Massimo Costantini, I've been reading that name all over the place...Why do so many of these, by now, familiar, names of palliative care researchers crop up together time and again, Eldoel? And so often in the same context?
Thankyou for that, Harlow Blogger. I
do apologise for not responding to comments on this blog. I make no excuses,
although there are many, for it is inexcusable. I will make amends.
Yes, Massimo Costantini...
A study, started in Italy
The majority of doctors may not be aware that , regrettably the lcp is not backed by the gold standard of evidence of an rct. Perhaps the climate is right for an rct of the lcp vs usual care. A similar study has been started in Italy (4).
4)Costantini et al; The effectiveness of the Liverpool care pathway in improving end of life care for dying cancer patients in hospital. A cluster randomised trial.BMC Health Services Research 2011, 11:13 doi:10.1186/1472-6963-11-13
Domnik Felix D'Costa, consultant physician
royal wolverhampton hospitals, wv10 0qp
This appears to refer to this study -
A service of the U.S. National Institutes of Health
The Effectiveness of the LCP in Improving End of Life Care for Dying Cancer Patients in Hospital.
This study is ongoing, but not recruiting participants.
Sponsor:
Regional Palliative Care Network
Information provided by (Responsible Party):
Regional Palliative Care Network
Purpose
The purpose of this study is to evaluate the effectiveness of the LCP-I Program in improving the quality of end-of-life care provided to cancer patients who die on hospital medical wards as compared to standard healthcare practices.
Please refer to this study by its ClinicalTrials.gov identifier: NCT01081899
Locations
| Italy | |
| National Cancer Research Institute | |
| Genoa, Italy, 16132 | |
Sponsors and Collaborators
Regional Palliative Care Network
Investigators
| Principal Investigator: | Massimo Costantini, MD |
More Information
No publications provided by Regional Palliative Care Network
Additional publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
| Responsible Party: | Regional Palliative Care Network |
| ClinicalTrials.gov Identifier: | NCT01081899 History of Changes |
| Other Study ID Numbers: | RFPS-2006-6-341619 |
| Study First Received: | March 4, 2010 |
| Last Updated: | November 11, 2011 |
| Health Authority: | Italy: Ministry of Health |
ClinicalTrials.gov processed this record on November 25, 2012
Under More Information, it is stated, "No publications provided by Regional Palliative Care Network".
Your post, here, is relevant, Harlow Blogger -
Liverpool Care Pathway – Anonymous Voices And The Silence Of The Lambs
The effectiveness of the Liverpool care pathway in improving end of life care for dying cancer patients in hospital. A cluster randomised trial
Massimo Costantini,
1 Simona Ottonelli,1 Laura Canavacci,2 Fabio Pellegrini,3,4 and Monica Beccaro1, the LCP Randomised Italian Cluster Trial Study Group massimo.costantini@istge.it
1 Simona Ottonelli,1 Laura Canavacci,2 Fabio Pellegrini,3,4 and Monica Beccaro1, the LCP Randomised Italian Cluster Trial Study Group massimo.costantini@istge.itReferences
- EAPC. Atlas of Palliative Care in Europe. European Association for Palliative Care: IAHPC Press; Milano; 2007.
- Higginson IJ, Sen-Gupta GJA. Place of care in advanced cancer: a qualitative systematic literature review of patients preferences. J Palliat Med. 2000;3:287–300. doi: 10.1089/jpm.2000.3.287. [PubMed] [Cross Ref]
- Beccaro M, Costantini M, Giorgi Rossi P, Miccinesi G, Grimaldi M, Bruzzi P. ISDOC Study Group. Actual and preferred place of death of cancer patients. Results from the Italian Survey of the Dying of Cancer. J Epidemiol Comm Health. 2006;60:412–416. doi: 10.1136/jech.2005.043646. [Cross Ref]
- Davies E, Higginson IJ. Palliative care: the Solid Facts. WHO Regional Office for Europe, Copenhagen; 2004.
Professor Massimo Costantini is involved in advisory and
collaborative capacities in palliative care in a number of bodies and that may
be why these, by now, familiar, names of palliative
care researchers crop up together time and again.
In their role in advising and collaborating, I
would imagine they may participate in numerous different studies in their
field. If these studies are then cited as a point of reference in other studies
in which they have been involved, then they are, effectively, citing themselves
to provide authority to their own study. That is corrupt and nullifies the
work.
It may not be obvious that this is the case. It may be that the
work or opinion of another body is cited. If, however, members of the
particular research team are members of this cited body, again, they are,
effectively, citing themselves to provide authority to their own study. That is
corrupt and nullifies the work.(NICE, DOH, Marie Curie, all cite each other and others in like manner).
This is, regrettably not an uncommon practice. The
well-documented medical controversy between ILADS and the corrupt practices
of IDSA are well documented on the net. (See - Dr.
Jemsek's license suspended because he adhered to the ILADS guidelines and the antitrust investigation by
the Connecticut Attorney General).
Various organisations are cited to substantiate
the IDSA guidelines, namely the CDC, ALDF and EUCALB - when those very
organisations actually hold no independent viewpoint at all but merely voice
and duplicate that of the IDSA Lyme disease panel. Different organisations are
cited to give the appearance of wider and more authoritative backing from
different, independent sources when the membership of these organisations
actually contains the very same people amongst their number and, therefore,
disqualifies them as an independent source.
There is no corroborating evidence from varying
authoritative points of reference, therefore, to support the view promulgated
by IDSA; there is, in fact, only one point of reference – the guidelines as set
out by the IDSA Lyme disease panel, which is currently under investigation for
GROSS conflicts of interest!
