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My 14 week old puppy still hasn’t got the hang of the Poochie-Bells but thats probably more my fault than hers and its only been one week. My only suggestion would be to offer a version that is more sturdy, prehaps instead of a ribbon use a canvas, leather or material similar to that of dog leashes (my puppy thinks its a toy and tugs on it and the ribbon is getting damaged). I believe that given time and more effort on my part this will be a great item.

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********************http://www.medscape.com/viewarticle/417699Physician-Assisted Suicide: The Influence of Psychosocial Issuesfrom Cancer Control: Journal of the Moffitt Cancer CenterWilliam Breitbart, MD, and Barry D. Rosenfeld, PhDAbstract and IntroductionAbstractBackground: Physician-assisted suicide (PAS) is perhaps the most compelling and clinically relevant mental health issue in palliative care today. The desire for death, the consideration of suicide, the interest in PAS, and the relationship of these issues to depression and other psychosocial issues appear to be of paramount importance.Methods: Psychiatric and psychosocial perspectives are used to understand the factors contributing to the interest in PAS, as well as to guide interventions in the clinical care of patients with advanced disease.Results: Research and clinical experience suggest that attending to issues of depression, social support, and other psychosocial issues in addition to pain and physical symptom control are critical elements in interventions that are useful in reducing the distress of patients who desire hastened death.Conclusions: Psychosocial and psychiatric issues are among the most powerful predictors of desire for death and interest in PAS. Evaluation and intervention in these areas, particularly depression, is a critical component of compassionate care.IntroductionPalliative care and quality-of-life issues in patients with advanced cancer and AIDS have become an important area Accident abstract of clinical care and investigation. Significant progress has been made in extending a palliative care/quality of life research agenda to the clinical problems of patients with cancer,[1] including efforts that focus on such mental health-related issues as neuropsychiatric syndromes and psychologic symptoms in patients with advanced cancer and AIDS.[2] Perhaps the most compelling and clinically relevant mental health issues in palliative care today, however, concern the desire for death and physician-assisted suicide (PAS) and their relationship to depression.Desire for death has been postulated as a construct that is central to a number of related issues or phenomena, including suicide and suicidal ideation, interest in PAS/euthanasia, and requests for PAS/euthanasia. This construct, which was initially proposed by Brown and colleagues[3] and further developed by Chochinov et al[4] focuses on the degree to which an individual wishes his or her life could end sooner rather than later. The ends of this hypothetical continuum, therefore, reflect acute suicidal intent (ie, a desire to end one’s life immediately) and a complete absence of any desire to die.Jerzy Kosinski, the Polish novelist and Holocaust survivor, committed suicide in May 1991. Like other individuals suffering with chronic medical illnesses, he chose suicide as a means of controlling the course of his disease and the circumstances of his death. “I am not a suicide freak, but I want to be free,” Kosinski told an interviewer in 1979. “If I ever have an accident or a terminal disease that would affect my mind or body, I will end it.” Twelve years later, he did so. Similar sentiments are shared by a significant proportion of Americans. Advocates demanding autonomy for patients regarding how and when they die have been increasingly vocal during recent years, sparked by the highly publicized cases of Drs Jack Kevorkian and Timothy Quill. These cases have centered on the plight of dying patients with terminal illnesses.What has often been overlooked, however, in the political and legal machinations, has been the importance of medical, social and psychologic factors (eg, depression) that may contribute to suicidal ideation, desire for hastened death, or requests for PAS by terminally ill patients. This paper seeks to review the relevant research regarding factors that may influence suicidal ideation, desire for death, and requests for PAS. In addition, a discussion of health care provider obligations and responses that are appropriate to such patient verbalizations is offered in order to respond in a manner that is both ethical and hopefully therapeutic.Section 1 of 11William Breitbart, MD, and Barry D. Rosenfeld, PhD, Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center (WB) and the Department of Psychology, Long Island University (BDR), New York, NY.Cancer Control 6(2):146-161, 1999. © 1999 H. Lee Moffitt Cancer Center and Research Institute, IncOK. rephrase: WHAT KIND OF DATABASE/WEBSITE is this?
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