ConclusionsThe lack of documentation and standardized practice of ps on our pcu has resulted in a quality improvement program to address those gaps. They also highlight the importance of conducting research and developing clinical guidelines in this area. KEY WORDSPalliative care, conscious sedation, deep sedation, documentation, hypnotics and sedatives BACKGROUNDPalliative sedation (ps) is the intentional, continuous use of sedative medications with the goal of reducing consciousness and relieving intolerable suffering from refractory symptoms in patients who are at end of life (that is, last hours to days) 1 . A symptom is considered refractory when all possible treatments available within a tolerable time frame and risk-benefit ratio have been tried, but have not been successful 1 . Throughout the literature, the frequency of ps ranges from 2% to 52% depending on setting, research methodology, and definition 2 . Studies show that, when appropriately administered, ps does not invariably hasten death 3 . It is an essential therapy that is ethically justifiable when used appropriately with the intention of relieving intolerable suffering and not shortening life [4][5][6] . Common indications for ps include intractable delirium, dyspnea, seizures, and severe pain 2,7 . Controversial indications that have to be evaluated on an individual basis include sedation for psychological or existential suffering 3,8 . Midazolam, administered by continuous infusion, is the drug of choice for ps 1,2,7 . Other medications include methotrimeprazine and phenobarbital 2,9 .Over the last several years, ps has appropriately received increasing attention, and national and international guidelines have been developed to guide ABSTRACT Background

Breast cancer is the most frequent neoplasm in women. Expression of the estrogen receptor (ER) has a key role in breast cancer; the ER gene is located at chromosome 6q24-q27 and is made up of 8 exons with a total of 140 kb. The polymorphism in codon 325 of exon 4 (ER325) is a transition CCC-->CCG. The objective of this study is to analyze the frequency of this polymorphism in breast cancer using the polymerase chain reaction single-strand conformation polymorphism (PCR-SSCP) technology. DNA was extracted from tumor cells of 70 breast cancer patients and from the peripheral blood of 69 individuals without any known pathology (control group). Amplification products of the ER gene were analyzed by SSCP. In breast cancer patients the ER325 polymorphism was detected in 42.8% of the cases. In contrast, in the control group, the frequency of the same polymorphism was 24.6. Statistical comparison of the frequency distributions revealed that they are significantly different (p = 0.023). There was also an association between ER325 polymorphism and the absence of lymph node metastases (p = 0.038). Our data suggest that there is a relationship between the ER325 polymorphism and susceptibility to breast cancer (OR = 2.3; 1.10 < OR < 5.1) and that it can also be related with the metastasization process.

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