Mark Klempner, an IDSA Lyme disease Practice Guideline author,
is also an associate editor for the New England
Journal of Medicine. The New England
Medical Journal plum-picked those articles which supported his viewpoints and
excluded from publication those that did not. (Curiously, the Advancing
Quality Alliance (AQuA) page (mentioned on this Blog)
actually sports a link to the New
England
Returning to Professor Massimo Costantini -
He is involved in advisory and collaborative capacities in
palliative care.
He has had work published in Journal of Pain and Symptom Management (here) and on behalf of the Ligurian Research Group (here)
He has had work published in Journal of Pain and Symptom Management (here) and on behalf of the Ligurian Research Group (here)
He is Consultant In Clinical Epidemiology and Director of the Regional Palliative Care Network, National Cancer Research Institute of Genoa
He is a Member of the Techno-Scientific Committee at The Maruzza Foundation. This seeks to promote palliative care programs and disseminate the culture of palliative care by organizing round-tables, workshops, conventions and training opportunities, through book publication and awareness campaigns. The Foundation provides care and support for patients with incurable illness through conventions stipulated with numerous associations and public hospitals. The Maruzza Foundation is striving at a national and international level to bring about important institutional changes, working directly with palliative care experts and policy makers to develop recommendations for the implementation of innovative health care policies through advocacy for pilot projects and research programs.
"We want to establish the right to access care even if recovery is not possible"
(Oh, to go back to the days when the goodies wore the white hats
and the baddies wore the black hats...)
He has collaborated with the Cicely Saunders Institute at Kings
college, London
He sits on the editorial board of Health and
Quality of Life Outcomes.
White hat or black hat? Sinister, or all just 'synastry'? Either way, he is well-placed to position himself for self-citation.
Harlow Blogger posted to the same Blog -
Liverpool Care Pathway – Anonymous Voices And The Silence Of The Lambs
-
In my opinion, all deaths on the Liverpool pathway are equivocal deaths, because the true cause of death - whether underlying illness, treatments given or withdrawn under the LCP (drugs administered or withdrawn, deliberate dehydration, withdrawal of nutrition) or some combination of these factors, or even complications arising from them - cannot be known.
As I understand it, English law requires a post mortem to be held in the case of all equivocal deaths and requires Inquests to be held in the case of suspicious deaths.
I've read that few post mortems are conducted in the case of those who die on the LCP - yet these must include many equivocal deaths. Is the legal requirement for post mortem being evaded in the case of those who die on the LCP? If so, why?
Also, does the law not require the true cause of death to be recorded on the death certificate? Yet how can the true cause of death be recorded for those who died on the LCP and without post mortems being carried out?
In the case of 'suspicious deaths', the police attend, but this does not assume a post mortem will be called.
In the case of my mother's death, I said to the officer whose face appeared through the curtains around the bed in A & E, that they'd dosed her with morphine. His response was that this would be a police matter if that was the case. I was still full of disbelief, unaware they had withdrawn all medication, that such a thing as The Pathway even existed! I retracted. It could not be, it just could not be!
We insisted on a post mortem.This took place - on the other side of the county, for whatever reason. They refused to test for morphine levels.
In this respect, thankyou for this -
In this respect, thankyou for this -
- Pro-Consensual Abortion and Euthenasia - ANTI-COST DRIVEN NATIONAL HEALTH SERVICE MURDER DRESSED UP AS 'PALLIATIVE CARE'21 November 2012 13:53they do appear to put the midazolam in first, to ensure the patient is unconcious. This allows them to do whatever they want in the patient's 'best interests'..ho ho. You should try to find out how much of these drugs they administered by finding out who your local police 'controlled drug liaison officer' is (every police force is supposed to have one now)...they can go and inspect the controlled drugs registers . The actual amount put on the ward for your mother should have been put in a locked cupboard and signed for...the amounts given to your mum should have been recorded on her records..any left over is supposed to either be witnessed being destroyed by two nurses OR returned to the pharmacy. Either way, there is supposed to be an 'audit trail' of ALL controlled drugs, to stop nurses 'misappropriating ' any for their own use AND to stop deliberate overdoses. My hospital had an audit 4 months before my father died , and no less than 60% of the CD registers were not up to standard!!! They dont bother with audits in pallio units, as they just accept large doses are used, and dont give a damn. Try the police ...they're useless, but if youre going to this meeting, you should tape the police response..to show that none of the safeguards put in post shipman are working, and that vast amounts of trust are placed on the word of 'caring' nurses in such units ....
-
Pro-Consensual Abortion and Euthenasia - ANTI-COST DRIVEN NATIONAL HEALTH SERVICE MURDER DRESSED UP AS 'PALLIATIVE CARE'21 November 2012 13:57I must add that rendering someone unconscious with midazolam is NOT the same as someone becoming unconcious because of a natural cause....it is an assault. This is a very important point....it is a ruse they use to facilitate giving a patient they are bored with treating any tablets at any dose they choose....the thing about midazolam is that it is eliminated in the urine very quickly, so even a post mortem blood sample wont show it...
If I sedate someone before I murder them, I dont actually expect a judge to take time off the sentence because they were unconcious when I suffocated them, do I?
By the time all this comes out a lot more will come out if we can't squeeze it out first. But justice will prevail, however long it takes.
However, I am concerned about whether there might be considered to be conflicts of interest in respect of some of this research. This is what I was refering to in my message yesterday.
A further, related, concern is the corporate nature of at least some of the charitable organisations carrying out and, or, funding the research into end of life care and the LCP and influencing government policy in this area. Once again, I am concerned about whether this might be considered to represent a conflict of interest. One of these organisations is a multi-million pound concern.