Volume 3 Issue 9, September 2006

Evidence gained in randomized controlled trials (RCTs) is considered superior to that gained from associated epidemiological studies, but both types of study can be prone to error. Issues such as reproducibility, recall bias and duration are important factors that contribute to these errors, as discussed in this Viewpoint.

The importance of positive N2 lymph node staging for prognosis and treatment decisions is now recognized for patients with Pancoast tumors. The authors of this review assert that a multi-disciplinary management strategy is needed for these patients, and that survival advantages have been observed using combined and multimodality regimens. The role of surgery in the context of viable treatment options and the use of imaging for assessing treatment response is critically discussed.

Sedation is used in multiple settings in palliative care, such as transient controlled sedation, respite sedation, and sedation for refractory psychological or existential suffering; however, it is a controversial technique that can diminish the capacity of the patient to interact, function, and, in some cases, to live. Cherny provides a comprehensive account of the risks associated with different sedation approaches and also highlights the controversies and ethical considerations for palliative care medicine.

Advances in the fields of genetics and gene-expression profiling and the advent of microarray technology have revolutionized the concept of patient tailored treatment. Before microarrays qualify as a useful clinical tool, however, they must demonstrate reliability and reproducibility. Limitations of microarray technology include sample acquisition and methods of biostatistical analysis required to analyze the enormous quantities of data obtained. Abdullah-Sayaniet al.overview the current status of microarray technology in clinical practice and propose how advances in this technology will help eliminate some of these limitations and improve patient management.