Presse Med
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Distress and suffering are words currently used in the medical vocabulary, the first carrying a more acute and dramatic feature, while suffering is more subjective. They may concern the somatic, psychic, social, and spiritual domains, with interactions such as excrutiating and unrelieved pain causing psychological distress. Distress during the end of life is induced by the threatening of an unavoidable death, more or less foreseen by the patient. ⋯ Deep continuous sedation maintained until death may be viewed as a psychic and social euthanasia, ethically questionable, and should be foreseen only in case of intractable distress. A controlled and reversible sedation, when needed, should be preferred, always with the agreement of the patient or his/her proxy. Existential distress by itself should not justify a deep continuous sedation.
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Review Comparative Study
[Metastatic non-small cell lung cancer: Systemic treatment of patients aged 70 and over].
Patients aged 70 and over represent the third of the population of patients with lung cancer. There has been for a long time a certain nihilism regarding the treatment of elderly patients with advanced lung cancer as well from medical doctors but also from families and patients themselves with the false belief of an indolent course of the disease in elderly patients. As a result, clinical trials devoted to elderly patients were quite scarce until the end of the last decade. ⋯ A carboplatin (every 4weeks)+weekly paclitaxel doublet was compared to a vinorelbine or gemcitabine (choice of the center). The survival benefit was of such magnitude that the paradigm of treatment of elderly patients PS 0-2 with advanced NSCLC should be modified in favor of the tested doublet. There should be a reappraisal of the geriatric indexes recommended by the oncogeriatricians regarding their exact prognostic or predictive role.
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Refractory suffering of terminally ill people may be physical (pain, dyspnea, vomiting...) or existential (spiritual sufferings, anxiousness...). End-of-life decisions are often around ethics. ⋯ In France, such decisions are defined by the deontology code and by the law of April 22nd, 2005 concerning the end of life and patients' rights. Recommendations from medical societies specify the means of implementation: obtaining other medical opinions, the patient's informed consent and full transparency of the decision (noted in the patient's medical chart).
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The Union européenne des médecins spécialistes (UEMS) has a mandate to lead the quality of care in Europe and harmonise the qualifications of specialists doctors. In 2000, UEMS has set the European Accreditation Council for Continuing Medical Education (EACCME), with the objective to accredit educational events and facilitate the reciprocity of CME credits obtained by attending international medical conferences. In 2010, UEMS has set the European Accreditation Council for Medical Specialist Qualification (EACMSQ). ⋯ Education must be independent from all influences and recommendations should be set. Countries have mandatory or voluntary CME/CPD systems but it's not a criterium of a better performance. National authorities accredit organisms or events, and that does not make any difference.