abstinence. Treatment
outcomes for these patients may improve because they
perceive the long-term cost of drug use (loss of family or job)
as outweighing the short-term benefit of drug use. Educational
efforts that stress the risks associated with drug abuse
help individuals to avoid drug use. No pharmacological or
nonpharmacological treatment strategy can match the success
of prevention. Research has shown that treatment
efforts and relapse prevention are especially effective in
impaired professionals (i.e., healthcare and other professionals
whose licenses are controlled by state agencies). It appears
as though these individuals have access to necessary inpatient
and residential care to reverse the patterns of this
devastating disease. These programs use a carrot and stick
approach and rely on abstinence verification through objective
urinalysis testing. Lessons from treatment of these
patients can be used to improve the treatment of all patients
with addiction.
The disease model of addiction should not be used to
excuse the addict’s responsibility; abuse has to begin somewhere.
The addict remains culpable for the initial decision to
use the drug and for continuing to use it despite adverse
consequences. Nevertheless, an understanding of addiction
and the addiction process allows us to comprehend the
existence of addiction as well as why abstinence in treatment
is difficult to achieve.
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