High-quality palliative care also requires special expertise in honest, compassionate communication. In addition to enhancing the patient's and family's experience, these skills help to establish trust and overcome barriers to adequate care and relief of symptoms. Several communication tasks are especially important: conveying accurate prognostic information while maintaining hope, eliciting information about symptoms, decision making about curative and palliative treatments, handling emotions, and dealing with requests from patients and families who have unrealistic goals [34, 35, 36] . The challenges of communicating effectively are discussed later in this course.
Anabolic steroids are synthetic derivatives of testosterone . Certain clinical effects and adverse reactions demonstrate the androgenic properties of this class of drugs. Complete dissociation of anabolic and androgenic effects has not been achieved. The actions of anabolic steroids are therefore similar to those of male sex hormones with the possibility of causing serious disturbances of growth and sexual development if given to young children. Anabolic steroids suppress the gonadotropic functions of the pituitary and may exert a direct effect upon the testes .
Oxandrin is available in and 10 mg tablets. The daily adult dosage of Oxandrin is mg to 20 mg given in 2 to 4 divided doses. For children the total daily dosage of Oxandrin is less than .1 mg per kilogram body weight or less than .045 mg per pound of body weight; this drug should only be administered by specialists. Oxandrin may increase sensitivity to oral anticoagulants, and interact with oral hypoglycemic agents, adrenal steroids or ACTH. This drug should not be given during pregnancy. It is unknown if Oxandrin passes into breast milk. Oxandrin may affect milk production and it may harm a nursing infant. Breastfeeding while using Oxandrin is not recommended.