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Cancer patients often suffer from refractory symptoms near death. The use of sedatives aims to relieve suffering caused by these symptoms. The practice varies broadly. The aim of this study was to evaluate the role and trends of midazolam use in cancer patients dying in a university hospital oncology ward.
Methods
The study population of this retrospective registry-based study consists of patients who died in a university hospital oncology ward in Eastern Finland in 2010–2018 (n = 639). Information about treatment decisions, midazolam use, and background factors were gathered.
Results
During the study period, 14.7 % of the patients dying in the ward received midazolam with sedative intent prior to death. 4.7 % (n = 30) of the whole study population had continuous infusion and the rest of the midazolam use was one or multiple single doses. Documented discussion of possible palliative sedation (PS) use was found in almost one third of all patients. Out of those, eventually receiving midazolam with sedative intent, two thirds had had this discussion. The most common symptoms leading to midazolam were dyspnea, pain, and delirium. In continuous use the median midazolam infusion rate was 4.0 mg/h. The continuous infusion started median of 23.25 h and multiple single doses 19 h before death. If only one dose of midazolam was needed, it was given median of 30 minutes prior to death and the most common symptom was dyspnea. Those who received midazolam were more likely to be younger (p = 0.003) and had had a palliative outpatient clinic visit (p = 0.045).
Significance of results
This is the first study to report the trends and practices of midazolam use for refractory symptoms in Finland. Midazolam was used for approximately every 7th dying cancer patient. Applying midazolam was supported by a history of palliative clinic visits and younger age.
This review continues the series published in previous issues of the African Studies Bulletin and which among them supplement the fourth edition of the writer's Guide to South African Reference Books (Balkema, 1965). Works published in 1965 which reached the writer too late for inclusion in the 1965 survey are also noted. Prices, where available, are given in South African rands (R1 = 1.4 U.S. dollars).
A major new atlas has been produced by the Government's Department of Planning. This Development Atlas (Government Printer, 1966, R14-90for binder and parts published to date) is loose-leaf in form and is issued in sections. Complemented by a brief but factual text, it covers such topics as physical features, administration, water resources, minerals, and mines.
The final two parts of the Africa Maps and Statistics (Africa Institute, 1962-1965) were issued in 1965. These were No. 9: Trade, Income and Aid; and No. 10: Political Development. The original plan was to publish 12 parts, but the series has been completed in 10. This publication, in loose-leaf form, will be revised in the future.
(The following article on the forthcoming First International Congress of Africanists is reprinted from theBulletin of the Academy of Sciences of the USSR, No. 2, 1962, pp. 88-9. Previous accounts of planning for the Congress, by Conrad Reining and William O. Jones, may be found in this Bulletin, October I960 and December 1961.)
African Studies until very recent times were developed as a part of Oriental Studies. To some extent this is explained by the fact that the northern, most developed areas of Africa are populated by Arabic-speaking peoples, and there are not a few reasons for regarding them in historical, cultural, and political aspects as part of the general Arab world. Northern Africa was usually included in the rather vague concept of “the Orient,” and then, this time without any reason for it, the whole continent began to be included in “the Orient.”
But the main reason for including African Studies in Oriental Studies is that the study of the countries of Asia and Africa was pursued primarily by the scientists of the colonial powers, and inasmuch as their work fundamentally served the aims of ruling enslaved countries in the interests of imperialist monopolies, both the great continents were regarded as one single colonial complex.
Scientific research of African societies and cultures in Czechoslovakia has developed only in the last two decades. Nevertheless, to precede the research there was a relatively extensive background shaped by the tradition of travelers whose interest was centered especially on geography, biology, and descriptive and collective ethnography. The most important of these travelers were Dr. Emil Holub (1847-1902), who crossed South Africa as far as the Zambezi River and published several books, most of which are now available in English, about his experiences; Remedius Prutký, a missionary who visited Ethiopia in 1751-1753 and not only described his travels but even compiled a vocabulary of the Amharic language; and Dr. Stecker and Čeněk Paclt, who traveled in the nineteenth century through Ethiopia and South Africa, respectively. In the twentieth century there was a considerable number of Czechoslovak travelers who acquainted their compatriots with the “Dark Continent.”
Before World War II, three professor of Semitology at Charles University, Prague -- R. Dvořák, R. Ru̇žička, and A. Musil -- started to study Ethiopian languages and history. The well-known Austrian scholar of Czech origin, Dr. Pavel Šebesta (Schebesta) became one of the best specialists in the anthropology and ethnography of the Pygmies.