Background The right to self-determination is a fundamental human right and is recognized in several national constitutions (e.g. German Constitution: Article 1, Section 1, Part 1), as is the guarantee of human dignity and the right to physical integrity. 1 For this, 'informed consent' between the patient and health care providers is essential. Discussions and questionnaire-based

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BackgroundTo determine the international recommendations and current practices for the treatment and prevention of palliative emergencies. The primary goal of the study was to gather information from experts on their nationally practised concepts.MethodsOne hundred and fifty self-report surveys were distributed by email to selected leading experts (palliative and emergency medical care) in Europe, North and South America, Africa, Asia, and Australia. An expert in this context was defined as an author of an article that was ranked by three reviewers as relevant to outpatient palliative and emergency medical .ResultsThe total response rate was 61% (n = 92 experts). Survey responses were obtained from 35 different countries. The following standards in the treatment of palliative emergencies were recommended: (1) early integration of “Palliative Care Teams” (PCTs) and basic outpatient palliative care systems, (2) end-of-life discussions, (3) defined emergency medical documents, drug boxes, and “Do not attempt resuscitation” orders and (4) emergency medical training (physicians and paramedics).ConclusionsThis study detected structurally and nationally differences in outpatient palliative care regarding the treatment of palliative emergencies. Accordingly, these differences should be discussed and adapted to the respective specifications of individual single countries. A single established outpatient palliative emergency medical care concept may be the basis for an overall out-of-hospital palliative care system.

The heavy metal (Pb, Cd, Cr, and Ni) content of a fish species consumed by the Sistan population and its associated health risk factors were investigated. The mean concentrations of Pb, Cd, and Cr were slightly higher than the standard levels. The Ni content of fish was below the maximum guideline proposed by the US Food and Drug Administration (USFDA). The average estimated weekly intake was significantly below the provisional tolerable intake based on the FAO and WHO standards for all studied metals. The target hazard quotients (THQ) of all metals were below 1, showing an absence of health hazard for the population of Sistan. The combined target hazard quotient for the considered metals was 26.94 × 10. The cancer risk factor for Pb (1.57 × 10) was below the acceptable lifetime carcinogenic risk (10). The results of this study reveal an almost safe level of Pb, Cd, Cr, and Ni contents in the fish consumed by the Sistan population. Graphical abstract ᅟ.